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CLINICAL ENZYMOLOGY
646 should be dialysed. C. BRUN and J. P. MERRILL thought it unwise, whereas N. ALWALL did not think that a generalisation
possible. Finally, those at present in charge of dialysing thought that their number should be limited, preferthe number at present in existence. Surprisingly, the well-known objections to this recurrent ladder-lifting syndrome was
centres ably to
were not
voiced.
Renal
T. D. ULLMAN showed that the antidiuretic effect of vasowater diuresis was influenced by the pH of the urine and that during the formation of an alkaline urine there It was was relative insensitivity to exogenous vasopressin. for that there is as no out though yet explanation this pointed unexpected finding it is in line with Nutboume and de Wardener’s observation that hydrogen-ion excretion is depressed by a water diuresis.
pressin during
Transplantation
In this exciting session J. P. MERRILL and J. HAMBURGER described the successful transplantation of kidneys from donors to recipients who were not identical twins. Both speakers described how they first irradiated the recipients with approximately 450r from a cobalt bomb, to depress immunological processes. Hamburger then placed the patient in a bacteriafree room, and the transplantation was performed under hypothermia on the day after the end of the irradiation. Merrill had one patient alive after a year with good renal function and no proteinuria, though six months after the operation proteinuria had begun to appear. This ceased after a further course of irradiation. Hamburger had had two successful cases, one for one year and the other for six months; the latter a girl of 21 had recently married. The transplant was most likely to be successful if the donor was a close relative of the recipient. Later P. P. LAMBERT, and R. Kuss, M. LEGRAIN, and G. MATHE described other cases.
Other
administration of dog serum-protein, if it is given in such large that proteinuria is induced. The foot processes returned to normal when protein administration was discontinued. This is a fairly convincing demonstration that the smudging of the foot processes in the nephrotic syndrome is probably secondary to the proteinuria. amounts
Topics
R. L. VERNIER demonstrated that the glomerular foot processes of dogs will become smudged after the intravenous
CLINICAL ENZYMOLOGY The 6th International Congress of Internal Medicine, held at Basle on Aug. 24-27, included a day devoted to Enzyme Regulations in the Clinic. ,
H. THEORELL (Stockholm) surveyed the various modes of enzyme action, taking catalases, cytochromes, and dehydrogenases as typical examples. It was important to elucidate the exact mode of action of an enzyme before using it as an analytical tool. When this had been done, then enzyme measurements were as accurate as any other microchemical
technique. C. H. GRAY (London) discussed the difficulties of measuring enzymes in body-fluids. The ability to read a galvanometer needle with an error of less than 0.1% did not mean that the final calculated result had the same accuracy. Clinical enzymology often produced results of relative significance only, and in the congenital abnormalities there was need for absolute values. The relation between genes and enzymes was reviewed by E. HADORN (Zurich), who discussed the " one gene--one enzyme " hypothesis and the possibility that a single gene may control several enzymes or an enzyme with multiple functions. The functions and metabolism of organic phosphate compounds in heart-muscle were described by A. FLECKENSTEIN (Freiburg); and R. L. BING (St. Louis) gave a stimulating account of enzyme changes in cardiac metabolism. The heart contained enzyme systems capable of utilising all the foodstuffs circulating in the blood but appeared to preferentially catabolise esterified fatty acids, particularly esters of oleic acid. Studies on cardiac biopsy samples in the dog showed that tachycardia and ventricular fibrillation resulted in temporary increase in active phosphorylase together with accumulation of lactic acid. J. V. TAGGART (New York) considered the role of enzymes in renal metabolism, particularly with respect to the transport of substances across the tubular epithelium. The exact location of the various enzymes in different segments of the nephron and the identification of the components of the transport
Finally, there was Y. J. KATZ and R. S. MooRE’s demonstration that the increase in white-cell excretion which follows an intravenous injection of a pyrogen in chronic pyelonephritis (Pears and Houghton) can also be obtained by the intravenous administration of 20 mg. of prednisone phosphate. An International Association
During the congress it was decided to form an International Association of those interested in the kidney, and Prof. J. HAMBURGER was unanimously elected its first president. It was proposed that there should be another international congress in three years, and an invitation from Dr. Jan Brod to come to Prague was accepted. H. E.
