Blood Gram Research Articles

Genetic Relationship Between Chronic Otitis Media Infection And TLR4 Gene In AL-Qadisyah province, Iraq .

Background :otitis media is considered the more diseases common spread related hearing loss ,This study is designed to focus on TLR4 expression that stimulating result presence LPS in otitis media
 Objective :detect the genotype more infection in otitis media on blood patients sample expression in PCR Technical.
 Methods :The current study blood specimens we get of 50 patient and chronic Otitis media and 50 blood samples from healthy people to Extracting and dissection of the DNA blood gram negative bacteria and evaluate the mechanical and work of LPS and its effect on Toll like receptor4.
 Results :The results show most patients with P. arogenosia isolates have GG genotype 9 in comparison with other genotype AG, 15 and AA 26 and control group show GG genotype 4 in comparison with other genotype AG 11, and AA 36 .
 Conclusions: The study is showed a high rate of chronic otitis media in patients with the GG genotype, suggesting that this genotype may be a risk factor compared to the control group. On the other hand, the AA genotype was found to be ӏow in patients but high in the control group, indicating a possible is protected factor.

Features of blood selection in kurchat broilers of different age

Features of blood selection in kurchat broilers of different age

A three-time-point method for assessing kinetic parameters of 64Cu-labeled Ramucirumab trapping in VEGFR-2 positive lung tumors

ObjectiveTo describe a three-time-point method for estimating kinetic parameters involved in 64Cu-labeled Ramucirumab (64Cu-NOTA-RamAb) trapping of VEGFR-2 positive lung tumors. Materials and methodsPositron emission tomography (microPET) data of tumor-bearing mice for 64Cu-NOTA-RamAb trapping in VEGFR-2 positive HCC4006 tumor were used, involving tissue activity measurements acquired at 3, 24 and 48 h post-injection, without and with administration of RamAb blocking dose. A kinetic model provided an analytical formula describing the tissue time-activity-curve, involving 64Cu-NOTA-RamAb uptake (Ki), release rate constant (kR) and fraction of free tracer in blood and interstitial volume (F). ResultsFitting analytical formula outcomes on mean microPET data yielded values of the kinetic parameters: Ki = 0.0314/0.0123 gram of blood per hour per gram of tissue, kR = 0.0387/0.0313 h−1 and F = 0.2075/0.2007 gram of blood per gram of tissue, without/with RamAb blocking dose, respectively (R = 0.99999 for the graph displaying microPET versus theoretical data; P < .01). ConclusionsThree independent kinetic parameters (Ki, kR and F) can be assessed from three data points acquired at early, mid and late imaging, i.e., at 3, 24 and 48 h post-injection, for further characterization of 64Cu-NOTA-RamAb trapping in VEGFR-2 positive lung tumors.

Case study: Complicated influenza pneumonia

This is a case presentation of a 16-year-old male patient who arrived in South Africa after a trip to Hong Kong. He had been on a sports tour. Previously, he had been healthy with no past medical history of note. Days prior to leaving Hong Kong, he had contracted a flu-like illness. On arrival at O.R. Tambo International Airport (in South Africa), he was showing signs and symptoms of deterioration in condition, including fever, coughing and confusion. He was tended to by paramedic staff at the airport, who transported him urgently to our emergency department (ED) by ambulance. He was extremely short of breath. At the time of arrival in the ED, he was not intubated. He had a quick sequential organ function assessment (qSOFA) score of 3, with a lactate level &gt;2 mmol/l. The patient&apos;s condition was found to be critical, with marked deterioration in his respiratory and haemodynamic status. Soon after arrival, he required resuscitation in the ED. With no return of spontaneous circulation (ROSC), despite aggressive resuscitation, it was decided to place him on veno-arterial extracorporeal membrane oxygenation (VA ECMO). He was cannulated femoral–femoral with a 23-French venous catheter and a 15-French arterial catheter. Extracorporeal cardiopulmonary resuscitation (ECPR)1 was performed promptly with successful return of spontaneous circulation. Due to poor saturation and oxygenation on blood gas, veno-venous (VV) ECMO was concomitantly performed. An 18 French Avalon catheter was separately placed in the internal jugular vein. This required a second ECMO machine to be used, as his clinical condition was deemed to be too unstable to create a hybrid circuit (VA-V). The patient had good oxygen saturation levels with a satisfactory blood pressure, and hence, he was transferred to the Intensive Care Unit (ICU). Appropriate clinical samples were sent (with a request for urgent influenza PCR test to be performed on a tracheal aspiration specimen), and a positive result was found for influenza B. As it was unusual for influenza B to result in such a severe septic shock clinical picture, a bacterial co-infection was suspected. He was started on empiric therapy with broad spectrum antibiotics, including Linezolid, to cover for Staphylococcus aureus infection. Urgent blood Gram stain confirmed Gram-positive cocci, and soon thereafter, a blood culture positive for Staphylococcus aureus was confirmed. Despite comprehensive treatment, pharmaceutically and mechanically, the patient continued to deteriorate. All parameters did not improve. Discussions were held regarding the central cannulation2 and it was decided to commence with the same immediately. The patient was transferred to the theatre for the placement of central ECMO. Despite successfully placing the cannula in the right atrium and aorta, the patient&apos;s condition did not improve, and flow3 and haemodynamics were deemed insufficient to maintain brain function. The patient had a cardiac arrest and was not further resuscitated in the theatre. Profound septic shock was in keeping with Staphylococcus aureus septicaemia and toxic shock syndrome.4 This case was an example of combining full medical therapy with mechanical intervention, i.e. ECMO. Note: Permission to report this case was obtained from the Hospital Administration on the basis that patient confidentiality was maintained. In addition, verbal consent was obtained from the patient&apos;s parents to present this case as a learning tool, also on the condition that anonymity is maintained.

