GASTROINTESTINAL ALLERGIC DISEASE

Gastrointestinal allergic disease undoubtedly does exist, but its frequency has been tremendously overrated. It is believed that in many cases there is not sufficient evidence for attributing chronic, recurrent digestive disturbances to allergic reaction, and that skepticism is particularly important because such a diagnosis exposes the patient to an unwarranted type of dietary management that is complicated, frequently unwise, and not too infrequently used as a substitute for critical clinical thinking.The demonstration and subsequent elimination of allergic substances that may at times be productive of digestive symptoms is, of course, important, and when based on proper evaluation of a carefully taken history will undoubtedly yield brilliant results.     

EXPERIENCE WITH ACTH AND CORTISONE IN PRIVATE PRACTICE

ACTH and cortisone are highly nonspecific in their action. A fundamental portion of the mechanism of action is the interposition of a blockade between toxin and end organ. This effect can be of great benefit in the management of a variety of acute and chronic diseases.A major hazard constantly to be kept in mind is the potential masking of advancing disease. This consideration makes concomitant chemotherapy mandatory in the presence of specific infections.In chronic diseased states it should be assumed that prolonged therapy will be necessary. Treatment should not be instituted unless such continued therapy is physiologically and economically feasible.     

EXPERIENCES WITH ACTH AND CORTISONE IN SELECTED DERMATOSES

Fifty patients with various kinds of skin diseases who were not adequately relieved by conventional therapy were treated with ACTH or cortisone given systemically.Almost all patients with disseminated neurodermatitis had dramatic initial response, but in only about half the cases was improvement maintained when use of the drugs was discontinued.It appeared that in other skin diseases, such as lupus erythematosus, scleroderma, psoriasis, dermatomyositis and pemphigus, while improvement may be noted for a time, relapse to the original state occurs after the treatment is stopped.In four cases of chronic discoid lupus erythematosus, although some improvement was observed when steroid therapy was given, the histologic pattern of biopsy material taken from the lesions after treatment still was characteristic of the disease.     

CORTISONE IN COCCIDIOIDOMYCOSIS

Cortisone administered orally, in low dosages for brief periods, promptly suppressed the allergic manifestations accompanying primary pulmonary coccidioidomycosis in 19 cases. There was no interference with the coccidioidin skin test reaction or with the usual serologic pattern.Dissemination of the disease as a sequel to the administration of cortisone and/or corticotropin has not been reported. A survey of physicians and of the known instances of disseminated coccidioidomycosis in Kern County failed to reveal any such episode.In none of the cases in which the authors gave cortisone in the presence of coccidioidomycosis was there any complication or undesirable sequel—specifically, no subsequent dissemination of the disease.The data presented are not to be interpreted as a therapeutic recommendation, but as a contribution to the information available concerning the effects of these drugs in infectious diseases.     

THE TOPICAL AND SYSTEMIC USE OF CORTISONE IN DERMATOLOGY

Part I of this report deals with the topical use of cortisone in a variety of skin diseases. Fifteen patients with chronic discoid lupus erythematosus, four patients with necrobiosis lipoidica diabeticorum, four with psoriasis, one with lichen planus and one with granuloma annulare were treated with cortisone ointment. All the patients with chronic discoid lupus erythematosus had some degree of improvement. In two patients with chronic lupus erythematosus, complete clearing of the eruption occurred. In four patients with necrobiosis lipoidica diabeticorum remarkable involution resulted. Patients with psoriasis, lichen planus and granuloma annulare were not benefited.Part II deals with the systemic use of cortisone. Eight patients with severe serum sickness-like penicillin reaction responded dramatically to parenterally administered cortisone. In two cases of pemphigus vulgaris and one case of Sulzberger-Garbe disease, the disease was kept in remission with cortisone administered intramuscularly as well as orally. Partial improvement resulted in a case of localized myxedema associated with malignant exophthalmus. Two patients with exfoliative dermatitis due to therapy with heavy metals responded dramatically to cortisone. No beneficial effects were noted in patients with chronic urticaria and atopic dermatitis.The systemic use of ACTH and cortisone in dermatology at present should be confined to patients with known fatal or hopelessly incapacitating diseases and to patients with extreme hypersensitivity reactions which may be protracted or life-endangering, and which can be controlled or cured with a relatively small total dosage of the agents in a short time.     