mechanisms research. L. VILLA
were
the most
DE
WARDENER.
challenging problems in
current
(Milan) classified hepatic enzymes as primary, secondary, and accessory. C. J. WATSON (Minneapolis) described bilirubin metabolism and discussed in detail the
extrahepatic conjugation of bilirubin. Even the severely damaged liver could both conjugate bilirubin and synthesise dihydroxy bile acids. M. J. H. SMITH (London) reviewed the use of blood-enzyme determinations in liver disease and concluded that it was not possible to distinguish specific patterns of blood-enzyme abnormalities for each hepatic disorder. But serial estimations of transaminases and of other enzyme activities could give valuable help both in the diagnosis and in the assessment of the course and prognosis of particular
liver diseases. The use of enzyme measurements in liver disease was discussed at length by a panel which included F. WROBLEWSKI (New York), F. SCHMIDT (Kassel), and D. ALLDIS (London). The heterogeneity of serum enzymes, the misconception that necrosis of the liver accounts for raised blood-enzyme activities, and the significance of serum-alkaline-phosphatase activities provoked vigorous debate. -
A. VANNOTTI (Lausanne) dealt with the enzymes present in the various cellular elements of the blood and with the effects of inflammation and hormone treatments on the enzyme patterns in leucocytes. J. B. STANBURY (Boston) distinguished five types of congenital hypothyroidism as inherited enzyme defects concerned with different stages in either the synthesis or the metabolism of the thyroid hormone. One of these syndromes-that caused by a deficiency of a dehalogenase enzyme-was described in detail by A. QUERIDO (Leiden). The primary defect appeared to be inability to dehalogenate iodotyrosine compounds, which led to increased urinary excretion of organically bound iodine and lack of inorganic iodine for recirculation and incorporation into thyroglobulin. The ultimate effect was a conditioned iodine deficiency causing decreased thyroxine
synthesis. The discussions on clinical enzymology are separate volume of the Congress proceedings.
to
be
published
as a
possible. Finally, those at present in charge of dialysing thought that their number should be limited, preferthe number at present in existence. Surprisingly, the well-known objections to this recurrent ladder-lifting syndrome was
centres ably to
were not
voiced.
Renal
T. D. ULLMAN showed that the antidiuretic effect of vasowater diuresis was influenced by the pH of the urine and that during the formation of an alkaline urine there It was was relative insensitivity to exogenous vasopressin. for that there is as no out though yet explanation this pointed unexpected finding it is in line with Nutboume and de Wardener’s observation that hydrogen-ion excretion is depressed by a water diuresis.
pressin during
Transplantation
In this exciting session J. P. MERRILL and J. HAMBURGER described the successful transplantation of kidneys from donors to recipients who were not identical twins. Both speakers described how they first irradiated the recipients with approximately 450r from a cobalt bomb, to depress immunological processes. Hamburger then placed the patient in a bacteriafree room, and the transplantation was performed under hypothermia on the day after the end of the irradiation. Merrill had one patient alive after a year with good renal function and no proteinuria, though six months after the operation proteinuria had begun to appear. This ceased after a further course of irradiation. Hamburger had had two successful cases, one for one year and the other for six months; the latter a girl of 21 had recently married. The transplant was most likely to be successful if the donor was a close relative of the recipient. Later P. P. LAMBERT, and R. Kuss, M. LEGRAIN, and G. MATHE described other cases.
