Estimation of megakaryocyte content of aspirated sternal marrow

American

Federation

EXPERIENCEWITH DARVISUL (PHENOSULFAZOLE) IN THE TREATMENT OF CLINICAL ..\NDEXPERIMENTAL POLIOMYELITIS.Mor~-is Schaefer, M.D. and (by invitation \Tohn A. [From

Toomey, the

M.D.,

Cleveland,

Department

Western

Reserve

tagious

Department

University of City

of

Ohio.

Pediatrics, and

Con-

Hospital.)

:A new sulfonamide compound, phenosulfazole, said to be therapeutically beneficial in poliomyelitis was administered parenterally and orally to sixty-eight patients at the onset of the acute phase of poliomyelitis. The outcome in these patients was compared with sixty-nine untreated control patients selected alternately on admission. No evidence was obtained that the natural course of the disease was affected by this treatment. Similarly, in the experimental disease produced in 150 mice with the Lansing strain of poliomyelitis virus, administration of phenosulfazole prior to or simultaneously with infection failed to prevent paralysis or death in the trt‘a ted animals.

PRELIMINARY REPORT ON THE PULMONARY CIRCULATION IN BRONCHIAL ASTHMA. H. .1. zimmermann, M.D., Cleveland, Ohio. i\ series of five patients with typical attacks of bronchial asthma was studied by means of intracardiac catheterization of the pulmonary artery by the method of Cournand. Pulmonary arterial pressures, femoral or brachial arterial and phase of pressures, the electrocardiogram respiration with a superimposed time trace were recorded simultaneously. This was done by means of pressure transmitters, strain gages, strain amplifiers and a six-channel, directwriting Brush oscillograph. Cardiac outputs were determined by the Fick principle using the Scholander method for blood oxygen levels and the Rahn method using a Pauling oxygen analyzer for determination of the amount of oxygen in the expired air. All patients had a moderate to severe attack of bronchial asthma and all had abnormally high pressures in the pulmonary artery. One patient had a few wheezes in the chest with normal pulmonary arterial pressure, but after an injection of mecholyl a moderately severe attack of asthma was induced and the pulmonary arterial pressure was elevated above normal. MA\‘, 1’,4’)

for Clinical

Research

667

Aminophylline may relieve an acute attack of bronchial asthma and the pulmonary arterial pressure drops to a subnormal level. .4drenalin. on the other hand. may relieve an acute attack of bronchial asthma but it causes a distinct elevation in the pulmonary arterial pressure. In patients whose asthmatic attacks were relieved we have found that the cardiac output was higher following the use of adrenalin than follo\j ing aminophvltinr.

FIFJRINOLYSIS AND PROTHROMHININ EXPKRI>IEWAI. APPENDICEAL PERITONITIS.Carlos Tanluri, .44. D., Raymond Anderson, ‘Vf. Il. and .,Vichola.s WetZei, ‘M.D.. Cintroduced by

N%lter

gery,

3.

(From

Illinois.

Maddock, the

Northwestern

School.

,W.D.).

Chicago,

Department

of

University

Sur-

Medical

)

Appendiceal peritonitis 11as produced in fortv-six dogs using the technic of Bowes. Serum fibrinolytic activity \vas studied pre- and postoperatively using the method of Kay and Lockwood. l’ariations in blood prothrornbin were measured by the technic of Tanturi and Banfi. Results showed that a decrease in prothrornbin is observed in appendiceal peritonitis in 85.7 per cent of the dogs, indicating some degree of injury to the liver. Forty-six per cent of the dogs showed fibrinolytic activity in the serum during the postoperative period. .4 decrease in prothrombin bears a closer relationship to death than does any variation in the fibrinolytic-antifibrinolytic equilibrium. An early postoperative decrease in prothrombin corresponded with a higher incidence of death. Chloroform anesthesia was given in ten dogs to increase liver damage. These dogs died earlier than those dogs who received no chloroform although no increase in fibrinolysis or hypoprothrombinemia was observed. The decrease in prothrombin is not the cause of death but appears to be the reflection of the primary cause of death in the animal more than the fibrinolytic activity of the blood.

