A.M.A. archives of internal medicine

Although Hodgkin's disease and the nephrotic syndrome secondary to amyloidosis are not uncommon individual entities, their association in the same patient is rare. When this association does occur, it is usual for the nephrotic syndrome to appear after the picture of Hodgkin's disease is well established. For the reverse to occur is rare and warrants adding the present case to those previously reported. The subject of amyloidosis in Hodgkin's disease was extensively reviewed by Wallace et al., in 1950. They discussed 29 previously reported cases of Hodgkin's disease and amyloidosis and added one case of their own, which presented with nephrosis. Although in all of their cases the association was present, only four presented with the nephrotic syndrome. Since this report, the literature was carefully searched for cases of nephrotic syndrome due to secondary amyloidosis in Hodgkin's disease and a total of nine additional cases 1-6 were found, six of

SIDNEY J. WINAWER

A M A Archives of Internal Medicine

Amyloid Nephrosis in Hodgkin's Disease

霍奇金病中的淀粉样肾病

Porphyria cutanea tarda (PCT) is one of the inborn porphyrinopathies. It is characterized by abnormal porphyrin synthesis and excretion, cutaneous photodynamic activity, fragility of the skin, and, usually, evidence of liver disease. Schmid, Schwartz, and Watson<sup>1</sup>termed porphyria cutanea tarda and acute intermittent porphyria as hepatic porphyrias, a group of disorders very distinct from congenital (erythropoietic) porphyria. Waldenström<sup>2</sup>recognized two forms of porphyria cutanea tarda. One form is familial (PCT hereditaria) and becomes clinically manifest shortly after puberty. It may occasionally be complicated by features of acute porphyria, including the excretion of porphobilinogen in the urine. The other form (PCT symptomatica) becomes manifest later in life and is associated with alcoholism or alcoholic cirrhosis and, in rare instances, with tumors of the liver. The treatment of porphyria cutanea tarda has been generally disappointing. However, some reports of treatment with dimercaprol (BAL) or edathamil (ethylenediaminetetraacetic acid)<sup>3-5</sup>have been

ALLAN G. REDEKER

Porphyria Cutanea Tarda

迟发性皮肤卟啉病

Despite the advent of potent antibacterial agents the frequency of chronic pyelonephritis has not been significantly reduced, and it has remained notably resistant to permanent cure. 1,2 In a prior study, prolonged treatment with a single agent, although sometimes suppressive, was curative as a rule only if the infecting bacteria were eradicated within the first several days after the initiation of treatment. 3 Similar results have been observed by others. 4 Eradication of the primary infecting strain was sometimes followed by the emergence in the urine of a resistant strain or an entirely new species. These circumstances—failure to eliminate the causative organism even after prolonged treatment, mixed infections or emergence of resistant strains, and superinfection with new species during and after treatment—have been suggested as conditions in which a combination of antimicrobial drugs might be indicated. 5 This investigation was undertaken to determine whether a combination of several antimicrobial agents designed to inhibit the

WILLIAM R. McCABE

Treatment of Chronic Pyelonephritis

慢性肾盂肾炎的治疗

<h3>Evolution of Modern Medicine</h3> This section, which has as its primary purpose a review of the contributions of medical investigators and observers of the past to the present-day concepts of disease, is under the special editorship of Dr. Arthur Bloomfield, 2398 Sacramento St., San Francisco 15. His editorial in the August, 1957, issue of theA. M. A. Archives of Internal Medicine, gives further detail of what it is hoped to accomplish in these articles. Contributions or comments for this section may be sent directly to Dr. Bloomfield, or to the Chief Editor for transmittal to him. On the occasion of the centennial of the publication of the "Origin of Species," that magnificent intellectual achievement of Charles Darwin, it is fitting to review the life of the man and the impact of his ideas on his time and ours. The generalizations of science help us to understand the orderly behavior

WILLIAM B. BEAN

In Praise of Darwin

赞美达尔文

Spurious heart disease resulting from an erroneous diagnosis and consequent treatment for nonexistent coronary artery disease is common. While spurious coronary disease does not result in death, it causes unnecessary restriction of physical activity and diet, expensive diagnostic procedures and therapy, and loss of time from work. It frequently produces a type of disability which is more detrimental to the patient, his family, and his community than true coronary artery disease. Numerous factors are responsible for the origin and aggravation of spurious coronary disease. They relate to the nature of coronary disease, the patient, and the attending or consulting physician. The incipient and subtle nature of coronary disease, the multiple symptoms by which it may be manifested, and the fact that if often defies diagnosis until an acute coronary occlusion occurs are features which produce anxiety on the part of the patient and overdiagnosis and false diagnosis by attending

