Linn J. Boyd

Aneurysm of the pulmonary artery

Abstract 1. 1. A statistical survey has been made of the clinical and pathologic features of 111 cases of aneurysm of the pulmonary artery in which the diagnosis was confirmed by autopsy. 2. 2. Some of the features of thirty cases in which a clinical diagnosis of aneurysm of the pulmonary artery was made have been summarized. 3. 3. Two cases of aneurysm of the pulmonary artery are reported.

Intestinal Absorption of Vitamin B12 in Humans as Studied by Isotope Technic.

Summary The scintillation measurements of the hepatic uptake of C060-B12 following its oral and parenteral administration to 20 normal humans, indicate that the efficiency of intestinal absorption of vit. B12 decreases sharply on increase of the intake. The peak of the absorption curve of vit. B12 was found at the oral dose of 0.5 μg, at which the hepatic uptake was found equivalent to 90.5 ± 5.8% of that observed following intramuscular injection of a similar dose of this vitamin. With the increase of the dose, a progressive decline in absorption followed a hyperbolic regression curve, so that at the oral dose of 50 μg B12 the hepatic uptake was equivalent to only 3.0 ± 0.7% of that found after intramuscular injection of a similar dose of this vitamin. The data obtained indicate that the increment in the oral dose of vit. B12 from 0.5 to 50.0 μg, results apparently in an increase of the amount absorbed of only 1.0 μg. It is suggested that in addition to Castles gastric intrinsic factor, an intramural “intestinal B12-acceptor” exists, which may be responsible for the partial mucosal block to the absorption of vit. B12 in the intestine of normal humans. The role of this hypothetic acceptor in the absorption of vit. B12 might be analogous to that of apoferritin in intestinal absorption of iron.

Three unusual cases of parasystole.

Abstract Three cases of parasystole with simple interference of two rhythms showing unusual features are described. In the first case the ectopic center was situated in the auriculoventricular bundle above the bifurcation. Combination beats were absent. Both rhythms were occasionally united when the protection of the ectopic center towards normal sinus stimuli disappeared. This phenomenon is explained by a supernormal phase of excitability of the ectopic center. The two other observations concern “intermittent parasystole” in which an ectopic center periodically appears and disappears. The first ectopic beat of each series is coupled to the preceding sinus beat and apparently elicited by the latter. Case 2 shows a parallel variation of the sinus rate and the rate of the ectopic center. Case 3 shows an interesting intraventricular disturbance of conduction following interpolated beats. It is emphasized that the term “protective block” is not applicable because we are not dealing with a zone of unidirectional block. The protection of the ectopic center against conducted stimuli is fully explained by its diminished excitability. Periodic changes of this excitability may cause the appearance and disappearance of parasystole. All three observations show temporary disappearance of the protection of a parasystolic center. This leads to hitherto unknown disturbances of rhythm and permits a better understanding of the mechanism of parasystole.

DIFFERENTIATION OF MACROCYTIC ANEMIAS AND DIAGNOSIS OF PERNICIOUS ANEMIA AND SPRUE IN REMISSION BY ACCELERATED MEASUREMENT OF HEPATIC UPTAKE OF RADIOACTIVE Co60B12

Excerpt The differential diagnosis of various types of macrocytic anemia often presents difficult clinical problems. Many cases of dietary folic acid or B12deficiency and sprue cannot be distinguis...

Patterns of Response of Gastric Mucoprotein and Acid to Insulin; Correlation With the Underlying Disease in the Non-Operated Stomach of Man

An intravenous injection of insulin represents a powerful stimulus for secretion of gastric acidl 8• The action of insulin arising through the central stimulative effect of hypoglycemia on the cerebral vagal centers5 differs from humoral and peripheral vagotropic stimuli which act directly upon parietal cells or peripheral autonomic ganglia. This difference of action found application in a test for determining the thoroughness of vagotomy9, 10 as well as in tests to evaluate the vagal mechanism of gastric secretionU 13 and for testing the functional status of all cellular secretory elements of gastric glands14. The last application of insulin is possible because it represents the most comprehensive gastric secretory stimulus known, for its action is not limited to an evocation of hydrochloric acidl 8 but it also affects pepsin12, 16, 16 and gastric mucoprotein16 , 18. The negative results obtained by some authors12, 17 in respect to the influence of insulin on gastric mucin components are now known to depend upon an inadequate technic for mucin determination18. Recently gastric mucoprotein has been separated from the total dissolved mucin of human gastric juice18 , 19. Being probably identical with the mucoprotein isolated from canine gastric juice after sham feeding20 human gastric mucoprotein is closely related to but different from gastric pepsin16, 21. Gastric mucoprotein has nothing in common with the secretion of surface epithelium, i.e. the visible surface epithelium mucus and its dissolution and split product, the dissolved gastric mucoproteose19 , 22. Apparently it is a secretory product of the gastric glands located in the fundus and body of the stomach and it is strongly under direct vagal influence18. Testing the mucoprotein and acid response to insulin has been suggested as a new test for evaluation the secretory status of the fundal glands23, and various patterns of mucoprotein and acid response to insulin were observed23 , 24: a) positive pattern characterized by a rise in mucoprotein concentration and gastric acidity; b) dissociated pattern characterized by a positive mucoprotein and negative acid response to insulin; c) negative pattern characterized by a negative response of mucoprotein and acid to insulin. In the present paper an attempt will be made to correlate the results of this test with the underlying gastric pathology in the nonoperated normal and pathological stomach.

