Streptococcic antihyaluronidase in acute rheumatic fever, acute rheumatoid arthritis and acute glomerulonephritis; a modified test

American Federation for Clinical Research active disease had both a normal zinc sulfate turbidity and sedimentation rate. With interesting exceptions, elevated sedimentation rates paralleled abnormal zinc turbidity values. There was no constant quantitative relationship between gamma globulin values obtained by electrophoresis and those with the turbidimetric technic. QUANTITATIVE STUDY OF SERUM ANTIPROTEOLYTIC ACTIVITY IN DISEASEWITH SEPARATIONOF Two SERUM PROTEOLYTICINHIBITORS.fl. R. Shulmon and H. J. Tagnon, Jvew York, N. 1: Increased serum antiproteolytic activity has been observed in various diseases. Published reports make no distinction in serum inhibition of the enzymes, trypsin, chymotrypsin and assumption is that a plasmin. The apparent single inhibitor for the three enzymes occasionally increases in disease. A method of measuring proteolytic activity tagged substrate was using a radioactively developed in this laboratory to permit highly sensitive measurements in media such as serum. Normal serum inhibition of trypsin, chymotrypsin and plasmin was determined and compared with that of patients with carcinoma and patients with tuberculosis. Many patients showed abnormal inhibition. Those abnormal sera showing increased trypsin inhibition also showed increased chymotrypsin inhibition. Increases in inhibition were quantitatively equal for these of increase two enzymes, and the magnitude was similar in carcinoma and tuberculosis. Sera with increased trypsin and chymotrypsin inhibition showed no increased plasmin inhibition. This new finding was evidence for at least two separate inhibitors. It was corroborated by ammonium sulfate fractionation of normal and abnormal sera. Plasmin inhibition was greatest in the globulin fraction whereas inhibition of trypsin and chymotrypsin was greatest in the albumin fraction. Fractions of normal and abnormal sera contained the same relative proportion of inhibition for the three enzymes. STREPTOCOCCICANTIHYALURONIDASEIN ACUTE RHEUMATIC FEVER, ACUTE RHEUMATOID ARTHRITISAND ACUTE GLOMERULONEPHRITIS;A MODIFIED TEST. Robert T. Thompson, M.D. and Florence M. Carpenter, B.A. (by invitation), Cincinnati, 0. The value of serum streptococcic antihyaluronidase titers for the diagnosis of acute rheumatic fever has been demonstrated by Quinn and Harris and Harris using the mucoprotein OCTOBER,

1951

5’9

clot prevention test, with two-fold serial dilution of patient’s serum. Diluents used by these authors were distilled water and physiologic saline, respectively. These diluents cause a partial loss in the potency of hyaluronidase in high dilution. Therefore, the present study was carried out using a modified mucoprotein clot prevention test with 1.0 per cent proteose peptone in physiologic saline as the diluent, and the patients’ serum was titrated by the more accurate method of measured dilution. Group A streptococcic antihyaluronidase serum titers of 417 or greater were found in thirty-six of forty-two patients with acute rheumatic fever, in eleven of fifteen patients with acute glomerulonephritis, in one of twenty patients with acute rheumatoid arthritis and in three of fifty “normal” subjects. Serum titers of 900 or greater were found in twenty-nine of these rheumatic fever patients and in nine of these glomerulonephritis patients. Serum titers of 278 or less were found in seven patients with inactive rheumatic heart disease, four patients with acute benign idiopathic pericarditis and three patients with acute gonococcic arthritis. QUANTITATIVE EVALUATION OF THE INCREASEIN BLOOD FLOW IN THE HUMAN BOOT AFTER HEXAMETHONIUMAS COMPARED TO PROCAINE BLOCK. Harold W. Schnaper, M.D., Robert L. Johnson, M.D., Edward Tuohy, M.D. and Edward D. Freis, M.D., Washington, D.C. Clinical and experimental studies in this laboratory indicated that the new ganglionic blocking agent hexamethonium (C,) produced greater vasodilatation in the feet than any previously known compound. Using the Abramson venous occlusion plethysmograph, foot blood flow was determined in normal volunteers both after Cc and again after lumbar epidural block and/or spinal anesthesia vironmental

to the level of the iliac temperatures

crests.

were maintained

Enat

a constant level of 68 to 69’~. The effectiveness of block was corroborated by skin temperature chahges and digital plethysmography. In all instances except one the increase

in

foot blood flow approached or exceeded the increase following epidural or spinal block. These studies indicate that Cs is not only a more potent peripheral vasodilator than any other previously studied compound but also produces a vasodilatation of the feet comparable to regional block (complete

sympathetic

blockade).