Herbert Pollack

Hyperglycemia in Coronary Thrombosis

The frequent association of hyperglycemia and coronary thrombosis has long been recognized. However, the significance and pathogenesis of this finding, and the possible relationship to diabetes mellitus have been obscure. The present study was undertaken in an attempt to clarify the problem.

Action of Picric Acid on Living Protoplasm.

Amoeba were injected with saturated aqueous and alcoholic (95%) solutions of picric acid. When an aqueous solution is injected in amounts equal to half the volume of the amoeba, no toxic effects can be seen. The amoeba is diffusely colored yellow, the intensity of color depending on the amount injected. If the injection be made so as to produce an injury at the point of insertion of the pipette, a local coagulation results. This coagulated portion is extruded by the amoeba, which then resumes normal activity and appearance, except for the yellow coloration. When a saturated alcoholic solution is injected, there is a tendency for coagulation to occur. Unless an enormous amount is injected, the coagulated portion is localized, and is always extruded. The yellow colored amoeba then recovers completely. Hiller 1 has shown that an injection of small quantities of alcohol in concentrations above 80% will cause a local reversible coagulation. The picric acid dissolved in the alcohol apparently makes this conoagulation irreversible. These experiments indicate that picric acid solutions which definitely coagulate proteins in the test tube, have no such action on the interior of the living amoeba. However, if there is a local injury, the picric acid will act on the injured cytoplasm, resulting in coagulation. In contrast to the non-toxicity to the internal healthy cytoplasm is the extreme toxicity of the picric acid when applied to the surface.

The Hydrogen Ion Concentration of the Nucleus and Cytoplasm of the Egg Cell.

By means of the microinjection apparatus the series of acid dye indicators of Clark and Lub and the basic dye Neutral Red were injected both into the cytoplasm and into the nucleus of the immature starfish egg. The color changes upon injection indicate the pH of the nucleus to be in the neighborhood of 7.6 to 7.8, whereas that of the living cytoplasm is 6.6 to 6.8, 1 and cytoplasm cytolyzed by mechanical injury is 5.4 to 5.6.

Fat Content of the Diabetic Diet

REFERENCES 1 Baker, R. D.: Mucormycosis—a new disease? J.A.M.A. 163:805, 1957. 2 Hutter, R. V. P.: Phycomycetous infection (mucormycosis) in cancer patients: a complication of therapy. Cancer 12:330, 1959. 3 Gregory, J. E., Golden, A., and Haymaker, M.: Mucormycosis of the central nervous system. A report of three cases. Bull. Johns Hopkins Hosp. 73:405, 1943. * Bauer, H., Ajello, L., Adams, E., and Hernandez, D. V.: Cerebral mucormycosis: pathogenesis of disease: description of fungus, Rhizopus oryzae, isolated from fatal case. Am. J. Med. 18:822, 1955. McCall, W., and Strobos, R. J.: Survival of a patient with central nervous system mucormycosis. Neurology 7:290, 1957. 6 Smith, H. W., and Yanagisawa, E.: Rhinomucormycosis: report of a fatal case. New England J. Med. 260:1007, 1959. 7 Baker, R. D.: Pulmonary mucormycosis. Am. J. Path. 32:287, 1956. 8 Dillon, M. L.: Mucormycosis of the bronchus successfully treated by lobectomy. J. Thoracic Surg. 35:464, 1958. 9 Blankenberg, H. W., and Verhoeff, H. W.: Mucormycosis of the lung. A case without significant predisposing factor. Am. Rev. Tbc. and Pulm. Dis. 79:357, 1959. 10 Josephiak, E. J., Smith-Foushee, J. H., and Smith, L. C : Cutaneous mucormycosis. Am. J. Clin. Path. 30:547, 1958. 11 Elder, T. D., and Baker, R. D.: Pulmonary mucormycosis in rabbits with alloxan diabetes. Arch. Path. 61:159, 1956. 12 Schauble, M. K., and Baker, R. D.: The inflammatory response in acute alloxan diabetes. Enhanced proliferation of Rhizopus and Micrococcus in cutaneous lesions of rabbits. Arch. Path. 64:563, 1957. 13 Chick, E. W., Evans, J., and Baker, R. D.: Treatment of experimental mucormycosis {Rhizopus oryzae infection) in rabbits with Amphotericin B. Antib. & Chemo. 8:394, 1958. 14 Long, E. L., and Weiss, D. L.: Cerebral mucormycosis. Am. J. Med. 26:625, 1959.

Excretion of thiamin and its degradation products in man.

The development of a simple procedure 1 to determine both thiamin and the pyrimidines in human urine permits the investigation of the possible relationship between the two. Schultz, Atkins and Frey showed that the rate of glucose fermentation by a yeast is directly proportional to the concentration of thiamin present. In addition to thiamin, the pyrimidines give mol for mol stimulation effect on the rate of fermentation. Such pyrimidines are found normally in human urines. Since the pyrimidine nucleus constitutes an integral part of the thiamin molecule, it is of interest to determine the relationship between thiamin and urinary pyrimidine. The total fermentation is a measure of thiamin and pyrimidine in the urine. The fermentation after oxidation of the free thiamin is a measure of the pyrimidines; the difference represents the free thiamin. This technic combines the gas method with the initial steps of the thiochrome procedure. The urinary excretion of the thiamin and pyrimidine of a group of patients was studied under various conditions. Three patients were given a diet completely deficient in B1 for 10 days. Two of these were normal and one had ileo-jejunitis. Fig. 1 and 2 and Table I illustrate that complete deprivation of dietary thiamin for a period of 10 days changed the thiamin-pyrimidine ratio from approximately 9:1 to 1:9. During this 10-day deprivation period, the absolute amount of pyrimidine excreted remained at approximately the same level, while the free thiamin disappeared almost completely. It becomes apparent, then, that the determination of free thiamin in the urine is an index of the dietary intake immediately preceding the measurement, since the urinary excretion of thiamin decreases so rapidly on deprivation. Therefore, low values for free thiamin need not necessarily indicate a state of chronic insufficiency with respect to this vitamin since the same values are obtained with temporary, acute deprivation.

