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Effect of hyperthyroidism and myxedema upon cerebral blood flow and metabolism
Southern
Society for Clinical Research
lung kinase converted about 60 per cent of the profibrinolysin to lysin. The remainder was apparently converted to inert protein, a reaction which may be similar to the conversion of trypsinogen to trypsin and inert protein at pH 7.0 to 9.0. EFFECT OF HYPERTHYROIDISMAND MYXEDEMA UPON CEREBRAL BLOOD FLOW AND METABOLISM. Leonard Madison, Willis Sensenbach and Lamar Ochs (introduced by ‘Arthur Grollman). (From the Department of Medicine, Southwestern Medical College of the University of Texas, and the Department of Medicine, Veterans Administration Hospital, Dallas, Tex.) Hyperthyroidism and myxedema afford the opportunity to study the effects of change in total body metabolism upon cerebral metabolism and blood flow. These functions were studied by the nitrous oxide technic in four patients with hyperthyroidism and four patients with myxedema before treatment and when euthyroid. The euthyroid state for each individual was considered the control. Hyperthyroid patients exhibited an increase in mean cerebral blood flow from 59 to 87 ml. /min./100 gm. brain or 47 per cent. Mean cerebral vascular resistance decreased from 1.5 5 to 1.00 mm.Hg/ml. blood/100 gm. brain or 36 per cent. Mean cerebral oxygen consumption remained unchanged. Myxedematous patients revealed a decrease in mean cerebral blood flow from 52 to 46 or 12 per cent. Mean cerebral vascular resistance increased from 1.77 to 2.15 or 21 per cent. No change was noted in mean cerebral oxygen or glucose utilization. From these data it seems that the brain does not share in the changes in total body metabolism in hyperthyroidism and myxedema. The changes in cerebral blood flow may be related to the alterations in cardiac index reported by others in hyperthyroidism (plus 32 per cent) and myxedema (-47 per cent). EFFECT OF A GROUP OF BACTERIA AND THEIR CARBOHYDRATES ON HUMAN LEUKOCYTES. Samuel P. Martin (introduced by E. A. Stead, Jr.). (From the Department of Medicine, Duke University School of Medicine, Durham, N. C.) The effect of a group of bacteria and their somatic carbohydrates was tested on human leukocytes. The leukocytes were observed in a slide cell, previously described, which allows
observation of the oriented migration from a buffy coat. The only materials added were bacteria, their carbohydrates, and a concentration of heparin known to be non-toxic to leukocytes. Salmonella typhosa and Pseudomonas aeruginosa in concentrations of one to ten bacilli per leukocyte exerted marked to moderate inhibition of migration of the human cells. The purified carbohydrate of these organisms in concentrations of 0.25 to 5.0 gamma per ml. produced the same effect. Micrococcus aureus in the same concentration had no effect on leukocytes. The somatic. carbohydrate of S. typhosa has been noted to exert a negative chemotaxis for guinea pig leukocytes and to prevent diapedesis of leukocytes from blood vessels. The latter effect has been attributed to shock induced by this agent. The inhibition of migration as tested in this system would seem to indicate a profound effect of these carbohydrates on the leukocyte. It would appear that this effect might be important in the leukopenia as well as the fever and other reactions which are followed with the administration of these materials. In addition to the shock these agents produce it would appear that they have a direct effect on the leukocytes. THECOMA IN A ONE YEAR OLD G!RL WITH FEMINIZATION.Horace N. Marvin and (by invitation) Vida H. Gordon. (From the Departments of Anatomy and Pediatrics, University of Arkansas School of Medicine, Little Rock, Ark.) The case is that of a one year old girl with the following symptoms: Excessive mammary development, sparse pubic hair, white vaginal discharge, a slightly enlarged uterus, an abdominal mass 4 by 6 cm., precocious bone development, and hyper-irritability and insomnia. Preoperative vaginal smears showed preponderantly cornified epithelial cells. Urinary estrogen determinations were elevated and 17ketosteroid values were within the normal range. Upon surgical exploration a tumor of the left ovary 17 by 11 by 9 cm. was found and removed with the left oviduct. Sections of the tumor revealed spindle-shaped cells containing sudanophilic birefringent granules and intercellular reticular fibers. The oviductal epithelium was highly developed and had cilia on its free border. Extracts of the tumor were assayed and found to contain the equivalent of 2 I.U. of estrone per gram of fresh tissue. Postoperatively the changes were reversed AMERICAN
