Michael G. Wohl

ATYPICAL SYNDROMES IN HYPERTHYROIDISM

Excerpt Unrecognized hyperthyroidism may progress insidiously to an advanced phase of the disease. The atypical syndromes disguising the true nature of the process are varied, with manifestations r...

Thiamine Deficiency in Organic Heart Disease

Since cocarboxylase, derived from thiamine, is necessary for normal utilization of pyruvate by heart muscle, the importance of adequate body stores of thiamine in patients with chronic heart disease is quite obvious. In order to investigate the occurrence of subclinical thiamine deficiency in patients with chronic heart disease, the thiamine was determined in the four-hour specimen of urine after loading dose in 35 male patients with congestive heart failure and compared with thiamine excretion in 17 persons free from cardiac disease. It was found that the noncardiac group had a significantly higher excretion of thiamine after a loading dose than patients with heart disease. Nine patients with severe heart failure receiving mercurial diuretics in the course of treatment were studied using 24-hour urine collections before, during and after the injection of the mercurial. The 24-hour urinary thiamine content was measured, demonstrating significant increases in thiamine excretion with mercurial diuresis.

Relationship of blood sugar and hypoproteinemia to antibody response in diabetics.

Summary Sixty-four diabetic patients were studied immunologically and chemically. Nineteen diabetic patients with hypoproteinemia received nitrogen supplementation in the form of lactalbumin hydrolysate or casein concentrate. The following conclusions appear to be warranted: 1. The decreased capacity to produce antibody in the diabetic is apparently not related to hyperglycemia. 2. Diabetic patients with hypoproteinemia showed a lower average agglutination titre than those with normal blood protein values. 3. Oral supplementation with lactalbumin hydrolysate or casein concentrate enhanced antibody formation.

Effect of Mercurials on Thiamine Excretion in Patients with Congestive Heart Failure

Summary The effect of mercurials on output of thiamine in the urine was investigated in 9 patients with congestive heart failure. The statistical analysis of the accumulated data indicates that the levels of thiamine excretion following mercurial administration are significantly increased over the levels observed on control days. The data seem to indicate that the mercurial-induced thiamine excretion is not due to the increased diuresis; it is suggested that it may be related to the depressed tubular absorption of the thiamine.