EXPERIENCE WITH CORTISONE AND ACTH IN A PRIVATE CLINIC

Cortisone and ACTH are valuable agents for treating a large variety of diseases. In appropriate situations they may save life. It may be possible to prevent loss of vision in eye disease or permanent damage to important viscera in generalized disease. With ready access to these agents through the pharmacist, it is important to know that cortisone and ACTH can be used in office practice provided patients are selected carefully and followed frequently and closely. Strict observation of criteria for selection of patients limited the size of the series of patients reported upon, but by the same token the incidence of complications from therapy was exceptionally small. Every physician who elects to employ these potent hormones must become familiar with their physiological effects and with the various methods of exhibiting them. Some of these effects are noted in this paper, but the experiences reviewed here provide an incomplete picture of the wide application of cortisone and ACTH.     

ALLERGIC IMPLICATIONS OF BLOOD DISORDERS IN INFANCY AND CHILDHOOD

The clinical manifestations of many of the blood disorders are wholly or partially dependent on immunoallergic reactions. A growing body of evidence permits the characterization of antigenantibody mechanisms in connection with hemolytic anemia, purpura and agranulocytosis, and more specifically for each of the blood cell elements and for the vessel wall.These reactions extend to maternal-fetal relationships producing well defined blood disorders manifest at birth or in the neonatal period.Once the effects of the hypersensitive state are set in motion during the course of a blood disorder, therapeutic measures to slow their progress are often futile. Because it is not always possible to identify the potentially allergic child in whom these circumstances will occur, it is extremely important to weigh the advantages of the use of a drug before it is administered especially when its side effects have not yet been thoroughly investigated.Important information has recently been obtained regarding the heightened susceptibility to infection in children with chronic anemia who have had splenectomy to reduce the frequency of transfusions. The hypersensitive responses in children with spleen removed may result in overwhelming and often fulminating infections necessitating rigid criteria in selecting patients of the pediatric age for this operation.     

CORTISONE IN TREATMENT OF BRONCHIAL ASTHMA

Twenty patients with intractable asthma were treated with cortisone on various dosage schedules. Results indicated that a rapid improvement in the asthmatic state may be expected in four to five days with high level dosage of the hormone—usually a total dose exceeding 200 mg. per day at the beginning. If treatment is discontinued after a week, relapse usually will occur within a period of eight days. If small doses are given two or three times weekly, following initial response, relapse may not occur for 20 or 30 days. The interspersed administration of ACTH during an attempt to discontinue cortisone apparently was of no value. It therefore appears that cortisone control of intractable asthma is dependent on large dosage until clinical improvement is obtained, then approximately 100 mg. two or three times a week for maintenance of a reasonable state of health.     

沈阳地区气传致敏花粉探讨

本文报道在沈阳地区1965—1985年间于空气中间断收集大气花粉5年,共收花粉玻片1100张,花粉45780粒,属于24科37属或种。其中9种(或属)超过千粒,为优势种类花粉。每年沈阳市大气中花粉出现两个高峰,一个为春季(四、五月),另一个为夏秋季(七八月)。通过长期观察发现,花粉种类和数量每年虽有不同,伹差异不大,唯有豚草花粉消长明显。大气中花粉种类及数量的变化往往受到气温、国家有关绿化政策以及社会风气的影响。花粉与过敏症关系十分密切,我们采用17种花粉制成浸液为病人皮试和治疗。皮试结果阳性率最高的为蒿属花粉,其次为其它夏秋花粉,春季花粉阳性率不高,致敏性不强。用花粉浸液对过敏症者进行免疫治疗,收到一定的疗效。     

OPERATIVE AND POSTOPERATIVE EMERGENCY USE OF HYDROCORTISONE DERIVATIVES AND CORTICOTROPIN

Impairment of adrenal function is a great hazard to patients undergoing major operation. The most important adrenal steroids are glucocorticoids (hydrocortisone), 17-ketosteroids, mineralo-corticoids (aldosterone), and small amounts of estrogen and progesterone. Urinary output of 17-hydroxycorticoids reflects overall adrenal cortical activity. Under severe stress this output increases greatly.Adrenal replacement therapy is facilitated by the advent of more powerful and more soluble adrenal hormone derivatives. Hydrocortisone hemisuccinate sodium is the agent of choice in surgical emergencies and for management of bilateral adrenalectomy. Fatal adrenal crisis may develop during operation in patients receiving hydrocortisone for long periods of time. Hydrocortisone may be of help in unresponsive shock not due to loss of blood. The usual side effects of the corticoids can be controlled easily.     

CHEMOTHERAPY IN VIRAL AND RICKETTSIAL DISEASE

Aureomycin and chloromycetin have now been used in a number of viral and rickettsial diseases and have gone far toward fulfilling their original promise. In local trials aureomycin has been shown to be a very effective drug in primary atypical pneumonia, and a valuable drug in Q fever. A small number of cases of psittacosis appear to have responded favorably to aureomycin. The search for chemotherapeutic compounds which may be effective in other viral diseases has been sharply stimulated by these developments.