JOURNAL
OF
MEDICINE
Society for Clinical Research
lung kinase converted about 60 per cent of the profibrinolysin to lysin. The remainder was apparently converted to inert protein, a reaction which may be similar to the conversion of trypsinogen to trypsin and inert protein at pH 7.0 to 9.0. EFFECT OF HYPERTHYROIDISMAND MYXEDEMA UPON CEREBRAL BLOOD FLOW AND METABOLISM. Leonard Madison, Willis Sensenbach and Lamar Ochs (introduced by ‘Arthur Grollman). (From the Department of Medicine, Southwestern Medical College of the University of Texas, and the Department of Medicine, Veterans Administration Hospital, Dallas, Tex.) Hyperthyroidism and myxedema afford the opportunity to study the effects of change in total body metabolism upon cerebral metabolism and blood flow. These functions were studied by the nitrous oxide technic in four patients with hyperthyroidism and four patients with myxedema before treatment and when euthyroid. The euthyroid state for each individual was considered the control. Hyperthyroid patients exhibited an increase in mean cerebral blood flow from 59 to 87 ml. /min./100 gm. brain or 47 per cent. Mean cerebral vascular resistance decreased from 1.5 5 to 1.00 mm.Hg/ml. blood/100 gm. brain or 36 per cent. Mean cerebral oxygen consumption remained unchanged. Myxedematous patients revealed a decrease in mean cerebral blood flow from 52 to 46 or 12 per cent. Mean cerebral vascular resistance increased from 1.77 to 2.15 or 21 per cent. No change was noted in mean cerebral oxygen or glucose utilization. From these data it seems that the brain does not share in the changes in total body metabolism in hyperthyroidism and myxedema. The changes in cerebral blood flow may be related to the alterations in cardiac index reported by others in hyperthyroidism (plus 32 per cent) and myxedema (-47 per cent). EFFECT OF A GROUP OF BACTERIA AND THEIR CARBOHYDRATES ON HUMAN LEUKOCYTES. Samuel P. Martin (introduced by E. A. Stead, Jr.). (From the Department of Medicine, Duke University School of Medicine, Durham, N. C.) The effect of a group of bacteria and their somatic carbohydrates was tested on human leukocytes. The leukocytes were observed in a slide cell, previously described, which allows
observation of the oriented migration from a buffy coat. The only materials added were bacteria, their carbohydrates, and a concentration of heparin known to be non-toxic to leukocytes. Salmonella typhosa and Pseudomonas aeruginosa in concentrations of one to ten bacilli per leukocyte exerted marked to moderate inhibition of migration of the human cells. The purified carbohydrate of these organisms in concentrations of 0.25 to 5.0 gamma per ml. produced the same effect. Micrococcus aureus in the same concentration had no effect on leukocytes. The somatic. carbohydrate of S. typhosa has been noted to exert a negative chemotaxis for guinea pig leukocytes and to prevent diapedesis of leukocytes from blood vessels. The latter effect has been attributed to shock induced by this agent. The inhibition of migration as tested in this system would seem to indicate a profound effect of these carbohydrates on the leukocyte. It would appear that this effect might be important in the leukopenia as well as the fever and other reactions which are followed with the administration of these materials. In addition to the shock these agents produce it would appear that they have a direct effect on the leukocytes. THECOMA IN A ONE YEAR OLD G!RL WITH FEMINIZATION.Horace N. Marvin and (by invitation) Vida H. Gordon. (From the Departments of Anatomy and Pediatrics, University of Arkansas School of Medicine, Little Rock, Ark.) The case is that of a one year old girl with the following symptoms: Excessive mammary development, sparse pubic hair, white vaginal discharge, a slightly enlarged uterus, an abdominal mass 4 by 6 cm., precocious bone development, and hyper-irritability and insomnia. Preoperative vaginal smears showed preponderantly cornified epithelial cells. Urinary estrogen determinations were elevated and 17ketosteroid values were within the normal range. Upon surgical exploration a tumor of the left ovary 17 by 11 by 9 cm. was found and removed with the left oviduct. Sections of the tumor revealed spindle-shaped cells containing sudanophilic birefringent granules and intercellular reticular fibers. The oviductal epithelium was highly developed and had cilia on its free border. Extracts of the tumor were assayed and found to contain the equivalent of 2 I.U. of estrone per gram of fresh tissue. Postoperatively the changes were reversed AMERICAN
JOURNAL
OF
MEDICINE