[Electromyographic studies on myasthenic symptoms by nerve stimulation].
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Daily treatment of rats with 2,4,7-triamino-6-phenylpteridine (triamterene, Dyrenium) a potassium sparing diuretic, in daly doses of 1.5 mg, 3 mg and 4.5 mg/100 g body weight over the period of three weeks caused severe degenerative changes of renal cortical and medullary tubules resembling osmotic (sucrose) nephrosis. The undesirable side-effects were absent in the kidneys of intact rats receiving human therapeutic dose of triamterene (0.36 mg/100 g body weight) and even higher dose (1.5 mg/100 g body weight) but administered according to the prescription of treatment recommended by the manufacturer--daily over the first week and three times weekly after that. Rats .2 days after adrenalectomy administered triamterene in daily dose of 1.5 mg/100 g body weight, survived no more than 6--7 days of treatment. The results presented in this paper undoubtedly show that triamterene, although a mild diuretic agent, should be monitored in order to avoid undesirable side-effects. In addition care should be taken in patients with hypofunction of adrenal cortex.
A study of adrenocorticosteroids and corticosteroid binding globulins was undertaken in 35 malnourished children with a weight deficit of 10 to 45%. The mean corticosteroid levels 5.9 +/- 3.0 mug% were not significantly different from control values of 6.43 +/- 3.2 mug%. Steroid levels were however low (4.38 +/- 1.8 mug%) in children with marasmic kwashiorkor. The corticosteroid binding globulin was reduced to 11.9 +/- 5.4 mug of cortisol bound in malnourished children with and without edema and was significantly lower than controls. "Free cortisol" levels were significantly raised in the malnourished state. In the presence of acute infection there was a remarkable rise of steroids suggesting that there was no hypofunction of the adrenal cortex. Where the infection was chronic (e.g., pulmonary tuberculosis) the levels were normal suggesting an adaptation to the stress. Early studies of the steroids and corticosteroid binding globulins within 2 to 3 weeks of starting a high protein diet showed that there was a remarkable rise of serum albumin 2.3 +/- 0.4 to 3.3 +/- 0.7 g%, steroids from 5.9 +/- 5.5 to 12.3 +/- 7.4 and corticosteroid binding globulins from 13.0 +/- 4.1 to 20.2 +/- 6.3 mug of cortisol bound per 100 ml. Weight gain was from 0.2 to 1.0 kg. A follow-up of four children for 6 weeks showed that the steroid levels fell to within normal limits. The integrity of the hypothalamohypophyseal adrenal axis was unimpaired in five out of six children studied. In conclusion it appears that marasmic children are well adapted to the stress of malnutrition and the ability of the adrenals to respond to stress is unimpaired.
An experiment was carried out to clarify the mechanism of occurrence of arthritis in goats. In it changes of the adrenal hormones in blood and urine were examined in goats with experimentally induced arthritis. Four groups of goats were used. A goat of group B was inoculated with anaerobic Corynebacterium organisms isolated from a joint of a field case. Group H was treated with hormones (deoxycorticosterone acetate and adrenalin). Group BH was inoculated with those organisms and treated with these hormones. The other group served as an untreated control. Arthirits was induced to three of the four goats of group BH. The blood level of 11-hydroxycorticosteroids and the urine level of 17-hydroxycorticosteroids were higher in group BH than in any other group at the time of appearance of clinical signs. The hypofunction of the adrenal cortex was seen in two of three goats with induced arthritis. Serotonin increased transitorily in group BH around the time of appearance of clinical signs, but there was finally no difference in its level among goats with or without induced arthritis. There was no definite tendency in the fluctuation of level of adrenalin or noadrenalin.
Various conditions of the adrenal gland are amenable to surgical treatment. Removal of a pheochromocytoma is almost always indicated when the tumor is diagnosed. The results of extirpation have been excellent in cases in which patients were operated upon before the onset of chronic hypertension. Removal of the "nerve cell" tumors of the adrenal is indicated if metastasis cannot be demonstrated. Hypofunction of the adrenal cortex may be partially alleviated by the repeated implantation of pellets of desoxycorticosterone acetate. Hyperfunction of the adrenal cortex causes a variety of clinical manifestations depending upon which of the numerous hormones are affected. Removal of a cortical tumor alleviates these symptoms. These tumors are malignant in more than 50 per cent of cases, and recurrence is frequent. Bilateral hyperplasia of the glands rather than a tumor may be present. In such circumstances, resection of 95 per cent of the adrenal tissue is effective in controlling the symptoms of the disease. Total bilateral excision of the adrenals is, at present, under investigation as a means of treatment for a variety of conditions.