The level of serum ablumin has been said to be the controlling factor in the accumulation of ascitic fluid in patients with cirrhosis of the liver (1 to 4). Several investigators have reported an increased portal pressure in patients with the disease (5 to 7) and this has been conceded to contribute to the development of ascites. During the past 3 years, we have observed patients with cirrhosis of the liver who have accumulated ascitic fluid in such quantities that repeated paracenteses were required. The plasma levels of albumin and globulin were determined at regular intervals. The patients received, in addition to an adequate diet, an aqueous extract of liver prepared at the Rockefeller Institute for Medical Research. The liver extract, diluted with saline, was administered intravenously. As a result of the combined therapy, the reaccumulation of ascitic fluid was arrested after varying periods of time in the different patients and further paracenteses were unnecessary. We were thus able to compare the plasma levels of albumin and globulin during and after the period of fluid retention. In addition, determinations of plasma proteins were made on a group of patients with severe cirrhosis of the liver in whom ascites had never been present.This report is concerned with these observations. As the results did not indicate that the level of albumin in the plasma was the determining factor in the fluid retention, data are presented to support another theory in explanation of this disturbance. STUDIES ON PATIENTSThe patients selected for this study were those in whom severe liver damage was unquestionably present 1 This research was aided by grants from the Milbank Memorial Foundation and from the Nutrition Foundation.as evidenced by the physical findings and laboratory tests. A history of chronic alcoholism extending over a period of years was given by each patient. During the period of hospitalization, the patients were on the wards of the 3rd (New York University) Medical Division of Bellevue Hospital. When discharged, they were seen regularly in the Meta5olism Clinic of New York University College of Medicine. The diet consisted of 450 grams of carbohydrate, 100 to 120 grams of protein, and 85 grams of fat. Meat was given only once a day and the rest of the protein was derived from milk, eggs, cheese, and gelatine.2 The liver extract8 was given intravenously in doses of 5 to 10 ml. diluted with 40 ml. of N/saline. Two to 3 injections were given weekly. The plasma levels of albumin and globulin were determined by the method of Howe (8). The total proteins were done by the micro Kjeldahl method. Plasma cholesterols were determined by a modification of the Schoenheimer and Sperry method (9)-, and were read in the photoelectric colorimeter (10). Five mgm. of bromsulphalein per kgm. of body weight were injected intravenously for this test and the retention was determined on a sample of plasma withdrawn after one-half hour. The readings were made in a photoelectric colorimeter. The colloid osmotic pressure was calcula...
As a result of intensified studies during recent years, the number of known arthropod-borne (arbor) viruses has been greatly increased. One of the most valuable pieces of knowledge which has emerged from these studies is that many of these arbor viruses fall into dearly defined antigenic groups (1). Although immunologic relationships between some of them had been previously shown, the introduction of the group concept by Casals (2, 3) clarified and systematized these relationships. While cross-neutralization and complement-fixation tests are also used in establishing group relationships, the technique of hemagglutination-inhibition (HI) has provided the best method for the demonstration of antigenic relationships between members of group B and, indeed, the extent of overlap observed by H I m y be so great as to resemble the situation that exists between various strains of type A influenza. As antigenic analysis by antibody absorption has proved fruitful in the study of the latter viruses (4-6), it was decided to apply a similar approach to an analysis of the relationship among certain group B arbor viruses. The results of some of the studies are the subject of the present paper. Materials and MethodsViru~es.--The viruses used in the study are given in Table I. Their designation in subgroups rests on particularly close antigenic relationships revealed by various serologic procedures (1). The place and date of isolation of certain strains are given when this information is pertinent to the present study.Immune Scra.--The sera were prepared in either rabbits or mice. Rabbits were immunized with one or more injections of infective virus depending upon the antibody response. Mice received multiple (four or five) immunizing inoculations. With viruses which were pathogenic by the intraperitonesl route, the first injections consisted of inactivated virus followed by one or two inoculations of infective virus. Where multiple inoculations were required, the animals were bled 7 to 10 days following the last dose.Hemagglu~inationdnhibition Tests.--The preparation of test antigens, removal of nonspecific inhibitors from sera, and performance of the tests were done as previously described from these laboratories (7). The test antigens were prepared by either the acetone-ether or sucrose-acetone extraction methods. All tests were carried out in tubes.Technique of Antibody Absorplion.--The absorbing virus was prepared from a 20 per cent homogenate of infected suckling mouse brain made in borate-buffered saline, pH 9.3 (0.05 M borate-0.12 M NaCI).
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