Plasma estrone, prolactin, neurophysin, and sex steroid-binding globulin in chronic alcoholic men.

The feminization frequently observed in men with alcoholic liver disease has not been satisfactorily explained by existing reports. We have measured plasma estrone, prolactin, estrogen-stimulated neuorphysin, and sex steroid-binding globulin concentrations in 50 men with chronic alcoholism and varying degrees of alcoholic liver disease in an effort to further elucidate possible hormonal mechanisms responsible for the observed feminization. Plasma concentrations of each of these parameters were at least two-fold elevated (p smaller than or equal to 0.01) when compared to values obtained for the same steroid or protein in plasma obtained from normal men. The plasma concentrations of estrone and prolactin in men studied with synecomastia were significantly greater (p smaller than or equal to 0.01 and p smaller than or equal to 0.05, respectively) than were the concentrations of these two hormones in those without this physical sign. Similarly, those men with spider angiomata had significantly greater (p smaller than or equal to 0.01) plasma estrone levels than did the men without this cutaneous vascular abnormality. These significant hormone elevations may contribute to the pathogenesis of feminization so frequently observed in chronic alcoholic men.     

Comparison of glucose,fructose, sorbitol,and xylitol utilization in humans during insulin suppression

During fructose, sorbitol, and xylitol perfusions, carbohydrate utilization was studied by continuous indirect calorimetry and compared with glucose utilization during pharmacologic inhibition of endogenous insulin secretion. The experiment was performed in 28 normal volunteers divided into 5 groups (glucose, fructose, sorbitol, xylitol, and saline), each subject being its own control. Insulin suppression was obtained by means of a constant infusion of epinephrine (6 μg/min) and propranolol (0.08 mg/min). After 90 min, during plasma insulin steady state, each sugar or polyol was infused at a rate of 6 mg/kg/min for 120 min. In contrast with a rise in plasma glucose from 161 ± 6 mg/dl to 291 ± 14 mg/dl during glucose infusion, glucose levels remained unchanged during infusion of the glucose substitutes. Carbohydrate oxidation showed a rise of 24, 65, 76, and 44 mg/min during infusions of glucose, fructose, sorbitol, and xylitol, respectively. Lipid oxidation rates decreased by 7, 20, 33, and 23 mg/min during the same infusions. These results indicate that fructose, sorbitol, and xylitol are oxidized at a higher rate than glucose during suppression of endogenous insulin secretion, without any significant rise in glycemia.     

Diet,pregnancy, and lactation: Effects on adipose tissue,lipoprotein lipase,and fat cell size

Adipose tissue fat cell size and lipoprotein lipase (LPL) activity were determined in the retroperitoneal and subscapular depots of nonpregnant, pregnant, and postpartum rats fed either a standard laboratory diet or a high-fat diet containing 55% fat by wieght. High-fat feeding for 20 days increased, in nonpregnant rats, fat cell size and LPL activity two-to threefold in both depots. In pregnant rats at term, fat cell size was increased and LPL activity was depressed in both dietary groups. Twenty days postpartum, both retroperitoneal fat cell size and LPL activity were decreased in proportion to the size of the litter. Rats not allowed to lactate had fat cell sizes and LPL activity that were not significantly different than in nonpregnant controls. Fat cell size and LPL activity in rats nursing four pups were reduced to 77% and 36% of control, respectively. Those nursing a normal-sized litter of eight pups demonstrated a further reduction of fat cell size to 38% and of LPL activity to 2% of nonpregnant control values. High-fat feeding and obesity did not prevent the fat loss and decreased LPL activity associated with lactation; fat cell size was decreased to 61% and LPL activity to 3% of control values. Values for the subscapular depot followed essentially the same pattern as that observed for the retroperitoneal depot. Mammary LPL activity was increased more than tenfold in animals nursing four or eight pups compared with values at term, whereas no activity was detected in rats not allowed to lactate.     

