Macrophage and polymorphonuclear leukocyte function in patients with Alzheimer disease.

Monocyte derived macrophages and polymorphonuclear leukocytes (PMNs) isolated from the peripheral blood of thirteen patients with Alzheimer disease were studied for their cytotoxic effects on a sensitive allogenic tumor target. PMN cells from 11 of the 13 patients with Alzheimer disease were able to kill the tumor cells. In addition, the macrophages from 12 of the 13 Alzheimer disease patients were cytotoxic towards the tumor targets. Four of these patients possessed a plasma inhibitory factor which was capable of suppressing macrophage mediated cytotoxicity. When the lymphocytes from these patients were studied for their ability to be stimulated with the specific antigen, streptokinase, to produce macrophage activating factor (MAF), only 5 of the 13 patients studied possessed lymphocytes which were capable of producing MAF. Thus, the only immunological defect in Alzheimer disease patients which was observed in this study was in the ability of the lymphocytes to synthesize MAF.

Geriatric acute perforated appendicitis: atypical symptoms lead to a difficult diagnosis.

A geriatric man was admitted to the hospital with left-sided chest pain and subsequently had a full cardiac evaluation by a cardiologist. The workup revealed no cardiac abnormalities, and the patient was discharged on the second hospital day. He returned within 48 hours for recurrence of the left-sided chest pain and the interval development of epigastric and left upper quadrant abdominal pain. He was admitted to the hospital for evaluation and serial examinations. Mild diffuse abdominal tenderness developed overnight, and computed tomography of the abdomen revealed a perforated appendix with suppuration. An appendectomy was done immediately. The diagnosis of appendicitis in the geriatric patient is occasionally difficult because of atypical and sometimes misleading physical findings.

Necrotic arachnidism.

Ten bites by Loxosceles reclusa, the North American brown recluse spider, are reported from South Carolina. Envenomation by the brown recluse spider is becoming a public health problem in the United States. The spider reportedly now is found from coast to coast in the southern half of the country and its range is probably increasing. The spider bite varies in intensity, causing reactions ranging from an area of severe necrosis to a mild cutaneous reaction. Treatment is unsatisfactory, and no antivenom is currently available. Even though a specific test is available for loxoscelism, diagnosis remains difficult.