Cholesterol studies in patients with myocardial infarction

Southern

Society

for Clinical

Research

975

is limited to the fraction of blood that has the highest concentration of reticulocytes.

Strole, Jr. and Byrd S. Leavell. Dept. of Internal Medicine, School of Medicine, Univ. of Virginia, Charlottesville, Va.

INTRAHEPATIC

A roller tube tissue culture technic has been applied to study certain aspects of iron utilization by human bone marrow. Using tracer amounts of Fesg the average amount of iron utilized by the erythrocyte precursor in the bone marrow culture was determined (69 X 10Vg gamma) and found to be of the same order of magnitude as the quantity of iron in the mature red blood cell (91 to 108 X 10eg gamma). Progressive reduction of iron available in the culture uncovers increasing percentage utilization of iron (10 per cent to 90 per cent) by the erythrocyte precursor while absolute utilization decreases. This inverse relationship suggests that the iron present in serum is readily available to maturing erythrocytes and that the needs of the cell are not compromised by the binding of serum globulin. Above a certain point increase of available iron does not result in increased utilization. The most efficient level of iron utilization in the culture is of the order of 150 X 10eg gamma Fe per cell. Application of this method to study of the marrow of patients with uremia has revealed a lower average cellular uptake of iron than normal. This suggests that a defect in hemoglobin synthesis may play a part in the anemia of these patients.

DISEASE

PORTAL

OBSTRUCTION

AS DEMONSTRATED

CATHETERIZATION

AND

BY

IN WILSON’S

HEPATIC

SPLENOPORTAL

VENOUS VENOG-

W. Jape Taylor, F. C. Jackson and Wallace N. Jensen. Depts. of Medicine and Surgery, Univ. of Pittsburgh Medical School, and V. A. Hospital, Pittsburgh, Pa. RAPHY.

Moderate to marked splenomegaly in four patients with hepatolenticular degeneration (Wilson’s disease) prompted investigation of the portal circulation in these patients. Hepatic venous catheterization, with blood flow and wedged venous pressure measurements, was performed in all four patients and percutaneous splenic pulp pressures with portal venograms were obtained in three. In three patients with primarily neurologic manifestations, the wedged hepatic venous pressure was normal (mean 8.0 mm. Hg) whereas in two of these three patients the splenic pulp pressures were elevated (mean 24.5 mm. Hg). The hepatic blood flow and bromsulphalein clearance were normal in these patients. In a fourth patient with long-standing, advanced liver disease the splenic pulp pressure and wedged hepatic venous pressure were elevated to the same degree. The hepatic blood flow and bromsulphalein clearance were low. The three patients who had portal venograms demonstrated patent, abnormally tortuous and dilated portal veins with collateral venous channels. A normal wedged hepatic venous pressure in the presence of an elevated splenic pulp pressure and a patent portal vein suggests that an intrahepatic presinusoidal block exists early in the course of Wilson’s disease. Comparable data are not available in mild Laennec’s cirrhosis, but in the more advanced stages of this disease? the splenic pulp pressure and wedged hepatic venous pressure are both elevated; indicating sinusoidal or postsinusoidal obstruction. With progression of the hepatic disorder in hepatolenticular degeneration, obstruction to intrahepatic circulation becomes more widespread, and presumably involves the sinusoidal or postsinusoidal bed, with resultant circulatory dynamics which resemble those of advanced Laennec’s cirrhosis. IN VITRO

IRON

MARROW.

Oscar A.

JUNE,

1957

UTILIZATION

BY

Thorup: Jr.,

HUMAN

BONE

William Earl

CHOLESTEROL

STUDIES

IN

PATIENTS

WITH

MYO-

William T. Tucker, John C. Forbes and Paul D. Camp. Depts. of Medicine and Biochemistry, Medical College of Virginia, Richmond, Va. CARDIAL

INFARCTION.

