Experimental studies on the virus of "Q" fever

The virus isolated by Derrick from cases of fever produces characteristic pathogenic effects on monkeys and mice. A well-defined febrile reaction, during which the blood is infective for guinea-pigs, follows subcutaneous inoculation of virus in the monkey. Mice inoculated intraperitoneally show enlargement of spleen and liver with characteristic histological changes. In sections and smears of infected mouse liver and spleen large numbers of rickettsial organisms are visible. These occur in relatively large intracytoplasmic microcolonies. Inoculation of mouse virus into guinea-pigs and monkeys gives a febrile reaction with a very short incubation period. Cross immunity tests indicate that mouse virus is identical with guinea-pig virus. The virus produces an inapparent infection in albino rats. The virus survives, but does not produce characteristic lesions on the chorio-allantois of the developing egg. The virus is filterable with difficulty through relatively permeable (0.7 mu) gradocol membranes. Agglutination of semi-purified rickettsial suspensions by immune human monkey and guinea-pig sera has been observed; this reaction appears to be specific.

Role of viruses in uveitis

The viruses and related organisms, which have been either demonstrated or suspected as the origin of various forms of uveitis, cause mostly morphologically non-specific disease. On the other hand, unidentified viruses have been supposed to play a role in the pathogenesis of well-defined systemic diseases complicated by uveitis. The syndromes in which the uveitis has a specific clinical appearance are briefly presented, including the available laboratory techniques, and their diagnostic value is discussed. In most cases, however, the determination of the responsible virus remains very difficult.

[Rift valley fever and rickettsial retinitis including fluorescein angiography (author's transl)]

Three cases of Rift Valley fever retinitis and one case of Tick Bite fever retinitis are presented. The clinical features are indistinguishable, manifesting as localised areas of retinal ischaemia and soft exudate formation. Fluorescein angiography shows that there is primary involvement of the retinal circulation without involvement of the choroidal circulation. Vascular occlusion is a feature of the retinal pathology. These patients were treated with steroids and immunosuppressives as their maculae were threatened and they all regained normal to near normal vision except in one case in whom old macula scarring from previous episodes of the disease prevented visual improvement.

[Richettsial pericarditis and pleurisy]

The authors report two cases of rickettsial disease due to R. Conori with mainly pericarditis in one case, sero-fibrinous pleurisy in the other. They then recall a few general data concerning this rickettsial disease and the very restricted place that it occupies in the etiology of pericarditis and, even more so, in the case of pleurisy. The conditons of diagnosis, which are mainly serological, are discussed, in particular with regard to pericarditis and tuberculous pleurisy.

Acute respiratory infections

In conclusion, the purpose of this dissertation has been to review the data on acute respiratory infections as to etiology, pathogenicity, clinical syndromes and treatment. It would take volumes to adequately discuss respiratory infections in all their complexity, and by the time any manuscript gets into print, it is likely to be outdated because of the rapid advances in the area of virology and antimicrobial agents. This review in no way claims completeness for any one subject, but an attempt has been made to bring into focus and with some sort of organization the vast amount of information in the literature, recent and old, relative to acute respiratory infections.

Perhaps the most encouraging aspects of acute respiratory infections are the mildness and short duration of the vast majority of these diseases, aspects which have been well expressed by A. A. Milne: Christopher Robin Had wheezles And sneezles,… Christopher Robin Got up in the morning, The sneezles had vanished away. And the look in his eye Seemed to say to the sky, “Now, how to amuse them today?” (From Now We Are Six [New York: E. P. Dutton & Co., Inc., 1950] pp. 12–14).

Fascia lata aortic valve reconstruction: long-term results in 33 patients

Aortic valve reconstruction with autologous fascia lata was performed in 33 patients (mean age 35 years) in 1966 and 1967. Eighty-two per cent had cusp extension rather than replacement, while 33% required additional intracardiac procedures. There were seven hospital deaths (21%) and 11 late deaths (33%), a total mortality of 54% over four years. Six late deaths followed reoperation for recurrent incompetence, and two other patients survived reoperation. Endocarditis (rickettsial, fungal, and bacterial) occurred in five cases, all required reoperation for incompetence, and four died. Sixty-nine per cent of the survivors of operation left hospital with competent valves and did better than the 31% with leaking valves in terms of late deaths, endocarditis, and reoperation for incompetence. Of the 15 patients (45%) still alive, 13 still have their original fascial valve, and of these only two (or perhaps three) have no diastolic murmur. Seven have insignificant murmurs and three have aortic incompetence. These poor results, particularly in the long term, make us sceptical about current enthusiasm for fascia lata heart valves.