- Email: [email protected]
Serum cholinesterase in health and disease
American
Federation
of bowel damage as estimated by x-ray and proctoscopy, and to fibrosis of the bowel wall. Wave-like contractions may reappear for short periods following administration of banthine, TEAC, urecholine and priscoline. Similar changes in sigmoid motility have been produced for short periods in normal subjects by the injection of acetylcholine or methacholine, and by unsympathetic interviews producing feelings of helplessness and defeat. It is concluded that this absence of wave-like activity in the sigmoid of patients with ulcerative colitis may represent sustained contraction resulting from neural impulses.
\r~~u~~~P~~~~~~~~~~~~~~~ EMPLOYED PRIOR TO SURGERY OF THE STOMACH AND SPLEEN. Bernard Maisel, M.D., Memorial Cancer Center, New York, N. Y. Pneumoperitoneum induced in man and dogs two weeks prior to exploratory laparotomy produced a striking visceroptosis of the liver, spleen and stomach. As a result of this ptosis of the stomach there was a herniation of a long segment of esophagus from the mediastinum into the peritoneal cavity. This long intra-abdominal segment of esophagus markedly facilitated total gastrectomy and esophagojejunostomy performed through an abdominal incision. The ptosis of the spleen, from beneath the costal margin, since it provided infinitely better exposure of the vascular pedicle of the spleen aided significantly in its removal.
SERUM CHOLINESTERASEINHEALTHANDDISEASE. Louis 3. Vorhaus, M.D. (by invitation), and Robert M. Kark, M.D., University of Illinois College of Medicine, Chicago, Ill. Serum cholinesterase is an enzyme or group of enzymes of hepatic origin about which little was known until recent years. Using Michel’s electrometric method for the determination of its activity, extensive studies were made of its properties and alterations in health and disease. We have shown that in hepatic disease there is a characteristic depression of serum cholinesterase activity. Serial studies of its activity made in chronic and acute liver disease more closely reflected the changing status of hepatocellular function than any of ten commonly used liver function tests with which it was compared. Its activity is depressed in malnutrition and rises with rehabilitation. Low levels are also found in many types of anemias and these rise as the blood picture improves. Normal levels were found in patients ill with myasthenia gravis, JANUARY,
1952
for Clinical
Research
“3
asthma, hyperthyroidism and hypertension. Exceedingly high levels were observed in patients ill with the nephrotic syndrome. Prolonged intravenous infusion of serum albumin caused a marked depression of serum cholinesterase activity. The data suggest that the serum cholinesterase molecule is synthesized in parallel with the albumin molecule, and that its synthesis is stimulated by factors which stimulate albumin production. Prompt and signiticant depression of serum cholinesterase activity has also been observed following administration of tetraethyl ammonium, vitamin K, folic acid and sodium amytal, probably due to reversible inhibition of the cholinesterase. Regeneration of serum cholinesterase following injection of di-isopropyl fluorophosphate has been studied, and the data suggest that the life span of the molecule is approximately four weeks. A CORRELATION BETWEEN CHANCES IN SERUM
PROTEIN FRACTIONS IN DIABETES MELLITUS. S. 0. Waife,M.D., Michael G. Wohl, M.D. (by invitation) and Barbara Sigmond, M.D. (by invitation), Philadelphia General Hospital, Philadelphia, Pa. When serum albumin levels fall, the serum globulin often rises. No quantitative expression of the relationship of these protein fraction changes is generally accepted. To study this problem statistical analyses were performed on 386 serum protein determinations (in duplicate) on 106 subjects (twenty-seven normal controls. twenty-eight hospitalized diabetic patients and fifty-one diabetics seen in the out-patient department). Albumin, globulin and gamma globulin concentrations were determined chemically. Significant differences (P < 0.1) were found in the mean value of total protein, albumin, globulin and gamma globulin fractions of the three groups. The hospitalized diabetics had a significantly lower albumin and higher globulin and gamma globulin levels than the controls. The clinic diabetics had intermediate values. Regression coefficients (of the diabetic values) show that the increase in gamma and total globulin does not proceed at a constant rate for each decrease in albumin. The rate is constantly diminishing. Plotting the A/G and A/GG ratios against albumin offers a more precise picture of the change and shows a correlation of f.87 and f.70, respectively. There was a +.87 correlation between total globulin and gamma globulin. The correlation between the absolute values of A: G and A:GG was - .42 and - .40, rc-
Federation
of bowel damage as estimated by x-ray and proctoscopy, and to fibrosis of the bowel wall. Wave-like contractions may reappear for short periods following administration of banthine, TEAC, urecholine and priscoline. Similar changes in sigmoid motility have been produced for short periods in normal subjects by the injection of acetylcholine or methacholine, and by unsympathetic interviews producing feelings of helplessness and defeat. It is concluded that this absence of wave-like activity in the sigmoid of patients with ulcerative colitis may represent sustained contraction resulting from neural impulses.
