[Antibody to 1-24 ACTH and hypofunction of the adrenal cortex in a patient who was unilaterally adrenalectomized for Cushing's syndrome (author's transl)]

We report here on a patient who was unilaterally adrenalectomized for Cushing's syndrome, and who developed antibodies to 1-24 ACTH. A 49-year-old nurse had undergone right adrenalectomy for adrenal adenoma. After surgery, she was treated with 0.5 mg of 1-24 ACTH-Z together with glucocorticoid replacement therapy for 40 days. Thereafter she was given 0.25-0.5 mg of ACTH-Z every other day for 4 months. ACTH-Z was then stopped for a year but glucocorticoid therapy was continued. About one year prior to this admission, 1 mg of ACTH-Z was again initiated 1 to 2 times a week. Glucocorticoid therapy was not withdrawn during the four years after adrenalectomy. She was admitted for the purpose of withdrawal of glucocorticoids. Her serum was found to bind labeled ACTH. This labeled ACTH was competitively displaced from binding by unlabeled hormones. Finally, reaction with specific antihuman Ig demonstrated an antibody of the IgG class. The titer of the antibodies gradually decreased after the discontinuation of ACTH-Z, but it is still present in measurable quantity in her serum. The clinical significance of the circulating anti-ACTH antibody in her serum is discussed.

[Amniotic fluid cortisol, tetrahydrocortisone, estriol and estetrol in normal and high risk pregnancy (author's transl)]

In order to determine the possibility of assessing intrauterine fetal well being by measuring amniotic fluid steroid levels, a number of selected glucocorticoids and estrogens were assayed. Estriol (E3) and estetrol (E4) levels at 36-40 weeks of pregnancy, especially that of total E3 (T-E3 and unconjugated E4 (U-E4) rose significantly (p less than 0.01), and were at a ratio of T-E3/U-E3 8; T-E4/U-E4 2, respectively. A definite correlation was found between T-E3 and U-E3 (r = 0.97) which was not detected in the case of E4, and there was a high correlation with umbilical arterial levels of both unconjugated and total E3 and E4. Amniotic fluid cortisol (F) levels in both unconjugated (U-F) and sulfate conjugated (S-F) rose preferentially at 36-40 weeks and exceeded the levels of both umbilical arterial and maternal peripheral plasma (p less than 0.01). Both tetrahydro-cortisone (THE) and -cortisol (THF) levels increased at 29-35 weeks which in the select cases were comparable with the increases seen at 36-40 weeks. The THE level showed a definite correlation with that of umbilical artery (r = 0.73) whereas this was not the case for S-F. In pregnancies complicated with toxemia and/or diabetes mellitus, T-E3 and S-F levels are less than the lower limits for normal pregnancies. This tendency was not observed with T-E4 and THE. In pregnancies with severe RH isoimmunization, the levels of T-E3, T-E4 and S-F are markedly lower than those seen in normal pregnancies, and do not display the increase with gestational advances. On the other hand, THE and THF levels were shown to be at levels higher than in normal pregnancies. Thus, in the latter half of pregnancy, amniotic fluid steroid assays, especially T-E3, S-F and THE may be of use in the assessment of fetal well being.

Cathodic isozyme of serum creatine kinase in a case of stomach cancer complicated by disseminated intravascular coagulation

A rare isozyme of serum creatine kinase (CK) migrating cathodic to CK-MM on electrophoresis was found in a 30-year-old male with stomach cancer complicated by disseminated intravascular coagulation leading to massive upper gastrointestinal bleeding and marked anemia. Serum CK activity rose to a maximum of 374 U/l without detectable CK-MB isoenzyme. The patient was also characterized by a marked increase in serum lactate dehydrogenase (all isozymes elevated) and by preferential leakage of mitochondrial aspartate aminotransferase and glutamate dehydrogenase, indicating the presence of extensive tissue damage involving mitochondria. Skeletal muscle mitochondria were considered the most likely source of the additional CK isozyme.