ESTIMATIONOF MEGAKARYOCYTE CONTENT OF ASPIRATED STERNAL MARROW. Lawrence Berman, R.

Axe/rod,

Kumke,

B.S.,

Departments

M.D. M.D. Detroit,

(by invitation), (by

invitation)

Michigan.

of Pathology

Arnold Else

S.

(From the

and Medicine,

American Federation for Clinical Research

668 Wayne cine,

University and

the

City

College of Detroit

of

Medi-

Receiving

Hospital.) The present methods of estimating the megakaryocyte content of aspirated sternal bone marrow are not satisfactory. Methods based on examination of marrow smears are unsatisfactory because the aspirated marrow is unavoidably diluted with sinusoidal blood; the distribution of megakaryocytes on smears is irregular; the total nucleated cell content of bone marrow is variable from patient to patient and the incidence of megakaryocytes may vary independently of the incidence of other nucleated cells. Hemocytometer counts of megakaryocytes are subject to error introduced by variable dilution with sinusoidal blood and also by the variable base of total nucleated cells. The present study showed that neither the smear nor chamber count method yields results which correlate with those obtained by study of actual marrow tissue sections. Instances of low counts obtained by the smear or chamber methods in patients with high megakaryocyte content, as revealed in marrow sections, were encountered. Even the section count produces arbitrary values which cannot be converted into terms expressive of the actual number of megakaryocytes per unit volume of marrow. Hence all section counts obtained from patients must be compared with counts made by identical means from suitable controls. Since the error of underestimating the megakaryocyte content of aspirated marrow samples may be of clinical importance, especially when the question of splenectomy for thrombocytopenic purpura is presented, examination of marrow sections for megakaryocytes should not be omitted whenever the chamber or smear methods yield values suggestive of decreased megakaryocytogenesis.

CLINICAL EVALUATION OF TETRAETHYLAMM~NIUM CHLORIDE IN CORONARY HEART DISEASE. Harold W. Christy, M.D., (introduced by Howard A. Lindberg, M.D.), Chicago, Illinois. Ten patients presenting symptoms that were considered classical of chronic coronary insufficiency with the angina1 syndrome, most of whom had abnormal electrocardiograms, were treated with bi-weekly intramuscular injections

of tetraethylammonium chloride. The dosage ranged from 200 to 800 mg. per injection. No reactions of moment were encountered in this group. Some of the patients received injections over a period of at least a year. Two patients had complete disappearance of their angina1 syndrome with improvement in the electrocardiogram during the course of treatment. Five patients reported considerable improvement in their symptoms. None developed what might be considered angina1 equivalents. Two had improvement in their electrocardiograms. Two patients reported no improvement whatsoever and one of them was the only one that did not have electrocardiographic or physical findings to support a diagnosis of coronary insufficiency. The tenth patient did not report for continuation of therapy and the results of treatment in this case are not known.

CAUSES OF DEATH IN ANEURYSMS OF THE HEART. Wendell A. Shullenberger, M.D., Indianapolis, Indiana. (From the Division of Internal

Medicine,

Methodist

Hospital.)

It is frequently stated that cardiac aneurysm is not incompatible with a considerable degree of physical activity and it is a fact that despite their spectacular pathologic features these when fully healed and fibrosed aneurysms undergo rupture infrequently. The usual causes of death following establishment of this condition in the heart are congestive failure, rupture and “sudden death.” The last group deserves more attention than it has received. The case reported here is believed to be unusual in the nature of the terminal event. A diagnosis of acute coronary thrombosis was made in a fifty year old male after he had suffered three attacks of epigastric pain in a period of eleven days. Aneurysm of the left ventricle was diagnosed by roentgenogram after three weeks in the hospital. He became ambulatory and carried on fairly normal business activities for thirteen months but died suddenly after several attacks of epigastric pain. Autopsy showed a large aneurysm of the left ventricle and a fresh thrombosis of the circumflex branch of the right coronary artery. Statistics obtained from analysis of forty-six well studied cases selected from the literature show that somewhat less than 50 per cent of patients may be expected to survive from a few months to several years. It is further shown that AMERICAN

JOURNAL

OF

MEDICINE