Effect of hemodialysis on contact group of coagulation factors,platelets, and leukocytes

Earlier reports have suggested possible activation and consumption of factor XII during hemodialysis. To investigate this possibility, a series of in vivo and in vitro experiments were conducted using different dialysis membranes and two different dialysates (acetate and bicarbonate). Factors XII and XI activities, factor XII concentration, and high-molecular-weight kininogen were measured. In addition, platelet count, white blood cell count, and hematocrit were monitored. Contrary to the previous reports, no discernible consumption of factor XII, factor XI, or high-molecular-weight kininogen was found irrespective of the type of membrane or the composition of the dialysate used. Transient leukopenia was noted with cellulosic membranes, whereas none occurred with polyachrylonitrile dialyzers. The composition of dialysate did not affect the white blood cell count during dialysis.     

Hemodynamic,electrocardiographic, and metabolic effects of fructose diphosphate on acute myocardial ischemia

The hemodynamic, electrocardiographic, and metabolic responses of dogs with acute myocardial ischemia to intravenous administration of fructose-1,6-diphosphate (FDP) were assessed.Analysis of the results (compared to dextrose control) revealed evidence of major improvement of LVEDP and cardiac output, significant decrease of the ST segment, and large increases of ATP and CP in the ischemic district and to a lesser degree in the normally perfused myocardium. These results indicate that FDP intervenes in the Embden-Meyerhof pathway not only as a high energy substrate but also as a metabolic regulator influencing the activity of phosphofructokinase and that of pyruvate kinase. FDP also stimulates glycolysis in dog erythrocytes and increases their ATP and 2–3 DPG content by a factor of 2.The most significant finding in these studies is that this biochemical intervention appears to restore the depressed activity of glycolysis in ischemic myocardium.     

Mineralocorticoid-induced blood pressure, electrolyte, and hormone changes, and reversal with spironolactone, in healthy men.

The pathophysiology of mineralocorticoid-induced hypertension is not clear, and the factors determining renal “escape” remain to be defined. In an attempt to clarify these unknowns, the effect of 9-alpha-fludrocortisone on blood pressure was studied in six healthy males on fixed sodium and potassium intakes. Systolic blood pressure increased by 10 mm Hg after 10 days of fludrocortisone therapy, and supine mean pressure rose by 6 mm Hg. During fludrocortisone administration, the increments of systolic blood pressure in individual subjects were negatively correlated with weight gained, the amount of sodium retained, and the degree of hypokalemia. Renal “escape” from the sodium-retaining influence of fludrocortisone was not determined by the amount of sodium retained, but was closely related to the rise in systolic blood pressure during the first 48 hr of treatment. A more pronounced rise in blood pressure was associated with earlier renal “escape”. Spironolactone therapy reversed the mineralocorticoid-induced abnormalities (increased body weight, rise in systolic blood pressure, fall in total body potassium, and decline in plasma renin concentration) in a dose-response manner. The results show that the hypertension resulting from fludrocortisone administration in normal man is not a function of expansion of the total body sodium content, and the renal “escape” appears to relate to the early development of hypertension rather than to the amount of sodium retained.     

Net metabolic changes of zinc, copper, nitrogen, and potassium balances in skeletal trauma patients

Zinc, copper, nitrogen, and potassium balances of 10 male skeletal trauma patients were determined over 5-6 days each. Nutrition consisted of electrolyte/glucose and/or blood/blood product infusions. Patients were started on balance studies within 24 hr following injury. Zinc and copper were analyzed by atomic absorption while nitrogen was measured by the microKjeldahl technique and potassium by flame photometry. The mean daily balances for these patients were -1563 micrograms zinc, -266 micrograms copper, -20.0 g nitrogen and -29 mEq potassium for 5 patients receiving electrolyte/glucose infusions and +1273 micrograms zinc, +322 micrograms copper, -12.9 g nitrogen, and -26 mEq potassium for 5 patients receiving blood/blood products in addition to electrolyte/glucose. Routine daily maintenance supplementation of 2 mg zinc and 2 mg copper is recommended for skeletal trauma patients on electrolyte/glucose and those on electrolyte/glucose with blood/blood products intravenous infusions. Further balance studies are necessary to ascertain the level of zinc and copper supplementation needed by skeletal trauma patients receiving different nutritional support.     

