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High serum transaminase levels following myocardial infarction with recovery
709
Abstracts decreased from 72/29 to 60/22 mm. Hg (group mean); left atria1 pressure (three patients), from 38/22 to 20/9 ; and pulmonary compliance increased from 0.053 to 0.062 water. The change in compliance was of L./cm. variable magnitude, not correlated with the magnitude of the change in pulmonary artery pressure and, for However, the group, was not statistically significant. two subjects whc manifested increases in compliance (decreased lung stiffness) of 50 and 100 per cent were among those with the most marked decrease in pulmonary artery pressure. It is concluded that changes in pulmonary vascular pressure of the magnitude which fcllowed mitral commissurotomy in these patients do not consistently alter pulmonary compliance.
RENAL
AUTOR~GULATION.
Harris B. Shumacker, M.D. Center,
Indianapohs,
Gus~auo Bounous, M.D. and Indiana University Medical
Ind.
Relative renal autoregulation is confirmed by direct measurement of renal flow in normal dogs, in animals in which renal flow is increased by the intravenous admirristration of dextrose and in animals made acutely hypovolemic. Autoregulation is abolished by renal decapsulation.
THE NORMAL CHILDREN
QRS
FROM
VECTORCARDIOGRAM
BIRTH
TO FIFTEEN
IN
YEARS.
INFANTS
AND
Homobono B. and Ray W.
Calleja, M.D., Raymond E. Barker, M.D. White Cross Hospital, Kissane, M.D., F.A.C.C. Ohio State Ohio.
University
College
of Medicine,
and the Columbus,
Previous studies on the normal vectorcardiograms of infants and children have been limited to specific age This study included the period of infancy and groups. childhood from birth to fifteen years, inclusive. Using an apparatus similar to that of Shillingford and Rrigden and employing the cube system of Grishman, 166 QRS vectorcardiograms of 154 patients with normal hearts were taken and analyzed according to morphology and rotation of the loop and position of the 0.02, 0.03, The age of 0.04 and 0.05 second instantaneous vectors. the patients ranged from birth to fifteen years, inclusive. Six patients were followed up with serial vectorcardiograms through their “transition” period. The horizontal plane was found to be most informative in following the progression of the loop from birth to fifteen years. The progression of the loop was conveniently divided Group 1 consisted of infants aged into three age groups. from birth to one month. The QRS loop in this group showed considerable variation with transition forms beginning as early as the first three days of life. The 0.02 and 0.03 second vectors were directed anteriorly, either to the right or to the left. The 0.04 second vector was widely scattered, while the 0.05 second vector was near or at the E point. Group 2 included patients aged from one month to one year. Figure of eight patterns were common. Group 3, patients aged from one year to fifteen years, showed all counterclockwise rotation in the horizontal plane. Some figure of eight patterns were seen up to ten years Normal adult pattern was seen but none later. The 0.02 and 0.03 second from ten to fifteen years. vectors were directed to the left and anteriorly, while MAY
1960
the 0.04 and 0.05 second
vectors
were
directed
to the
left and posteriorly. THE
CURRENT
PARTICULAR
STATUS
Failey, Jr., .V.D. tine,
OF
REFERENCE
Indianapolis,
BILE TO
Indiana Ind.
ACID
ME’I’ABOLISLI
CHOLESTEROL.