\r~~u~~~P~~~~~~~~~~~~~~~ EMPLOYED PRIOR TO SURGERY OF THE STOMACH AND SPLEEN. Bernard Maisel, M.D., Memorial Cancer Center, New York, N. Y. Pneumoperitoneum induced in man and dogs two weeks prior to exploratory laparotomy produced a striking visceroptosis of the liver, spleen and stomach. As a result of this ptosis of the stomach there was a herniation of a long segment of esophagus from the mediastinum into the peritoneal cavity. This long intra-abdominal segment of esophagus markedly facilitated total gastrectomy and esophagojejunostomy performed through an abdominal incision. The ptosis of the spleen, from beneath the costal margin, since it provided infinitely better exposure of the vascular pedicle of the spleen aided significantly in its removal.
SERUM CHOLINESTERASEINHEALTHANDDISEASE. Louis 3. Vorhaus, M.D. (by invitation), and Robert M. Kark, M.D., University of Illinois College of Medicine, Chicago, Ill. Serum cholinesterase is an enzyme or group of enzymes of hepatic origin about which little was known until recent years. Using Michel’s electrometric method for the determination of its activity, extensive studies were made of its properties and alterations in health and disease. We have shown that in hepatic disease there is a characteristic depression of serum cholinesterase activity. Serial studies of its activity made in chronic and acute liver disease more closely reflected the changing status of hepatocellular function than any of ten commonly used liver function tests with which it was compared. Its activity is depressed in malnutrition and rises with rehabilitation. Low levels are also found in many types of anemias and these rise as the blood picture improves. Normal levels were found in patients ill with myasthenia gravis, JANUARY,
1952
for Clinical
Research
“3
asthma, hyperthyroidism and hypertension. Exceedingly high levels were observed in patients ill with the nephrotic syndrome. Prolonged intravenous infusion of serum albumin caused a marked depression of serum cholinesterase activity. The data suggest that the serum cholinesterase molecule is synthesized in parallel with the albumin molecule, and that its synthesis is stimulated by factors which stimulate albumin production. Prompt and signiticant depression of serum cholinesterase activity has also been observed following administration of tetraethyl ammonium, vitamin K, folic acid and sodium amytal, probably due to reversible inhibition of the cholinesterase. Regeneration of serum cholinesterase following injection of di-isopropyl fluorophosphate has been studied, and the data suggest that the life span of the molecule is approximately four weeks. A CORRELATION BETWEEN CHANCES IN SERUM
PROTEIN FRACTIONS IN DIABETES MELLITUS. S. 0. Waife,M.D., Michael G. Wohl, M.D. (by invitation) and Barbara Sigmond, M.D. (by invitation), Philadelphia General Hospital, Philadelphia, Pa. When serum albumin levels fall, the serum globulin often rises. No quantitative expression of the relationship of these protein fraction changes is generally accepted. To study this problem statistical analyses were performed on 386 serum protein determinations (in duplicate) on 106 subjects (twenty-seven normal controls. twenty-eight hospitalized diabetic patients and fifty-one diabetics seen in the out-patient department). Albumin, globulin and gamma globulin concentrations were determined chemically. Significant differences (P < 0.1) were found in the mean value of total protein, albumin, globulin and gamma globulin fractions of the three groups. The hospitalized diabetics had a significantly lower albumin and higher globulin and gamma globulin levels than the controls. The clinic diabetics had intermediate values. Regression coefficients (of the diabetic values) show that the increase in gamma and total globulin does not proceed at a constant rate for each decrease in albumin. The rate is constantly diminishing. Plotting the A/G and A/GG ratios against albumin offers a more precise picture of the change and shows a correlation of f.87 and f.70, respectively. There was a +.87 correlation between total globulin and gamma globulin. The correlation between the absolute values of A: G and A:GG was - .42 and - .40, rc-