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Clinical and pathological features of influenza-associated deaths, Louisiana, 1957
Southern
gm./day; phosphorus (+) 0.43, (+) 1.60 gm./ day; nitrogen 0.0 gm. and (-) 3.0 gm./day. On prednisone therapy the patients were in positive balance, 3 and 7 gm./day, respectively. During the twenty-one-day study the body weight loss was 4.0 and 5. 0 kg., respectively. Renal function tests, glomerular filtration rate (inulin, Cr), renal plasma flow, Tm (PAH) showed only a decrease in renal plasma flow of 18 and 35 per cent, as compared to measurements the day prior to administration of halogenated steroid. The levels of glucose and plasma electrolytes remained stable. Negative electrolyte balance is a major factor in weight loss. The clinical status of both patients was controlled throughout the study. CLINICAL
AND
PATHOLOGICAL
INFLUENZA-ASSOCIATED
DEATHS,
FEATURES LOUISIANA,
OF
1957.
L. F. Dietlein, J. Walsh, W. Pelon, W. J. Mogabgab* and G. E. Burch. Dept. of Medicine, The Tulane Univ. of Louisiana School of Medicine, the New Orleans V. A. Hospital, The Charity Hospital of Louisiana at New Orleans, and the Louisiana State Department of Health, New Orleans, La. From July to November, 1957, approximately eighty deaths could be attributed directly or indirectly to “Asian” influenza, and more than half of these occurred during the height of the epidemic in September. The majority of the patients (70 per cent) were ill only a week; a number of them, however, ran more rapid, fulminating courses. An autopsy was performed in twenty-nine (62 per cent) of forty-seven intensively investigated cases, and Asian strain virus was isolated antemortem or postmortem in three of these; others exhibited highly suggestive serologic and/or epidemiological evidence of infection. Bacterial pneumonia was the most frequent complication (59 per cent) with resistant Staphylococcus aureus the most common offender. Most of the pneumonias were severe fulminating bronchopneumonias. Five of the six obstetrical deaths were due to extensive bacterial pneumonitis and/or septic shock. Most of these occurred during the fifth month of gestation. Other associated conditions included chronic pulmonary disease, cardiovascular disease and chronic alcoholism. Pathological examination of the lungs revealed a purulent pneumonitis in most cases, but interstitial pneumonitis and hyaline membranes were found in a few inJULY,
1958
117
Society for Clinical Research
stances. Areas of denuded bronchial mucosa with submucosal edema were also found in most specimens, and resembled the changes observed in biopsy material from acute influenza cases. EARLY LEASE
EFFECTS AND
OF THYROTROPIN
ON PLASMA
IODIDE’31
ON
PBI131
RE-
DISAPPEARANCE.
William P. Deiss, Jr., *Patrick J. 0’Shaughne.q and James 0. Wynn. V. A. Hospital, and Department of Medicine, Duke Durham, N. C.
Univ.
School
of Medicine,
Thyroid stimulating hormone (TSH) stimulates thyroidal hormone release, iodide uptake, and growth. The sequence of these events and the mechanisms involved are not clear. These studies were designed to evaluate the first two parameters of TSH activity simultaneously in euthyroid subjects given I13r. PBIr3l was determined after separation of iodide by anion exchange resin. Total plasma radioactivity minus PBI131 was assumed to be iodide131. TSH given twenty-four hours after administration of radioiodide caused prompt release of PBI’sl, frequently beginning within thirty minutes, and by four hours in all but one of eighteen patients. It was not until twelve to thirty hours after administration of TSH, however, that a stimulus to thyroidal uptake of plasma iodide was noted, as reflected by increased plasma iodide disappearance rate. These observations indicate that hormone release precedes stimulation of plasma iodide uptake. Not only was there no immediate stimulus to thyroidal uptake, but a distinct “slowing” of uptake was apparent in nine of thirteen subjects, lasting for varying periods up to eighteen hours after administration of TSH. The mechanism of this slowing is not yet clear but it appears that it represents a period of decreased trapping of circulating iodide, perhaps due to increased availability of intrathyroidal iodide from stimulated deiodinase activity following administration of TSH. THE RELATION
OF GAMMA GLOBULIN
TO INFECTION.