High Intestinal Obstruction In the Dog Treated with Extract of Adrenal Cortex

Acute intestinal obstruction as a representative of a group of conditions that are characterized by hyperazotemia and hypochlo-remia bears resemblance to adrenal insufficiency. 1 , 2 , 3 Indeed, we described the histologic1 changes of the adrenal glands in the dog with high intestinal obstruction as that of lipoid exhaustion of extreme degeneration of the adrenal cortex.∗ In view of Kendall 5 separation of 2 fractions of the cortical extract one of which produces results only when salt is administered with it, it seemed desirable to study the combined effect of cortical extract and salt solution in high intestinal obstruction. The amount of salt solution employed was considerably less than previously found sufficient to prevent adrenal exhaustion. High intestinal obstruction was induced on 6 dogs. The method, the preoperative and postoperative care were the same, as employed previously. 1 Daily blood studies were made for NaCl, urea nitrogen, CO2 combining power of blood plasma, hemoglobin specific gravity and red blood cell count. Two dogs received 200 cc. of physiological salt solution intraperi-toneally on the day of operation and every day thereafter plus 3 cc. of adrenal cortex extract intramuscularly; 2 dogs had neither cortin, nor salt solution; 2 dogs received daily intramuscular injections of 3 cc. of extract of adrenal cortex.† The dogs receiving adrenal cortex and salt solution lived for 15 days, when they were anesthetized and killed. They showed a loss of weight of 1.3 kilos and towards the last 2 days developed twitchings of muscles of hind legs. The blood urea nitrogen rose from 9.8 mg. % on the day of operation to 21 mg. % on the day of postmortem. The blood chlorides decreased from 510 mg. % to 420 mg. %. The CO2 increased from an initial 48.5 volume % to 75.3 volume %. The specific gravity remained practically the same. (1.028 to 1.030). The hemoglobin decreased from 14 gm. to 10.5 gm. The red blood cells decreased by 1,470,000. The postmortem and histological findings of the organs as well as those in other dogs will be described elsewhere. 6 The dogs without salt solution and cortin lived 5 days. They became toxic; vomited on the second day after operation, gradually grew worse and died on the fifth day after operation. The blood urea nitrogen increased from 16.1 mg. % on the day of operation to 144.2 mg. % on the day of death. The blood chlorides decreased from 440 mg. % to 302 mg. %. The specific gravity of the blood increased from 1.025 to 1.043. The hemoglobin has increased from 8.5 gm. to 17 gm. The red blood cells increased by 1,410,000. The dogs receiving cortin alone lived for 7 days. They lost one kilogram in weight; they apparently were not toxic and on the seventh day developed twitchings of muscles of trunk and of all 4 extremities and died. On this day, an additional dose of 3 cc. of cortin was given without much benefit. The blood changes were as follows : The blood urea nitrogen increased from an initial 14.7 mg. % to 66.5 mg. % on the day of their death; the blood chlorides decreased from 480 mg. % to 260 mg. %. The CO2 increased from 48.1 vol. % to 78.2 vol. %. The specific gravity increased from 1.027 to 1.030; the hemoglobin decreased from 14 gm. to 11 gm., and the red blood cells decreased by 1,300,000. Heuer and Andrus 7 prolonged the lives of dogs receiving intravenous injections of aqueous extracts of closed intestinal loops by administering cortical extract combined with transfusion. Scudder, Zwemer and Truszkowski 8 fortified our comparison between the clinical and biological picture of acute intestinal obstruction and adrenal insufficiency by demonstrating high blood potassium values in cats with high intestinal obstruction. This assumes special importance in view of Zwemers and Truszkowskis 9 findings that symptoms of adrenal insufficiency may be explained in terms of a disturbance of cortico-adrenal-potassium interrelation. We appreciate that our experiments are too few in number to permit the drawing of definite conclusions, but one would seem justified in emphasizing: 1. The many features in common in acute intestinal obstruction and adrenal insufficiency. 2. The apparent benefit from the combined administration of physiological salt solution and adrenal cortex extracts in combating the toxemia of high intestinal obstruction.

The occurrence of avitaminosis A in diseases of the liver.

The dark adaptation test for Vitamin A deficiency was utilized in 36 patients with various forms of liver disease. The results show that this procedure is of value in the estimation of hepatic parenchymal damage with the inference that such a process is associated with a change in Vitamin A metabolism. Jaundice of itself showed no particular effect on dark adaptation. The prothrombin level did not parallel the dark adaptation test in 50% of the cases investigated, although the liver function tests and dark adaptation were indicative of liver damage.

Adrenal Glands in Dogs with High Intestinal Obstruction

In high intestinal obstruction in man, 1 in the dog, 2 and in the monkey 3 the essential changes in the blood chemistry are primarily a fall in blood chlorides; usually a rise in alkaline reserve and a rise in non-protein nitrogen. The fall in the blood chlorides is not always conditioned by loss of chloride through vomiting. 3 The group of conditions associated with hyperazotemia and hypochloremia 4 bear certain clinical and chemical similarities; loss of weight, asthenia, and marked prostration, decline in blood pressure, rapid pulse, shallow respiration, dehydration and anhydremia. The mechanism of the nitrogen retention in these conditions is not well understood, but it would appear to be intimately related in a majority of instances to alterations of salt and water metabolism. 4 Both clinically and biochemically the syndrome of hypochloremia and hyperazotemia resembles adrenal insufficiency in Addisons disease. The findings recorded were observed in studies to determine whether the adrenal glands are altered morphologically in the hypochloremic state of high intestinal obstruction as a representative type of this syndrome. The literature contains, to our knowledge, no reference to histologic studies of adrenal glands in high intestinal obstruction.∗ High intestinal obstruction was induced on a series of 12 dogs by sectioning the duodenum by cautery and closing the ends by inversion. No food was given for 24 hours before operation and none during the experiment. Water was allowed ad libitum.

Medical Management of Thyroid Disease

What do you do to start reading medical management of thyroid disease? Searching the book that you love to read first or find an interesting book that will make you want to read? Everybody has difference with their reason of reading a book. Actuary, reading habit must be from earlier. Many people may be love to read, but not a book. Its not fault. Someone will be bored to open the thick book with small words to read. In more, this is the real condition. So do happen probably with this medical management of thyroid disease.