Measuring Post-Partum Haemorrhage in Low-Resource Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in Hemoglobin.

BackgroundAccurate estimation of blood loss is central to prompt diagnosis and management of post-partum hemorrhage (PPH), which remains a leading cause of maternal mortality in low-resource countries. In such settings, blood loss is often estimated visually and subjectively by attending health workers, due to inconsistent availability of laboratory infrastructure. We evaluated the diagnostic accuracy of weighed blood loss (WBL) versus changes in peri-partum hemoglobin to detect PPH.MethodsData from this analysis were collected as part of a randomized controlled trial comparing oxytocin with misoprostol for PPH (NCT01866241). Blood samples for complete blood count were drawn on admission and again prior to hospital discharge or before blood transfusion. During delivery, women were placed on drapes and had pre-weighed sanitary towels placed around their perineum. Blood was then drained into a calibrated container and the sanitary towels were added to estimate WBL, where each gram of blood was estimated as a milliliter. Sensitivity, specificity, negative and positive predictive values (PPVs) were calculated at various blood volume loss and time combinations, and we fit receiver-operator curves using blood loss at 1, 2, and 24 hours compared to a reference standard of haemoglobin decrease of >10%.ResultsA total of 1,140 women were enrolled in the study, of whom 258 (22.6%) developed PPH, defined as a haemoglobin drop >10%, and 262 (23.0%) had WBL ≥500mL. WBL generally had a poor sensitivity for detection of PPH (<75% for most volume-time combinations). In contrast, the specificity of WBL was high with blood loss ≥ 500mL at 1h and ≥750mL at any time points excluding PPH in over 97% of women. As such, WBL has a high PPV (>85%) in high prevalence settings when WBL exceeds 750mL.ConclusionWBL has poor sensitivity but high specificity compared to laboratory-based methods of PPH diagnosis. These characteristics correspond to a high PPV in areas with high PPH prevalence. Although WBL is not useful for excluding PPH, this low-cost, simple and reproducible method is promising as a reasonable method to identify significant PPH in such settings where quantifiable red cell indices are unavailable.

A Comparison of Hemostatic Effectiveness and Safety of Two Fibrin Sealant Patch Products after Severe Renal Hemorrhage in Swine Model of Dilutional and Hypothermic Coagulopathy

Background: Two fibrin sealant patch products (EVARREST™ and TachoSil™) are approved by the USFDA for use in surgical settings. While these products are among the most likely to be useful for trauma use, they are not approved for this use. There is a clinical need for trauma hemostats. Methods: A well characterized animal model for severe soft tissue hemorrhage (partial nephrectomy) was combined with another well characterized model for dilutional and hypothermic coagulopathy. The two fibrin sealant patch materials available in the US were each applied to 12 animals. Animal assignment was randomized. If hemostasis could be achieved, the animals were resuscitated and survived for 48 hours. Results: TachoSil™ was able to achieve hemostasis in 2 of 12 animals which survived to the scheduled necropsy date without significant pathology. For the two successful animals, the mean time to achieve hemostasis was 6.5 (+/-2.12) minutes, and 178.00 (+/-79.22) grams of blood were lost before hemostasis was achieved. EVARREST™ was able to achieve hemostasis in all 12 animals, and all animals survived to the scheduled necropsy date without significant pathology. The mean time to achieve hemostasis was 3.5 (+/-1.45) minutes, and 52.11 (+/-18.92) grams of blood were lost prior to achieving hemostasis. Conclusions: When fibrin sealant patch products can achieve intraoperative hemostasis, animals can be resuscitated and survive without significant pathology. The two available products vary considerably in intraoperative efficacy.

