- Email: [email protected]
Eosinopenic responses to varying doses of intravenous ACTH
Research American
Society Abstracts Federation
for Clinical
Research
ABSTRACTS OF PAPERS PRESENTED AT THE WESTERN SECTIONAL MEETING IN CARMEL, JANUARY 24, 1952 EOSINOPENIC RESPONSES TO VARYING DOSES OF INTRAVENOUS ACTH. H. W. Mclntosh, M.D. (by invitation), R. A. Palmer, M.D., H. S. Robinson, M.D., E. P. Carruthers, M.D. (by invitation) and R. D. T. Cape, M.D. (by invitation). (From the Vancouver General Hospital, Vancouver, B. C., Canada.) On continuous intravenous administration of ACTH a characteristic curve was obtained by plotting the numbers of eosinophils found in the peripheral blood against units of time. It was considered that the type of curve obtained might vary with varying doses of the hormone and, if so, in quantitative significance. Six patients were given graded amounts of ACTH over an eighthour period and the results were plotted on graphs. The results show that, apart from a small range between 0.075 and 0.175 mg./hour, the response is of the “all or none” type. Either there is a complete response as shown by a fall in eosinophils of 80 to 90 per cent in the eight-hour period or there is no significant fall at all. In the range mentioned above, however, there is a suggestion of an increasing response which will be illustrated. AMIDATION OF GLUTAMIC ACID BY HUMAN BRAIN IN VIVO. G. S. Gordan, M.D., J. E. Adams, M.D. (by invitation), C. T. Anderson, M.D. (by invitation), E. Eisenberg, M.D. (by invitation), H. Harper, Ph.D. (by invitation) and Q. J. G. Hobson, M.D. (by invitation). (From the Langley Porter Clinic of the Department of Mental Health, State of California, the University of California, Divisions of Medicine, Neurological Surgery and Psychiatry, and the University of San Francisco, Department of Biology, San Francisco, Calif.) The original nitrous oxide technic of Kety and Schmidt permits quantitation of the rate of cerebral blood flow in man. Since mixed cerebral venous and arterial blood are sampled, arteriovenous differences can be determined for any substance which may be analyzed in blood. It is therefore possible to measure rates at which the measured substances are utilized and liberated. We have previously reported that the carbo496
CAI.IFORNIA,
hydrate metabolism of brain is subject to endocrine influence and that oxidation of glucose accounts for only part of the oxygen utilized by brain. In the course of this study we have measured cerebral metabolic rates for other substrates. It was observed that glutamic acid is removed from blood by the brain at the rate of 0.4 mg./lOO gm. of brain/minute. Simultaneously, glutamine is liberated at the rate of 0.6 mg./lOO gm. of brain/minute. Krebs (1935) and Weil-Malherbes (1938) observed a similar reaction in vitro. They found that energy for amidation of glutamic acid is supplied by the oxidation of glucose. We investigated the effect upon this reaction of desoxycorticosterone glucoside (DCG) which interferes with the oxidation of glucose by the brain. Following the intravenous administration of DCG, a small amount of glutamic acid (0.2 mg./lOO gm. of brain/ minute) is still taken up but glutamine is no longer liberated. A tentative hypothesis is that the energy derived from oxidation of glucose is no longer available to permit the reaction by which the brain excretes ammonia. OBSERVATIONS
ON THE
TREATMENT
OF SYSTEMIC
E. L. Dubois, M.D., R. R. Commons, M.D. and P. Starr, M.D. (by invitation). (From the Department of Medicine, University of Southern California School of Medicine, Los Angeles, Calif.) Seventy patients with systemic lupus erythematosus (L. E.) are the basis for this report. Thirty-six were treated with various regimens including ACTH and/or cortisone. Life expectancy and the incidence of remission before and since the introduction of ACTH and cortisone have been compared. In the latter group these observations were of interest: (1) Small doses of ACTH may produce a clinical remission, yet massive doses may not be adequate in fulminating L. E. (2) If a “cushingoid” appearance is obtained there is usually a simultaneous remission of the L. E. The appearance and remission may be maintained on small doses of ACTH or cortisone. All patients showed LUPUS
ERYTHEMATOSUS.
