[Thymic lymphocyte subpopulations and myasthenia gravis (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Miyata.
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The effect of pancreatoduodenectomy on insulin secretion was determined in seven patients with periampullary malignant tumors. As a uniform stimulus for secreting insulin, 100 gm of glucose was administered orally to all patients and glucose tolerance tests were carried out. Glucose intolerance and poor insulin secretion were obvious both pre- and postoperatively. Indexes of an initial insulin response, of a maximum insulin increment, and of total secretion of insulin responding to the stimulus of glucose were significantly lower in these patients before and after pancreatoduodenal resection, as compared with normal subjects. It was also observed that these three indexes, which express the ability of the pancreas to secrete insulin, decreased without exception after pancreatoduodenectomy. In light of these data it is postulated that radical pancreatoduodenectomy further diminishes the already insufficient secretion of insulin indicated by the oral glucose tolerance test in patients with periampullary malignant tumors.
A rapid intravenous glucose load (20 g) was given with a phentolamine infusion during and after elective abdominal surgery. Plasma levels of glucose, free fatty acids, and insulin were measured to investigate the influence of surgical stress on insulin secretion. When Ringer's lactate solution was infused into a control group of subjects during surgery, plasma levels of insulin did not change during and after the surgery while plasma levels of glucose and free fatty acids increased gradually during this period. Similar results were also noted in another control group in whom only Ringer's lactate solution and phentolamine had been infused. This evidence suggests that insulin secretion responding to endogenous hyperglycemia is suppressed during surgery. In the group which was given the glucose load during infusion of only Ringer's lactate solution, plasma levels of insulin significantly increased soon after the glucose load and the gradually decreased. In another group which was given the glucose load during infusion of Ringer's lactate and phentolamine, plasma levels of insulin also increased significantly after the glucose load and remained elevated during surgery. The maximum increment of plasma insulin after the glucose load in the latter group was significantly higher than that in the former group. From these results it is suggested that suppression of insulin secretion by surgical stress is inhibited by the alpha blocking agent phentolamine.
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Effects of surgical stress under the same general anesthesia (nitrous oxide, oxygen and halothane following induction with thiopental and succinylcholine chloride) on serum LH levels were studied in 18 postmenopausal females, 15 menstruating females and 17 males. In addition, serum FSH levels in female patients and testosterone levels in male patients were estimated. As controls without surgery and anesthesia, serum levels of LH, FSH and testosterone were estimated at identical time intervals to the experimental group in 15 normal postmenopausal females, 15 normal menstruating females and 10 normal males. In male patients, serum LH levels at 30 min and 1 hr after onset of anesthesia increased significantly over those of pre-anesthesia, while no significant intra-operative increase in LH levels was found in female patients. In male and female patients, the LH levels decreased slightly 5-6h and 2 days after onset of anesthesia, though the decreases were not statistically significant except in postmenopausal females. On the 7th postoperative day, the LH levels returned toward the baseline. In female patients, no significant intra-operative changes in FSH levels were found. In male patients, there were significant intra- and post-operative decreases in testosterone levels. In control subjects, no significant changes in serum levels of LH, FSH and testosterone were demonstrated. These observations suggest that significant intraoperative increases in serum LH levels occur in males but not in females.
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Endocrine functions were investigated in a case of "beta-adrenergic hyperdynamic circulatory state". This state was diagnosed by (1) typical symptoms of cardiac awareness, (2) physical findings (increments of pulse rate and blood pressure by changing positions or walking), (3) increase in cardiac output (5.25 l/min leads to 14.03 l/min) and decrease in circulatory time (10.8 sec leads to 5.5 sec) by isoproterenol infusion (0.02 mug/min/kg body weight), (4) rapid loss of symptoms and above findings by propranolol treatment (30 mg per os daily) and reappearance by discontinuing medication. The mechanism of insulin response to glucose has been a controversy as to whether the secretion is transmitted by beta-receptor or independent glucose receptor. And in this physiologic beta-adrenergic state, it was found that insulin responses in IVGTT and OGTT were within normal limit. When beta-adrenergic condition was corrected by propranolol treatment, insulin responses were shown lowered, though in the normal range. This could be reproduced by discontinuing medication. Insulin, glucagon and growth hormone secretions caused by arginine were also found normal, but during the period the patient was on propranolol therapy, all responses were decreased, within the normal range. These results do not positively support the idea that glucose receptor is linked to beta-receptor. They do not either agree with the contention that secretions of insulin, glucagon and growth hormone induced by arginine are mediated through beta-receptors.
