Arthur Grollman

GLUCAGON DEFICIENCY AS A CAUSE OF HYPOGLYCEMIA.

Abstract The relative number of alpha to beta cells was determined as it appeared in the pancreas of 3 patients presenting the classic symptoms and laboratory findings of hyperinsulinism but in whom no adenoma was demonstrable. In all 3 patients there was a marked deficiency of alpha cells suggesting that their hypoglycemic reactions were a consequence of glucagon deficiency. Glucagon deficiency should be considered as a potential cause in the pathogenesis of some cases of hypoglycemia.

Correlation of the Pressor Activity of the Renal Venous Effluent with Excretory Function and Other Tests in Focal, Parenchymal, and Vascular Renal Disease

A series of 170 hypertensive patients suspected of suffering from renovascular disease have been subjected to various tests designed to identify the presence of a surgically remediable lesion.The presence of a pressor agent in the renal venous effluent, as determined by bioassay on the rat, has proven to be an accurate method for detecting the presence of renovascular hypertension responsive to surgical treatment. Split-function excretory tests, aortography, and other tests used for this purpose could not be relied on as the sole criterion as to whether surgical intervention is indicated in a given patient.

Atrophy of the Lymphoid Tissues of Mice Induced by Extracts of the Submaxillary Gland

Summary Infarction of the submaxillary glands of male A/Jax mice or the administration intraperitoneally of an extract of these glands induced atrophy of the thymus, spleen and mesenteric lymph node and a moderate degree of lymphopenia of A/Jax and C3H mice. The observed response was also noted following adrenalectomy and following ultrafiltration or ultra-centrifugation of the extract and is not attributable, therefore, to a stress reaction or viral infection, but rather to the presence of a factor which inhibits lymphoid tissues.

The role of salt in health and disease.

Abstract Sodium chloride constitutes an integral part of the living organism and alterations in the concentration of its constituent ions in the body fluids have a profound influence on the animal economy. Such alterations are encountered in many disease processes and their understanding contributes not only to the elucidation of normal mechanisms but also of the pathogenesis of certain clinical disorders and their practical management. Alterations in sodium intake, particularly its drastic restriction, constitute an important part of therapy in several common disorders. Dietary restriction of sodium has certain advantages over the accomplishment of the same result by the administration of natriuretic agents and should be used together with these when indicated.

Differentiation of Nephrotensin from Angiotensin I and II

Summary Nephrotensin, a newly described pressor agent which appears in the renal venous effluent of the ischemic kidney is not inactivated by angiotensin I antibody. It can also be differentiated from angiotensin I and II by the response to its injection of the rats blood pressure and the perfusion pressure of the isolated rabbits ear. These findings add further evidence that nephrotensin is a unique pressor agent responsible for the elevation in blood pressure observed in renovascular (surgically remediable) hypertension as observed in man and in the acute stage of experimental hypertension induced by drastic restriction of the renal artery or infarction of the kidney.

Pressor Activity of Circulating Blood After Focal Infarction of the Kidney in the Rat

Summary The pressor activity of the plasma of the renal venous effluent of rats rendered acutely hypertensive by focal infarction of the kidney has been demonstrated. The pressor effect is transient and is due to the elaboration of an agent which can be differentiated from renin and angiotensin. The rat, accordingly, resembles the dog and man in manifesting a form of acute hypertension which differs from chronic hypertension in being mediated by a previously unrecognized pressor agent elaborated by the kidney. As in the dog and man, the pressor agent may be demonstrated in the renal venous effluent. Its concentration in the peripheral blood is proportional to the observed elevation in blood pressure. The pressor effect and rise in blood pressure appear within a day after focal infarction of the kidney and last for about 30 days.