Harold L. Dobson, William Fahlberg, Dean Dukes and Ellard M. row.* Dept. of Medicine and Microbiology, Baylor Univ. College of Medicine, Houston, Texas; and Jack Turner, Odessa, Texas. Fifty patients with disturbances in gamma globulin levels have been studied clinically and by means of serum electrophoresis and immunologic , +echnics. Frequent bacterial infection,
gm./day; phosphorus (+) 0.43, (+) 1.60 gm./ day; nitrogen 0.0 gm. and (-) 3.0 gm./day. On prednisone therapy the patients were in positive balance, 3 and 7 gm./day, respectively. During the twenty-one-day study the body weight loss was 4.0 and 5. 0 kg., respectively. Renal function tests, glomerular filtration rate (inulin, Cr), renal plasma flow, Tm (PAH) showed only a decrease in renal plasma flow of 18 and 35 per cent, as compared to measurements the day prior to administration of halogenated steroid. The levels of glucose and plasma electrolytes remained stable. Negative electrolyte balance is a major factor in weight loss. The clinical status of both patients was controlled throughout the study. CLINICAL
AND
PATHOLOGICAL
INFLUENZA-ASSOCIATED
DEATHS,
FEATURES LOUISIANA,
OF
1957.
L. F. Dietlein, J. Walsh, W. Pelon, W. J. Mogabgab* and G. E. Burch. Dept. of Medicine, The Tulane Univ. of Louisiana School of Medicine, the New Orleans V. A. Hospital, The Charity Hospital of Louisiana at New Orleans, and the Louisiana State Department of Health, New Orleans, La. From July to November, 1957, approximately eighty deaths could be attributed directly or indirectly to “Asian” influenza, and more than half of these occurred during the height of the epidemic in September. The majority of the patients (70 per cent) were ill only a week; a number of them, however, ran more rapid, fulminating courses. An autopsy was performed in twenty-nine (62 per cent) of forty-seven intensively investigated cases, and Asian strain virus was isolated antemortem or postmortem in three of these; others exhibited highly suggestive serologic and/or epidemiological evidence of infection. Bacterial pneumonia was the most frequent complication (59 per cent) with resistant Staphylococcus aureus the most common offender. Most of the pneumonias were severe fulminating bronchopneumonias. Five of the six obstetrical deaths were due to extensive bacterial pneumonitis and/or septic shock. Most of these occurred during the fifth month of gestation. Other associated conditions included chronic pulmonary disease, cardiovascular disease and chronic alcoholism. Pathological examination of the lungs revealed a purulent pneumonitis in most cases, but interstitial pneumonitis and hyaline membranes were found in a few inJULY,
1958
117
Society for Clinical Research
stances. Areas of denuded bronchial mucosa with submucosal edema were also found in most specimens, and resembled the changes observed in biopsy material from acute influenza cases. EARLY LEASE
EFFECTS AND
OF THYROTROPIN
ON PLASMA
IODIDE’31
ON
PBI131
RE-
DISAPPEARANCE.
William P. Deiss, Jr., *Patrick J. 0’Shaughne.q and James 0. Wynn. V. A. Hospital, and Department of Medicine, Duke Durham, N. C.
Univ.
School
of Medicine,
Thyroid stimulating hormone (TSH) stimulates thyroidal hormone release, iodide uptake, and growth. The sequence of these events and the mechanisms involved are not clear. These studies were designed to evaluate the first two parameters of TSH activity simultaneously in euthyroid subjects given I13r. PBIr3l was determined after separation of iodide by anion exchange resin. Total plasma radioactivity minus PBI131 was assumed to be iodide131. TSH given twenty-four hours after administration of radioiodide caused prompt release of PBI’sl, frequently beginning within thirty minutes, and by four hours in all but one of eighteen patients. It was not until twelve to thirty hours after administration of TSH, however, that a stimulus to thyroidal uptake of plasma iodide was noted, as reflected by increased plasma iodide disappearance rate. These observations indicate that hormone release precedes stimulation of plasma iodide uptake. Not only was there no immediate stimulus to thyroidal uptake, but a distinct “slowing” of uptake was apparent in nine of thirteen subjects, lasting for varying periods up to eighteen hours after administration of TSH. The mechanism of this slowing is not yet clear but it appears that it represents a period of decreased trapping of circulating iodide, perhaps due to increased availability of intrathyroidal iodide from stimulated deiodinase activity following administration of TSH. THE RELATION
OF GAMMA GLOBULIN
TO INFECTION.
Harold L. Dobson, William Fahlberg, Dean Dukes and Ellard M. row.* Dept. of Medicine and Microbiology, Baylor Univ. College of Medicine, Houston, Texas; and Jack Turner, Odessa, Texas. Fifty patients with disturbances in gamma globulin levels have been studied clinically and by means of serum electrophoresis and immunologic , +echnics. Frequent bacterial infection,