We studied 34 family members at risk of having dominant progressive foveal dystrophy of Lefler, Wadsworth, and Sidbury (also called North Carolina macular dystrophy) and found 17 to be affected. Fifteen of these affected subjects were observed over at least a 10-year period for evidence of progressive macular degeneration. Only one subject showed objective evidence of progressive deterioration in only one eye. Our findings further substantiate that this dystrophy generally has a stable course, contrary to its original description.
2556-8 weeks from the onset of the attack, the T wave may lose its characteristic shape and approach the normal. From our experience in other cases of coronary artery occlusion, we know that the cove-plane T may persist for years. On the other hand, we have seen no example of long duration of the changes of the first stage, i. e., marked elevation of the R-T transition. The general similarity of the successive changes in the four cases cannot be regarded as accidental. Therefore, it iiiay be said that the early electrocardiographic changes associated with acute coronary artery occlusion are first seen in the R-T interval, and then in the T wave itself. 2920Lactic acid of normal and pathological spinal fiuids.In 1917 Levinson' observed that spinal fluids from cases of epidemic meningitis immediately after withdrawal had a subnormal pH. This was in some instances further decreased when the fluids were permitted to stand a t room temperature unstoppered. However, normal and tuberculous meningitic fluids when freshly drawn showed similar figures for pH, and the pH increased on standing, particularly in the tuberculous fluids. Levinson believed that the lowering of the p H of the spinal fluid in meningococcus meningitis was due to the accumulation of lactic acid in the fluid, but he presented no data to substantiate this explanation.In the present communication, data are presented for the sugar and lactic acid of the spinal fluid of normals, miscellaneous pathological conditions and meningitis. Clausen's method was employed for the determination of the lactic acid, and the Folin-Wu procedure for the sugar.Specimens of spinal fluid obtained from five normal adults, after a night's fast and rest, showed lactic acid concentration from 8 to 15 mg. per 100 cc. In twenty-one miscellaneous non-meninllevinson, A,, J . Infect. D k , 1917, xxi, 556.
In 1926,1 one of us (Dr. Killian) and his associate reported that spinal fluid from cases of meningitis showed unusually high values for lactic acid and low ones for sugar. The source of the increased lactic acid appeared to lie in the metabolic activity of the leukocytes. These studies were continued, and in 1928 2 we came to the conclusion that the changes in lactic acid concentration were a better index of the progress of the infection than the changes in the sugar content. In meningitis the lactic acid of the spinal fluid was greater than that of the blood, but the sugar of the spinal fluid was less than that of the blood. Furthermore, the lactic acid of the spinal fluid may fluctuate within a wide range, although the amount of sugar remains normal. Since our first observations, similar studies have been reported by others.3 In the recent paper by Wright, Herr and Paul 4 on the spinal fluid in suppurative meningitis, an excellent review on this subject is found, and it is therefore unnecessary to repeat such a summary here.In the present report we wish to add further evidence to support the original conclusions and to enlarge on their significance. An intensive study of the sugar, lactic acid and cell count of the spinal fluid in various types of meningitis was made in order to determine whether the lactic acid varies with the cell count and whether it may be utilized as an index of the progress of the infection or of the From the
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