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Peripheral blood lymphocytes from 20 patients with systemic lupus erythematosus (SLE) and 21 normal donors were incubated with pokeweed mitogen in order to assess in vitro terminal-differentiation of B lymphocytes into cells synthesizing intracytoplasmic immunoglobulin (Ig). Although the percentage (mean k SEM) of B lymphocytes bearing surface Ig in the initial cell suspensions was not statistically different in SLE than in normal subjects (15 f 2.2% versus 16 f 1.9%, respectively), the frequency of cells containing intracytoplasmic Ig per lo3 mononuclear cells was significantly lower in mitogen-stimulated cultures derived from the patients than from the normal controls (10 f 2.3 versus 56 f 13.0 for IgM, P < 0.01; 21 f 3.6 versus 63 f 10.4 for IgG, P < 0.01; 13 f 3.1 versus 24 f 3.8 for IgA, P < 0.05 respectively).Coculturing active SLE lymphocytes with cells from nor- Submitted for publication April 28, 1977; accepted May 19. 1977. ma1 subjects resulted in a significant (P < 0.05) increase in the frequency of cells containing intracytoplasmic IgG when stimulated with pokeweed mitogen. Moreover, culturing SLE lymphocytes in cell-free media derived from activated normal lymphocytes also resulted in a significant increase in the frequency of IgG-containing cells. These results suggest that B-lymphocyte differentiation in vitro is depressed in SLE and may, at least partially, be reversed by products derived from normal lymphocytes.

The concentration of the conjugated bile acid, cholylglycine, in serum is a sensitive and specific indicator of hepatic function. We describe a convenient, specific, and precise radioimmunoassay for cholylglycine, in which 125I-labeled cholylglycyltyrosine is used as tracer. In addition, a blocking agent in the buffer system eliminates binding of bile acids to serum albumin. Therefore no extraction is required. We found no interference by (a) abnormal concentrations of albumin or gamma-globulin, (b) lipemic sera, (c) hemolyzed sera, (d) anticoagulants, or (e) various commonly used drugs. The reference interval for fasting subjects is estimated to be 0.0 to 0.6 mg/L. Our clinical studies show that serum cholylglycine concentrations are usually abnormal in most hepatobiliary diseases, such as viral hepatitis, alcoholic liver disease, cirrhosis, and pediatric liver diseases.

A case of encephalopathy complicating cat-scratch disease has been described. Neurologic signs manifested by convulstions and stupor appeared ten days after epitrochlear lymphadenopathy. The clinical course gradually improved over the next few days and recovery was complete. The spinal fluid was normal. The skin test with CSD antigen was positive. In all cases of encephalopathy developing within six weeks following the appearance of unexplained lymphadenopathy, the diagnosis of cat-scratch disease should be entertained. The importance of the cat-scratch disease antigen in diagnosis is emphasized.

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Infective endocarditis (IE) is a rare but serious condition. We present a case of endocarditis in a healthy 40-year-old male with no predisposing conditions. His physical examination was suggestive of peripheral microembolization and prompted us to consider the diagnosis of IE and order the appropriate investigations. After treatment, he later presented to the emergency department with abdominal pain, and a superior mesenteric artery aneurysm was discovered. We discuss recent advances in the changing epidemiology and microbiology of IE, review the presentation and diagnosis of IE, and highlight the potential complications of this disease. RÉ SUMÉL'endocardite infectieuse (EI) est une maladie rare mais grave. Il sera ici question d'un cas d'endocardite chez un homme de 40 ans, auparavant en bonne santé et exempt de facteur de pré disposition. L'examen physique é tait é vocateur d'une micro-embolie pé riphé rique, ce qui a incité à envisager le diagnostic d'EI et à procé der à une exploration approprié e. Aprè s le traitement, le patient est revenu au service des urgences pour des douleurs abdominales, et les examens ont ré vé lé la pré sence d'un ané vrisme de l'artè re mé senté rique supé rieure. Nous ferons donc é tat, dans le pré sent article, des changements observé s dans l'é pidé miologie et la microbiologie de cette affection; passerons en revue le tableau clinique de l'EI et le diagnostic; et ferons ressortir les complications possibles de cette maladie. Keywords: endocarditis, fever, Janeway lesions, Staphylococcus aureusInfective endocarditis (IE) is the inflammation of the endocardium and heart valves caused by bacteria or fungi. It is an uncommon condition with an incidence of between 2 and 10 per 100,000 person-years. Despite advances in diagnosis and treatment, it still has a high mortality rate, with in-hospital mortality of 15 to 20% and 1-year mortality of 20 to 30%. Recent prospective studies show that the epidemiology and microbiology of IE are changing over time. There is a higher rate of diagnosis of health care-associated IE and Staphylococcus aureus IE.1 In the emergency department (ED), key points include maintaining an appropriate index of suspicion in patients with risk factors or specific presentations, performing a thorough history and physical examination, and obtaining blood cultures prior to antibiotic administration if possible. Despite being treated for IE, patients can still present to EDs with relapse and delayed complications of IE. CASE REPORTA 40-year-old previously healthy male presented to our ED with a 1-week history of fever and chills and a 2-day history of pain and redness on his right foot. His only medication was ciprofloxacin, which he had been taking for 6 days. This was prescribed for a presumed urinary tract infection based on complaints of dysuria, urinary frequency, and left flank pain on the second day of illness, which had resolved by the time of representation. He had no other infectious symptoms to account for his fever and no recent travel history. ...