Biomedical subjects
Publications and source records attributed to H Hinterberger.
The case report is presented of a 35 year-old patient with fibrosing mediastinitis. Clinically, only non-specific features were present. Radiography, computed tomography and cavography were of great importance in establishing the diagnosis and in following up the patient. Diagnosis was confirmed histologically following thoracotomy. Fibrosing mediastinitis, although a rare condition, should be considered in the differential diagnosis of mediastinal processes.
The content of 5 hydroxytryptamine and 3,4-dihydroxyphenylethylamine was measured in 8 mucosal sections over the entire expanse of 11 human stomachs obtained at post-mortem examination. It was shown that the concentration of 5-hydroxytryptamine is significantly greater in the pyloric region than in the remainder of the gastric mucosa (P < 0.001). 3,4-dihydroxyphenylethylamine also increased more than twofold near the pylorus (P < 0.05). While the presence of this catecholamine in the mucosal layer could be unequivocally established by chemical means, no definite cellular localization could be demonstrated by formaldehyde-induced fluorescent microscopy.
Marked weight reduction of rat adrenals was observed after 131I-6beta-Iodocholesterol administration whether or not the animals were treated with metapyralone. Damage or even histologic changes of the adrenals have not been found. Though the radiation dose is high with the applied dose of 131-i-6-beta-Iodocholesterol and might limit or even prevent its application in the treatment of human adrenal disease, the influence of endogenous irradiation on rat adrenals is obvious and justifies further investigations.
An unusual case of a gastric carcinoid tumour producing multiple biogenic amines is described in a patient with pernicious anaemia. Electron microscopy demonstrated two distinct types of secretory granules.
Serial plasma levels of sodium valproate were estimated in 12 epileptic patients and 10 normal subjects after a single dose of the drug, whilst random estimations were performed in another group of 32 patients already stabilised on sodium valproate. The tentative conclusions arrived at by this study were: 1) In the majority of patients and normal subjects peak plasma levels were reached by the end of the first or second hour. 2) The majority of clinically controlled subjects showed a plasma level above 40microgram/ml. 3) Similar doses of sodium valproate (mg/kg) produced higher plasma levels in normal subjects than in the epileptic patients. Whether this is an effect of other anticonvulsants the patients were taking at the same time is a matter for conjecture. 4) Dosage and plasma levels did not appear to show a close correlation. 5) Random estimation of plasma levels are of little value for monitoring therapeutic efficacy, unless timed in relation to the dose, for reasons already mentioned above.
In a series of 27 patients with proved pheochromocytoma, differential analysis of catecholamines in blood, urine, and tumor specimens of 19 patients enabled grouping of subjects into those whose tumors produced predominantly norepinephrine (NE) (11 patients), predominantly epinephrine (E [Two patients]) and approximately equal amounts of both (six patients). Sustained hypertension was more common in the first group and pallor and tremor in the latter two groups, but no distinctive syndrome could be recognized as signifying the secretion of NE or E. Headache was a symptom in 20 of 27 patients and was related to sudden, transient elevation of the blood pressure, rather than sustained hypertension. The variable duration and intensity of the headache in different patients can be explained by the pressor and cranial vasoconstrictor effects of the secreted amines, which respectively enhance and diminish vascular headache.
One hundred and forty-four human pineal glands obtained at necropsy were analysed for their content of catecholamines, indolealkylamines and calcium and the findings related to sex, age, terminal illness and medication. A preliminary study of 45 pineal organs revealed no significant differences in amine pattern in glands removed 6-48 hours post mortem. A statistically significant difference of pineal weight, calcium and amine content could not be detected in glands of age-matched groups of male and female patients who died suddenly without apparent clinical illness. A highly significant correlation between pineal weight and calcium content was established in patients older than 60 years. Considerable variability of amine levels existed in all groups of patients. Adrenaline as well as noradrenaline were detected in most glands. This finding was corroborated by the formation of radioactively labelled adrenaline from noradrenaline and 14C-S-adenosylmethionine by extracts from human pineals. Dopamine was most abundant in glands from patients dying of malignant tumours. The content of the indolealkylamines (5-hydroxytryptamine and melatonine) varied between a few nanograms to 21 mug/g tissue. The highest mean calcium content was detected in glands of patients who died of renal disease associated with hypertension.
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Excretion of the vaso-active amines tyramine, serotonin, noradrenaline, adrenaline and histamine and blood levels of serotonin, noradrenaline, adrenaline and histamine, were estimated in 10 patients before, during and after an attack of migraine. During the headache process there was a statistically significant fall in the excretion of tyramine and a similarly significant rise in the excretion of serotonin. Excretion of the other 3 amines showed no significant fluctuation during the various phases of the migraine attack. Blood levels of serotonin were significantly lower during headache than during freedom from headach. whilst whole blood histamine was significantly higher only during the postheadach phase. The meaning of the latter observation is not obvious. The above results are discussed in the light of recent reports that tyramine is the substance responsible for headache attacks in patients who have a history of dietary migraine. Reasons are offered as to why this is unlikely to be the case.
Of 27 patients with phaeochromocytoma, 20 were subject to headaches as a part of their symptom complex and 7 were not, in spite of the fact that 4 of the latter had experienced other forms of headache at other times. There was no correlation between the proportion of noradrenaline to adrenaline produced by the tumour and the presence or absence of headache or the nature of the headache. Liability to headache appeared to be linked with the rate of change in blood pressure and was not related to absolute values of blood pressure. Two patients experienced a "funny turn" typical of catecholamine release during a spontaneous migraine headache. The migraine headache became pulsatile and severe in one patient but was unaltered in the other. The variable duration and intensity of the headache in different patients can be explained by the pressor and cranial vasoconstrictor effects of the secreted amines which respectively enhance and diminish vascular headache.
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