Impact of Reporting Gram Stain Results From Blood Culture Bottles on the Selection of Antimicrobial Agents

We assessed the usefulness of reporting direct blood Gram stain results compared with the results of positive blood cultures in 482 episodes and monitored impact on selection of antimicrobial treatment. We found that the reporting groups "Staphylococcus spp," "Pseudomonas spp and related organisms," and "yeasts" identified in this way matched perfectly with later culture identification. When the report indicated Staphylococcus spp or Pseudomonas spp and related organisms, physicians started or changed antimicrobials suitable for these bacteria more frequently than when "other streptococci" and "family Enterobacteriaceae" were reported (P < .05). Incorrect recognition of Acinetobacter spp as Enterobacteriaceae family is still the most challenging problem in this context. Gram stain results that definitively identify Staphylococcus spp, Pseudomonas spp and related organisms, and yeasts reliably can be rapidly provided by clinical laboratories; this information has a significant impact on early selection of effective antimicrobials. Further investigation is needed to assess the clinical impact of reporting Gram stain results in bacteremia.

COMMUNITY-ACQUIRED ACINETOBACTER BAUMANII PNEUMONIA IN A 75-YEAR-OLD VETERAN.

Acinetobacter baumanii is a well-known causative agent of nosocomial infections. However, community-acquired A. baumanii pneumonia is rare in the United States; thus, we present this case of community-acquired pneumonia with a fulminant course. A 75-year-old Caucasian male with hypertension, moderate chronic obstructive lung disease, alcoholism, and diabetes mellitus presented with dyspnea, changes in behavior, hypotension, and hypoxemia with diffuse wheezes and crackles. Chest radiography showed dense right base infiltrate. He had profound respiratory distress started on BiPAP support and was treated with azithromycin and ceftriaxone. Blood Gram stain showed gram-negative diplococci, suggesting Neisseria meningitidis infection. CSF fluid was negative for infection. Final blood culture grew A. baumanii. Antibiotics were changed to imipenem and vancomycin. His condition continued to deteriorate, and the patient9s family decided to withdraw care, leading to the patient9s demise. Risk factors associated with community-acquired Acinetobacter pneumonia are smoking, significant alcohol use, and/or concomitant comorbid conditions (COPD, HTN, DM). Patients present with fever, cough, and dyspnea and progresses to shock with a very fulminant course. A HIGH index of suspicion is warranted during the initial course. The organism has been described as a gram-negative coccibacilli. Rarely, as in our case, it may initially be described as a gram-negative diplococcus, leading to the delay in appropriate therapy. With the increasing prevalence of hospital-acquired Acinetobacter infection, we need to maintain high vigilance in the bacterial flora responsible for community-acquired pneumonia.

Radiofrequency Cauterization with Biopsy Introducer Needle

The principal risks of needle biopsy are hemorrhage and implantation of tumor cells in the needle tract. This study compared hemorrhage after liver and kidney biopsy with and without radiofrequency (RF) ablation of the needle tract. Biopsies of liver and kidney were performed in swine through introducer needles modified to allow RF ablation with the distal 2 cm of the needle. After each biopsy, randomization determined whether the site was to undergo RF ablation during withdrawal of the introducer needle. Temperature was measured with a thermistor stylet near the needle tip, with a target temperature of 70 degrees C-100 degrees C with RF ablation. Blood loss was measured as grams of blood absorbed in gauze at the puncture site for 2 minutes after needle withdrawal. Selected specimens were cut for gross examination. RF ablation reduced bleeding compared with absence of RF ablation in liver and kidney (P <.01), with mean blood loss reduced 63% and 97%, respectively. Mean amounts of blood loss (+/-SD) in the liver in the RF and no-RF groups were 2.03 g +/- 4.03 (CI, 0.53-3.54 g) and 5.50 g +/- 5.58 (CI, 3.33-7.66 g), respectively. Mean amounts of blood loss in the kidney in the RF and no-RF groups were 0.26 g +/- 0.32 (CI, -0.01 to 0.53 g) and 8.79 g +/- 7.72 (CI, 2.34-15.24 g), respectively. With RF ablation, thermal coagulation of the tissue surrounding the needle tract was observed. RF ablation of needle biopsy tracts reduced hemorrhage after biopsy in the liver and kidney and may reduce complications of hemorrhage as well as implantation of tumor cells in the tract.

