Serotonin metabolism with idiopathic grand mal seizures

Summary Serotonin was determined in platelets of 140 patients with idiopathic grand mal seizures. According to anticonvulsive therapy these patients were divided into the following five groups: no medication, Diphenylhydantoin, Diphenylhydantoin calcium, Primidon, and combination of various of the anticonvulsants mentioned. The results obtained in the entire group of patients as well as in the various subgroups were compared with those of a group of healthy persons without therapy. In addition the various subgroups were compared to each other.There were significantly reduced serotonin values in the patients with idiopathic grand mal seizures as well as in each of its various groups as compared with the values obtained in healthy persons. Furthermore, significantly higher values were observed in the patients receiving primidone as compared with those receiving no anticonvulsants, Diphenylhydantoin, and a combination of various anticonvulsants.Our results taken together with those reported in the literature point to the possibility that a special imbalance in the cerebral neurotransmitter system, including a deficiency of serotonin, may represent a pathogenetic factor for idiopathic grand mal seizures. In addition, this investigation indicates that primidone elevates serotonin in platelets of patients with grand mal seizures.

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Zusammenfassung Der Serotoningehalt von Thrombocyten wurde bei 140 Patienten bestimmt. Entsprechend der antikonvulsiven Therapie wurde diese Patientengruppe in folgende 5 Untergruppen unterteilt: keine Medikamente, Diphenylhydantoin, Diphenylhydantoin-Calcium, Primidon und Kombination verschiedener der obengenannten Medikamente. Die Ergebnisse bei dieser Gruppe bzw. den einzelnen Untergruppen wurden mit jenen einer Gruppe gesunder Personen ohne Therapie verglichen. Weiterhin wurden die verschiedenen Untergruppen miteinander verglichen.Die Ergebnisse zeigen signifikant reduzierte Serotoninwerte in der Gruppe mit idiopathischen Grand-mal-Anfällen und ebenso in den einzelnen Untergruppen im Vergleich zu Werten, die bei gesunden Personen gefunden wurden. Weiterhin zeigten sich signifikant höhere Serotoninwerte bei den mit Primidon behandelten Patienten im Vergleich zu jenen Patienten, die keine antikonvulsive Therapie erhielten, mit Diphenylhydantoin oder einer Kombination verschiedener Antikonvulsiva behandelt wurden.Unsere Ergebnisse in Verbindung mit jenen der Literatur deuten auf die Möglichkeit hin, daß ein spezielles Ungleichgewicht im zerebralen Neurotransmitter-System einschließlich einem Mangel an Serotonin als pathogenetischer Faktor bei idiopathischen Grand-mal-Anfällen von Bedeutung ist. Weiterhin weisen unsere Untersuchungen darauf hin, daß Primidon den Serotoningehalt von Thrombozyten bei Patienten mit idiopathischen Grandmal-Anfällen anhebt.

     

Adenylate cyclase activity of avian granulosa: Effect of gonadotropin-releasing hormone

The activity of adenylate cyclase in crude and purified preparations of hen granulosa was investigated by measuring the production of cyclic AMP during a 20-min incubation at 30°. Both NaF and guanosine 5′-β,γ-imidotriphosphate (Gpp(NH)p), the nonhydrolyzable analog of GTP, stimulated enzyme activity in a dose-related manner. Ovine LH and, to a lesser extent, ovine FSH also activated adenylate cyclase in the presence of half-maximally stimulating concentrations of Gpp(NH)p (10^?7M). Gonadotropin-releasing hormone (10^?10–10^?4M) failed to significantly affect basal- or gonadotropin-promoted adenylate cyclase activity or the production of cyclic AMP by intact granulosa cells. Progesterone production, on the other hand, was enhanced by gonadotropin-releasing hormone (GnRH) (10^?8–10^?6M). It is suggested that in chicken granulosa cells, as in the mammalian pituitary cells, the adenylate cyclase/cyclic AMP system is not a mediator of GnRH action.     

