The authors describe a highly selective transsacral microsurgical procedure for sacral nerve rootlet interruption in five patients with hypertonic neurogenic bladder. Magnification and systematic stimulation of sacral roots provided accurate identification of motor fibers supplying bladder detrusor muscle and differentiation of efferent components to the legs and anal sphincter. Although the technique prevented incontinence and adverse effects of nerve section on rectal and lower extremity function improvement in voiding patterns and diminution of urinary sepsis was of brief duration in three of the five patients. Physiological data from these procedures reaffirms the importance of S-3 and S-4 motor roots in detrusor innervation, but clinical responses bring into question the possibility of sustained improvement from such a highly selective procedure at the sacral level. The authors suggest that alternative pathways, not apparent on initial stimulation, may develop after section of sacral root components, and that dissection and stimulation of fibers at the level of the conus medullaris should be investigated as an alternative procedure.

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✓ In 10 dogs, identifiable bundles of motor rootlets were stimulated as they left the conus medullaris at various levels. It is concluded that the bladder musculature is supplied by individual rootlets in variable combinations or patterns, originating from S-1 to S-4, with negligible overlapping innervation of the rectum and lower extremities. This experimental verification of clinical results suggests the possible value of a highly selective rhizotomy in humans with spastic neurogenic bladders (a procedure the authors term “selective sacral rhizidionotomy” from the Greek word rhizidion, meaning rootlet).

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Subscriptionshttp://jimmunol.org/subscriptions is online at: ImmunologyThe Journal of Information about subscribing to PermissionsPreviously reported experiments (1, 2, 3) on anaphylaxis apparently due to the toxin or toxoid antigen were made upon actively sensitized (antitoxic immune) animals. The results had indicated that while other diphtheria antigens participated to some extent, the major part of the anaphylaxis could be assigned to the toxin or toxoid antigen, provided one used both for the immunization and for the intravenous test minimal amounts of unheated filtrate in which toxin or toxoid was the dominant antigen, and selected for intravenous test the individual guinea pigs that had been "earliest" in antitoxin production. Passive sensitization possesses certain advantages over active sensitization in the distinction of reactions due to toxin-antitoxin from reactions due to other diphtheria antigen-antibody combinations, for with the passive method it is possible to examine each of the sensitizing sera for antibodies other than antitoxin and, when desired, to remove the other antibodies by absorption of the antisera before using them for sensitization. This investigation consisted essentially of a comparison of the anaphylaxis obtained by sensitization with antitoxic sera and that obtained with antibacterial sera. Four different materials were used in the shock tests: toxin-containing broth culture filtrates, solutions of semipurified toxin precipitated from filtrate, solutions of nucleoprotein obtained by alkaline extraction of the bacilli, and solutions of material (principally carbohydrate) extracted by boiling acidified (HC1) suspensions of the bacflli. The primary interest is in the anaphylaxis referable to toxin antigen and antitoxin antibody, the other diphtheria antigens and antibodies being introduced as controls in order to show that 131 A nti-P precipitins. The solutions of nucleoprotein used in these tests were prepared in essentially the same manner as used at Upstate Medical University Health Sciences Library on August 24, 2015 http://www.jimmunol.org/ Downloaded from ANAPHYLAXIS TO DIPHTHEtLIA TOXIN * Although a considerable number of tests were made with different antisera, all of the results reported in this paper were obtained with the same pooled lots of