Other
administration of dog serum-protein, if it is given in such large that proteinuria is induced. The foot processes returned to normal when protein administration was discontinued. This is a fairly convincing demonstration that the smudging of the foot processes in the nephrotic syndrome is probably secondary to the proteinuria. amounts
Topics
R. L. VERNIER demonstrated that the glomerular foot processes of dogs will become smudged after the intravenous
CLINICAL ENZYMOLOGY The 6th International Congress of Internal Medicine, held at Basle on Aug. 24-27, included a day devoted to Enzyme Regulations in the Clinic. ,
H. THEORELL (Stockholm) surveyed the various modes of enzyme action, taking catalases, cytochromes, and dehydrogenases as typical examples. It was important to elucidate the exact mode of action of an enzyme before using it as an analytical tool. When this had been done, then enzyme measurements were as accurate as any other microchemical
technique. C. H. GRAY (London) discussed the difficulties of measuring enzymes in body-fluids. The ability to read a galvanometer needle with an error of less than 0.1% did not mean that the final calculated result had the same accuracy. Clinical enzymology often produced results of relative significance only, and in the congenital abnormalities there was need for absolute values. The relation between genes and enzymes was reviewed by E. HADORN (Zurich), who discussed the " one gene--one enzyme " hypothesis and the possibility that a single gene may control several enzymes or an enzyme with multiple functions. The functions and metabolism of organic phosphate compounds in heart-muscle were described by A. FLECKENSTEIN (Freiburg); and R. L. BING (St. Louis) gave a stimulating account of enzyme changes in cardiac metabolism. The heart contained enzyme systems capable of utilising all the foodstuffs circulating in the blood but appeared to preferentially catabolise esterified fatty acids, particularly esters of oleic acid. Studies on cardiac biopsy samples in the dog showed that tachycardia and ventricular fibrillation resulted in temporary increase in active phosphorylase together with accumulation of lactic acid. J. V. TAGGART (New York) considered the role of enzymes in renal metabolism, particularly with respect to the transport of substances across the tubular epithelium. The exact location of the various enzymes in different segments of the nephron and the identification of the components of the transport
Finally, there was Y. J. KATZ and R. S. MooRE’s demonstration that the increase in white-cell excretion which follows an intravenous injection of a pyrogen in chronic pyelonephritis (Pears and Houghton) can also be obtained by the intravenous administration of 20 mg. of prednisone phosphate. An International Association
During the congress it was decided to form an International Association of those interested in the kidney, and Prof. J. HAMBURGER was unanimously elected its first president. It was proposed that there should be another international congress in three years, and an invitation from Dr. Jan Brod to come to Prague was accepted. H. E.
mechanisms research. L. VILLA
were
the most
DE
WARDENER.
challenging problems in
current
(Milan) classified hepatic enzymes as primary, secondary, and accessory. C. J. WATSON (Minneapolis) described bilirubin metabolism and discussed in detail the
extrahepatic conjugation of bilirubin. Even the severely damaged liver could both conjugate bilirubin and synthesise dihydroxy bile acids. M. J. H. SMITH (London) reviewed the use of blood-enzyme determinations in liver disease and concluded that it was not possible to distinguish specific patterns of blood-enzyme abnormalities for each hepatic disorder. But serial estimations of transaminases and of other enzyme activities could give valuable help both in the diagnosis and in the assessment of the course and prognosis of particular
liver diseases. The use of enzyme measurements in liver disease was discussed at length by a panel which included F. WROBLEWSKI (New York), F. SCHMIDT (Kassel), and D. ALLDIS (London). The heterogeneity of serum enzymes, the misconception that necrosis of the liver accounts for raised blood-enzyme activities, and the significance of serum-alkaline-phosphatase activities provoked vigorous debate. -
A. VANNOTTI (Lausanne) dealt with the enzymes present in the various cellular elements of the blood and with the effects of inflammation and hormone treatments on the enzyme patterns in leucocytes. J. B. STANBURY (Boston) distinguished five types of congenital hypothyroidism as inherited enzyme defects concerned with different stages in either the synthesis or the metabolism of the thyroid hormone. One of these syndromes-that caused by a deficiency of a dehalogenase enzyme-was described in detail by A. QUERIDO (Leiden). The primary defect appeared to be inability to dehalogenate iodotyrosine compounds, which led to increased urinary excretion of organically bound iodine and lack of inorganic iodine for recirculation and incorporation into thyroglobulin. The ultimate effect was a conditioned iodine deficiency causing decreased thyroxine
synthesis. The discussions on clinical enzymology are separate volume of the Congress proceedings.
to
be
published
as a