Antisyphilitic Treatment Research Articles

SEROLOGIC PARADOX IN JUVENILE DEMENTIA PARALYTICA

I shall report the results of serologic tests of the blood and of the spinal fluid in a case of juvenile dementia paralytica before, during and after the first phase of antisyphilitic treatment. A perusal of the literature fails to reveal any consideration of similar serologic findings. In view of the widespread interest in all matters pertaining to syphilis at this time and the consequent danger of too definite assumptions concerning the value and, above all, the meaning of serologic tests, I have decided to present this material. No attempt is made in this presentation to explain the phenomenon. REPORT OF CASE The patient, a white girl aged 11 years, is a foster child of farmers. Her intellectual and physical development were supposedly normal until the latter part of 1937, when her school grades gradually fell off, and she became more and more restless and slept poorly. On

ANEURYSM OF THE INNOMINATE ARTERY

Within recent years, particularly since the development of methods for the intensive treatment of syphilis, aneurysms of the large vessels, on the whole, have not been of as much clinical interest to physicians and students as formerly. Recently a patient with aneurysm of the innominate artery was under my observation. This case perhaps illustrates the potential danger to the patient of vigorous antisyphilitic treatment in association with aneurysm, with its resultant subjective improvement, and also may serve as a gentle reminder that clinicians in the past were thoroughly familiar with aneurysm of this type, that they developed methods of treating such an aneurysm which often were successful and that past experience may well serve as a guide toward improving in the future the methods of treatment when an aneurysm involves this particular vessel. Curiously, aneurysms of the innominate artery are by no means common. According to Osler¹and Reid

Routine Methods of Treatment as Employed from Time to Time in the Government Ophthalmic Hospital, Madras.

This book is a compilation of the methods of treatment which are used in the Government Ophthalmic Hospital, at Madras, India, and serves as a convenient memorandum for postgraduate students who are attending the practice of the hospital. The treatment for protein shock, tests and treatment for tuberculosis, antisyphilitic treatment, narcosis, nonoperative treatment of glaucoma (excellent) and trachoma are only a few of the items which are described. A great convenience for the student and invaluable for the practitioner, as the material and information presented is often difficult to find, this little book brings the methods which have been approved of by the directing surgeon of the hospital from his vast clinical experience.

CLINICAL EXCRETION OF BISMUTH AFTER ORAL ADMINISTRATION OF SOBISMINOL

Pursuant to a preliminary report 1 on sodium bismuthate soluble, now called sobisminol, this report presents complete clinical data on excretion. This is important in relation to the use of this bismuth compound in antisyphilitic treatment. The results obtained leave no doubt of a prompt and well sustained absorption of bismuth. Continued daily medication sustains concentrations of bismuth in the blood and tissues comparable to those resulting from intramuscular injections. Effects, in general, indicate that oral administration of sobisminol bids fair to be a practical therapeutic measure. PROCEDURE Twelve complete observations were made on seven different persons, i. e., on four healthy male research workers, two male patients and one female patient. Study of the excretion of bismuth in the urine was made with administration of small and of large single doses of sobisminol, of divided weekly doses and of daily doses for two weeks, with both soluble and insoluble

Syphilis of the stomach

This case of gastric syphilis is reported because: 1. The diagnosis was confirmed by histo-pathological study. 2. The diagnosis may be compatible with (a) negative or weakly positive serologic reactions (b) failure of symptomatic and/or roentgenologic improvement after intensive antisyphilitic treatment. 3. It resembled late carcinoma therapeutically as well as roentgenologically insomuch as neither condition is amenable to treatment.

Gumma of muscle

A patient presented a tender, painful tumor in the left upper quadrant of the abdomen, near the midline. On exploration the tumor was found to be a gumma of the rectus muscle. It was cured by excision and antisyphilitic treatment.

Medical Members' Monthly Meeting

This meeting, attended by about sixty members, was held in the Reid Knox Hall of the Institute on Friday, November 20. Dr. Russell Reynolds was in the chair. The following cases were discussed:— Dr. Staveley: (1) A case for diagnosis. The patient, a male aged 60 years, was referred for X-ray examination on account of many months of vague pelvic pains and symptoms suggestive of unilateral sciatica. The appearance of the pelvis was normal, but in the upper third of the femoral shaft, just below the level of the lesser trochanter, was an area of superficial erosion of the cortex of the inner aspect of the bone. The periosteum around this area was raised and proliferated into a delicate tracery of new bone formation extending into the soft tissues. The femoral shaft subjacent to the eroded area appeared perfectly healthy. Despite the radiological report that the condition was either a chondroma or a secondary deposit, and a negative Wassermann reaction, antisyphilitic treatment was given, but without result. ...

