Southern Society for Clinical Research 133

absorbed from the gastrointestinal tract, and that more strontium than calcium is excreted by the kidney. Enhancement of radiostrontium excretion could be achieved by raising the uri- nary calcium excretion through administering calcium intravenously and/or orally, either alone or in combination with ammonium chloride. The technic of Srs6 determinations in biological specimens is a simple and sensitive indicator of mineral metabolism, and has been extensively used in the study of patients with metabolic or neoplastic bone diseases and for the objective evaluation of various thera- peutic agents. The metabolic effects of 17-ethyl- 19-nortestosterone (nilevar), of 3-methoxy-lba- methyl-1,3,5 (lo)-estratriene-16@,17&diol (man- vene) and of 17a-ethinyl-19-nortestosterone (norlutein) were studied with this tracer. Im- provement of mineral metabolism was readily demonstrable by balances and Srs6 studies.

EXCRETION OF ALDOSTERONE IN NORMAL MEN AND

WOMEN AND IN PATIENTS WITH TOXEMIA OF

PREGNANCY. L. L. Sulya, J. Slocum, M. D. Turner. Dept. of Physiological Chemistry, and J. E. Lindley, Dept. of Obstetrics and Gynecology, Univ. of Mississippi Medical Center, Jackson, Miss.

The excretion of aldosterone in the urine of normal men, normal women and patients with toxemia of pregnancy was determined by the following procedure. The urine after acidifica- tion to pH 1 was extracted continuously for twenty-four hours and the extract purified as outlined by Ayres, Garrod, Simpson and Tait (1957). The purified residue was chromato- graphed successively with the systems chloroform- formamide and Bush’s system C (Neher and Wettstein 1956). The aldosterone was eluted and determined spectrophotometrically after color development with blue tetrazolium. Analy- sis of the urine of thirteen normal men, mainly medical students, gave an average of 19.9 gp. per twenty-four hours with a range of 8 to 33.5. Results with ten normal women (student nurses, technicians) were in the range of 8.8 to 30.7, with an average of 17.2 pg. per twenty-four hours. The difference is not statistically signifi- cant. These results are higher than reported by Ayres et al. who obtained an average of 11 pg. per twenty-four hours with a range of 4.6 to 23.5. Ten patients with toxemia of pregnancy excreted an average of 22.7 pg. of aldosterone during the first hospital day. The difference between this mean and the normal series is not

JULY, 1958

significant. Medication and/or bedrest produced a significant reduction within twenty-four hours to an average of 12.7 pg.

EXCHANGE AND EQUILIBRATION CHARACTERISTICS

OF POTASSIUM IN RHEUMATOID ARTHRITIS AND

OTHER DISEASE STATES AS DETERMINED THROUGH

THE USE OF POTASSIUM 42. Ernest S. Tucker, ZZZ, Howard L. Ho&y, * William E. Martindale, Mar- shall S. Little and William L. Hawley. Dept. of Medicine, Medical College of Alabama, and the Radioisotope Service of the V. A. Facility, Birmingham, Ala.

The observation that generalized muscular weakness is common in rheumatoid arthritis and characterizes states of hypopotassemia prompted these studies: (a) A comparison of the ex- changeable K42 in rheumatoid subjects with patients having other types of chronic illness; (b) measurement of rates of diffusion of K42C1 from the intravascular compartment and into the urine in two groups of patients with rheuma- toid arthritis, one symptomatically treated, the other receiving maximal ACTH stimulus to the adrenal glands; (c) observations similarly made in two dogs given steroid hormones or ACTH following intravenous administration of K42C1.

Twenty-four hours following the administra- tion of 200 to 250 PC. K42C1 intravenously the exchangeable K, as mEq. K./kilo, in seven rheumatoid arthritic patients was not different from exchangeable K in nine other patients with chronic illnesses. In patients with rheumatoid arthritis exchangeable K was 45 + 18.3 mEq./ kilo. The disappearance rate of K42 from the blood stream was faster and the rate of secretion into the urine slower in rheumatoid subjects receiving maximal stimulus with ACTH for a short time after intravenous administration of K42. This observation was most striking at thirty minutes when the urine concentration of K42/K3s in untreated subjects was three times that of the treated subjects. Supplemental dog experiments suggest that this rapid loss probably results from equilibration with the extravascular compartment.

INHIBITION OF THYMOL FLOCCULATION BY NORMAL

AND ICTERIC SERUMS. Malcolm P. Tyor. Dept. of Medicine, Duke Univ. School of Medicine and the V. A. Hospital, Durham, N. C.