Serial measurements of plasma "true glucagon" (PG) and of glucagon-like immunoreactive materials (GLI) were carried out during and after total resection of the pancreas in a 62-year-old man with calcified pancreatitis. The postoperative course of this patient was uneventful and diabetes was well controlled. PG disappeared from the blood within 30 min after resection of the pancreas. In spite of the evidence that no pancreatic tissue was present in the abdomen, PG was detected again in the blood from 18 hr after total pancreatectomy until the ninth postoperative day. However, plasma PG did not rise following infusion of arginine during the fourteenth postoperative week. After an initial decrease, plasma GLI rose abruptly on the second postoperative day and remained elevated thereafter. The fluctuations of plasma PG and GLI were not parallel.
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The lymphocyte subpopulations in the thymus and in the blood were investigated in ten myasthenic patients who had been thymectomized. Histologically, the thymuses tested comprised three cases of thymoma including two cases with malignant characteristics, five cases of hyperplastic thymus with lymph follicles and germinal centres, and two cases of persistent thymus without lymph follicles. Virtually all lymphoid cells in the three thymomas formed spontaneous rosettes with sheep red blood cells as did normal thymocytes from non-myasthenic patients. There was no significant proportion of immunoglobulin Ig-bearing lymphocytes. While the majority consisted of cells forming spontaneous rosettes with sheep red blood cells, there was a certain proportion (2-17%) of Ig-bearing lymphocytes in four of five hyperplastic thymuses, in one of two persistent thymuses, and in a residual atrophic thymus of a thymoma. The myasthenic patients tested were for the most part normal, as compared with healthy individuals, in the proportion of rosette-forming lymphocytes and Ig-bearing lymphocytes in the blood collected immediately before and one to three months after thymectomy. The presence of Ig-bearing lymphocytes in the thymus was not necessarily related to the appearance of circulating antibody to striated muscle. The antibody to striated muscle was demonstrated in all myasthenic patients with thymoma.
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Due to recent reports claiming that gastrin is present in the gastric juice, the method for gastrin determination has been evaluated. Separate experiments showed that gastrin added to gastric juice disappears rapidly if the juice is not boiled or neutralized. A total of 82 patients with various abdominal disorders were examined. No or only a trace amount of gastrin was found in untreated, boiled, or boiled and neutralized gastric juice in every patient, including three patients with achlorhydria. Histamine injection (0.04 mg. per kilogram, subcutaneously) did not influence this and was without effect upon serum gastrin concentrations of nine duodenal ulcer patients. Because gastrin apparently is degraded rapidly by gastric juice, this study does not necessarily disprove that gastrin is secreted into the stomach. However, the virtual absence of gastrin in all specimens examined, including some collected directly upon boiling water bath during continuous gastric aspiration lends no support to this speculation. Because gastrin does not survive even a short exposure to gastric juice without degradation, we suggest that earlier reports on the presence of gastrin within the stomach are questionable.
The results of clinical studies on OE-7 (erythromycin stearate, enteric coated granule) were as follows. (1) Thirty-two cases with respiratory infections were treated OE-7 by the oral route of 300 mg every 6 hours in 5 cases and 400 mg every 8 hours in 27 cases. In 28 of 32 cases (87.5%) OE-7 was effective. Gram-positive cocci, namely pneumococcus, alpha- and beta-streptococcus, staphylococcus etc. are the most important pathogens in acute respiratory infections statistically and the most of them are susceptible to many chemotherapeutic agents, especially to erythromycin and penicillin. This is the case also with our studies. Acute exacerbation of asthmatic patients are frequently complicated with secondary respiratory infections caused by those pathogens and sometimes this condition in turn exacerbate asthmatic states. In our studies OE-7 displayed a good effect to such cases. (2) As the side effect gastrointestinal disturbances were slightly observed in 8 of 32 cases and allergic reactions in none. Hepatic and renal function test examined in 17 cases revealed no change after treatment. (3) The mean serum concentration of OE-7 by the oral route of 300 mg every 6 hours revealed about two times higher levels than by the same route of 400 mg every 8 hours, the peak was both reached after 3 hours after ingestion 1.96 mcg/ml and 0.97 mcg/ml respectively. This experiment was done for 5 healthy persons in the condition of free food ingestion and cross over in one week interval.
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