Continuous bilateral electrophrenic pacing in an infant with total diaphragmatic paralysis.

An infant with bilateral diaphragmatic paralysis, etiology undetermined, is presented in whom bilateral intrathoracic phrenic nerve pacemakers were inserted. He was maintained with continuous bilateral electrophrenic pacing for 142 days. A review of the literature by the authors has not revealed any previously reported cases.     

Nitroglycerin treatment following experimental coronary occlusion

The effect of sublingual (0.2 mg.) nitroglycerin (TNG) was studied in anesthetized dogs before and after coronary occlusion. Coronary artery occlusion was accomplished by embolization of the circumflex branch of the left coronary artery. TNG was administered before embolization and again at one minute, one, two, and six hours after embolization. TNG treatment did not significantly increase the number of arrhythmias or deaths compared to untreated animals with coronary occlusion. Hemodynamic and blood biochemical parameters were measured 5 to 15 minutes after TNG treatment. At this time of measurement, blood pressures (AO, LV, LA, PA, RV, RA), cardiac output, pulmonary and systemic resistances, and left ventricle work were not significantly different in the TNG-treated group compared to the animals with coronary occlusion but no TNG treatment. In the first five minutes after TNG administration, aortic pressure is reduced. Blood samples withdrawn five minutes after TNG treatment are not significantly different from the untreated animals in Po₂, Pco₂, pH, glucose, lactate, pyruvate, free fatty acids, LDH, CPK, and SGOT. It is concluded that TNG is not detrimental to animals with acute coronary occlusion and that TNG has a transient, short-duration effect.     

Massive Arterial Air Embolism Due to Rupture of Pulsatile Assist Device: Successful Treatment in the Hyperbaric Chamber

We present the case of a patient who had rupture of a pulsatile assist device (PAD) accompanied by massive air embolism, and the treatment that brought it to a successful outcome. After rupture of the skin of the PAD balloon, a massive amount of air was injected into the ascending aorta. The patient was placed in Trendelenburg position and cooled in deep hypothermia with cardiopulmonary bypass. He was given 1 gm of methylprednisolone intravenously, and the aortic valve replacement and double vein bypass graft were performed.After completion of the operation, the patient was partially rewarmed to 30°C central temperature and transported by ambulance to a hyperbaric chamber where he was compressed to 6 atmospheres absolute 9 hours after the accident with clinical signs of severe brain dysfunction. The patient recovered completely and was discharged from the hospital on the tenth postoperative day.     

Coronary Venous Arterialization: Acute Hemodynamic,Metabolic, and Chronic Anatomical Observations

Nine dogs that had anastomosis of the internal mammary artery (IMA) to the left anterior descending coronary vein (LADV) were studied acutely on right-heart bypass. Occlusion of the left anterior descending coronary artery (LADA) and LADV without venous arterialization resulted in a significant decline in stroke work, total coronary flow, and myocardial oxygen uptake; with reactive hyperemia an increase in lactate and pyruvate consumption resulted. Occlusion of the LADA and LADV with VA did not change these variables greatly, except for a marked increase in total coronary flow with reactive hyperemia.Chronic venous arterialization in 14 dogs was associated with a 14% mortality, while 10 controls had a 40% mortality. Dogs were killed at six weeks, and prior angiography in 9 showed patency of the IMA to the heart without filling of cardiac veins. All dogs had infarcts in the distribution of the LADA; these infarcts were smaller in dogs with venous arterialization. The anastomoses were obliterated by mature or maturing fibrous tissue, with alteration of the vein so that it was frequently not discernible, while the IMA was well preserved. Distal veins had foci of intimal proliferation, subintimal fibrosis, and medial hypertrophy.Although venous arterialization provides protection for the acutely ischemic myocardium, this effect does not persist, perhaps because of anastomotic occlusion due to fibrous proliferation.