Identification and significance of spirochetesin the placenta: A report of 105 cases with positive findings

<h2>Summary</h2> <ul><li>1. The finding of spirochetes in the placenta in 105 cases is recorded.</li><li>2. Spirochetes can be found in the placenta of the syphilitic newborn in sufficient frequency to justify the search for them in suspicious cases.</li><li>3. The search should be made after Levaditi infiltration in portions of the placenta which give an indication of their presence by the presence of pale yellow foci surrounded by dark granular peripheries.</li><li>4. In 391 pregnancies from 75 syphilitic mothers who were untreated and with whom there were demonstrable spirochetes in the placenta of the last delivery, an apparently healthy baby was produced in three out of five pregnancies.</li><li>5. The fact that the newborn baby appears to be healthy does not indicate the absence of syphilis.</li><li>6. The successful termination of pregnancy after antisyphilitic treatment does not denote the absence of spirochetes from the placenta.</li><li>7. The histopathologic appearance of a placenta containing spirochetes is discussed.</li><li>8. Thorough antisyphilitic treatment, while it may not cause the disappearance of spirochetes from the placenta, is nonetheless indicated as it assures about 90 per cent apparently healthy full-term babies.</li></ul> The authors desire to express their appreciation of assistance in the arrangementand presentation of the text, kindly rendered by Dr. Amin A. Kheirallah, Lecturerin Surgery in the American University of Beirut.

CHANGES IN THE GROWING SKELETON AFTER THE ADMINISTRATION OF BISMUTH

In a previous discussion of the skeletal changes in lead poisoning, I¹commented on the possibility that other heavy metals might produce similar alterations in growing bones. At that time, however, I had not seen comparable lesions in the roentgenograms of infants and children who had received bismuth in antisyphilitic treatment. More recent observations have revealed shadows in the skeletal roentgenograms of such patients similar to "lead lines." In addition, I have since had an opportunity to study roentgenologically and histologically the lesions in the bones of growing dogs after the intramuscular injection of bismuth. <h3>ROENTGENOLOGIC FINDINGS FOR INFANTS AND CHILDREN</h3> Four types of lesion have been selected to illustrate the bismuth changes which follow syphilitic therapy: (1) the lesion which occurs directly after a single course of treatment with bismuth; (2) that which occurs many weeks after a single course; (3) that which occurs after multiple courses during

Experiences with Anti-Syphilitic Treatment from the Pre-Salvarsan Era to the Present and Their Possible Bearing on Present Treatment Practice: Discussion

Experiences with Anti-Syphilitic Treatment from the Pre-Salvarsan Era to the Present and Their Possible Bearing on Present Treatment Practice: Discussion

Enlargement of One Sternoclavicular Articulation: A Sign of Congenital Syphilis

In 1930, a new sign in the diagnosis of congenital syphilis was first described by Higoumenakis (1), namely, the unilateral enlargement of the sternoclavicular articulation. The authors wish to present another case in addition to those previously described in the literature. Case Report A white male, aged 56 years, presented himself to the clinic complaining of a severe sore throat which had been present for the past two months and was becoming progressively worse. The physical examination was essentially negative, with the following exceptions: The patient is left-handed. The pharynx, uvula, and soft palate were injected. Deep serpiginous ulcerations were noted on the posterior surface of the uvula, extending on to the soft palate. These ulcerated areas were dark gray in color, having a thick tenacious exudate. The otolaryngologist concluded that the throat involvement was of syphilitic origin. Inspection of the thorax revealed an enlargement of the sternal end of the left clavicle; palpation and comparison with the opposite side revealed a definite thickening of this area (Fig. 1). Roentgen examination revealed a prominence at the sternal end of the left clavicle (Fig. 2); that of the right clavicle was normal in size. The radiologic conclusion was enlargement of the sternal end of the left clavicle, apparently a manifestation of congenital syphilis. Serologic examination upon two occasions revealed a three plus Kahn and a negative Wassermann test. Dark field examination was negative for Spirochœta pallida. Past History.—The patient gave a history of gonorrhea approximately 25 years previously. There was no history of any syphilitic infection and the patient had been well up to the present time, except for an attack of lumbar myalgia four years previously. Family History.—The patient's father died of a cardiovascular (?) disease at the age of 38 years. His mother was also dead, cause unknown; he had no brothers or sisters. The patient has been married for the past 15 years; there was no history of pregnancies or miscarriages. Progress.—Intensive antisyphilitic treatment was instituted, and after a period of three weeks the throat had become practically clear of the ulcers and had lost its normal redness. Discussion In the original report by Higoumenakis, he described 23 cases of enlargement and anteroposterior thickening of the sternal end of the clavicle. Seven presented this stigma and no other signs of the disease except a positive Wassermann test, while the remaining 16 cases presented this sign with a negative Wassermann test. In a total of 197 cases of congenital syphilis, he found this sign present in 170; 157 involved the right side, while the remaining 13 involved the left side. Stokes (2), Plishkin (3), and Dorne and Zakon (4) all reported similar findings, with the involvement being on the right side. The enlargement is readily noted upon inspection and palpation, and is frequently found upon roentgen examination.

