Gunnar Birke

Pulseless Disease A Clinical Analysis of Ten Cases

From the Department of Medicine, Karolinska Sjukhuset, Stockholm, Sweden (Head: Professor N. Svartz). Takayashu’s syndrome, or pulseless disease (p.d.), was first reported from Japan in 1908 (16). Caccamise and Whitman (1952) (3) stated that 58 cases of this clinically characteristic entity had been observed in Japan, and that p.d. appeared to be rare in other countries. Ask-Upmark (2) in his recent comprehensive survey of the literature, however, stressed that the syndrome is not unusual outside of Japan. He, for instance, had personally seen three cases. Hitherto more than 30 cases have been reported from countries other than Japan [vide Ask-Upmark (2), Ross and McKusick (13) and Harders and Wenderoth (8).] .] These cases include 13 from Sweden (1, 2, 9, 14, 17). Since the etiology of this syndrome is obscure, the clinical observations and laboratory findings in ten cases in which the diagnosis of Takayashu’s syndrome was considered should be of interest. Various studies were performed in order to determine, if possible, contributing etiologic factors. The fact that we observed these cases within a relatively short period of time indicates that the syndrome probably is as common in Sweden as in Japan. The frequency of p.d. in these countries may well be ascribable to the interest it has attracted there.

Distribution and losses of plasma proteins during the early stage of severe burns.

The rate of distribution of albumin and gamma‐G globulin was studied in patients with burns of varying degree by means of isotopically labeled proteins. The rate was highest in patients with extensive burns and higher the sooner the examination was made after the accident. By isotope studies using whole‐body counting the magnitude of the extravascular distribution of albumin as well as the losses of albumin from the wound surfaces were established. In cases of very extensive burns about one plasma pool of albumin was retained extravascularly during the first few days, and up to one plasma‐pool can be lost from the wound surfaces. The importance of adequate protein therapy is emphasized.

Metabolism of Human Gamma Microglobulins

Birke, G., Norberg, R., Olhagen, B. & Plantin, L.-O. Metabolism of Human Gamma Macroglobulins. Scand. J. clin. Lab. Invest. 19, 171-180, 1967. The metabolism of gamma M-globulin was studied in 4 cases with macroglobulinaemia and 4 controls. The macroglobulinaemic cases received autologous preparations, one of them got his own cryoglobulin, two controls with severe cerebral lesions received gamma M-globulin prepared from macroglobulinaemic serum and 2 controls received gamma M-globulin from pooled normal sera.The fractional catabolic rate was independent of the serum gamma M-globulin level. It was found to be around 10 per cent, corresponding in the controls to 0.1-0.4 g per day and in macroglobulinaemia to 3.8-18.8 g per day.The macroglobulins remained predominantly in the intra-vascular compartment.Special attention was directed to the question of the metabolic behaviour of autologous and homologous gamma M-globulin. The metabolic data argued in favour of different initial treatment of homologous and aut...

Studies on Burns: XI. Immunoglobulin and α2 macroglobulin patterns and bacterial flora during treatment of burns with warm dry air

Twelve out of 30 burned patients treated with warm dry air were investigated for the amounts of circulating IgG, IgM, IgA, and α2 macroglobulin and with respect to the bacterial flora.The immunoglobulins decreased from initially normal levels and reached the lowest values on days 4 and 7, IgG decreasing to 40-70% of established normal values for healthy controls. The fall of the IgM and IgA levels was less pronounced. The decrease in immunoglobulin concentration correlated roughly with the extent of burning. All the immunoglobulins increased subsequently in the course and reached maximum values after 10 days for IgM, after about 2 weeks for IgA, and after 3 weeks for IgG.Two patients with large burns died, one after 8 days in circulatory failure and the other on day 32 of septicaemia due to Ps. aeruginosa. In the latter the immunoglobulin pattern differed markedly from those of the others, in that it showed a successive decrease in concentrations to about 50% of normal values.A detailed analysis of the ba...

THE INFLUENCE OF DIFFERENT TYPES OF EARLY TREATMENT ON THE PROGNOSIS OF SEVERE BURNS

A comparison between group A, containing 426 patients treated with dextran and blood in the proportion 4:1, and group B, comprising 308 patients treated with plasma and blood in the proportion 4:1, extra protein, and adequate electrolytes, revealed significant improvement of the therapeutic results in group B and also significantly better results than those in Bull and Fishers series.

Corticosteroidbestimmungen und ihre klinische Bedeutung

ZusammenfassungFormeln und Nomenklatur für Corticosteroide werden beschrieben. Die Prinzipien und Reaktionen, durch welche Corticosteroide festgestellt werden können, wie auch die bestehenden Methoden für klinische Untersuchungen werden diskutiert. Normale Corticosteroidausscheidungswerte, die mit verschiedenen Methoden gewonnen wurden, sowie Werte von im Blut kreisenden Corticosteroiden werden vorgelegt. Die pathologischen Zustände, bei denen die Bestimmung der Corticosteroidausscheidung aufschlußreich sein kann, werden aufgeführt.