Studies on the biological effects of ozone: 8. Effects on the total antioxidant status and on interleukin-8 production.

Ozone (O3) is a controversial gas because, owing to its potent oxidant properties, it exerts damaging effects on the respiratory tract and yet it has been used for four decades as a therapy. While the disinfectant activity of O3 is understandable, it is less clear how other biological effects can be elicited in human blood with practically no toxicity. On the other hand plasma and cells are endowed with a powerful antioxidant system so that a fairly wide range of O3 concentrations between 40 and 80 microg/ml per gram of blood (approximately 0.83-1.66 mM) are effective but not deleterious. After blood ozonation total antioxidant status (TAS) and plasma protein thiol groups (PTG) decrease by 20% and 25%, respectively, while thiobarbituric acid reactive substances (TBARS) increases up to five-fold. The increase of haemolysis is negligible suggesting that the erythrocyte membrane is spared at the expense of other sacrificial substrates. While there is a clear relationship between the ozone dose and IL-8 levels, we have noticed that high TAS and PTG values inhibit the cytokine production. This is in line with the current idea that hydrogen peroxide, as a byproduct of O3 decomposition, acts as a messenger for the cytokine induction.

Neutrophils are not necessary for ischemia-reperfusion lung injury

The role of neutrophils (PMNs) in ischemia-reperfusion injury after lung transplantation is unclear. If PMNs are involved in ischemia-reperfusion injury in the intact rat, then PMNs should sequester in the injured lung and PMN-depleted rats should develop less injury. Group A rats were treated with a rabbit anti-rat PMN antibody causing profound neutropenia (<100 PMNs/μL) and group B with control serum (>2,000 PMNs/μL). Rats were anesthetized and left lung ischemia was sustained for 90 or 180 minutes by clamping the bronchus and the pulmonary artery and vein. Lung injury was quantified by the accumulation of radiolabeled ( 125I) albumin in ischemic left and nonischemic right lungs (cpm per gram of lung/cpm per gram of blood). Ischemia caused significant lung injury ( p < 0.05) in both PMN-depleted (albumin leak index: 90 min, 0.208; 180 min, 0.218) and nondepleted (90 min, 0.222; 180 min, 0.241) animals compared with nonischemic controls (depleted: 90 min, 0.050; 180 min, 0.100; nondepleted: 90 min, 0.063; 180 min, 0.101); microscopy also demonstrated lung injury. The injury was not associated with PMN sequestration as shown by light microscopy. Thus, we conclude that PMNs are not necessary for ischemia-reperfusion injury and PMN-depletion does not attenuate ischemiareperfusion injury.

The enforcement of moral obligations to potential fetuses: Johnson Controls vs. the United Auto Workers.

The Globe Battery Division of Johnson Controls is the largest manufacturer of automobile batteries in the United States. One important element in the production of its batteries is lead which is known to cause birth defects. In 1982, citing a duty to the potential fetuses of its female workers, the company initiated a policy excluding women are pregnant or who are capable of bearing children from the high exposure areas unless they can provide medical certificates indicating that they are incapable of bearing children. The policy covers all jobs in which employee blood-levels might rise above 30 micrograms of lead per 100 grams of blood. Any female already on the job is required to prove that she can keep the lead content in her blood below the minimum figure. In other words, women at Johnson Controls are expected to sacrifice their own economic interests for the benefit of persons who do not now, and perhaps never will, exist. The United Auto Workers, local unions, and several individual employees filed suit arguing that the policy violates title VII of the 1964 Civil Rights Act, which set guidelines for bona fide occupational qualifications (BFOQ) as a means of preventing employers from using discriminatory job qualifications. In order to substantiate a BFOQ, a company must prove that an exclusion relates to the central mission of the business. The union argued that gender and fertility cannot be considered BFOQs since fertile women produce batteries as efficiently and proficiently as anyone else. Moreover, lead exposure also carries risks for the progeny of male workers, hence raising the specter of gender based injustice.1 On September 26, 1989 the United States Court of Appeals for the Seventh Circuit ruled that the policy does not violate the Civil Rights Act. In the summer of 1991

Enhancement of experimental bacteremia and endocarditis caused by dysgonic fermenter (DF-2) bacterium after treatment with methylprednisolone and after splenectomy.