University
School
WITH
Robert B. of Mc-di-
The bile acids are presently considered the final oxidation product of cholesterol and as such represent an important means for the excretion of cholesterol. Analysis for its bile acid content of gallbladder bile obtained at autopsy showed variability in composition with changes in the degree of atherosclerosis. Specifically, the ratio of dihydroxycholanic to trihydroxycholanic acid rose as atherosclerosis increased. Further study of this correlation was suggested in particular because deoxycholic acid, an important component of the dihydroxy group, has been shown to be a product of bacterial action in the intestine. Antibiotic therapy appropriate to alter the bile acid content of the intestinal contents has been followed by lowering of the serum cholesterol in man and animals. Since feeding of diets rich in linoleic acid also lowers the ratio of dihydrosy- to trihydroxycholanic acid, an important, although presently unexplained, correlation may be involved in this aspect of cholesterol metabolism. As they are excreted into the bile, bile acids are onjugated with either of the amino acids, glycinc and taurine. Taurine, an organic sulfur compound, is of particular interest because it is the predominant conjugate found in animals low in the evolutionary scale. Among the various species of animals surveyed, there appears to be a rough correlation between “immunity” to atherosclerosis and the percentage of taurine conjugaPreliminary studies have shown that tion of bile acids. nicotinic acid, used as an agent to lower strum cholesterol levels in man, enhances taurine coqjugation. The significance of this and other aspects of bile acid metabolism are under current investigation with particular reference to their relationship to cholesterol mrtabolism. IIIGH
SERUM
TRANSAMINASE
LEVELS
FOLLOWING
MY”-
.Ma.Yu,ell L. Gelfand, M.D., F.A.C.C. and Robert Fishbeuz. .\f.D. NtYV CARDIAL
York,
INFARCTION
WITH
RECOVERY.
N. Y.
Recently we have observed eight patients with myocardial infarction and serum transaminase levels ranging from over 500 to 1,800 units, who recovered. In the one patient with marked elevation who subsequently died, autopsy revealed an underlying pancreatic carcinoma with metastases to the liver. Furthermore, all the electrocardiograms of this group were analyzed and found to be as extensively involved as was to have been expected from the rise in the serum transaminase level. The purpose of this paper is to present these cases and to emphasize that although SGOT levels are extremely useful in indicating the degree of myocardial necrosis, marked elevations are not necessarily incomWhen serum levels rise following patible with recovery. a previously noted decline, however, this may indicate not only extension of the original infarction but also possible hepatic involvement, either primary or secondary. We are likewise convinced that the changes in the electrocardiogram are proportional to the elevated st=rum transaminase level.
Abstracts decreased from 72/29 to 60/22 mm. Hg (group mean); left atria1 pressure (three patients), from 38/22 to 20/9 ; and pulmonary compliance increased from 0.053 to 0.062 water. The change in compliance was of L./cm. variable magnitude, not correlated with the magnitude of the change in pulmonary artery pressure and, for However, the group, was not statistically significant. two subjects whc manifested increases in compliance (decreased lung stiffness) of 50 and 100 per cent were among those with the most marked decrease in pulmonary artery pressure. It is concluded that changes in pulmonary vascular pressure of the magnitude which fcllowed mitral commissurotomy in these patients do not consistently alter pulmonary compliance.
RENAL
AUTOR~GULATION.
Harris B. Shumacker, M.D. Center,
Indianapohs,
Gus~auo Bounous, M.D. and Indiana University Medical
Ind.
Relative renal autoregulation is confirmed by direct measurement of renal flow in normal dogs, in animals in which renal flow is increased by the intravenous admirristration of dextrose and in animals made acutely hypovolemic. Autoregulation is abolished by renal decapsulation.
THE NORMAL CHILDREN
QRS
FROM
VECTORCARDIOGRAM
BIRTH
TO FIFTEEN
IN
YEARS.
INFANTS
AND
Homobono B. and Ray W.
Calleja, M.D., Raymond E. Barker, M.D. White Cross Hospital, Kissane, M.D., F.A.C.C. Ohio State Ohio.
