Eugene Y. Berger

A System for Rating the Severity of Senility

Although the development of senility in members of the aging population is not invariable or predictable at a specific age, the incidence is high and presents a constant problem for those responsible for the care of this group. A simple classification (Classes I‐VI) is suggested to describe the severity of senility. The crucial dividing line in the estimation of severity lies at mid‐point on the scale, i.e., between Clases III and IV. Class III (direction) represents patients who can accomplish activities if told what to do, and Class IV (assistance) represents patients who need physical help for the activities of daily living. On either side are Classes I and II (minor manifestations) versus Classes V and VI (ambulatory or bedridden patients, unable to communicate appropriately). The severity is estimated in terms of the needs of the patient.

Simultaneous flux of sodium into and out of the dog intestine

The simultaneous unidirectional flow of sodium into and out of isolated loops of jejunum, ileum and colon of the dog, has been measured, in vivo . Four loops of bowel observed over a 5-year period did not degenerate physiologically or histologically. The variability of sodium flux, measured repeatedly over the five years, was no greater in experiments conducted 1 day apart than in those conducted over a period of years. Adrenalectomy did not reduce this inherent variability. Moderate salt loading by intravenous administration, or by dietary intake, did not alter the transfer rates of sodium across the intestine. Approximately 1 ml of water was transferred into and out of a 20-cm length of intestine/min. Sodium concentration was usually maintained at 144 mEq/l. in the lumen of the small intestine, while sodium concentration in the lumen of the large intestine usually decreased to be partially replaced by potassium. It is suggested that the rates of sodium flow across the dog intestine, in vivo , are of the same order of magnitude per unit surface area as those of sodium flux across amphibian tissues, in vitro . While water may enter the amphibian tissue 50 times as fast as sodium, water and sodium traverse the dog intestine in the ratio of their free diffusion coefficients, water moving twice as fast as sodium.

Mercurial Diuresis in Edematous Individuals

The electrolyte and water losses in 75 instances of diuresis following Mercuhydrin were studied in 17 edematous patients. The loss of potassium was appreciable following exhibition of the drug to patients who retained their dietary sodium almost completely. Occurrence of such clinical symptoms as weakness, nausea, and ventricular premature contractions might be attributed to this loss of potassium. The fluid lost by mercurial diuresis was isotonic with body fluids. The chloride concentration was fairly constant at 151 mEq. per liter. The concentrations of sodium and potassium were more variable, the average concentrations being 97 and 35 mEq. per liter, respectively. Loss of water and electrolyte in these concentrations leaves the patient in relative alkalosis, with a loss of intracellular potassium and a gain in intracellular sodium.

Renal Excretion of Mannitol.

Conclusions I. The renal clearance of mannitol is frequently less than the simultaneous clearance of inulin in man. 2. The intravenous injection of manitol depresses the inulin clearance in man. 3. The clearance of inulin is equal to that of creatinine in the dog, but the mannitol clearance is usually less than that of creatinine. 4. mannitol undergoes metabolic alteration in man, and therefore, cannot be utilized in the infusion pump technique for measuring the rate of glomerular filtration. 5. Inulin appears to be the most generally useful substance for the measurement of glomerular filtration in man.

Effect of desoxycorticosterone on the colon; its relation to the action of cation exchange resins in man.

Summary The present data indicate that the action of DOCA is not limited to a control of the transfer of sodium from the lumen of the kidney tubule to the surrounding blood stream but also influences the transfer of sodium from the lumen of the intestine to the surrounding blood stream. DOCA, in addition, influences the transfer of sodium through the sweat and salivary glands by decreasing the sodium concentrations in their secretions (13,14). The evidence indicates that DOCA affects the transfer of sodium through various organs, among them the colon, in each instance limiting the escape of sodium from the body.

Renal Function in Decompensated Cirrhosis of the Liver.

Summary Glomerular filtration and renal plasma flow were found to be normal in eleven patients with cirrhosis of the liver who were accumulating edema fluid indicating that the retention of sodium is due to increased tubular reabsorption.

Measurement of Total Body Chloride.

Summary Total body chloride was measured in normal man by the dilution of bromide and it has been estimated that nearly half the total body chloride is intracellular.

Electrolyte Excretion During the Spontaneous Recovery from the Ascitic Phase of Cirrhosis of the Liver

Abstract Five patients are described who recovered from the edematous state of cirrhosis of the liver while on a liberal salt intake, without the intervention of diuretic agents. This event is not infrequent, but there is little documentation of the daily electrolyte excretion before, during and after this spontaneous recovery, such as is here recorded. Ascites had been present from four to eleven months and the patients had required four to fourteen paracenteses. Natriuresis began a month before recovery was evident clinically. The urinary sodium excretion increased from less than 1 mEq. to over 100 mEq. per day. The rate of increase was strikingly constant, sodium excretion doubling every 2.2 to 3.0 days.

TRANSFER RATES IN TWO-COMPARTMENT SYSTEMS NOT IN DYNAMIC EQUILIBRIUM*

I choose to develop this text in chronological sequence. Fortunately or unfortunately the chronological sequence is not the logical sequence, nevertheless, by apparently illogical observations I hope to eludicate a point or two about specific activity and tracer technology. In so doing, I am forced to start with the practical applications and then progress to the theory, which should be a change for the mathematician. We were interested in measuring the rate at which sodium entered and left the intestinal lumen. Sodium simultaneously enters and leaves the lumen and, depending on which of these two fluxes is faster, there is a net decrease or increase of sodium in the intestine. The experimental subject was B dog in which a section of intestine 20 cm. long was resected and continuity of the intestinal tract was re-established. The blood supply to the resected portion remained intact through the attached mesentery. One end of the resected portion was sewn closed and fixed to the wall of the peritoneal cavity; the other end was brought out through the abdominal wall and fixed to the skin with the lumen left open. Thus a small pouch of intestine was formed into which solutions could be placed and samples removed. After recovery from surgery these animals were trained to lie quietly on a table for several hours while solutions were administered intravenously or into the pouch and samples of blood or pouch contents were removed. The dogs put up with this kind of treatment for years and in fact some seemed to enjoy it. What follows is a record of observations made on a pouch prepared from the dog ileum. TABLE 1 records the measured specific activities in two experiments. In the first experiment a solution containing stable sodium and radiosodium was placed in the pouch; samples were removed at intervals and the decrease of the specific activity of sodium in terms of counts per min. per pEq. in these samples was measured. For purposes of comparison the measured specific activity is recalculated in terms of a ratio of the specific activity a t any time, t , to the specific activity at the start. For the second experiment, the pouch was cleansed and radiosodium was administered intravenously. When plasma specific activity became constant, the pouch was cleansed again, fresh solution without radioactivity was placed in it, and the rise in specific activity with time was measured.