Bruno W. Volk

Newer laboratory aids in the differential diagnosis of acute pericarditis: With particular emphasis upon the value of the fibrinogen polymerization test

Abstract 1. (1) The present report concerns itself with comparative studies of the fibrinogen polymerization test, and several acute phase reactants such as the CRP, ESR, and plasma fibrinogen concentration, and also the ASO titer. These were followed serially in patients with idiopathic, rheumatic and presumably tuberculous pericarditis and also in cases of atypical myocardial infarction. 2. (2) A consistently positive F.P. test indicated the presence, and mirrored the course, of rheumatic and idiopathic pericarditis, while it was negative in tuberculous pericarditis. Of the acute phase reactants only the ESR was abnormal to a comparable degree in all conditions studied. It seems, therefore, that the F.P. test can serve as a valuable aid in the diagnosis of idiopathic pericarditis. 3. (3) In contrast to all nonspecific acute phase reactants the F.P. test appears not to be suppressed by salicylates or steroid therapy but reflects the activity of the disease and thus provides a useful criterion for the efficacy of therapy. 4. (4) The F.P. test appears, furthermore, of value for the differential diagnosis between atypical myocardial infarction and acute non-specific pericarditis, particularly, when used concomitantly with the SGO-transaminase or serum aldolase tests.

Plasma Fibrinogen and Serum Aldolase in Acute Myocardial Infarction

maximum fibrinogen concentration, which usually is reached during the first few days of illness, seems to correlate closely with the severity of the clinical picture. Our study was facilitated by the use of a rapid and simple procedure of fibrinogen determination which has been developed in our laboratory in recent years. This test, termed the clot density method, is based on the increasing optical density of coagulating plasma and yields results within a few minutes after withdrawal of venous blood. The normal values range from 5 to 15, which corresponds to a fibrinogen concentration of 210 to 390 mg percent. The sedimentation rate is still commonly employed as a laboratory guide for the clinical evaluation of patients with acute coronary occlusion. Since the results obtained by this method are in many instances erratic and misleading, we attempted to compare the data obtained by the clot density method with those of the sedimentation rate in serial studies carried out on 75 patients with acute myocardial infarction. Although there is frequently a parallelism between the corrected sedimentation rate and the fibrinogen concentration as expressed in clot density terms, there

Comparison in Rabbits of Hypoglycemia and B Cell Degranulation After Various Sulfonylureas.

Summary 1) A single injection of same dose of 3 sulfonylureas, tolbutamide, chlorpropamide and metahexamide showed that tolbutamide caused a lesser hypoglycemia, whereas the 2 other drugs caused a more severe lowering of blood sugar level, most marked after administration of chlorpropamide. In no case was any B cell degranulation observed. 2) Infusion of glucose alone or simultaneously with various drugs for 7 hours each day on 3 successive days caused an identical hyperglycemic response in all animals. However, infusion of glucose alone produced no B cell degranulation; when sulfonylureas were added to the perfusate, degranulation of B cells was found. This was most pronounced after administration of chlorpropamide and metahexamide. That absence of hypoglycemia did not prevent B cell degranulation is further proof that degranulation of B cells after sulfonylureas is a primary action of these drugs on B cells to increase insulin output. Furthermore, relative B cell degranulating efficacy of the 3 compounds, in accord with their hypoglycemic effectiveness, supports the conclusion that they act directly on the B cell.

Effect of experimentally induced fever on alimentary lipemia.

Summary Administration of typhoid and paratyphoid vaccine as well as Piromen caused rapid clearing of alimentary lipemia in dogs which developed fever of 103°F or more. This phenomenon appears to be unspecific and seemingly due to marked temperature rise induced by these agents, since no change of turbidity occurred in animals with fever below 103°F. Administration of protamine sulfate to vaccine-treated dogs prevented clearing of the lipemic sera despite a marked elevation of temperature. No clearing of turbidity occurred when the lactescent sera were kept in water bath at 105°F for 24 hours. It is suggested that high body temperature in the dog may cause release of heparin or a heparin-like substance to produce a lipemia clearing factor.