ADVANTAGES OF PROZINSULIN (PROTAMINE ZINC INSULIN) THERAPY: DIETARY SUGGESTIONS AND NOTES ON THE MANAGEMENT OF CASES

Excerpt Prozinsulin is being used in the routine control of the diabetic state. Difficulties have been encountered in a certain group of patients with this type of therapy. This group corresponds i...

Treatment of Diabetic Coma

The basic principles in the treatment of diabetic coma are divided into two main parts. Immediate emergency treatment includes measures to restore carbohydrate metabolism to normal; to overcome dehydration; to eliminate ketosis; in extreme cases only, to combat acidosis specifically; and to treat precipitating factors, such as acute appendicitis, acute pyelitis and pyelonephritis. Management in the convalescent period demands watchfulness (for relapse and hidden infections), continued treatment of precipitating factors, and rapid nutritional rehabilitation with special reference to protein deficits and vitamin deficits.

A Test Proposed to Measure Vitamin B1 Saturation in Humans

A test designed to measure the individual patients saturation with respect to Vitamin Bi would have a wide clinical application. Experiments have been carried out in an attempt to develop such a procedure. The validity of such a test depends upon, among other things, the accuracy of the method of assay for the Vitamin B1. The assay methods fall into two categories—chemical and biological. The chemical methods on the whole are specifically for pure thiamin. Among the biological methods the Schultz, Atkins and Fry technic which employs the rate of fermentation of glucose by a yeast is the most suitable for clinical investigation. This method measures not only the thiamin but the pyrimidines as well. The pyrimidines present in the urine may be considered for practical purposes as originating from the members of the B complex. The actual test in its present form employed in this laboratory is summarized as follows: Patients were injected with 1 mg of thiamin hydrochloride intramuscularly in the fasting state. The urine was collected for a 4-hour period following the injection. The Vitamin B1 activity of this collected urine was assayed by means of the Schultz, Atkins and Fry yeast fermentation method. Fig. 1 shows the tabulation of the results of the test on 349 unselected patients. The distribution curve of the results indicates that an excretion of 180 gammas or more in the 4-hour period represents the average normal. Patients excreting less than 180 gammas may be considered as below average saturation. This group of patients represents the population of hospitals and dispensaries and cannot be considered a representative cross section of the population. Fig. 2 shows the tolerance test on 35 normal, healthy students, instructors and physicians.

Protein as a Source of Carbohydrate for Patients Using Protamine Zinc Insulin

The introduction of protamine zinc insulin for the management of diabetes gave rise to several difficulties. Some of these, with suggested solutions, have been discussed in previous papers. 1 2 3 In addition, the prolonged action of protamine zinc insulin during the whole 24-hour period led to severe nocturnal hypoglycemic episodes. The recommendation by Conn and Newburgh 4 of high protein diets for the treatment of spontaneous hypoglycemia can be applied in principle to this problem. It is well known that about 50% of protein is available to the body as carbohydrate. It is also known that the gastric-emptying time with a meat meal may be prolonged to 3 or more hours. The time of small intestinal digestion, absorption, transportation to the liver, deaminization, and synthesis of glucose further delays this availability. To test this hypothesis, 40 diabetic patients were given 400 g of lean chopped beef, lightly broiled. This test meal was given 24 hours after the last dose of insulin (protamine zinc insulin) on a fasting stomach. Blood sugars were taken at one-half hourly intervals for a period of 4 hours, as previously described. Control experiments consisted in blood sugar determinations on the same patients under similar conditions, but without any food. The results were uniform in all patients. There is a slow but definite rise in blood sugar concentration throughout the whole experimental period. In contrast to the curves obtained after orange juice, banana, or banana and cream, previously published, and bread, oatmeal and potato, there is absolutely no compensatory drop in blood sugar level. Curves 1 and 2 are representative examples of this series of experiments with their controls. The application of this principle to the problem of protamine zinc insulin therapy has eliminated nocturnal hypoglycemia.

Ionized Blood Calcium in Patients with Renal Calculi

The statement has been made that hyperparathyroidism is frequently found as the etiological factor in renal calculi. 1 It becomes of interest to examine this hypothesis by all possible methods at our disposal. Since one may find normal total calcium figures in the presence of hyperparathyroidism the simple determination of the total calcium and phosphorus is not entirely reliable. McLean and Hastings 2 have recently proposed a simple method for the determination of the ionized calcium in the serum. This they believe is the most sensitive test available for detecting the presence of hyperparathyroidism. Twenty-four patients with proven calcium stones were referred to the Metabolic Clinic by the Second Surgical Service (Dr. Edwin Beer). The Collip modification of the Tisdall method was used for the determination of the total serum calcium, and the Fiske-Subbarow method for the inorganic phosphorus. The serum proteins, after removal of non-protein nitrogenous substances, were determined by a modification of the Pregl micro-Kjeldahl procedure. The results are shown in Table I with the addition of data from control cases. These controls are used in addition to the normal figures published by McLean and Hastings. There is no evidence of increased calcium ion concentration in any of the stone cases.