The Relation between Cutaneous Blood Flow and Cell Content in the Tuberculin Reaction

The relationship of velocity of blood flow to density and microanatomical distribution of inflammatory cells in the dermis was studied in 20 human tuberculin tests. Most positive reactions showed maximal blood flow velocities (measured as red blood cell (RBC) flux) at the centre of the reaction, but the two most intense responses showed 'central relative slowing' (CRS) with higher RBC flux at the periphery. Two of the four clinically negative reactions showed a considerable acceleration of blood flow, but the other two showed no such acceleration. The packing density of lymphocytes/monocytes in the perivascular zone was greater in the stronger positives than in the weaker reactions. The density of cells in the intervening dermis was markedly lower than in the foci: the lesions with CRS had the highest density of cells in the diffuse infiltrate of the reticular dermis. At the centre of the reaction, blood flow velocity was generally related to density of cellular infiltrate, except in those with CRS, which had a disproportionately lower blood flow velocity. The finding that the circulatory adaptation to a delayed hypersensitivity reaction can be inadequate may explain the dermal acidosis previously observed in intense skin test reactions, and may be the underlying mechanism of necrosis in hypersensitivity reactions.     

Survival of Radiochromium-labeled Platelets in Thrombocytopenias

Platelet survival studies were performed by the radiochromium method in280 patients. Although various types of patients were studied, markedly accelerated platelet destruction was encountered only in those with ITP. Nothrombocytopenic patient was found with accelerated platelet production andchanges in platelet count with therapy reflected corresponding changes insurvival. The use of surface scanning showed that patients with significantsplenic localization were more suitable candidates for splenectomy that thosewithout this localization.

Submitted on December 24, 1962 Accepted on June 21, 1963     

APPLICATION OF THE DOPPLER ULTRASOUND BLOODFLOW DETECTOR IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

A Doppler ultrasound bloodflow detector was used to localizethe third division of the subclavian artery, rendering the supraclavicularapproach to the brachial plexus safer and highly successful. ^* Present address: Launceston General Hospital, Launceston,Tasmania.     

B超在低出生体质量儿体质量估计中的应用

目的 探讨B超估计低出生体质量儿体质量的准确性及其受羊水减少的影响程度.方法 230例体质量＜2 000 g的新生儿,分娩前1周内B超估计出生体质量,并进行羊水测定,根据羊水指数分组.对照实际出生体质量,评价B超估计体质量的准确性及其受羊水减少的影响程度.结果 估计体质量与实际出生体质量密切相关(P＜0.000 1);各组估计体质量与实际出生体质量均无显著差异(P＞0.05);各组估计体质量与实际出生体质量的差值也具有相关性(P＜0.000 1).结论 B超能对体质量＜2 000 g的低出生体质量儿在产前提供一个较为可靠的体质量估计,且不受羊水量减少的影响,具有临床应用价值.     

CHANGES IN RESPIRATORY PHYSIOLOGY DURING ETHER/AIR ANAESTHESIA

Measurements of arterial oxygen and carbon dioxide tension,alveolar ventilation, alveolar to arterial oxygen difference,and ratio of deadspace to tidal volume have been made to showthe changes induced by ether/air anaesthesia with spontaneousrespiration, with mechanical ventilation, and with mechanicaloverventilation. There was a disproportionate fall in oxygentension during spontaneous respiration with ether/air anaesthesia,and an increased alveolar to arterial oxygen tension difference.The latter was still further increased by both "normal" ventilationand over ventilation. Alveolar ventilation was at all timesadequate for the elimination of carbon dioxide. The ratio ofthe physiological deadspace to the tidal volume was increasedduring anaesthesia only when artificial ventilation was used.The possible causes of these findings are discussed togetherwith their implications for the use of ether/air anaesthesia. ^*Work performed during the tenure of an Elmore Research Studentshipat the University of Cambridge Postgraduate Medical School.Present address: Department of Anesthesia, Hospital of Universityof Pennsylvania, Philadelphia, U.S.A.     

Human herpesvirus 6 infection associated with anticonvulsant hypersensitivity syndrome and reactive haemophagocytic syndrome

Viral infections are thought to play a part in some cutaneous drug reactions. Human herpesvirus 6 (HHV6), which is the agent of exanthema subitum (sixth disease), has never been implicated in a drug reaction. We report a patient with severe phenobarbital-induced anticonvulsant hypersensitivity syndrome in whom a fulminant haemophagocytic syndrome was associated with HHV6 infection. We discuss the possible role of HHV6 in this reactive condition.