Lester Tuchman

Choline-Esterase Activity of Human Sera, with Special Reference to Hyperthyroidism.

Summary The acetylcholine esterase activity of the blood serum was determined in 500 individuals including normal and pathological cases. A modification of the Ammon gasometric method was utilized. The acetylcholine esterase was relatively high in cases of untreated hyperthyroidism. The acetylcholine esterase activity may be one of the elements related to the so-called sympathicotonicity or vagotonicity of an individual.

Decreased Choline-Esterase Activity of Serum in Jaundice and in Biliary Disease.

Summary The choline-esterase activity of the serum in patients with jaundice or biliary tract disease was found to be depressed.

Cardiac hypertrophy caused by glycogen storage disease in a fifteen-year-old boy

Abstract Evidence is presented which suggests that some cases of idiopathic hypertrophy of the heart, described in the older literature, represent end stages of glycogenosis of the heart, and that our first case represents a transition between the infantile, fully developed picture of massive glycogen deposition, and the end stage, with only reactive inflammation, degeneration, and fibrosis.

Blood Amylase Response to Acetylcholine and its Modification by Physostigmine and Atropine

Summary 1. Intramuscular administration of acetylcholine in dogs results in an increase in the blood aniylase titre. 2. Physostigmine markedly increases the blood amylase response to acetylcholine. 3. Previous atropine admiinistration inhibits the blood amylase response to acetylcholine.

Subacute streptococcus viridans endarteritis superimposed on patent ductus arteriosus

Abstract A 51-year-old female with patent ductus arteriosus, suffered an episode of subacute Streptococcus viridans endarteritis twelve and one-half years previously. At the time, the diagnosis of a congenital cardiac lesion was based upon the absence of a history of rheumatic fever and the presence of a characteristic murmur, known to be of long duration. The diagnosis of superimposed infection rested upon the presence of irregular fever, chills, malaise, splenic enlargement, petechiae, and several episodes of pulmonary infarction, and was confirmed by blood cultures which repeatedly were positive for Streptococcus viridans . The treatment consisted of repeated blood transfusions, supportive therapy, and injections of an autogenous vaccine. After an illness of approximately fifteen months, she apparently recovered completely. The patient first came under the observation of one of the authors, with symptoms of mild circulatory failure, approximately eight years prior to the present admission. During the ensuing years the circulatory symptoms increased slowly but progressively. Approximately four and one-half weeks before admission to the hospital, clinical manifestations of superimposed infection, similar to those present twelve and one-half years previously, reappeared. During a twenty-three-day period of hospital observation, the clinical course was progressively downhill. The administration of both sulfapyridine and sulfathiazole was without sgnificant effect; and blood cultures revealed as many as fifty-two colonies of Streptococcus viridans per cubic centimeter. Operation was performed primarily for the purpose of eliminating the infection. The procedure consisted of double ligation of the ductus, by a modification of technique devised by one of the authors. A blood culture taken forty minutes after operation was sterile throughout fourteen days of incubation. Four blood cultures were taken subsequently, and these likewise were negative. Chemotherapy was not administered during the postoperative course. Approximately nine months have elapsed since operation. All manifestations of infection and of circulatory failure remain absent, and the patient is in better health than in many years. This is the first case of spontaneous recovery from subacute Streptococcus viridans infection superimposed upon a proved patent ductus arteriosus. It also is the first case of infected patent ductus in which, after recovery from an initial episode, the infection recurred. Finally, it is our third, in which operation upon a patent ductus arteriosus has been followed by recovery from infection.

Blood Amylase Response to Acetyl-Beta-Methylcholine Chloride in Rabbits.

Conclusion 1. In rabbits, as in dogs, there is a rise in blood amylase following the intramuscular injection of acetyl-betamethylcholine chloride. 2. The blood amylase response of rabbits to acetyl-beta-methylcholine chloride is not as constant as in dogs.

Blood Amylase Response to Acetyl-Beta-Methylcholine Chloride in Pancreatectomized Dogs.∗:

It has been shown that there is a conspicuous rise of blood amylase after the administration of acetyl-beta-methylcholine chloride.† 1 In order to determine the possible pancreatic origin of this increase, the experiments were repeated both before and after pancreatectomy. Determinations of the blood amylase in 5 dogs showed constant rises in the blood amylase titer after the intramuscular administration of the choline ester. The same dogs were then pancreatectomized under pernoston anesthesia and the extent of the blood amylase response to acetyl-beta-methylcholine chloride was again estimated. The viscosimetric method utilized for these determinations was identical with that reported in the original communication. 1 Determinations were made on the insulin-treated pancreatectomized animal in the fasting state, without the administration of insulin on the day of the experiment. A fasting specimen of blood, and one collected 4 hours after the intramuscular administration of acetyl-beta-methylcholine chloride was deemed sufficient for this investigation. Repeated post-pancreatectomy estimations revealed no blood amylase increase (Table I), the rise obtained in the unoperated animal being totally or almost totally abolished after removal of the pancreas. In one dog, it was noted that the blood amylase could again be elicited about 4 weeks after pancreatectomy. We suspected, therefore, that remnants of the pancreas remained which later regenerated and hypertrophied. With this in mind, an exploratory laporatomy was performed, and 8.5 gm. of pancreatic tissue was found and removed. After this secondary operation, no amylase response to acetyl-beta-methylcholine chloride could be elicited after a period of 55 days. Table II.) As additional controls, determinations were made on 4 dogs after pernoston anesthesia alone, and after abdominal operations. Although the Blood amylase in some of these failed to show an appreciable rise after the procedure, the rise could again be elicited after a period of from one to 2 days.

Diagnostic value of serum cholinesterase determinations in jaundice and in cirrhosis of the liver

1. In cases of uncomplicated common duct stone with jaundice, serum Cholinesterase values varied from 41 to 112; 21 of 25 observations were above 50; a value below 40 speaks strongly against this diagnosis. 2. In cases of neoplastic obstruction of biliary passages with jaundice but without Cholangitis or metastases, Cholinesterase values varied from 40 to 74; a value below 40 throws considerable doubt on this diagnosis. 3. In cases of obstructive jaundice with Cholangitis or metastases, Cholinesterase values varied from 6 to 58 with 13 of 17 observations below 40; a value above 60 points to the absence of these complications. 4. In the jaundice of “catarrhal icterus” or toxic hepatitis values for Cholinesterase ranged from 28 to 100, 13 of 30 observations were below 50; 17 of 30 observations were above 50. Milder cases appeared to have higher values, and clinical improvement was accompanied by rise in the Cholinesterase level. 5. In the most important clinical problem, the differential diagnosis between biliary tract obstruction and toxic hepatitis (including catarrhal jaundice) a high value is of no aid; a value below 40 speaks against obstruction provided metastases or Cholangitis can be excluded. 6. Cases of cirrhosis of the liver, with or without jaundice, show low Cholinesterase values, the range being 9 to 69; 36 observations were below 50, 32 of 38 below 40. A value above 40 speaks against cirrhosis; a value above 50 practically excludes cirrhosis.