Inhibitory factors have been demonstrated for mostcommonlyused flocculation and turbid- ity tests, except the thymol flocculation test. The purpose of the present study was to determine

134 Southern Society for Clinical Research

the presence of an inhibitory factor in normal and icteric serums.

The degree of flocculation of serums was measured by their turbidity ratio,

48 hour turbidity units

30 minute turbidity units

Strongly flocculating serum (turbidity ratio = 0.05) was diluted with serums which did not flocculate (turbidity ratios = 0.85 to 1.40); the range of dilutions was 3 : 1 to 1 : 3, respectively. The non-flocculating serums were obtained from twelve control subjects, seven jaundiced patients with primary liver disease, and seven jaundiced patients with pancreatic or biliary carcinoma. The mean turbidity ratios for the three groups at dilutions of 1: 1 and 1 : 2 were most significant; control subjects = 0.12 and 0.33, patients with primary liver disease = 0.12 and 0.45, patients with extrahepatic ob- struction = 0.37 and 0.79, respectively. When group means were compared, the t values of the extrahepatic group were significantly greater than those of the control group, p = <O.Ol. The two jaundiced groups were suggestively differ- ent, p = <0.05.

Inhibition of thymol flocculation by icteric serums from patients with neoplastic extra- hepatic obstruction was significantly greater than that produced by serums from control subjects, and suggestively greater than that produced by serums from patients with primary liver disease.

ASIAN INFLUENZA. A CLINICALSTUDY. John Walsh, Lawrence Dietlein, H. A. White, William Mogab- gab, * William Pelon and George Burch. * Dept. of Medicine, The Tulane Univ. of Louisiana School of Medicine, New Orleans V. A. Hospital. The Charity Hospital of Louisiana at New Orleans, New Orleans, La.

This study deals with forty patients in whom the diagnosis of Asian influenza was established by virus recovery of fourfold or greater rise in the hemagglutination inhibition antibody titer of paired serums. Fatal cases are reported else- where. The clinical syndrome was rather typical of influenza of varying severity. Physical findings were sparse and non-specific. Relative brady- cardia during the first two days of illness was noted in one-fourth of the patients. A normal or depressed leukocyte count was usual, although leukocytosis was encountered in uncomplicated

influenza. Bacteriologic studies of nasopharyn- geal, blood and sputum specimens revealed no abnormalities. Laboratory studies, including evaluation of hepatic, adrenal and renal func- tion were within normal limits. One-fifth of the patients exhibited transient electrocardiographic changes consisting of inverted or diphasic T waves without rise in serum glutamic oxalacetic transaminase.

Of seven pregnant patients, one experienced premature labor with death of the fetus, one lost a full term infant at nine days of bacterial meningitis, and two had complicating pneumo- nia. There were seven patients with associated pneumonia. All were treated with antibiotics, and on the average, were febrile for only two days longer than those patients with simple influenza. There was one case of severe meningo- encephalomyelitis with paraplegia followed by complete recovery.

OBSERVATIONS ON THE FUNCTIONALSTATE OFTHE

PULMONARY BLOOD VOLUME. James V. Warren,* Joseph J. Combs and Gerald D. N. Bryant. Dept. of Medicine, Duke Univ. School of Medicine, Durham, N. C.

In an effort to separate the dynamic and static components in the pulmonary blood volume, observations on twelve normal subjects have been carried out. Measurements of so-called “pulmonary blood volume” (Q value of Stewart) have been made under control conditions and during atropine-induced tachycardia. The rapid heart rate was associated with a 75 per cent higher mean cardiac output and a 24 per cent larger mean “pulmonary blood volume.” In four subjects additional evaluation of total thoracic blood volume was made by another technic utilizing external radiation over the thorax following intravenous injection of radio- active iodinated serum albumin. Atropine tachycardia failed to produce changes indicative of altered blood content of the underlying lung.

These apparently disparate results are con- sistent with the thesis that at rest some pul- monary capillaries, although filled with blood, are perfused so slowly that they are not included in the initial circulation involved in the calcula- tion of “pulmonary blood volume” by the dye technic. With increased cardiac output, the perfusion rate in these vessels was accelerated, and an apparent increase in pulmonary blood volume was obtained. Such a concept of stag- nant flow through some pulmonary capillaries

AMERICAN JOURNAL OF MEDICINE