Induction of adrenal insufficiency in the rat by sensitization with homologous tissue

Abstract Rats immunized with adrenal cortical tissue in complete Freunds adjuvant developed adrenocortical insufficiency as evidenced by failure to gain weight, hypoglycemia during fasting, an increased rate of water and salt excretion when placed on a salt-free diet, and a reduced corticosterone content of the blood plasma. These functional disturbances were reflected in degenerative changes throughout the adrenal cortex, as manifested by vacuolization of the cytoplasma and changes in the mitochondria. The presence of isoantibodies against adrenocortical tissue was demonstrated by immuno-diffusion tests. There was also an increased gamma globulin content of the serum and infiltration of the affected tissues by mononuclear cells, suggestive of an autoimmune reaction. Rats immunized with adrenomedullary tissue developed degenerative changes in the chromaphil cells and a mild elevation in blood pressure, but no evidence of anatomic or functional disturbances of the cortex.

PRESENT CONCEPTS OF THE MECHANISM OF URINE FORMATION AND OF DIURETIC ACTION

Traditionally, diuretics have been considered drugs that increase the volume of the urine.I However, the dependence of the rate of excretion of water on the elimination of sodium in the urine and the effectiveness of salt depletion in the therapy of hypertension have centered attention on the natriuretic action of the diuretics rather than on their effect on the volume of the urinary output. Although many drugs and procedures may exert a diuretic or natriuretic action, the most potent of the diuretic drugs exert their effect by direct action on normal renal function. To understand their action, therefore, we must consider first the mechanisms concerned in the formation of the urine. In the normal person the kidneys maintain a constant composition, volume, and osmolarity of the extracellular fluid. Hence, the administration of an excessive amount of water or other substance not metabolized in the body and excretable by the kidneys results in diuresis. Water thus constitutes an effective diuretic in the normal patient when one desires only to increase the volume of the urine. The addition of certain salts, designated as osmotic diuretics, such as potassium salts and urea, accentuates the diuretic action of water. Under these conditions diuretic action involves only normal renal functions that respond to maintain homeostasis. Our chief interest in diuretics centers on agents that actively modify renal function and thus lead to the excretion of salt and water retained in the body. Such retention may be a consequence either of the direct effects of disease on the kidney or peripheral tissues or of indirect effects induced by the primary disturbance on normal renal function.

THE EFFICACY AND THERAPEUTIC UTILITY OF HOME REMEDIES

The efficacy and therapeutic utility of the more commonly used home remedies, such as aspirin, the cathartics, the antipyretics, etc., are wellestablished. In fact, the widespread use of these agents over the years is tribute to the fact that they bring sufficient relief of symptoms to inspire their continued use. However, considering the human propensity for taking medications and the potent placebo effect inherent in all therapeutic endeavors, more direct evidence is required to establish their efficacy and therapeutic utility (Grollman & Grollman, 1965 ) . Since most of the symptoms of complaint that beset the individual are not of serious import and are self-limited, there is ample justification for the use of home remedies and self-medication; in this way the patient avoids the need for an expensive and time-consuming evaluation by a physician. Failure of the symptoms to respond to a preliminary trial of home remedies usually brings the patient to the physician. This paper will consider the pharmacologic basis and therapeutic efficacy of the most commonly used home medications that is, those procurable without a physicians prescription. Insulin, although procurable without a prescription, will not be considered since its efficacy and therapeutic utility require no comment and i t can hardly be considered a home remedy. Preparations concocted in the home and physical measures such as the application of heat, plasters, etc., although a t times of therapeutic value, will not be considered. Other more esoteric preparations, such as the lipotropic agents, although procurable without a prescription, will also be omitted since these a re not well known to the laity and are usually prescribed by the physician. Although specific curative treatment is the goal of therapy, this is not always available, and much of medical practice is concerned with the treatment of symptoms. There is, to be sure, a certain hazard in treating symptoms without reference to the basic disease since many serious illnesses often have their onset with relatively common symptoms of complaint. However, in such cases, as already indicated, failure to attain relief will usually bring the patient to the physician.

Medical management of hypertension.

The panelists discuss the relation of atherosclerosis to hypertensive disease, the cause of malignant hypertension, the treatment of mild hypertension, and the effects of guan-ethidine and methyldopa in the management of patients with hypertension.