Howard E. Ticktin

Cerebral metabolism in hepatic insufficiency

S TUDIES dealing with neurologic disturbances associated with hepatic insufficiency have been confined chiefly to attempts at identifying the neurotoxic substance or substances responsible for the condition. For the most part, attention has been directed to the concentration of ammonia and other nitrogenous or sulfur-containing compounds in the arteriallP3 and cerebral venous blood.4 It is believed that these substances may alter the activity of certain enzyme complexes concerned with intermediate cerebral metabolism.4 In the present study, cerebral hemodynamics and oxygen utilization of patients with varying degrees of neurologic dysfunction associated with hepatic insufficiency were investigated to determine whether or not changes in the functions mentioned could be correlated with alterations in blood ammonia and pyruvate levels or with electroencephalographic activity.

DIAGNOSTIC VALUE OF A NEW SERUM LIPASE METHOD.

Summary 1.Clinical experience with a new method of serum lipase determination is presented. The normal mean for serum lipase concentration is 4.5 units/ml. with a 95% confidence range of 1 to 10 units. 2.Significant elevations of serum lipase were found in the 20 cases of acute pancreatitis studied. These elevations occurred early in the course of illness (within 24 hr) and were found to parallel those of serum amylase. 3.Elevation of serum lipase was not observed in 2 cases of inflammatory disease of the salivary gland. 4.No consistent elevations of serum amylase or lipase concentration were noted in 16 patients with liver disease or in 10 patients with carcinomatous involvement of the pancreas and liver. 5.Elevations of serum amylase concentrations were noted at relatively low levels of blood urea nitrogen (50 mg/100 ml) and elevation of both serum amylase and lipase concentration were noted with blood urea nitrogen of 77 mg/100 ml. However, some patients with elevated BUN did not have elevated enzyme levels. 6.The short hydrolysis period (1 hr) and the sensitivity for detection of acute pancreatic injury of this new lipase method make it a rapid, practical, and reliable test in the diagnosis of acute pancreatitis.

Serum glutamic-oxalacetic transaminase in coronary artery disease; a review of 201 cases.

The results of serial glutamic-oxalacetic transaminase (GOT) assays in 201 cases in which coronary artery disease was suspected are correlated with the clinical, laboratory, and electrocardiographic changes. In 95 per cent of the cases diagnosed as myocardial infarction on the basis of clinical and electrocardiographic evidence there was an elevation of serum GOT. On the other hand, in 12 per cent of the cases in which clinical and electrocardiographic findings were negative or equivocal with regard to myocardial infarction, there was an elevated serum GOT. In 18 cases that were autopsied the correlation between acute myocardial necrosis and serum GOT elevation was 100 per cent.

Evaluation of diazepam for pre-endoscopy medication.

SummaryDiazepam was administered as an adjunct to endoscopic premedication in 260 patients undergoing examination in both in- and outpatient settings.The technic entailed intravenous administration of diazepam plus meperidine just prior to instrumentation. Satisfactory results were obtained in 87.7% of the subjects (179 patients).Intravenous diazepam alone was administered to 6 patients just prior to endoscopy. This was not found to allow satisfactory examinations, since the gag reflex was not obliterated.Evaluation of diazepam by double-blind technic in 50 patients showed that only 55% of the endoscopic examinations were satisfactory in the placebo group, and 76.6% in the diazepam group.Diazepam is a useful adjunct to endoscopic premedication since it induces sedation and voluntary muscle relaxation without increasing the dangers of cardiovascular collapse and respiratory arrest. When combined with meperidine it offers a practical technic for preparing patients for endoscopic examination without the need for general or local anesthesia, or large doses of potentially harmful drugs.

CURRENT THERAPEUTIC CONCEPTS OF CEREBRAL AND MYOCARDIAL VASCULAR DISEASE.

The intuitive belief that what is good for one organ should be good for the other, can, to a considerable extent, be supported by various physiologic analogies between the two, bearing in mind that the product of myocardial activity is mechanical energy while that of the brain is neuronal energy, and that oxygen needs of the heart vary with changes in workload while those of the brain remain relatively constant. Physiologically, both heart and brain are characterized

Effect of methylphenidate hydrochloride in antagonizing barbiturate-induced depression.

THE TREATMENT of central nervous system depression induced by the ingestion of barbiturates is a problem not infrequently encountered in clinical practice. Although there are many analeptic agents currently available for such purposes, their efficacy, with the possible exception of pentylenetetrazol and picrotoxin,’ is questionable. In fact, there are some who believe that the use of such drugs may even be harmful and advocate only good symptomatic care and dialysis, when necessary, as the treatment of choice for deep barbiturate intoxication.2 Recently a new analeptic agent, methylphenidate hydrochloride (Ritalin), has been reported to be of therapeutic value in barbiturate-induced depression.3 In this study, findings concerning its effectiveness in overcoming self-induced barbiturate depression, as well as its influence on cerebral hemodynamics and oxygen consumption in subjects to whom various dosages of amobarbital were administered, are presented.