A prospective study of acute hypoxic respiratory failure

A prospective study of acute hypoxic respiratory failure was carried out by nine centers in a collaborative NIH study from 1 September 1975 to 1 March 1977. Serious hypoxic respiratory failure was defined in 713 patients by the presence of (1) endotracheal intubation and positive airway pressure for at least 24 hours, and (2) the administration of at least 50 percent oxygen. The 490 patients between 12 to 65 years of age had a mortality of 61 percent. Mortality increased with increasing organ failure: one organ system failure (lung only) 40 percent; two, 54 percent; three, 72 percent; four, 84 percent, five, 100 percent. Only 103 patients died with isolated lung failure, whereas 353 died of a combination of lung and other organ failures. Both the overall mortality (66 percent) and the mortality of those with only isolated lung failure (40 percent) were much higher than anticipated for the selection criteria.

Autoimmune hemolytic anemia as the presenting manifestation of malignant thymoma

Severe autoimmune hemolytic anemia is described as the presenting manifestation of malignant thymoma. The hemoglobin level was 5.7 g/dl, the direct IgG antiglobulin test (direct Coombs' test) was strongly positive and the indirect Coombs' test was weakly positive. Prompt remission of the hemolytic process was achieved by thymectomy combined with corticosteroid therapy; the hemoglobin level rose to 12.2 g/dl and both the direct and indirect Coombs' tests became negative. To our knowledge, this is the first case to be described in which autoimmune hemolytic anemia was the presenting manifestation of malignant thymoma. Autoimmune hemolytic anemia may be considered as a manifestation associated with malignant thymoma.

Countertransferential and attitudinal considerations in the treatment of drug abuse and addiction

This article explores countertransferential and attitudinal considerations in relation to their impact on the evaluation, diagnosis, and therapeutic management of drug-dependent individuals. Following a literature survey of the manner in which countertransference has been applied to the treatment of drug dependency, the authors discuss the status of the drug-dependent individual as a psychiatric patient and the resultant treatment implications when such a patient is viewed from within, rather than exclusive of, the mental health treatment delivery system. A number of examples are provided of patient-induced countertransferential reactions, in addition to specific attitudinal factors often present in the treatment of addiction.

Successful chemotherapy of transfusion babesiosis

We describe babesiosis transmitted by transfusion. The infected blood donor was identified and a minimum period of infectivity of the donor's blood was established. We report a new modality for chemotherapy consisting of quinine plus clindamycin, and a new endemic focus for this zoonosis on Fire Island, New York. There are insufficient data to establish a reasonably safe period after which visitors and residents of Babesia-endemic foci can become blood donors. Screening of such persons by a rapid serologic test, such as the ELISA or immunofluorescent antibody tests, is suggested.

On the interaction of seryl-tRNA synthetase with tRNA Ser. A contribution to the problem of synthetase-tRNA recognition

By following the tryptophan fluorescence of yeast seryl-tRNA synthetase on addition of tRNA Ser it was observed that the number of binding sites for tRNA decreases from two to one with increasing temperature, ATP or KCl concentration. Concomitantly a considerable decrease of the apparent binding constant was observed. The variation in the number of binding sites is explained by the presence of at least one temperature and ionic strength sensitive binding site and one temperature and ionic strength independent binding site. Relaxation kinetic experiments revealed two binding processes: a fast one depending on tRNA concentration and ionic strength and a slow one, which appeared to be independent of tRNA concentration and ionic strength. Enzyme kinetic studies showed that the activity of seryl-tRNA synthetase strongly depends on the KCl concentration and exhibits a maximum at 0.2 M KCl. Based on the data from relaxation and enzyme kinetic experiments a model is suggested for the recognition process involving a first unspecific step where all tRNAs, cognate and non-cognate, are bound to the synthetase (scanning step). The identification of the cognate tRNA is then performed at the recognition site by a conformational transition of the tRNA . synthetase complex (identification step).

[Isolation and characterization of seryl- and phenylalanyl-tRNA synthetase from yeast (author's transl)]

A procedure for the simultaneous isolation of seryl- and phenylalanyl-tRNA synthetase from yeast is described. In addition some other synthetases as well as tRNA nucleotidyltransferase can be obtained in an enriched state. The isolated seryl- and phenylalanyl-tRNA synthetases were compared to earlier preparations with respect to purity, specific activity, and structure. Previous investigations with fluorescence spectroscopy and kinetic methods were complemented and extended by experiments on the specificity of aminoacylation and on the isolation, by sucrose gradient centrifugation, of complexes between synthetase and tRNA or tRNA fragments. A protection of synthetases against inactivation by addition of substrates was observed. The dissociation of seryl-tRNA synthetase, at low concentrations, into monomer subunits was investigated by chemical modification with bifunctional reagents and by kinetic experiments. By modification of SH-groups fluorescent dyes were incorporated into both, seryl- and phenylalanyl-tRNA synthetase which retained most of their activity. The binding of tRNAPhe to phenylalanyl-tRNA synthetase which had been modified with pyrene maleimid was followed by fluorescence intensity measurements.

Setting inventory levels for hospital blood banks

A method is devised to predict the hospital blood bank inventory of each of the eight blood types that will be adequate on all but a given fraction of days (shortage rate). Analysis of the model confirms and extends prior statistical models and provides a rationale for a number of observations made on some common blood inventory practices. Comparison of the relationship between inventory levels and shortage rates predicted by the model and that calculated from data from 21 hospital blood banks of varying sizes, located in four separate parts of the country, reveals agreement within approximately 10 per cent. A procedure is presented and allows blood banks to select inventory levels and shortage rates based on their mean demand for blood.

Expressivity of heritable telecanthus in five generations of a kindred

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