THOMAS W. MATTINGLY

Spurious Heart Disease

虚假心脏病

When Thannhauser and Stanley<sup>1,2</sup>fed I<sup>131</sup>-labeled olive oil and followed the appearance and disappearance of the radioactivity in the blood of their patients, they introduced a new, simple, and very valuable technique for the study of neutral fat metabolism in health and disease. Numerous reports soon followed<sup>3-6</sup>in which I<sup>131</sup>-labeled neutral fat was used as a diagnostic tool in various malabsorptive syndromes. The fruitfulness of this field of investigation probably led to a delay in the use of this technique in studying hyperlipemic states, although the original workers reported abnormal curves in nephrotics and idiopathic hyperlipemia as well.<sup>1,2</sup>Recent studies by others as well as in our laboratory<sup>7-9</sup>have demonstrated that individuals with proven myocardial infarction display elevated levels of blood radioactivity following ingestion of a radioactively labeled fat meal. Since it is well known that patients with diabetes mellitus have a tendency to develop atherosclerotic lesions at an

HERSCHEL SANDBERG

I131 Triolein Tolerance Curves in Patients with Diabetes Mellitus

糖尿病患者中I131三油酸甘油酯耐受曲线

The symptoms associated with the abnormal physiology in patients with hypofunction of the lachrymal, nasal, and salivary glands have been termed variously as the sicca syndrome or complex, Sjögren's syndrome, keratoconjunctivitis sicca, or filamentary keratitis. In 1933, Henrik Sjögren, an ophthalmologist, described 19 such patients, some with an associated polyarthritis and parotid swelling, as well as the microscopic changes in the conjunctivae, cornea, lachrymal, and salivary glands.<sup>1</sup>The main manifestations of the disorder were the dryness of the eyes and mouth with a chronic polyarthritis plus certain general symptoms, not all present in all cases, such as acrodermatitis, scleroderma, achylia, pernicious anemia, Raynaud's phenomenon, purpura, and alopecia.<sup>2</sup>Other recent reports have dealt with the historic aspects and clinical characteristics of the disorder<sup>3,4</sup>; the microscopic features of biopsy and autopsy material,<sup>5-7</sup>and therapeutic regimens.<sup>8-11</sup> The protean nature of this condition reflects a multisystemic involvement including features seen in the more

CHARLES W. DENKO

The Sicca Syndrome (Sjögren's Syndrome)

干燥综合征（斯耶格伦综合征）

Recovery from myocardial infarction is dependent upon the ability of the organism to withstand a given amount of heart damage in the face of preexisting pathology. Characteristics such as age, presence of diabetes and hypertension, various arrhythmias, congestive heart failure, and shock long have been thought by clinicians to be of prognostic value. Indeed, many attempts have been made to evaluate individual features such as age at the time of infarction, 2,3,5,12 specific arrhythmias, 1,7 diabetes, 4 and hypertension. 7 Schnur 10,11 and Russek 8,9 have attempted on clinical grounds to separate good from bad risks. The present study is an effort to evaluate statistically the prognostic significance of certain features of acute myocardial infarction as seen in a large public hospital. A survey was made of all hospital charts of male patients with the diagnosis of acute myocardial infarction for the fiscal year 1956-1957 at the Los Angeles County Hospital. The diagnosis was accepted

ALBERT E. WHITE

Prognostic Features of Acute Myocardial Infarction in Men

男性急性心肌梗死的预后特征

<h3>Introduction</h3> Macroglobulins have, in recent years, been identified as normal constituents of human blood serum. Macroglobulinemia has been recognized in association with neoplastic, collagen, and chronic infectious diseases. There remains, however, a group of patients with the findings of macroglobulinemia unassociated with these entities. Ultracentrifugal, immunophoretic, and viscosity studies have provided further clarification of this disorder. The patients below illustrate two clinical types of primary macroglobulinemia. Of interest is the fact that the disease developed while both patients were under medical observation. In both, the macroglobulinemia was of the uncommon cryogelglobulinemia variety. <h3>Report of Cases</h3><h3>Case 1.</h3> —A 55-year-old Turkish-born white American seaman was admitted to the U.S. Public Health Service Hospital, Galveston, Texas, on Sept. 17, 1957, with weakness, dyspnea, and cough of one month's duration. There was no associated hemoptysis or pedal edema. There was a past history of asthma and a subtotal gastrectomy and gastrojejunostomy performed in

STEPHAN E. RITZMANN

The Syndrome of Macroglobulinemia

巨球蛋白血症综合征

<h3>Introduction</h3> Similarities between the anti-inflammatory effects obtained from salicylate and glucocorticoid therapy in rheumatic diseases have led to speculation as to a common mode of action of these two substances. Metabolic studies using current laboratory procedures have, however, often produced conflicting results. Data have been reported supporting the concept that salicylates stimulate the pituitary-adrenal axis in man. In other studies these data have not been confirmed and, indeed, appear to have been contradicted. Some investigators have reported an<i>increase</i>in the urinary reducing steroids and no change in neutral 17-ketosteroids after salicylate therapy.<sup>1-3</sup>Others have reported a significant<i>decrease</i>in the urinary 17-hydroxycorticosteroid excretion with a slight decrease in 17-ketosteroid excretion in individuals who have been given large doses of salicylates.<sup>4</sup>Other reports have shown no significant alteration in either urinary 17-ketosteroids<sup>5-7</sup>or 17-hydroxycorticosteroids<sup>6,7</sup>following salicylate administration. In many of the earlier studies in man, massive

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