The dysgonic fermenter-2 bacterium is a newly recognized fastidious gram-negative bacillus that causes bacteremia and sometimes endocarditis in immunocompromised persons after they are bitten by dogs. To develop an experimental model of this infection, we placed polyethylene catheters across the aortic valves of New Zealand white rabbits, which were inoculated intravenously the next day with dysgonic fermenter-2 bacteria. After 1 week, the rabbits were killed and the endocardial vegetations were homogenized for quantitative culture. Large inocula (1.3 X 10(10) to 2.1 X 10(10) viable bacteria) were required to produce infected vegetations. All infected rabbits had negative blood cultures at the time of autopsy and most developed serum agglutinins against dysgonic fermenter-2 bacteria. Three daily injections of methylprednisolone (30 mg/kg), starting the day before inoculation, significantly increased the incidence of endocarditis and the number of bacteria per gram of infected vegetation (P less than 0.05). Treatment with methylprednisolone prolonged the initial bacteremia and caused significant increases in the numbers of bacteria per gram of blood, spleen, and liver compared with those of untreated controls (P less than 0.05). Rabbits that had previously undergone splenectomy showed prolongation of the initial bacteremia but no significant increase in the incidence of infected vegetations. These results showed that the dysgonic fermenter-2 bacterium is a pathogen that causes endocarditis in rabbits but that it requires a large inoculum and produces blood culture-negative infections. Treatment with methylprednisolone enhances infection by prolonging the initial bacteremia and probably by diminishing bactericidal activity in the vegetations.

An extractive method for determination of benzene in blood by gas chromatography.

A gas chromatographic procedure has been developed using toluene extraction for the analysis of benzene in hemolyzed blood. No sample incubation is required and only small quantities of blood (0.2 to 0.5 g) are needed. Levels as low as 0.5 mug benzene per gram of blood have been determined.

Thermal aspects of uterine blood flow in nonpregnant sheep

Thermocouples were implanted in the uterine cavity and aorta of 1 normal and 4 ovariectomized ewes. A temperature difference of 0.2 to 0.4° C. between cavity of uterus and aorta, characteristic of these sheep, was reduced to 0.05° C. 1.5 hours after administration of 1 to 2 mg. of estrone. In 2 acute experiments, the uterine blood flow was measured by a direct method. Flows between 100 and 1,150 grams of blood per kilogram uterus per minute were inversely related to differences in temperature between uterine cavity and aorta. Alterations in the temperature difference between the uterus and the blood coming to it appear to result from a dissociation between the rate of heat loss from this organ and its rate of heat production. The thermal technique appears to be useful as a qualitative bioassay in continuous, long-term studies of uterine blood flow in waking animals.

Prevention of Lead Paint Poisoning among Baltimore Children: A Hard-Sell Program

Since 1935, as an aid in diagnosis, the bureau of laboratories of the department has provided a free service to physicians and hospitals for the quantitative determination of lead in blood (3). The resultant followvup in the field and the heightened interest on the part of the pediatric services of the city's large hospitals enabled the department to acquire relatively accurate morbidity data. From 1956 through 1964 there were 540 clinically diagnosed cases of lead paint poisoning (plumbism) and 797 cases of abnormal lead absorption among Baltimore children, or a total of 1,337 cases. All the clinically diagnosed cases of lead poisoning were investigated as were all instances of abnormal absorption of lead as evidenced by a blood level exceeding 0.06 mg. of lead per 100 grams of blood. The homes of patients were visited, and paint samples obtained for testing from surfaces accessible to the affected children. The owners were required to remove paint from the indicated areas (2). In 1949 a public health nurse was assigned to the department's bureau of industrial hygiene to investigate reported instances of abnormal absorption of lead in young children and to insure compliance in the removal of the offending paint (4). Preventing a recurrence of the disease was deemed especially important as there is a highly significant correlation between second attacks of encephalopathy and severe permanent brain damage (5). Pamphlets designed to highlight the problem were used by public health nurses and sanitarians in clinics and in their home visits. Information on lead paint poisoning was mailed periodically to physicians and hospitals. Exhibits and otlher visual aids were shown at various meetings and in public buildings. Newspapers, regional trade periodicals, medical and public health publications, and radio and television programs all were used to inform the public of the serious consequences attending the ingestion of lead paint by children. The first effort toward legislative control of the problem was the adoption in 1951 of a regulation, under the ordinance on the hygiene of housing, that prohibited the use of paint containing lead pigment in the interior of dwellings (6). This was followed in 1958 by an ordinance requiring a warning label on paints containing more than 1 percent of lead and stating that the paint contained lead; was harmful if eaten; Alr. Schucker is director of sanitary services, Baltimore City Health Department. Mr. Vail is a principal sanitarian, Miss Kelley is director of the bureau of biostatistics, and Dr. Kaplan is assistant director of the bureau of laboratories and chairman of the department's lead paint poisoning prevention committee.