Interrelated changes in gamma-glutamyltransferase activity and HDL-cholesterol level in the sera of patients with alcoholic liver injury

The levels of HDL-cholesterol and gamma-glutamyltransferase in the sera of 17 patients with alcoholic liver injury were followed after abstinence and compared with those of 11 patients with acute non-alcoholic hepatitis. The activity of gamma-glutamyltransferase decreased in all cases irrespective of the type of liver injuries. The level of HDL-cholesterol also decreased in 11 of 17 cases with alcoholic liver injury. The other alcoholics, in whom HDL-cholesterol level increased or showed no definite change after withdrawal of alcohol, had severe and advanced liver injuries. In non-alcoholic hepatitis, the HDL-cholesterol level increased as normal liver functions were restored except for one case with cholestatic features. It was concluded that alcohol intake can increase HDL-cholesterol level even in the presence of a concomitantly induced hepatic lesion.

An enzyme immunoassay for the measurement of anti-thyroglobulin autoantibody in human serum

An enzyme-linked sandwich immunoassay using human thyroglobulin conjugated with beta-D-galactosidase and silicone rods coated with human thyroglobulin was developed for the measurement of circulating anti-thyroglobulin autoantibody. The volume of serum needed for the assay was as little as 5 microliter. The sensitivity of the assay was approximately 7 x 10(-15) mol/tube of antithyroglobulin immunoglobulin G corresponding to 220 ng/ml of serum, which was equal to or rather higher than that of radioimmunoassay. The specificity of the assay was demonstrated by (1) parallelism of the standard curve with dilution of sample sera of patients with thyroid diseases, and (2) non-detectability of anti-thyroglobulin in autoantibody in the sera of normal subjects. The precision of the assay was proven by (1) sufficient recovery of antithyroglobulin immunoglobulin G added to serum, and (2) coefficients of variance within and between assays were 6.5 to 10.3% and 4.9 to 14.1%, respectively. No effect of thyroglobulin on the present assay was observed when the ratio of the amount of thyroglobulin to that of anti-thyroglobulin immunoglobulin G was lower than 1 : 10. Furthermore, a significant correlation was observed between anti-thyroglobulin autoantibody concentrations measured by our enzyme immunoassay and those by tanned red cell hemagglutination (r = 0.78), and between those by the enzyme immunoassay and those by radioimmunoassay (r = 0.80). The application to clinical samples ensured the high sensitivity and the adequate validity of the present assay.

An enzyme immunoassay for the measurement of thyroglobulin in human serum

An enzyme-linked sandwich immunoassay using silicone rods coated with rabbit (anti-human thyroglobulin) immunoglobulin G and rabbit (anti-human thyroglobulin) monovalent fragment of immunoglobulin F (Fab') conjugated with beta-D-galactosidase was developed for the measurement of thyroglobulin in human serum. The volume of serum needed for the assay was as little as 2 microliters. The sensitivity of the assay was 3.5 ng/ml, which is equal to or rather higher than that of radioimmunoassay. The specificity of the assay was demonstrated by the following observations: (1) The absence of crossreaction of thyroxine and triiodothyronine, (2) non-detectability of thyroglobulin in the sera of patients who underwent total thyroidectomy, (3) parallelism of the standard curve with dilutions of reference serum. The precision of the assay was proven by the demonstration of the sufficient recovery of human thyroglobulin added to sera (92--99%) and coefficients of variance in within and between assays were 6.2--9.3 and 2.5--5.3%, respectively. Furthermore, a highly significant correlation was observed between thyroglobulin concentrations measured by our enzyme immunoassay and those by radioimmunoassay (r = 0.99, p less than 0.001, n = 63). Human thyroglobulin in serum was detectable in 90% of 146 normal subjects, the concentration (mean +/- S.D.) being 13.3 +/- 10.3 ng/ml.