ANTISYPHILITIC TREATMENT

The problem expressed in the title of this paper has been given little consideration in modern syphilologic literature. Among the modern textbooks only that by Stokes 1 gives adequate consideration to a discussion of the paramount necessity of rest as an adjunct to specific treatment, while others have little or nothing to say. Even less can be found about the general effect of specific treatment on the patient. Yet the distinct influence which antisyphilitic treatment has on the patient's general well-being must be apparent to every experienced syphilologist. To a certain extent this influence can be objectively evaluated, for example, by the increase in the patient's weight. There is, however, a less tangible, but none-the-less important, change which can be observed in the majority of the patients, namely, a distinct improvement in the subjective feeling of well-being. In cases of latent syphilis the difference between the way the patient

Occurrence of agranulocytosis during antisyphilitic treatment: Sprafke, H.: Dermat. Ztschr. 71: 88, 1935

Occurrence of agranulocytosis during antisyphilitic treatment: Sprafke, H.: Dermat. Ztschr. 71: 88, 1935

FIXED ARSENICAL ERUPTION

The occurrence of a fixed eruption due to tryparsamide is a rare complication of antisyphilitic treatment, the case reported by Robinson 1 being the only one on record. For some time I have had under observation a patient in whom sensitivity to tryparsamide developed at the sites of pigmentation which remained after arsphenamine dermatitis sustained four years previously. It was found that the patient was sensitive to all trivalent arsenicals over the entire cutaneous surface, as evidenced by patch and intradermal tests, and to tryparsamide only in the pigmented areas. REPORT OF CASE W. Y., a white man aged 40 years, was first seen in June 1933, when he requested continuation of antisyphilitic treatment. He stated that he had a penile lesion in 1919, which healed in five or six weeks. No secondary lesions were noted and no treatment was given. In 1925 he became depressed and nervous.

HEPATIC COMPLICATIONS IN THE TREATMENT OF SYPHILIS

Article1 May 1936HEPATIC COMPLICATIONS IN THE TREATMENT OF SYPHILISII. INCIDENCE OF HEPATIC DISEASE IN PATIENTS WITH UNTREATED SYPHILIS AND DURING THEIR SUBSEQUENT TREATMENT*FREDERICK KELLOGG, M.D., NORMAN N. EPSTEIN, M.D., WM. J. KERR, M.D., F.A.C.P.FREDERICK KELLOGG, M.D.Search for more papers by this author, NORMAN N. EPSTEIN, M.D.Search for more papers by this author, WM. J. KERR, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-9-11-1561 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHepatitis as a complication of anti-syphilitic therapy is not an uncommon occurrence. The injury thus suffered by the liver may be transient or it may be permanent, resulting in cirrhosis. Thus Baldridge1reported that, of a series of 36 patients with definite portal cirrhosis, one-third had histories of treatment for syphilis. During the past 10 years the value of controlling the arsphenamine treatment of syphilis by functional tests of the liver has been repeatedly emphasized. Such tests are indicated especially for patients with histories of hepatic disease or with evidence of disturbance of the liver developing during the course of...Bibliography1. BALDRIDGE CW: The relationship between antisyphilitic treatment and toxic cirrhosis, Am. Jr. Med. Sci., 1934, clxxxviii, 685. Google Scholar2. BISKINDEPSTEINKERR GRNNWJ: Hepatic complications in the treatment of syphilis, ANN. INT. MED., 1934, vii, 966. LinkGoogle Scholar3. ALTHAUSENBISKINDKERR TLGRWJ: The Rose Bengal test of hepatic function; a spectroscopic method, Jr. Lab. and Clin. Med., 1933, xviii, 954. Google Scholar4. ALTHAUSENGUNTHERLAGENKERR TLLJBWJ: Modification of the dextrose tolerance test as an index of metabolic activity of the liver, Arch. Int. Med., 1930, xlvi, 482. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: San Francisco, California*Received for publication March 18, 1936.From the Division of Medicine and the Department of Dermatology, University of California Medical School, San Francisco.†Research Fellow, American College of Physicians. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAllgemeine Pathologie der Syphilis 1 May 1936Volume 9, Issue 11Page: 1561-1571KeywordsCirrhosisDermatologyHepatitis ALiverLiver diseasesSyphilis Issue Published: 1 May 1936 PDF downloadLoading ...