A reliable colorimetric method for the quantitative determination of procaine in human whole blood.

A method which has been developed for the satisfactory estimation of procaine in whole blood avoids the loss of procaine which was apparent in methods where blood proteins were precipitated by use of trichloroacetic acid. Approximately 85 per cent of the added procaine was constantly recovered by this method from test samples of blood and the procedure was considered to be satisfactory for determining concentrations of procaine m patients’ blood The peak concentration of procaine m blood twenty minutes after the infiltration of procaine (2.06-3.7 gm) varied from 0 7 ¼g to 50 ¼g. per gram of blood m the patients studied

Left auricle with a capacity of 1,695 grams of blood in a case of mitral stenosis

Left auricle with a capacity of 1,695 grams of blood in a case of mitral stenosis

The influence of phenylquinolin carbonic acid (atophan) and of radium emanation upon the uric acid concentration of the blood

The prompt and marked increase in the uric acid output following the administration of 2-phenylquinolin-4-carbonic acid (atophan) has been repeatedly demonstrated. More recently, Folin and Lyman reported a concomitant diminution in the uric acid concentration of the blood, which suggested an increased renal permeability as an important factor in the physiological action of atophan. In the course of our studies with atophan, begun more than a year ago, we have endeavored to ascertain, (1) the promptness with which the decrease in blood uric acid is brought about; (2) the minimum to which it can be reduced; and (3) the rapidity with which the initial concentration is regained after the administration of atophan has ceased. We have observed a marked decrease in the uric acid concentration of the blood after a two day period with atophan; and are attempting to determine more exactly the speed of this reaction. The minimum uric acid concentration of the blood under the influence of atophan varied among twelve individuals (normal, gouty and arthritic) from 0.7 to 2.0 mgm. per hundred grams of blood (initial values −2.0 to 5.7). These minima are apparently irreducible. In one case, the daily administration of 4 grams of atophan for a period of 45 days failed to lower the uric acid below 0.7 mgm. The initial concentration is restored within at leaste to 4 days after the cessation of the use of atophan. Our studies upon the uric acid concentration of the blood under various conditions are being continued, and will include the influence of colchicum and the salicylates. With a radium emanation concentration of 2 to 4 M. U. per liter of air, Gudzent2 claims to have caused uric acid to disappear from the blood for long periods of time.

STUDIES ON THE CIRCULATION IN MAN

1. In the cases of fever investigated the flow in the feet never exceeded the normal flow and was usually much below the normal 2. In explanation of the relatively small foot flow in the fever cases it is suggested that the vasoconstrictor mechanism of the peripheral parts, especially of the skin, is abnormally excited, and some direct evidence that this is the case is brought forward. 3. The significance of this hypersensitiveness, or at least increased action, of the cutaneous vasoconstrictor mechanism is assumed to be that the peripheral vasoconstriction is a compensatory arrangement which secures for the organs mainly suffering from the infective process an increased flow of blood. 4. On this hypothesis the rise of temperature is, chiefly at least, secondary, inevitably following the vasoconstriction, provided that the metabolism is, upon the whole, not diminished. 5. Accordingly the rational treatment of hyperpyrexia, or of pyrexia if it is considered necessary to treat it, is to abstract heat by a process which will not diminish and may even increase the cutaneous vasoconstriction. This condition is exactly fulfilled by the cold bath, at least as regards its initial effect. Other so called tonic effects of the cold bath are not considered here. Antipyretic drugs which act by dilating the cutaneous vessels would seem to be inferior in this regard. They diminish the temperature, it is true, but at the cost of defeating the beneficial redistribution of the blood which it is the function of the peripheral vasoconstriction to insure. 6. It is obvious that for the elimination of a given quantity of heat from the skin by radiation and conduction in fever, a smaller cutaneous blood flow will suffice than with normal body temperature, since the elimination of heat per gram of blood passing through the surface must be greater in fever owing to the greater difference of temperature between the surface of the body and its surroundings. I am much indebted to the staff of the City Hospital for their coöperation which has rendered this investigation possible.