The Plasma Antithrombin Titer in Incipient and Advanced Liver Failure

Recent reports have stressed the frequent lack of correlation between clinical, laboratory and histologic findings in various liver diseases1s. While liver function studies adequately confirm the presence of hepatocellular injury, the complex and often dissociated metabolic, excretory and circulatory derangements in liver disease cause ambiguous results which seriously interfere with definitive clinical and pathological diagnosis and prognosis. Furthermore, the sensitivity of many tests for a specific liver function yield findings often inconsistent with the clinical state of the patient. Since there is no parallel, therefore, between laboratory findings and the natural course of liver disease, the transition phase of long standing hepatic decompensation (ascites, jaundice, edema, spiders, liver palms, etc.) into the fl,nal stage of hepatic failure (degeneration and necrosis) is seldom recognized. (Table I). From the standpoint of clinical appraisal and prognostic evaluation during any phase of hepatic decompensation, liver function studies do not accurately reflect the critical variables of duration, magnitude, severity, pathologic type and physiologic extent of hepatic parenchymal derangement. It seems plausible to assume that neither composite laboratory determinations nor histologic preparations adequately mirror basic alterations (perhaps involving major enzyme systems) of hepatic cellular function. Detection of such significant changes may require special histochemical technics. A liver function test whose titer specifically parallels variations in the severity and extent of liver cell damage should therefore prove valuable. Evidence shall be presented supporting the hypothesis that the level of antithrombin is conditioned by the degree of functional over-all dissociation of the liver cell in both incipient and advanced stages of hepatic insufficiency. § In addition, these studies suggest a theoretical basis for the mechanisms of plasma antithrombin formation and activation.

Effect of yogurt with prune whip on constipation

1. A mixture of Prune Whip and Plain Yogurt has been prepared and administered to one hundred ninety-four (194) institutionalized, chronically ill patients with an average age of 71.6%. Of these ninety-one (91) or 46.9% were diabetic. 2. Twenty-nine (29) or 14.5% refused to take the mixture. 3. One hundred eighty-seven (187) patients, or 95.8%, required no laxatives during the period of administration of the Prune Whip Yogurt. Of those who ate the mixture, seven (7) or 4.2% had to resort to laxatives. 4. Twenty (20) or 22% of the diabetics revealed an increase in blood sugar but little or no glycosuria. 5. Improvement in skin tone, seborrheic dermatitis, chronic ileus and diabetic ulcers was noted. 6. During the period of Yogurt administration, nursing care was simplified because of an improvement in morale. There were fewer requests for additional food.

Metabolic interrelations between intrinsic factor and vit. B12. III. B12 absorption at varied intrinsic factor doses.

Conclusions Increase in oral dose of intrinsic factor preparations from hog stomach or active gastric materials from humans, with a constant oral dose of vit. B12, up to a certain point, increases the intestinal absorption of vit. B12 as measured by the hepatic uptake of Co60-B12. However, further increase in the amount of intrinsic factor may be devoid of any enhancing effect or even result in decreased absorption of B12 in the intestine. The latter might be due to an excessive binding of B12 to the non-absorbed fraction of the intrinsic factor preparation, having high binding capacity for vit. B12.

Prerequisites of Successful Heparinization to Prevent Gangrene After Frostbite.

Summary 1. Prevention of gangrene after severe frostbite requires a continuous uninterrupted prolongation of the coagulation time by heparin injections or infusions for at least 5 days after the exposure. 2. Even brief interruptions of this prolongation lead to a rapid increase in percentage of failure of the treatment. 3. Experiments in which such a prolongation is not achieved continuously are of no value in judging the merits of the therapy. 4. The term “heparinization” should be reserved for such instances in which heparin injections are proved to have produced a continuously maintained elevation of coagulation time to the desired level.

Perkussion und Auskultation

In den vergangenen Jahren, seit der Entwicklung und immer haufigeren Anwendung der Rontgenologie, wird die Perkussion der Herzgrenzen an vielen Instituten kaum mehr gelehrt oder geubt. Man nannte sie eine „aussterbende Methode“, welche in der Vergangenheit ihren Dienst getan hat, jetzt aber „aus der grosen und anwachsenden Zahl der brauchbaren klinischen- und Laboratoriumsmethoden verdrangt werden sollte“.