Galactose Tolerance Research Articles

Galactose Tolerance in Jaundice and Hyperthyroidism

Galactose Tolerance in Jaundice and Hyperthyroidism

Galactose Tolerance Test and the Thyroid Gland. Urea in Saliva

Galactose Tolerance Test and the Thyroid Gland. Urea in Saliva

A New Intravenous Galactose Clearance Test for Differentiation of Obstructive from Parenchymatous Jaundice.

The intravenous galactose tolerance test offers valuable assistance in the differentiation of the parenchymatous or “medical” type from the obstructive or “surgical” type of jaundice.

An Analysis of the Hippuric Acid, Galactose Tolerance, Bromsulphthalein and Prothrombin Tests in 381 Cases

The relative value of various test of liver function has been 'receiving much attention in recent years. The mechanisms of these tests in general are based upon the physiological activities of the liver which are varied, often not apparently related, and in general may be grouped as attempted estimates of excretory, metabolic and detoxifying functions. Numerous empiric tests of liver function have been described, which have attained varying degrees of popularity. It is not our purpose to discuss the merits of all the various tests of liver function which have been proposed, as others have thoroughly recorded their experience with various individual tests' 8 1 9 . We desire to present our experience and study of the comparative value of four of the more popular liver function tests in use today, with particular reference to prognosis. Following the publication of Quick's Hippuric acid liver function test in 1933 • u we began its use as a routine examination in suspected liver disease along with the galactose tolerance test, the bromsulphthalein test and more recently we have added the determination of the blood prothrombin •. Originally these tests were instituted as a preoperative routine in various types of gall bladder disease because of the frequently associated liver disease'-'-. Our results in general substantiate their value in such cases and confirm the findings of Quick' , Snell and Plunkett, Magath and others in prog-

Chronic Gaucher's disease

Summary A case of Gaucher's disease is reported in a white boy of Jewish race. Changes in the blood, bones, and spleen have been demonstrated. Normal blood lipoid values were obtained, as well as the normal values for calcium and phosphorus. On the other hand, the cholesterol esters and phosphatase values were decreased. The ingestion of milk containing 20 per cent cream was followed by a normal fat tolerance curve. The galactose tolerance test and bromsulphalein test gave normal responses. The phenolsulphonephthalein test showed a normal rate of excretion. Liver extract administered by mouth over a five-year period, as well as other measures enumerated, failed to cause a reduction in the size of the liver and spleen and resulted in only a temporary improvement in the secondary anemia.

The Value Of A Combined Study Of The Newer Laboratory Test In The Differential Diagnosis Of Toxic And Obstructive Jaundice Including Blood Phosphatase, Cholesterol Partition, Galactose Tolerance And Glucose Tolerance

The use of any liver function test in jaundice should not be limited to a single determination. Furthermore, a combination of tests whose interpretation and limitations are reasonably well understood would certainly lessen the chance for error. It is our belief that mistakes in diagnosis between obstructive and toxic jaundice could be practically eliminated if the group of tests employed in this report are repeated approxi mately three times in the course of a week during any period of jaundice. By evaluating the results obtained with the clinical picture, one may with assurance determine the type of jaundice present. Furthermore, the various tests are influenced somewhat differently by the obstructive phase in toxic jaundice, and a superimposed toxic factor in obstructive jaundice. In general the results of the galactose tolerance test appear to parallel those obtained by a study of the cholesterol partition. In some cases, Case 6 and Case 9, normal levels of galactose were reached before the return of the ester ratio to normal. In such cases the cholesterol partition seems to be the more sensitive of the two. In other instances, Case 4, the reverse appears to be the case. In still other instances, Case 7, 8, and 11 positive galactose tolerance readings were obtained when the cholesterol partition was entirely normal. The obstructive phase in toxic hepatitis does not appear materially to affect either the galactose tolerance or cholesterol partition while the phosphatase may at such times reach the indeterminate zone or even obstructive levels. This is especially important in adults (Case 5). On the other hand, both the galactose tolerance and the cholesterol partition are more readily affected than the phosphatase level by toxic changes superimposed upon obstructive jaundice. It has been our experience that a sharp drop in phosphatase level which accompanies a sharp drop in total cholesterol and esters in the presence of a rising blood bilirubin is of very serious import especially if occurring in obstructive jaundice (Cases 3 and 10) when it usually spells a fatal outcome. The exact value of the glucose tolerance test in this problem must be established by further work. For those who may not have available fully equipped laboratories to carry out the elaborate chemical proceses involved in the cholesterol and phosphatase determinations, the simple galactose tolerance test, if done properly early in jaundice and interpreted on the basis of the criteria laid down, still remains the most reliable single laboratory test in the differentiation of toxic and obstructive jaundice.