University
College
of Medicine,
and the Columbus,
Previous studies on the normal vectorcardiograms of infants and children have been limited to specific age This study included the period of infancy and groups. childhood from birth to fifteen years, inclusive. Using an apparatus similar to that of Shillingford and Rrigden and employing the cube system of Grishman, 166 QRS vectorcardiograms of 154 patients with normal hearts were taken and analyzed according to morphology and rotation of the loop and position of the 0.02, 0.03, The age of 0.04 and 0.05 second instantaneous vectors. the patients ranged from birth to fifteen years, inclusive. Six patients were followed up with serial vectorcardiograms through their “transition” period. The horizontal plane was found to be most informative in following the progression of the loop from birth to fifteen years. The progression of the loop was conveniently divided Group 1 consisted of infants aged into three age groups. from birth to one month. The QRS loop in this group showed considerable variation with transition forms beginning as early as the first three days of life. The 0.02 and 0.03 second vectors were directed anteriorly, either to the right or to the left. The 0.04 second vector was widely scattered, while the 0.05 second vector was near or at the E point. Group 2 included patients aged from one month to one year. Figure of eight patterns were common. Group 3, patients aged from one year to fifteen years, showed all counterclockwise rotation in the horizontal plane. Some figure of eight patterns were seen up to ten years Normal adult pattern was seen but none later. The 0.02 and 0.03 second from ten to fifteen years. vectors were directed to the left and anteriorly, while MAY
1960
the 0.04 and 0.05 second
vectors
were
directed
to the
left and posteriorly. THE
CURRENT
PARTICULAR
STATUS
Failey, Jr., .V.D. tine,
OF
REFERENCE
Indianapolis,
BILE TO
Indiana Ind.
ACID
ME’I’ABOLISLI
CHOLESTEROL.
University
School
WITH
Robert B. of Mc-di-
The bile acids are presently considered the final oxidation product of cholesterol and as such represent an important means for the excretion of cholesterol. Analysis for its bile acid content of gallbladder bile obtained at autopsy showed variability in composition with changes in the degree of atherosclerosis. Specifically, the ratio of dihydroxycholanic to trihydroxycholanic acid rose as atherosclerosis increased. Further study of this correlation was suggested in particular because deoxycholic acid, an important component of the dihydroxy group, has been shown to be a product of bacterial action in the intestine. Antibiotic therapy appropriate to alter the bile acid content of the intestinal contents has been followed by lowering of the serum cholesterol in man and animals. Since feeding of diets rich in linoleic acid also lowers the ratio of dihydrosy- to trihydroxycholanic acid, an important, although presently unexplained, correlation may be involved in this aspect of cholesterol metabolism. As they are excreted into the bile, bile acids are onjugated with either of the amino acids, glycinc and taurine. Taurine, an organic sulfur compound, is of particular interest because it is the predominant conjugate found in animals low in the evolutionary scale. Among the various species of animals surveyed, there appears to be a rough correlation between “immunity” to atherosclerosis and the percentage of taurine conjugaPreliminary studies have shown that tion of bile acids. nicotinic acid, used as an agent to lower strum cholesterol levels in man, enhances taurine coqjugation. The significance of this and other aspects of bile acid metabolism are under current investigation with particular reference to their relationship to cholesterol mrtabolism. IIIGH
SERUM
TRANSAMINASE
LEVELS
FOLLOWING
MY”-
.Ma.Yu,ell L. Gelfand, M.D., F.A.C.C. and Robert Fishbeuz. .\f.D. NtYV CARDIAL
York,
INFARCTION
WITH
RECOVERY.
N. Y.
Recently we have observed eight patients with myocardial infarction and serum transaminase levels ranging from over 500 to 1,800 units, who recovered. In the one patient with marked elevation who subsequently died, autopsy revealed an underlying pancreatic carcinoma with metastases to the liver. Furthermore, all the electrocardiograms of this group were analyzed and found to be as extensively involved as was to have been expected from the rise in the serum transaminase level. The purpose of this paper is to present these cases and to emphasize that although SGOT levels are extremely useful in indicating the degree of myocardial necrosis, marked elevations are not necessarily incomWhen serum levels rise following patible with recovery. a previously noted decline, however, this may indicate not only extension of the original infarction but also possible hepatic involvement, either primary or secondary. We are likewise convinced that the changes in the electrocardiogram are proportional to the elevated st=rum transaminase level.