Metabolic clearance of endogenous and radioiodinated thyroglobulin in rats

The basal concentration and metabolic clearance of radiolabeled and endogenous thyroglobulin (Tg) were measured in normal male rats. Serum Tg concentrations (by RIA) in Sprague-Dawley adult males ranged from 70-680 ng/ml (mean +/- SD, 218 +/- 177). In male Fisher rats, basal serum Tg concentrations were 32-263 ng/ml. The fractional disappearance rate of endogenously radioiodinated rat Tg and of endogenous rat Tg after thyroidectomy were both about 8%/h. The MCR of endogenously labeled Tg was 2.4 +/- 1.1 ml/100 g/h. Using this clearance and the mean serum Tg concentration in these rats, a daily thyroidal release rate of about 201 microgram Tg/100 g BW would be required to provide the T4 metabolized daily by the rat, the Tg released into the circulation comprises about 7% of the total rat Tg produced in a 24-h period.

Correlation of sequential changes in serum thyroglobulin, triiodothyronine, and thyroxine in patients with Graves' disease and subacute thyroiditis

Serum thyroglobulin (Tg), triiodothyronine (T3), and thyroxine (T4) concentrations were measured in sera from selected patients with hyperthyroidism due to Graves' disease and with subacute thyroiditis. In agreement with previous reports, the concentration of serum Tg was elevated in untreated hyperthyroidism due to Graves' disease, being 132 +/- 124 ng/ml (mean +/- SD) as opposed to 11 +/- 6.4 ng/ml in normal subjects. During treatment of hyperthyroidism with antithyroid drugs with or without iodide, reductions in thyroid hormone concentrations were not associated with a change in serum Tg. On the other hand, marked elevations in serum Tg to concentrations as high as 7000 ng/ml were observed within 24-48 hr after subtotal thyroidectomy or 131I treatment of patients with Graves' disease. These abrupt 10-50-fold increases in serum Tg were not associated with changes in serum T3 and T4. As previously demonstrated, patients with subacute thyroiditis may have elevated serum Tg concentrations that are not associated with elevations in serum T3 and T4. Serum Tg may remain elevated long after clinical and other biochemical mainfestations of this disease have disappeared. These data suggest that the disruption in thyroid function in patients with subacute thyroiditis may persist in a subclinical form for longer periods than previously suspected. Serum Tg appears to be a sensitive indicator of acute thyroidal damage due to surgical, radiation, or inflammatory trauma. The absence of parallel changes in serum Tg, T3, and T4 indicates that release of these thyroidal components can occur by different mechanisms and that nonthyroid tissues cannot efficiently generate T3 and T4 from circulating Tg. Accordingly, local or systemic stimulation of thyroidal Tg hydrolysis may be involved in the generation of hyperthyroidism sometimes seen in patients with subacute thyroiditis.

Isolation of labeled triiodothyronine from serum using affinity chromatography: application to the extimation of the peripheral T4 to T3 conversion in rats

A method for the isolation of small quantities of labeled 3,5,3' -triiodothyronine (T3) from serum or thyroid extracts is described. Conjugates of rabbit anti-T3 antibody to Sepharose 4B are incubated with 0.5 to 1 ml of human or rat serum at pH 8.6 for 1 hr. The tubes are centrifuged and washed with buffer followed by 6 M guanidine to remove nonspecifically bound labeled thyroxine (T4). The fraction of T3 and T4 bound to the Sepharose conjugate varies depending on the concentration of serum in the initial incubation tubes, the T3 and T4 content, and the specificity of the antiserum used. In a system that contains 0.5 ml of normal human serum, 1 ml of glycine-acetate buffer (pH 8.6), and 0.25 ml settled Sepharose-anti-T3 conjugate, the T3 to T4 binding ratio was generally 150-200, with up to as much as 50% of T3 bound to the pellet. The coefficient of variation of the method is less than 5%, and it may be performed in a matter of hours. There is no detectable conversion of T4 to T3 during the separation process. Using this technique, conversion of T4 to T3 was evaluated in euthyroid rats after injection of 125l-T4. Over the period of 36-72 hr after injection, a ratio of T3 to T4 of 0.74 +- 0.06 x 10-2 (mean +- SE) was present in the plasma. Using the calculated metabolic clearance rates for T3 and T4 in these animals, fractional conversion of T4 to T3 was estimated to be 27%, in good agreement with results obtained by other techniques. This method would appear to be of value for specific isolation of the small quantities of T3 produced from T4 after in vivo or in vitro T4 to T3 conversion.