Only a small percentage of the total cholesterol is removed when the lyophilized serum of young male subjects is extracted with cold chloroform for a three-hour period. The concentration of this fraction and the total cholesterol were determined in 303 male and 235 female patients without demonstrable heart disease and 214 patients with myocardial infarction. Of fifty-one men with myocardial infarction, aged fifty or less, 71 per cent exhibited elevated three-hour extraction values as compared to 25 per cent of 191 control subjects. Of ninety-five men with myocardial infa.rction over fifty years of age, only 53 per cent had elevated three-hour extraction values. Of 22 women with myocardial infarction over fifty years of age, 81 per cent showed elevated three-

Southern Society for Clinical Research

976

hour values compared to 36 per cent of ninetyeight control subjects. Total cholesterol was above 300 mg. per cent in 95 per cent of women over fifty years of age with myocardial infarction, as compared to 40 per cent in female control subjects. Sixty-three per cent of male patients under 51 years of age with myocardial infarction had total cholesterol values greater than 300 mg. per cent, compared to only 23 per cent of 191 male control subjects. Total cholesterol and three-hour extraction fraction measured during the acute stages following myocardial infarction were often low while subsequent determinations showed elevated values. The results emphasize the apparent relationship between cholesterol metabolism and myocardial infarction. FACTORS

CONTROLLING

CARDIAC

OUTPUT:

THE

J. V. Warren, A. M. Weissler and J. J. Leonard. Dept. of Medicine, Duke Univ. School of Medicine, and V. A. Hospital, Durham, N. C.

EFFECT OF POSTURE

AND ATROPINE.

It has long been recognized that when the patient is in the passive erect posture the cardiac output is lower than when the patient is in a recumbent position. In an effort to determine whether or not this represents lessened demands on the heart or inability to respond, studies on the effect of alterations in heart rate induced by atropine were undertaken. Three groups of normal male volunteers were studied. In group I cardiac output (dye technic) was determined before and two minutes after 2.0 to 2.8 mg. atropine sulphate was administered intravenously with the subject in a recumbent position. In group II similar studies were carried out with the subject in a 60 degree head-up tilt position. In group III the effect of atropine on induced vasodepressor syncope was observed. In group I marked increases in cardiac output (74 per cent above control average of 3.0 L. cardiac index) were observed, predominantly the result of increased heart rate. Despite even greater increases in rate, subjects in group II were found to have only slight increases in minute output (12 per cent above control). In syncopal subjects no significant effect on are output was observed. These observations consistent with the thesis that availability of blood is a limiting factor in cardiac output response and, in particular, may explain the reduced output found with subjects in the passive erect posture.

ALIMENTARY

LIPEMIA

AND

CORONARY

ARTERY

A. M. WeiSSler and 0. W. Sha@iro. Dept. of Medicine, Duke Univ. School of Medicine, and V. A. Hospital, Durham, N. C.

DISEASE IN TWO

RACIAL

GROUPS.

In an effort to detect and study susceptibility to coronary artery disease, a test of alimentary lipemia has been utilized. This test is based on reported alterations in lipemic response in patients with coronary atherosclerosis. Because of the recognized difference in incidence of this disease in white and Negro races, groups of fourteen patients of each race were studied. They came from a hospital population in which the racial difference in incidence of coronary artery disease was 2.2 white to 1 Negro. The subjects were fasting young male patients without cardiovascular or gastrointestinal disease. The groups were of similar average age and body surface area. Alimentary lipemia was assayed by following the plasma turbidity (Beckman DU spectrophometer at 650 my) over a six-hour period following the test meal of 100 cc. of 10 per cent cream per square meter. The mean fasting and hourly turbidities as well as planimetrically integrated areas under the turbidity curves were compared. No significant differences in the turbidity curves in the white and Negro groups were observed, the two behaving statistically in this respect as if selected from the same population. Individual variation from the normal distribution was likewise not different in the two groups. CARDIOVASCULAR DRUGS

EFFECTS OF PROVOCATIVE

USED IN THE DIAGNOSIS

CYTOMA

GIVEN DURING

INFUSIONS OF EPINEPHRINE

Joseph A. Albert A. Brust. Dept. of Internal Emory Univ. School of Medicine, Memorial Hospital, AtIanta, Ga.

AND

TEST

OF PHEOCHROMO-

NOR-EPINEPHRINE.

Wilber and Medicine, and Grady

Since provocative test drugs are widely employed in suspected pheochromocytoma, this study was designed to clarify the actions of these agents in the presence of known amounts of circulating catecholamines. In twenty-one fasting normotensive subjects, auscultatory blood pressures and pulse responses to histamine base (0.025 mg. intravenously), mecholyl (10 mg. subcutaneously), tetraethylammonium chloride (TEAC 400 mg. intravenously) and atropine sulfate (1.2 mg. intravenously) were recorded during control periods, during constant infusion

AMERICAN JOURNAL

OF

MEDICINE