The results of treatment in cardiovascular syphilis: A report of three years' additional observation

1. 1. An analysis of the course of 161 patients with outspoken forms of cardiovascular syphilis is presented with reference to the effect of antisyphilitic treatment. Fifty-two of the patients had saccular aortic aneurysm; 109 had syphilitic aortic insufficiency. 2. 2. One-third (53) of the patients died in less than a year of observation, and these are considered in a separate groups, as unamenable to the beneficial effects of specific therapy because of the gravity of their disease and its rapid progress. 3. 3. One hundred and eight survived for more than a year of observation and received varying amounts of antisyphilitic treatment. Of these, 53 are considered in an “inadequate treatment” group and 55 in an “adequate treatment” group. 4. 4. The mean potential period of observation was ten years and eight months. 5. 5. The mortality rate for the poorly treated group was 1.37 times that of the well-treated group in patients with aneurysm; 2.62 times as great in those with aortic insufficiency; and 2.02 times as great for the group as a whole. 6. 6. The deaths due to cardiovascular syphilis were 1.62 times as great in the poorly treated as in the well-treated patients with aneurysm; 2.46 times as great in those with aortic insufficiency; and 2.06 times as great for the whole group. 7. 7. Seventy patients of the series are dead. 8. 8. The duration of life from onset of symptoms for those dead was 1.47 times as great in the well-treated as in the poorly treated patients for the whole group; 1.71 times as great in those with aneurysm; and 1.37 times as great in the patients with aortic insufficiency. The latter figure is not of certain statistical significance. 9. 9. A restudy of Grant's cases of syphilitic aortic insufficiency was made. 10. 10. The mortality rate of his poorly treated group was 1.35 times that of those well treated; deaths due to cardiac disease were 1.78 times as frequent in the former as in the latter. 11. 11. No significant difference in the duration of life in his two groups was observed.

ACUTE METASTATIC SYPHILITIC CORNEAL ABSCESS

When in 1915 Fuchs 1 gave a classic description of a corneal lesion which he called pustuliformis profunda, he left open only the question of the earliest symptoms of the disease and its etiology. Concerning these two points Meller 2 and Seefelder 3 in the following years gave valuable additional information supported by the rapidly increasing general use of serologic tests. Meller had the opportunity to observe the incipient symptoms of the corneal lesion in a patient who showed the fully developed picture in the other eye. He reached the conclusion that the keratitis is probably primary or at least coordinate with the severe hypopyon iritis. In Meller's and Seefelder's cases the Wassermann reaction of the blood was positive, and the course of the disease was favorably influenced by antisyphilitic treatment, resulting in useful visual acuity. Other cases with similar therapeutic results were reported by A. Fuchs, 4 Schneider,

Antenatal Anti-Syphilitic Treatment: A Hopeful Outlook

Antenatal Anti-Syphilitic Treatment: A Hopeful Outlook

TREATMENT OF ARSENICAL HEPATITIS WITH SODIUM DEHYDROCHOLATE

PATHOLOGIC PHYSIOLOGY Disturbances of the digestive tract during or soon after treatment of syphilis with arsphenamine are common. There are at least two forms of these disturbances, one characterized principally by fever, chills, vomiting and diarrhea and a second characterized primarily by jaundice. There can be no question that the latter syndrome is due in most cases to damage to the liver. The former reaction is possibly also due to some transient injury of the liver, as shown by the evidence that these manifestations can be prevented by treatment which relieves the load carried by the liver and by the fact that some patients who have had repeated reactions eventually have jaundice. The jaundice which occurs during antisyphilitic treatment may be due to the primary infection, to a hepatic Herxheimer reaction or to direct or indirect injury of the liver by the arsenicals. Jaundice occurred in syphilitic patients before

Aplastic anemia following stovarsol (acetarsone) therapy

<h2>Summary</h2> The patient was a seven-year-old girl with congenital syphilis, who suddenly developed a severe form of aplastic anemia apparently due to the arsenicals used in the treatment. The antisyphilitic treatment had extended over a period of ten months and had consisted of ten injections of a bismuth preparation, six injections of 0.1 gm. of neoarsphenamine (total of 0.6 gm.) and four courses of stovarsol (total of 56 gm.) Treatment included eleven blood transfusions, and the child gradually improved during the next four months making a complete recovery.