AMERICAN
JOURNAL
OF
MEDICIN,?
Society Abstracts Federation
for Clinical
Research
ABSTRACTS OF PAPERS PRESENTED AT THE WESTERN SECTIONAL MEETING IN CARMEL, JANUARY 24, 1952 EOSINOPENIC RESPONSES TO VARYING DOSES OF INTRAVENOUS ACTH. H. W. Mclntosh, M.D. (by invitation), R. A. Palmer, M.D., H. S. Robinson, M.D., E. P. Carruthers, M.D. (by invitation) and R. D. T. Cape, M.D. (by invitation). (From the Vancouver General Hospital, Vancouver, B. C., Canada.) On continuous intravenous administration of ACTH a characteristic curve was obtained by plotting the numbers of eosinophils found in the peripheral blood against units of time. It was considered that the type of curve obtained might vary with varying doses of the hormone and, if so, in quantitative significance. Six patients were given graded amounts of ACTH over an eighthour period and the results were plotted on graphs. The results show that, apart from a small range between 0.075 and 0.175 mg./hour, the response is of the “all or none” type. Either there is a complete response as shown by a fall in eosinophils of 80 to 90 per cent in the eight-hour period or there is no significant fall at all. In the range mentioned above, however, there is a suggestion of an increasing response which will be illustrated. AMIDATION OF GLUTAMIC ACID BY HUMAN BRAIN IN VIVO. G. S. Gordan, M.D., J. E. Adams, M.D. (by invitation), C. T. Anderson, M.D. (by invitation), E. Eisenberg, M.D. (by invitation), H. Harper, Ph.D. (by invitation) and Q. J. G. Hobson, M.D. (by invitation). (From the Langley Porter Clinic of the Department of Mental Health, State of California, the University of California, Divisions of Medicine, Neurological Surgery and Psychiatry, and the University of San Francisco, Department of Biology, San Francisco, Calif.) The original nitrous oxide technic of Kety and Schmidt permits quantitation of the rate of cerebral blood flow in man. Since mixed cerebral venous and arterial blood are sampled, arteriovenous differences can be determined for any substance which may be analyzed in blood. It is therefore possible to measure rates at which the measured substances are utilized and liberated. We have previously reported that the carbo496
CAI.IFORNIA,
hydrate metabolism of brain is subject to endocrine influence and that oxidation of glucose accounts for only part of the oxygen utilized by brain. In the course of this study we have measured cerebral metabolic rates for other substrates. It was observed that glutamic acid is removed from blood by the brain at the rate of 0.4 mg./lOO gm. of brain/minute. Simultaneously, glutamine is liberated at the rate of 0.6 mg./lOO gm. of brain/minute. Krebs (1935) and Weil-Malherbes (1938) observed a similar reaction in vitro. They found that energy for amidation of glutamic acid is supplied by the oxidation of glucose. We investigated the effect upon this reaction of desoxycorticosterone glucoside (DCG) which interferes with the oxidation of glucose by the brain. Following the intravenous administration of DCG, a small amount of glutamic acid (0.2 mg./lOO gm. of brain/ minute) is still taken up but glutamine is no longer liberated. A tentative hypothesis is that the energy derived from oxidation of glucose is no longer available to permit the reaction by which the brain excretes ammonia. OBSERVATIONS
ON THE
TREATMENT
OF SYSTEMIC
E. L. Dubois, M.D., R. R. Commons, M.D. and P. Starr, M.D. (by invitation). (From the Department of Medicine, University of Southern California School of Medicine, Los Angeles, Calif.) Seventy patients with systemic lupus erythematosus (L. E.) are the basis for this report. Thirty-six were treated with various regimens including ACTH and/or cortisone. Life expectancy and the incidence of remission before and since the introduction of ACTH and cortisone have been compared. In the latter group these observations were of interest: (1) Small doses of ACTH may produce a clinical remission, yet massive doses may not be adequate in fulminating L. E. (2) If a “cushingoid” appearance is obtained there is usually a simultaneous remission of the L. E. The appearance and remission may be maintained on small doses of ACTH or cortisone. All patients showed LUPUS
ERYTHEMATOSUS.
AMERICAN
JOURNAL
OF
MEDICIN,?