Clinical and physiologic study of normal sleep and hypersomnolent states

Southern Society for Clinical Research

962

framework of specific diagnoses. We conclude that specific etiologic diagnosis is now possible in all varieties of the nephrotic syndrome and should precede rational management. Emphasis on specifically diagnosed cases will permit more definite interpretations from correlative data than has previously been possible. STEROL INHIBITORS

OF CHOLESTEROL

ABSORPTION.

Maurice M. Best and Charles H. Duncan. Dept. of Medicine, Univ. of Louisville cine, Louisville, Ky.

School

of Medi-

It has previously been reported from this laboratory that p-sitosterol exerts a hypocholesterolemic effect in the cholesterol-fed rat and in man. Recent studies have shown: (1) The inhibition of cholesterol accumulation in serum and liver of the cholesterol-fed rat is greater when sitosterol and cholesterol are fed together than it is when they are fed in separate food pellets (serum and liver cholesterol concentrations of 68 + 6 mg./lOO ml. and 2.7 + 0.4 mg./gm., respectively, as compared to 97 + 13 and 11.3 + 2.9). (2) When sitosteryl palmitate is substituted for the free sterol in equimolar amounts it exerts essentially no inhibitory effect on cholesterol absorption. (3) “Isocholesterol,” a mixture of C30 compounds derived from wool fat, acts as an inhibitor of cholesterol absorption in the cholesterol-fed rat. The addition of 5 per cent isocholesterol to a 1 per cent cholesterol diet for two weeks resulted in serum and liver cholesterol concentrations of 68 + 5 mg./lOO ml. and 3.4 + 0.3 mg./gm., respectively, as compared to 82 f 12 and 12.2 + 3.9 for the controls. From these findings it appears that a free hydroxyl group on carbon-3 may be an essential feature of sterol inhibitors of cholesterol absorption. Further, the results support the hypothesis that such substances interfere with cholesterol absorption by tying up the esterification mechanism in some way. CLINICAL SLEEP AND

AND

PHYSIOLOGIC

HYPERSOMNOLENT

STUDY STATES.

OF

NORMAL

R. I. Birch-

jield, H. 0. Sicker and A. Heyman. Dept. of Medicine, Duke Univ. School of Medicine, Hospital, Durham, N. C.

and V. A.

This investigation was undertaken to elucidate various factors associated with sleep in ten control subjects and in fifteen patients with idiopathic narcolepsy or hypersomnolent disease states, for example, cerebrovascular disease. In addition to clinical observations and psychiatric

evaluation, ventilation, arterial blood gases and pH were measured during various stages of sleep monitored by electroencephalography. Narcolepsy was usually associated with moderate obesity or emotional factors and was characterized by frequent daytime napping and disturbances of nocturnal sleep. With the onset of sleep, the control subjects showed a significant fall in arterial pH (7.39 to 7.34) with elevation of pCOZ (44 to 49 mm. Hg). These changes were more pronounced in deep sleep but returned to normal immediately on arousal. In narcolepsy there was considerable variation in the awake pCOz and pH values without significant change during sleep. Marked alterations in the arterial blood oxygen saturation, pH and pC0~ occurred primarily during periodic respiration in the hypersomnolent states. These studies indicate that sleep normally is associated with mild respiratory acidosis. In hypersomnolent states there are no alterations in blood gases or ventilation, e.g. idiopathic narcolepsy, or marked cyclic changes occur due to impaired respiratory regulation as seen in organic disease. AN

HEPATOJUGULAROMETER, QUANTITATIVE

CONTROL

APPLIED

OVER HEPATIC

REFLUX

TEST.

APPARATUS

OF PRESSURE

FOR

AND FORCE

AREA FOR HEPATOJUGULAR

G. E. Burch. Dept.

Tulane Univ. School Hospital of Louisiana

of Medicine, of Medicine, and Charity at New Orleans, La.

Recent studies of the hepatojugular reflux revealed the need for control of pressure applied over the hepatic area. For this purpose the “hepatojugularometer” was devised, an apparatus that consists of a soft flexible rubber bag (basketball bladder), partially inflated with air, to which is attached the mercury or aneroid manometer of the clinical sphygmomanometer. The rubber bag is placed over the hepatic area, and pressure is exerted with both hands upon the bag with a force sufficient to raise the air pressure within the bag to the desired level. Thus it is possible to control and reproduce the force applied over the hepatic area and relate venous pressure quantitatively to it. Pressure of 50 mm. Hg within the bag was adequate for most purposes. By proper selection of the size of the rubber bag, each mm. Hg pressure is essentially equal to 1 pound of force. Pressure in the median basilic vein of patients with congestive heart failure varied with the AMERICAN

JOURNAL

OF MEDICINE