There were 21 patients with rapidly progressive multiple sclerosis (MS) treated on a phase 1/2 study of intense immune suppressive therapy and autologous hematopoietic stem cell (HSC) support with no 1-year mortality. Following transplantation, one patient had a confirmed acute attack of MS. Neurologic progression defined by the expanded disability status scale (EDSS) did not increase in disability by 1.0 or more steps in any of 9 patients with a pretransplantation EDSS of 6.0 or less. In 8 of 12 patients with high pretransplantation disability scores (EDSS > 6.0), progressive neurologic disability as defined by at least a 1-point increase in the EDSS has occurred and was manifested as gradual neurologic deterioration. There were 2 patients with a pretransplantation EDSS of 7.0 and 8.0 who died from complications of progressive disease at 13 and 18 months following treatment. Our experience suggests that intense immune suppression using a total body irradiation (TBI)-based regimen and hematopoietic stem cell transplantation (HSCT) are not effective for patients with progressive disease and high pretransplantation disability scores. Further studies are necessary to determine the role of intense immune suppressive therapy and HSC support in ambulatory patients with less accumulated disability and more inflammatory disease activity. Specifically, more patients and longer follow-up would be required in patients with an EDSS of 6.0 or less before drawing conclusions on this subgroup.

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Strain variation in the spirochaete B. anserina has been reported MULEY, 1968, 1972;PARATKAR and MEHTA, 1973). This information on strain variation is of paramount significance from the prophylaxis point of view. In spirochaetosis, strain specific immunity is produced and in some cases partial protection is afforded where two strains share common antigens. In this communication, studies with a strain isolated from the Akola region of Maharastra (India) as compared to the local Jabalpur (India) strain are presented.Akola strains of B. anserina were procured from a private poultry farm cmd were passaged in chickens 6 weeks of age. After infection, birds were treated by penicillin injection (20,000 IU, intramuscular per bird). A new batch of chickens were infected with Jabalpur strain of B. anserina and were similarly treated. Ten days after recovery, recovered plasma was obtained. The recovered chickens were saved for challenge test. Similarity or otherwise of the strains under study was detected by the cross immobilization test.For challenge test, the recovered chickens with Akola strain infection, were challenged with 0.2 ml. B. anserina Jabalpur strain infected blood by intra-muscular mute. Jabalpur strain recovered chickens were likewise challenged with Akola strain. The challenged chickens were observed daily for the presence or absence of infection for a total period of ten days. Presence or absence of spirochaetes was observed under dark ground illumination.It was observed that Akola strain was equally potent in infecting the susceptible chickens and followed practically the same course as observed in chickens infected with Jabalpur strain of B. anserina. * Associate Prof. Very. Medicine (Officer In charge Ambulatory Clinic).

Primary hepatic angiosarcoma (PHA), a rare and aggressive malignancy, has rarely been reported to present with disseminated intravascular coagulation with liver hemorrhage. Incidence is estimated at 0.5–2.5 cases per 10,000,000. To our knowledge, it has not been reported to mimic liver abscess with a septic presentation. Advanced imaging techniques may aid in the diagnosis, though biopsy with microscopy and immunohistochemistry is the mainstay. Prognosis is very poor, with a 5-year survival rate estimated at 6.4%. We present the case of a 70-year-old man who presented with sepsis thought to be due to a multifocal liver abscess, who did not respond to drainage and antibiotics. This atypical course led to further workup which subsequently revealed a diagnosis of PHA.