Abstract
Systematic studies concerning the effect of induced hypoxemia on visceral circulation and metabolism in human beings are being carried out in our department. They show that a reguratory reaction appears clearly in normal subjects but not so in patients with various diseases of visceral vessels or tissues. Inference that Epinephrine and its derivatives take part in this reguratory reaction can be made. How-ever, few reports have been published concerning the part played by the pituitary-adrenocortical system in the reguratory mechanism which takes place in acute induced hypoxemia. This study was designed with the intention of clearing this point. Materials and Methods The materials consisted of 1) normal subjects ………… 9 cases 2) patients with hypopituitarism …… 3 cases 3) patients with essential hypertension and heart diseases ………………… 6 cases 4) patients with chronic liver diseases …………………………… 8 cases Individuals having severe myocardosis, arrhythmia or renal disturbance were excluded. Two-hours urinary samples (Sample 1 to 5) were collected from 11.00 a.m. to 9.00 p.m.. After excretion at 3.00 p.m. Subjects inhaled a 10% O2 mixture from a Douglas bag for 20 minutes, while the arterial O2 saturation was observed by ear oxymeter. Urinary 17-Hydroxycorticosteroid (urinary 17-OHCS) was determined by the method of Porter and Silber as modified by Reddy, Smith and Iwai. Two control studies were performed previous to the study : 1) The diurnal variation of urinary 17-OHCS was investigated in 8 healthy subjects. This showed the pattern of maximal excretion in the morning (9.00-12.00 a.m.) becoming minimal at night (9.00-12.00 p.m.). 2) In order to observe the effect of mental stress, 7 healthy subjects were made to inhale room air from the Douglas bag with the same technique as used during the hypoxemia test. No significant difference from the diurnal pat-tern was observed. Results 1) Normal subjects : Urinary 17-OHCS excretions of 7 cases were increased in the 2-hours urine sample collected during the 10% O2 inhalation (Sample 3) and one case in the next 2-hours (Sample 4). All of these 8 cases showed moderate hypoxemia state with mini-mum arterial O2 saturation (SaO2) under 73% and above 54%. One case showed no significant variation from the diurnal pattern and its minimum SaO2 Was 85%. 2) Patients with hypopituitarism : 2 cases of pituitary dwarfism and one case of Sheehan's syndrome, the formers with mild hypoadrenocorticoidism and the later with a severe one, showed no significant variation of urinary 17-OHCS excretion in spite of moderate hypoxemia state with minimum SaO2 of 67-58%. 3) Patients with hypertension and heart diseases : In one case urinary 17-OHCS level increased in Sample 3 and in 4 cases in Sample 4, but another case showed no significant variation from the diurnal pattern. The minimum SaO2 of these cases was under 75% and above 54% which was quite similar to that of the normal controls. 4) patients with chronic liver diseases : Increase ef urinary 17-OHCS excretion by the 10% O2 inhalation was observed in Sample 3 in 4 cases and in Sample 4 in 2 cases, but 2 other cases showed no significant variation. The minimum SaO2 of this group was under 71% and above 50%, which was also comparable with the control cases.
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