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Biomedical subjects

D O Hakanson

Publications and source records attributed to D O Hakanson.

At least 19 recordsLinked to original sources

Melatonin: the dark force.

Although the pineal gland was described 2,300 years ago, its functions remained obscure and productive research was limited until 1958, when Lerner and associates defined melatonin. In 1965 Wurtman and Axelrod advanced the "melatonin hypothesis," according to which the pineal gland acts as a transducer responding to changes in circumambient light by changing its rates of melatonin output. Sites and mechanisms of melatonin action are still poorly understood. Two consistent effects are the induction of sleep and an antigonadotropic influence on reproductive structure and behavior. The former is demonstrable and clinically useful in human subjects; the latter has been shown in birds, rodents, and sheep. Alteration of skin color by the contraction of melanophores was effected by pineal extracts before the discovery of melatonin. This phenomenon, seen in reptiles, amphibians, and fish, has received little recent attention. Areas of greater interest and potential importance include the antimitotic effects of melatonin on some types of tumor cells in culture and the apparent in vivo protection of immunocompetent lymphocytes during chronic stress, which reduces the functional capacity of lymphocytes in control rodents. Clinical application of the antimitotic and immunosupportive properties of melatonin seems likely in the near future. Unfortunately, this innocent molecule has been touted in two recent books and many advertisements as an aphrodisiac, rejuvenator, protector against disease, and general wonder-worker. Because interest in melatonin is high, all physicians can expect questions and may have use for the information provided in this review.

Animals↗

Pineal and adrenal effects on calcium homeostasis in the rat.

In human infants and newborn rats, white light at the intensity used to treat hyperbilirubinemia lowers serum calcium concentration. Occipital shielding or (in newborn rats) exogenous melatonin prevents this effect. Propranolol, by inhibiting melatonin synthesis, also causes hypocalcemia, which is preventable by melatonin. Metyrapone or adrenalectomy prevents hypocalcemia after light exposure or propranolol. Exogenous corticosterone lowers serum calcium; this is prevented by supplementary melatonin. In adult rats, the change in calcium after light, propranolol, or corticosterone is minimal. After parathyroidectomy or a diet with a high calcium/low phosphorus ratio, the hypocalcemic effect of these three agents is restored. Bone samples removed after light exposure or corticosterone administration show increased calcium uptake; this is blocked by supplementary melatonin in vivo or by addition of melatonin to the incubation medium. We postulated that the hypocalcemic effect of light or propranolol was due to an acute increase in corticosterone-mediated bone calcium uptake when circulating melatonin was decreased by reduction of the rate of melatonin synthesis. In our study, pinealectomized rats showed no change in serum calcium after light or propranolol; their hypocalcemic response to corticosterone was greater than that of sham-operated controls. Exogenous parathyroid hormone prevented light-induced hypocalcemia in newborn rats.

Adrenal Glands↗

The inaccuracy of Apgar scoring.

A short Apgar quiz was prepared with eight descriptive neonatal cases. The quiz was completed by 223 health professionals caring for newborns. Pediatricians and pediatric housestaff, the most accurate scorers, assigned the correct score only 68% of the time. Nurses from community hospitals were only 24% accurate. Improper scoring limits the usefulness of the Apgar score in comparing neonates within and between hospitals.

Apgar Score↗

Calcemic responses to photic and pharmacologic manipulation of serum melatonin.

Phototherapy of newborn rats (NBR) resulted in a decrease in serum calcium and melatonin levels. Transcranial light penetrance in NBR increased with wavelength. Below 640 nm (penetrance = 6.9%), no hypocalcemic effect could be demonstrated. Shielding the occiput of NBR prevented a decrease in serum calcium during phototherapy and substantially reduced the decrease in melatonin found in unshielded NBR. Intraperitoneal injection of propranolol, an inhibitor of melatonin synthesis, caused a decrease in serum calcium in shaded NBR. In contrast, when melatonin was injected with propranolol a decrease in serum calcium did not occur. Additionally, intraperitoneal isoproterenol before phototherapy protected against a decrease in serum calcium. These data are consistent with an hypothesis that a decrease in serum calcium during phototherapy results from transcranial photic inhibition of melatonin synthesis.

Animals↗

Massive thymic hyperplasia in an infant with Beckwith-Wiedemann syndrome.

We report the clinical and postmortem findings in a newborn with Beckwith-Wiedemann syndrome and pulmonary hypoplasia. The infant was found to have a massively enlarged thymus gland that apparently caused pulmonary hypoplasia and respiratory insufficiency. Massive hyperplasia of the thymus gland should be considered in the differential diagnosis of respiratory distress in the Beckwith-Wiedemann syndrome.