The Galactose Tolerance and Urobilinogen Tests in the Differential Diagnosis of Painless Jaundice

The Galactose Tolerance and Urobilinogen Tests in the Differential Diagnosis of Painless Jaundice

The galactose tolerance and urobilinogen tests in the differential diagnosis of painless jaundice

The galactose tolerance and urobilinogen tests in the differential diagnosis of painless jaundice

A STUDY OF ONE HUNDRED CASES OF JAUNDICE

During the last three years we have studied a group of 100 patients with jaundice at the Cincinnati General Hospital with particular attention to clinical manifestations, galactose tolerance and ability to excrete bromsulphalein. We have determined the degree of jaundice during the course of illness by means of the icteric index and van den Bergh determinations and the presence or absence of complete obstruction by study of duodenal contents, urine and stools. We are thoroughly in accord with the importance of clinical observations in the differential diagnosis of jaundice as recently stressed by Flood, Seegal, Spock and Loeb. 1 We feel, however, that laboratory studies, particularly the galactose tolerance test, may prove of great help in the diagnosis of some cases and lend confirmatory evidence in others. The galactose tolerance test was devised by Bauer 2 in 1906 as a test of hepatic function. Two years later he 3 reported

GALACTOSE FOR DIABETIC PATIENTS

To the Editor: —InThe Journal, Nov. 19, 1932, appeared a communication by Dr. Harry Shay, which contained such incorrect interpretations of our report on galactose tolerance of normal and diabetic subjects ( J. Biol. Chem. 96 :717 [June] 1932) that we find it necessary to submit the following rebuttal of Shay's statements: Shay pointed out that, in our tests on normal and diabetic subjects in which 1 Gm. of galactose per kilogram of body weight was administered by mouth, there occurred in the samples of blood collected one hour after ingestion an average drop of 36 mg. of fermentable blood sugar per hundred cubic centimeters for the normal subjects, and an average increase of 22 mg. of fermentable sugar for the diabetic patients, making an average observed difference in fermentable blood sugar of 58 mg. per hundred cubic centimeters. We object to the calculations made by Shay in the first

THE TREATMENT OF INVOLUTION MELANCHOLIA WITH OVARIAN HORMONE

Seven cases of involutional melancholia were treated with ovarian hormone in the form of Squibb's amniotin. The method and amount of treatment varied. A careful study before and after treatment was made of the blood pressure, basal metabolism, blood chemistry, (including non-protein nitrogen, uric acid, cholesterol, fasting sugar and sugar curve), and the galactose tolerance. Two cases showed a good social recovery (Cases 1 and 5). Three cases were unimproved and now show a chronic picture (Cases 2, 3 and 6). Keeping in mind Dreyfus' findings, it is still possible that recovery may occur, but if it should, the amniotin treatment could not be regarded as playing any part in the recovery. Two cases died, Case 4 of anemia and broncho-pneumonia, Case 5 of carcinoma of the uterus. Our treatment, therefore, appears to have had little or no effect on the final outcome of these cases. In giving amniotin, we had in mind the possible restoration of the menstrual cycle. The results were quite different. Except in Ca...

THE GALACTOSE TOLERANCE TEST

To the Editor: —The discussion inThe Journal(February 7, p. 459) between Dr. Blankenhorn of Cleveland and Dr. Loewy of London relative to the galactose tolerance test concerns a technic which we have studied for the past three years at the Jewish Hospital. Our conclusions regarding it are to appear in the Archives of Internal Medicine . I am in complete accord with Dr. Loewy, barring minor differences. I believe that the galactose tolerance test of Bauer stands today as our only positive means of identifying toxic hepatitis early, a condition whose identification becomes paramount in the painless (clinically obstructive) jaundice seen in persons past 30 or 40 years of age. Is it carcinoma of the head of the pancreas or silent stone in the duct or is it a so-called catarrhal jaundice? Should the patient be operated on early and spared the imminent danger of hemorrhage if operated on

THE METABOLISM OF GALACTOSE

In 1901, Strauss 1 suggested the use of levulose for testing the function of the liver. Five years later, Richard Bauer, 2 of Vienna, introduced galactose for a similar purpose. While this phase of studies on the liver aroused considerable interest in England and on the continent, American literature on clinical medicine has given little consideration to the subject. American contributors have usually been concerned with levulose, while galactose has either been ignored or mentioned only with a word of condemnation. This is all the more strange since American biochemical literature is replete with contributions concerning the metabolism of this sugar. While working with Bauer in 1927, one of us was impressed with the information obtained through studies on galactose tolerance in various conditions of the liver. For the past two years we have been utilizing this test at the Jewish Hospital of Philadelphia in an attempt to satisfy ourselves as to

A SIMPLE TEST TO DIFFERENTIATE BETWEEN OBSTRUCTIVE AND OTHER TYPES OF JAUNDICE

<h3>To the Editor:</h3> —Dr. Loewy's criticism of my recent paper on jaundice is valid criticism—if the galactose tolerance test of liver function is as good as Dr. Loewy thinks it is. My estimate of the galactose test for liver function, as shown by not mentioning it, is shared by most writers of textbooks in this country dealing with the clinical aspects of jaundice. I may mention that Osler's Modern Medicine, 1926, describes seven tests but not galactose; the Oxford System (Rolleston's Treatment of the Subject) does not mention it; Blumer's Bedside Diagnosis describes eight tests but not galactose; Oxford Monographs on Diagnosis and Treatment lists twenty-five tests, among them galactose, but makes no comment on its use or estimate of its value. In current literature of this country, the galactose test has been discussed but generally discarded. Snell, Greene and Rowntree (<i>Arch. Int. Med.</i><b>36:</b>273 [Aug.] 1925), after a

