Two Years' Experience with Rh Hemolytic Disease Reporting

California law, since January 1 1970, has required that all pregnant women, regardless of outcome of delivery, be tested for Rho(D) type, that the mother and physician be notified of the result and that hospitals providing service to newborns report all cases of Rho(D) Hemolytic Disease to the State Department of Public Health. Although there has been only a gradual decrease in the number of deaths due to Rho(D) Hemolytic Disease of the Newborn since 1950, there has been a precipitous fall in the past two years. Since the commencement of reporting of the disease to the State Health Department the number of cases has also dropped dramatically. It is felt that because of our conscientiously administered reporting law the morbidity and mortality figures from HDN in California are accurate, in contrast to results obtained in most other states.It is believed that this report reflects the first really accurate look at a large population for the incidence and mortality from Rho(D) HDN since the advent of widespread use of anti-Rho(D) gamma globulin. Review of the recent literature failed to reveal definitive data on recent incidence and mortality trends for Rho(D) HDN. A survey of state health departments also failed to produce data comparable with California''s.A number of factors have played a part in reducing the incidence and mortality from Rho(D) HDN in California—namely, required testing of pregnant women combined with the almost routine use of of anti-Rho(D) immune globulin in eligible women, early recognition and treatment of Rho(D) HDN, and the reduction in family size with an increasing percentage of primiparous mothers.     

Clinical Experience with Vincaleukoblastine Sulfate in the Treatment of 11 Patients with Hodgkin's Disease

Eleven patients with established Hodgkin''s disease were treated with vinblastine sulfate. Each patient received from 0.15 to 0.20 mg./kg. of body weight intravenously in 10 divided doses over a five-hour period as initial therapy. All had received one or more of the more established forms of treatment before being given vinblastine. The response to treatment with vinblastine was excellent in three patients, good in one, and poor in three; there was no response in four. The longest remission was 15 months. Two of the patients were father and son. The side effects of treatment in this series included alopecia, leukopenia, and septicemia.     

Serological Studies in Infectious Mononucleosis

Serological investigations performed on 27 patients with illnesses resembling infectious mononucleosis showed a significant increase in high antibody titres (more than 1:40) to EB virus in 11 of the 12 who developed heterophile antibodies. Two of these patients, however, had a significant increase in antibody titre to cytomegalovirus and rubella virus, respectively. Of 15 patients who failed to develop heterophile antibodies, one had a high antibody titre to EB virus, the others generally having undetectable or low antibody titres. The insidious onset of the illness in many patients together with the fact that EB virus antibodies rose to high titres rapidly reduced the value of this investigation diagnostically.EB virus antibody was still present in the sera of five patients who had had well-authenticated heterophile-antibody-positive infectious mononucleosis some four to seven years previously. Twenty-seven out of 70 (39%) healthy nurses had antibody at a level of more than 1:10 to EB virus. The presence of EB virus antibody in different population groups appears to be related to such factors as age and socioeconomic status.     

Severe Neutropenia in Infectious Mononucleosis

Mild neutropenia is a well-known concomitant of infectious mononucleosis caused by the Epstein-Barr virus (EBV) occurring in the first weeks of illness. However, severe neutropenia (less than 200 polymorphonuclear leukocytes per μl) is not generally regarded as a complication of infectious mononucleosis. Three patients were seen with severe neutropenia and EBV infection, and an additional eight cases were found in the literature. In two of the latter cases the neutropenia was fatal.In the 11 cases the severe neutropenia began 14 to 40 days after illness and usually lasted for three to seven days. At the time of severe neutropenia, studies of marrow specimens showed increased proportions of promyelocytes and myelocytes. Our data suggest that EBV infection is the proximate cause of the severe neutropenia in some patients with infectious mononucleosis and that in such cases close observation and early treatment of suspected superinfections is necessary.     

Infectious Mononucleosis and Mononucleosis Syndromes: Clinical,Virological and Immunological Features

Infectious mononucleosis (IM) and cytomegalovirus (CMV) mononucleosis are caused by a primary infection with related viruses, Epstein-Barr virus (EBV) and CMV. Despite the similarity of clinical manifestations, basic differences exist: (1) The heterophil antibody (HA) response is absent in CMV mononucleosis, whereas it is present in IM. (2) In IM atypical lymphocytosis reflects proliferation of B cells early and of T cells later in the disease course; in CMV mononucleosis the situation appears complex. (3) In blood, EBV is restricted to B lymphocytes, whereas CMV is found in polymorphonuclear and mononuclear leukocytes. (4) Complications of CMV mononucleosis such as hepatitis and pneumonitis may be due to virus cytopathic effect in target organs. Prominent tonsillopharyngitis with adenopathy, and visceral complications of IM are related to lymphoproliferation which is self-limited except in males with a rare familial defect in defense against EBV. Immune complex-mediated pathology may occur in both diseases. (5) CMV is frequently transmitted to a fetus in utero or to an infant during or after birth, and this occasionally leads to severe cytomegalic inclusion disease; vertical transmission of EBV appears to be exceptional. (6) Secondary EBV infections are associated with certain malignancies whereas such an association has not been recognized in the case of CMV.Toxoplasma gondii is another cause of HA-negative mononucleosis. Its complications in the heart, in skeletal muscle and in the central nervous system are related to direct invasion by the parasite. Cellular immunity plays an important role in defense against all three agents.     

Smooth Muscle Autoantibodies in Infectious Mononucleosis

Smooth muscle antibodies (S.M.A.) were found in the sera of 81% of 126 patients over 10 years old with seropositive infectious mononucleosis tested within one month of onset. In 27 patients presenting clinically with infectious mononucleosis but having negative Paul-Bunnell tests the incidence of S.M.A. was 44%. In children 10 years of age or less in these two categories S.M.A. were present in 75% and 25% respectively, while in children of similar age not suspected of having infectious mononucleosis the incidence of S.M.A. was 10%. Among 45 adults with past histories of seropositive infectious mononucleosis more than one year before the incidence of S.M.A. was 33%, in contrast to 14% in 98 subjects with a negative history for infectious mononucleosis.     

Lymphangiography: Its Practical Value in Surgically Staged Patients with Hodgkin's Disease

Since the introduction of “staging laparotomy” (to determine the disease''s stage) in assessing Hodgkin''s disease, some observers have argued that lymphangiography could be safely omitted in the initial diagnostic evaluation.To test these opinions a series of 75 patients with Hodgkin''s disease who had a staging laparotomy and histological correlation with lymphangiograms was reviewed. Of 16 examinations with positive results, one proved to be a false positive. Of the 14 examinations with equivocal results, one proved histologically positive. In the remaining 45 lymphangiograms, five were falsely negative. In all five of these patients abdominal lymph nodes were involved, but in areas that do not routinely opacify on lower extremity lymphangiography. The overall accuracy was 90 percent.Therapeutically, the lymphangiogram permits accurate planning for treatment by radiation therapy so that all known disease is treated and yet bone marrow is not excessively irradiated. Changes in lymph node architecture after therapy provide valuable information as to regression of the disease or signs of its early recurrence.