Cross-sectional echocardiography: Physical principles, anatomic planes, limitations and pitfalls

Although M mode echocardiography has achieved a prominent role in the diagnosis and management of patients with cardiovascular disease, the limited area of view afforded by M mode techniques has restricted the application of ultrasound in many areas. The development of two dimenslonal echocardiography has obviated many of the limitations inherent in the narrow view of the M mode technique. It has enabled imaging of the heart from additional transducer locations, permitted determination of shape and anatomy and provided the ability to determine motion along two axes. Several types of two dimensional echocardiographs have been developed, and each type offers both advantages and disadvantages. Although two dimensional echocardiography has provided a larger area of view with ultrasound, it has also introduced new limitations including a larger and bulkier transducer, a much reduced sampling rate and a difficult display medium (videotape). In addition, new considerations regarding ultrasonic resolution have been raised. Two dimensional techniques have resulted in new pitfalls in ultrasonic diagnosis related to instrument artifacts as well as to performance and interpretation of the examination. The spurious appearance of cardiac masses because of these ultrasonic artifacts represents a particularly prominent diagnostic pitfall that must be avoided in daily practice. It is anticipated that the new wider field of view provided by two dimensional echocardiography combined with a Standard high resolution capability of ultrasound (2 to 4 mm) will result in an increasingly large role for echocardiography in the management of patients with heart disease.     

Platelets, carotids, and coronaries. Critique on antithrombotic role of antiplatelet agents, exercise, and certain diets

"Antiplatelet" drugs and certain life styles seem to have an "antithrombotic" effect that may help protect against stroke and heart attack. This review of the experience with aspirin, dipyridamole, and sulfinpyrazone offers new interpretations of some of the major clinical trials, suggests guidelines for use of antiplatelet drugs, and integrates novel observations on diet and exercise into the "thromboxane-prostacyclin balance" hypothesis. It is argued that the Canadian stroke study showed that aspirin protects men with transient ischemic attacks from coronary death as well as from stroke, that type II errors may have been made in some clinical trials, that aspirin protects women as well as men, that aspirin benefits patients who have had a heart attack, that the effect of aspirin in angina varies with the type of angina, that the dose of aspirin used may not be critical, that guidelines for use of dipyridamole and sulfinpyrazone are still inconclusive, and that exercise and fish oil supplements may be "antithrombotic."     

Vectorcardiographic, electrocardiographic, and angiographic correlations in apparently isolated inferior wall myocardial infarction.

Twenty-six patients with ECG evidence of localized inferior myocardial infarction and poor ejection fraction (less than 50 per cent) were compared with 26 patients with similar ECG's, but with normal ejection fraction (over 50 per cent). The poor ejection fraction group had significantly more frequent and more severe disease in left anterior descending artery and a higher incidence of triple coronary obstruction than the normal ejection fraction group. The poor ejection fraction group had a significantly greater incidence of ventricular asynergy in the anterior and apical segments of left ventricle. Vectorcardiography was available in 35 of the 52 patients studied and frequently supplied diagnostic information not available in the scalar ECG's. Of 18 patients with scalar ECG patterns of isols, vectorcardiography identified five cases with anterior infarction, three with left ventricular hypertrophy, and one with left anterior hemiblock. Vectorcardiography is a valuable supplementary tool in the clinical assessment of patients with apparently isolated inferior infarction. When extensive coronary and poor ventricular function exist, VCG clues may be expected in about half the patients.     

Comparison of patients with ischemic, myopathic, and rheumatic heart diseases as cardiac transplant recipients

Fifty-four human-to-human cardiac transplants (10 orthotopic and 44 heterotopic) in 50 patients were performed between December, 1967, and December, 1981. The underlying cardiac pathology was ischemic (IHD) in 29, cardiomyopathic (CM) in 17, rheumatic (RHD) in four, and mixed or other pathology in four. Patients with RHD survived for a mean period over three times as long as those with either CM (p less than 0.02) or IHD (p less than 0.05). Although CM patients were on average over a decade younger than those in other groups, they had a lower survival rate. There was a higher incidence of death from chronic rejection in patients with IHD, in whom there was also a higher incidence of thromboembolic episodes. Major infections were over twice as frequent in IHD patients as in CM patients (p less than 0.01). Noncompliance with regard to adherence to instructions and therapy was a significant factor in morbidity and mortality, especially in CM patients. Our data suggest that survival and morbidity of recipients of heart transplants might be influenced to some extent by the nature of the underlying primary cardiac condition, RHD being considered a favorable survival factor when compared with IHD, and CM being particularly unfavorable.