A SIMPLE TEST TO DIFFERENTIATE BETWEEN OBSTRUCTIVE AND OTHER TYPES OF JAUNDICE

To the Editor: —Dr. M. A. Blankenhorn states inThe Journal, Oct. 11, 1930, that the differentiation between painless jaundice due to obstruction and catarrhal or arsphenamine jaundice is often impossible without an operation. I believe that this represents the current view, but those who have had an experience with the galactose tolerance test know better. Richard Bauer published a paper on this simple and reliable test as early as 1906, and the practical value of the test has since been confirmed by Warren R. Sisson, Woerner, and many others (Bauer, Richard: Wein. med. Wchnschr. 66: 2537, 1906; Wien. Arch. f. inn. Med. 6: 9, 1923. Sisson, W. R.: A Clinical Study of Two Hepatic Functional Tests, Arch. Int. Med. 14: 804 [Dec.] 1914. Woerner: Med. Klin. , 1919, number 45. Davies, D. T.: Lancet 1: 380 [Feb. 19] 1927). The galactose test can be carried out by any practitioner and

GALACTOSE TOLERANCE IN DEMENTIA PRAECOX

During the course of a diagnostic and therapeutic survey of dementia praecox at the Worcester State Hospital, a series of one or more determinations of the galactose tolerance in 135 untreated male patients has been accumulated. The group constitutes a fairly representative cross section of the male schizophrenic population in such an institution. The ages range from 16 to 63 years, the periods of hospitalization from one week to twenty-three years. This study of the galactose tolerance is a part of a larger study directed toward an attempt to secure further light on two major problems: Are there any metabolic peculiarities by which the schizophrenic psychosis can be characterized? Within the schizophrenic group, are there any characteristic metabolic differences among the various subgroups? Such differences, if present, would be of obvious aid in differential diagnosis and of possible prognostic value. <h3>THE GALACTOSE TEST</h3> The galactose tolerance test has been selected

MODIFICATION OF THE DEXTROSE TOLERANCE TEST AS AN INDEX OF METABOLIC ACTIVITY OF THE LIVER

Attempts to utilize disturbances of carbohydrate metabolism for a diagnosis of functional impairment of the liver are not new. But the levulose and galactose tolerance tests that are available do not give sufficiently uniform results to warrant their general adoption. The objections to these sugar tolerance tests as an indication of liver function are twofold. The first and real objection is that while sugar metabolism suffers in certain diseases of the liver, this fact is susceptible of consistent demonstration only by group averages. In individual cases of even proved diseases of the liver, the results of these tests frequently fall within the limits of normal and minimize their significance. The second objection is that other organs, such as the pancreas and the hypophysis, also play a prominent part in the metabolism of carbohydrates, and therefore any discovered abnormalities of such metabolism may not be due specifically to a deficiency of

The metabolism of galactose: V. The effect on the tolerance of the cycle of reproduction

1.1. The several stadia of sex development and activity seemingly influence the capacity of female to assimilate and utilize galactose.2.2. Lowering of ovarian function, from whatever cause, produces a like change in the galactose tolerance.3.3. Criteria are established for the normal galactose tolerance of the female during the several stadia of existence.4.4. The mammary glands play a most important rôle in the determination of the assimilation limit, but one apparently secondary to hormonic agencies which seemingly are the primary regulators.5.5. From changes in sugar tolerance, it may be inferred that pregnancy produces a physiologic hypo-ovarianism which persists for some time after parturition but ultimately disappears.

The metabolism of galactose: IV. The effect on the tolerance of the level of ovarian activity

1.1. The human female, in health, has a series of definite assimilation limits for galactose, the fluctuations of which are seemingly associated with changes of physiologic activity of ovarian function.2.2. Starting at a low level in prepubertal years, with the onset of puberty the tolerance rises to a level in maturity double the first, and maintains this until the cessation of the catamenia is accompanied by a recession of moderate degree.3.3. To those whose level is superior to the prepubertal, the act of menstruation usually determines a slight depression in the tolerance.4.4. Castration of the adult lowers the sugar tolerance to the prepubertal level, and functional failure exhibits the same tendency, the degree of the depression correlating with the severity of the impairment.5.5. The mammary glands are shown to have an important but apparently secondary influence in determining assimilation limits.6.6. The menstrual relationships consititute a possible exception, but presumably are more closely associated with the events of the reproductive cycle, which are not considered in this paper.7.7. In the main, the results of the study are in harmony with Frank's observations and his theory of the female sex hormone. Equally, the results could be explained by other endocrine formulas wholly independent of the foregoing.8.8. The interstitial glands, at least during adult years, seemingly have only a secondary influence, if any, on the regulation of galactose tolerance.9.9. The reproductive phase is to be considered independently in a subsequent paper.