Structural Studies of Immunoglobulins

In 1946, when I was starting work as research student under the supervision of Dr F. Sanger, the second edition of Karl Lansteiner's book" The Specificity of Serological Reactions'[I] reached England. In it was summarized the considerable body of information available on the range of antibody specificity and much of it was Landsteiner's own work or by others using his basic technique of preparing antibodies against haptenes and testing their ability to inhibit the precipitation of the antisera and t he conjugated protein. Also described in this book was the work in Uppsala of Tiselius and Pederson in collaboration with Heidelberger and Kabat in which they showed that all rabbit antibodies were in the y globulin fraction of serum proteins and that they had a molecular weight of 150.000. This combination of an apparently infinite range of antibody-combining specificity associated with what appeared to be a nearly homogeneous group of proteins astonished me and indeed still does.     

Preservation of the great auricular nerve during parotidectomy

The great auricular nerve is routinely divided during the operation of parotidectomy, however some surgeons have suggested that preserving the posterior branches reduces the area of post-operative anaesthesia. A prospective study was performed comparing the area of anaesthesia and hypoaesthesia in patients undergoing parotidectomy. In 20 patients the great auricular nerve was preserved and in 11 it was sacrificed. Mapping of the area of sensory loss at 2 weeks, 3, 6, 9 and 12 months showed that there was no difference between the two groups. The area of sensory loss decreased in an exponential fashion in both groups. The majority of the change occurred within 6 months. We conclude that preservation of the posterior branches of the great auricular nerve is unnecessary.     

Vitamin E Deficiency in the Monkey. IV. Further Studies of the Anemia with Emphasis on Bone Marrow Morphology

Nuclear abnormalities were observed in all the erythroid precursors in thebone marrow of vitamin E-deficient monkeys. Many of these cells were multinucleated. The remainder of the marrow elements appeared normal. Reasonsfor considering the anemia to be primarily due to inadequate erythropoiesisare given.

Serum iron, glutathione stability of the erythrocytes, hemoglobin electrophoresis, osmotic fragilities and platelet counts were all found to be normalin the vitamin E-deficient monkey.

Submitted on March 23, 1962 Accepted on May 12, 1962     

Effects of a Health Activist Course on Knowledge and Awareness of Antibiotic Use

A cohort study investigated the specific outcomes of a healtheducation coursed carried out by recently graduated physiciansin an urban primary care setting in Israel. Questionnaires wereused to study the effects of the programme on knowledge andawareness concerning antibiotic usage. The results showed asignificant gain in knowledge about the causes of infectiousdisease, appropriate duration of antibiotic intake, side effectsof antibiotics and the importance of compliance. In contrastwith other studies, low income blue collar workers with lessthan high school education showed the most significant gainsfrom the programme. Inexperienced physicians were able to implementa community health education programme with clearly definedgoals.     

SURFBOARD-RELATED OCULAR INJURIES

Three cases of ocular trauma caused by surfboards are reported. The severe nature of the injuries is discussed and the prevalence of this type of injury is reviewed.     

Outcomes in Adolescents with Postural Orthostatic Tachycardia Syndrome Treated with Midodrine and β-Blockers

Background: Postural orthostatic tachycardia syndrome (POTS) is associated with debilitating fatigue, dizziness, and discomfort in previously healthy adolescents. The effects of medical therapy have not been well studied in this patient population. This study assessed the relative efficacy and impact of drug therapy on the functioning and quality of life in adolescents with POTS.
Methods: A retrospective, single center, chart review analysis with a follow-up written survey was conducted on a group of 121 adolescents who had undergone autonomic reflex screening at the Mayo Clinic from 2002 to 2005 as part of an evaluation for possible POTS.
Results: Of 121 surveys sent, 47 adolescents returned a completed survey. In this cohort of patients, the two most commonly prescribed drug therapies were midodrine (n = 13) and β-blockers (n = 14). Patients in the midodrine group were comparable to patients in the β-blocker group in gender, age, pretreatment postural heart rate changes, and months from initial evaluation to survey completion. More patients treated with a β-blocker reported improvement after visiting Mayo Clinic (100% vs 62%, P = 0.016) and more attributed their progress to medication (63.6% vs 36.4%, P = 0.011) than did those treated with midodrine.
Conclusion: Treatment with both midodrine and β-blockers was associated with overall improvement in POTS patients' general health; however, adolescents taking β-blockers were more likely than those taking midodrine to credit the role of medications in their improvement.