Charles L. Hoagland

CHRONIC LIVER DISEASE FOLLOWING INFECTIOUS HEPATITIS. I. ABNORMAL CONVALESCENCE FROM INITIAL ATTACK

Excerpt The problem of the after-effects of infectious hepatitis is of particular importance at the present time because of the high incidence of this disease during the recent World War. It is now...

Urinary excretion of estrogens and 17-ketosteroids in young, adult males with infectious hepatitis.

Summary The levels of excretion of estrogens and 17-ketosteroids in the urine have been determined in 11 young adult males with acute infectious hepatitis, at frequent intervals, from onset of the disease to convalescence. In 9 moderately severe cases there was a significant elevation in the level of excretion of biologically active estrogens in the urine which persisted at a slowly diminishing elevation until convalescence was considerably advanced. There was no significant increase in the concentration of the urinary estrogens in 2 cases of hepatitis which presented only mild clinical symptoms. Marked to moderate depression occurred in the level of excretion of urinary 17-ketosteroids early in the course of acute hepatitis, with a return to normal values considerably in advance of the period of diminished estrogen excretion and of clinical recovery.

THE LEVEL OF VITAMIN A AND CAROTENE IN THE PLASMA OF RHEUMATIC SUBJECTS

It is recognized that rheumatic fever occurs more frequently in individuals from low income groups than in those from economic groups with greater income. In a recent study (1), the diets of 50 rheumatic children from families of low income were analyzed and compared with those of 50 non-rheumatic children from families on high income. Striking differences were found. The diets of the rheumatic children contained less than required amounts of various food components, with most marked inadequacies of protein, iron, and vitamin A. The occurrence of inadequate intake of vitamin A was much more frequent in the rheumatic than in the nonrheumatic children, only 2 of the former and 36 of the latter having diets deficient in this component. There was a statistically significant association between susceptibility to rheumatic fever and inadequate intake of vitamin A. In the half of the rheumatic group considered most susceptible to rheumatic fever, only one child received vitamin A in required amounts. An analysis of the diet in terms of units of vitamin A obtained from animal and plant sources revealed the following facts: (a) children most susceptible to rheumatic fever received an average of 2280 I.U.4 from animal and 2340 I.U. from vegetable sources, daily; (b) corresponding values for children less susceptible to rheumatic fever were 4840 I.U. and 4900 I.U., respectively; (c) nonrheumatic children from families of high income groups received 10,580 I.U. from animal and 4960 I.U. from plant sources. It was not

An analysis of the effect of fat in the diet on recovery in infectious hepatitis.

NCREASING attention has been given in recent years to the dietary treatment of diseases of the liver. Information supplied from the growing fields of nutrition and metabolism has resulted in the abandonment of nearly all the older methods employed in the therapy of hepatic insufficiency, and in the adoption of numerous new measures which in many instances have provided a sharp contrast to those which were formerly in use. Proof of the essentially rational nature of the concepts which form the basis of current therapy in diseases of the liver has been afforded by the achievement of increasing success in a field of medical endeavor which was once outstanding for its spectacular failures., The medical literature on diseases of the liver abounds with specific guides, frequently diametrically opposed in character, for the selection of an optimum diet for the treatment of hepatic insufficiency in man. Until the turn of the century, diets prescribed for patients with liver disease were generally low in all constituents. Carbohydrate was avoided because it was believed that intestinal fermentation might arise and

Persistence of elevated values for the thymol turbidity test following infectious hepatitis.

Summary Values for the serum thymol turbidity test show a delayed rise and fall following an acute attack of infectious hepatitis. Recurrences of the disease produced a marked increase in the thymol reactivity of the serum which persisted long after other objective signs had disappeared. These findings indicate that the thymol turbidity reaction may show a delayed and prolonged response to liver injury.

Observations on a family epidemic of infectious hepatitis.

AN epidemic of infectious hepatitis occurring in 9 of 10 children in a single family was followed for five months in New York City. Such a high incidence of the disease in a group is unique in itse...

Effect of Testosterone Propionate and Methyl Testosterone on Creatinuria in Progressive Muscular Dystrophy.