Adrenal Glands↗

Phototherapy-induced hypocalcemia in newborn rats: prevention by melatonin.

When young rats are exposed to white fluorescent light the concentration of calcium in their serum decreases. This effect is prevented by shielding the occiput, by inhibiting corticosterone synthesis, and by exogenous melatonin. Furthermore, the expected hypocalcemic response to cortisol injection is prevented by melatonin. Light-induced hypocalcemia may result from increased calcium uptake by bone when the blocking effect of melatonin decreases after pineal inhibition by transcranial illumination.

Animals↗

Early development of infants of birth weight less than 1,000 grams with reference to mechanical ventilation in newborn period.

Growth, development, and neurologic status were assessed at 1 year of age in 38 infants of birth weight less than 1,000 gm who were born in 1976 through 1978. Twenty had received mechanical ventilation as newborns, and this group had a significantly higher incidence of respiratory distress syndrome, seizures, cardiac arrest, bronchopulmonary dysplasia, and retrolental fibroplasia than those not ventilated. The ventilated infants had a high incidence (70%) of bronchopulmonary dysplasia and of retrolental fibroplasia (20% grade III or IV). Seven of eight infants with severe developmental delay (greater than 2 SD), six of nine with moderate delay (greater than 1 SD), and seven of eight with neurologic disability had received ventilation. There was no difference in growth between the ventilated and nonventilated children. Of the total group, 53% showed no problems.

Bronchopulmonary Dysplasia↗

Hyperviscosity in the small-for-gestational age infant.

Small-for-gestational age infants are prone to hyperviscosity but the precise incidence in unknown. A prospective survey was conducted on 4,974 consecutive livebirths for hyperviscosity in small-for-gestational age infants. Small-for-gestational age is defined as birth weight below the 10th percentile of the intrauterine growth curve and signs of malnutrition and hyperviscosity as venous blood viscosity (measured by a microviscometer) above the 2 SD of the norm. 79 infants were identified as small-for-gestational age. Of these, 14 were hyperviscous and 65 were normoviscous. The venous hematocrit range from 61 to 70% in hyperviscous and 37 to 62% for normoviscous. A predefined symptom complex referrable to cardiovascular, respiratory, gastrointestinal, and central nervous system were assessed by an unbiased observer; 57% of hyperviscous and 25% of normal viscous infants were symptomatic (p less than 0.05 by chi 2). The data indicate that the hyperviscosity syndrome occurs in 17.7% of small-for-gestational age infants; venous hematocrit (64%) is predictive of hyperviscosity, and that in spite of a positive correlation between symptom complex and hyperviscosity, there is a lack of specificity for the clinical manifestation of this neonatal complication.

Birth Weight↗

Necrotizing enterocolitis and hyperviscosity in the newborn infant.

During a one-year prospective survey to determine the incidence of hyperviscosity in small-for-gestational age infants, we found a significant increase in the incidence of necrotizing enterocolitis in SGA infants with HV. Of the 14 SGA infants with HV, five developed NEC, and of 65 SGA infants with normal blood viscosity,one had NEC (p less than 0.005). Comparison of clinical features of the five HV infants with NEC with those reported in the literature showed that the infants with HV and NEC had had longer gestational periods and higher weights and, in contrast to those reported in the literature, were free of clinical evidence of asphyxia distress. The respiratory disorders have been proposed as the clinical events that might lead to ischemia of the intestine and subsequently to NEC. It is proposed that HV may be another factor leading to ischemia in the gastrointestinal tract with subsequent development of NEC.

Blood Viscosity↗

Foam-stability test on gastric aspirate and the diagnosis of respiratory-distress syndrome.

Gastric aspirate, collected from 79 infants within 30 minutes of birth, was subjected to the foam-stability test. The lecithin/sphingomyelin ratio was determined in 27. The results were compared with the incidence of respiratory-distress syndrome as determined independently by different investigators. Of the 59 infants with a positive foam-stability test on gastric aspirate, three had transient respiratory distress, and one the respiratory-distress syndrome; 17 of 22 had lecithin/sphingomyelin ratios greater than 2.0. Of nine infants who had intermediate test results, three were normal, four had transient respiratory distress, and two had the respiratory-distress syndrome. In all the 11 infants with negative foam-stability tests the respiratory-distress syndrome developed. The three gastric aspirates tested in this group had lecithin/sphingomyelin ratios of less than 1.5. These data indicate that the foam-stability test on gastric aspirate is a reliable index of fetal lung maturity in infants whose amniotic fluid is not available.

Amniotic Fluid↗