Progressive muscular dystrophy is a disease in which large groups of voluntary muscles undergo primary degeneration and atrophy. The disease is hereditary and familial, although isolated cases are encountered. Atrophy is marked in all forms, but hypertrophy or pseudohypertrophy is an early and prominent symptom in one form. Numerous attempts have been made to understand the nature of the process underlying this disorder, to the end that effective treatment may be found. Failure thus far to evolve a basis for therapy has characterized most of the results of studies on this disease, although enthusiastic claims have been advanced from time to time only to have been discarded at the hands of sober and objective therapeutists. During a period of 2 years, in which we have had 40 cases of progressive muscular dystrophy under study, we have been impressed, as have other workers, with the marked predilection of this disease for males, in whom the disease, if established early, tends to run a much more acute course than in the occasional female in whom the disease in encountered. this observation, together with the fact that disease in the male tends to become less actue following the onset of puberty, leads one to the hypothesis that the essential aberration in progressive muscular dystrophy is one connected closely with the biological phenomenon of maleness on the one hadn and, perhaps, with those systems concerned with growth and development on the other. Since certain of these phenomena are mediated through the hormones of the anterior pituitary, the adrenal cortex, and the gonads, it was believed that an investigation of the effects of these agents on the metabolism and clinical course of patients with this disease should be carried out, in so far as modern technics of endocrinology permit.

Ultra-Violet Photomicrography of Muscle

Summary By means of an improved technic of ultra-violet light microscopy described in an earlier communication, it has been possible to obtain photomicrographs of muscle which reveal structures heretofore not seen by technics which employed stained sections and photography in visible light. The photomicrographs have been produced from sections of muscle fixed and embedded in the manner usually employed by cytologists and pathologists for microscopy of stained tissue, and cut at 5 μ on an ordinary laboratory microtome.

Alterations in body fluids during acute infectious hepatitis.

Summary Interstitial fluid volume (thiocyanate space), total blood volume and plasma volume were measured at frequent intervals in 14 young adult males with acute infectious hepatitis. In each patient, the body fluid movement pattern was similar. Detailed data presented in one typical case disclose an increase in the interstitial fluid compartment during the preconvalescent period and a tendency to store ingested water as measured by a water tolerance test. Diminished plasma and urinary chloride values are also found during this period, probably because of chloride storage in the increased interstitial fluid compartment. With convalescence and the restitution of liver function, the interstitial fluid and its retained chloride are mobilized and the interstitial fluid volume falls to lower values. There is an accompanying fall in body weight and frequently a diuresis follows. Less tendency to store ingested fluid is also observed at this time. Plasma chlorides are now restored and urinary chlorides appear in normal amounts. A slight drop in plasma volume and total blood volume accompany these changes and appear to be independent of alterations in the plasma proteins. It is suggested that these movements in the body fluids may have an endocrine basis.

Biotin in Elementary Bodies of Vaccinia.

Studies of the constituents of elementary bodies of vaccinia have shown that preparations purified by a standard technic exhibit uniformity in their chemical constitution and in their biological activity. 1 , 2 The virus appears exceedingly complex and therefore the view that respiratory catalysts, which are known to play an important rôle in bacterial metabolism, may function in the organization of elementary bodies of vaccinia is not untenable. With this in mind, we have examined elementary bodies for growth-factors. By means of a technic similar to that described by McDaniel, Woolley, and Peterson, 3 vaccine-virus has been shown to contain relatively large quantities of a substance capable of stimulating the growth of Clostridium butylicum in a synthetic medium. Moreover, partial hydrolysis of the virus by normal alkali or 4 normal sulfuric acid gives rise to increased quantities of this substance in active form, which, on the basis of studies similar to those made by Snell, Eakins, and Williams, 4 and others 5 , 6 on liver, yeast, egg-yolk, etc., we believe to be biotin. Two recognized technics exist for the microbiological assay of biotin. The first, employed by Snell, Eakins, and Williams 4 depends upon the growth-stimulus afforded by this substance to a standardized strain of yeast, while the second depends upon the stimulus afforded to the growth of Clostridium butylicum in a synthetic medium devoid of biotin. 3 Since the growth-requirements are simpler and somewhat better understood in the case of Clostridium butylicum, the second technic was adopted as affording the greatest guarantee against introducing with the material to be tested other physiologically active substances. Elementary bodies of vaccinia were prepared for biotin-assay in 3 ways: first, as dried virus, resuspended by physical agitation; second, by dissolving the dry virus in normal alkali with the aid of heat; and third, by refluxing the dry virus with 4 normal sulfuric acid for 30 minutes at 100°C.