Triiodothyronine, thyroxine, and iodine in purified thyroglobulin from patients with Graves' disease

Previous studies have suggested that there is an overproduction of triiodothyronine (T(3)) relative to thyroxine (T(4)) in patients with thyrotoxicosis associated with Graves' disease. To evaluate whether or not an increased ratio of T(3) to T(4) in thyroidal secretion could be contributing to this relative T(3) hyperproduction, T(3), T(4), and iodine were measured in thyroglobulin (Tg) from controls and patients with Graves' disease who had been treated either with propranolol only or with antithyroid drugs plus iodide before surgery. To avoid possible artifacts associated with pulse labeling and chromatography, T(3) and T(4) were determined by radioimmunoassay of Pronase hydrolysates of purified Tg. Results of analyses of Tg from six control patients and seven with Graves' disease, not receiving thiourea drugs or iodide, showed that the iodine content of Graves' disease Tg was not different from normal. Both contained 3.4 residues of T(4)/molecule Tg, but there was 0.39+/-0.08 (mean+/-SD) residue of T(3)/molecule Tg in Graves' Tg as opposed to 0.23+/-0.07 residue T(3) molecule Tg in controls matched for iodine content (P < 0.01). This difference resulted in a significantly lower T(4)/T(3) molar ratio (9+/-2) in Graves' Tg as opposed to control (15+/-2, P < 0.001). In Tg from patients with treated Graves' disease, iodine, T(3), and T(4) were reduced, but the reduction in the latter was more substantial, resulting in a T(4)/T(3) molar ratio of 3.4+/-1. Fractionation of Tg from all groups by RbCl density gradient ultracentrifugation indicated that at physiological levels of Tg iodination, the molar ratio of T(3)/Tg was consistently higher in Graves' disease. The specific mechanism for this difference is not known, but it is not due to iodine deficiency. If T(3) and T(4) are secreted in this altered ratio in patients with Graves' disease, the magnitude of the difference could explain the relative T(3) hyperproduction which is characteristic of this state.

Characterization of abnormal thyroglobulin in a transplantable rat thyroid tumor

The solube iodoproteins in a transplantable rat throid tumor (Wollman Line 1-8) were studied after in vivo labeling with 125 I and were partially purified by affinity chromatography on anti-thyroglobulin-AGAROSE. A major fraction ('Peak A') was excluded from gels of large pore size, but had a low sedimentation rate (approximately8S) and did not appear to contain aggregates. It had a high density (approximately1.4) which was possibly due to a high content of carbohydrate, since treatment with a crude glycosidase mixture lowered the density to approximately1.3. A second fraction ('Peak B') had a similar sedimentation coefficient (6-9S) but penetrated the same gels and had a lower density (approximately 1.3). Both proteins formed soluble complexes with antibodies against normal rat thyroglobulin, and had other properties somewhat similar to those of thyroglobulin. After hydrolysis, mono- and diiodotyrosine were the only iodoamino acids liberated. These iodoproteins appears to represent abnormal forms of thyroglobulin synthesized by the tumor.

Use of lithium as an adjunct to radioiodine therapy of thyroid carcinoma

The effect of lithium on iodine kinetics after oral 131I-iodide was studied in an athyreotic patient with follicular thyroid carcinoma. Lithium decreased the disappearance rate of 131I from the whole body and from a tumor mass in the patient's thigh from control values of 0.126/day, respectively, while having only a minimal effect on the rate of 131I disappearance from blood. The increased tumor 131I retention would be expected to increase the therapeutic:toxic ratio of 131I. However, a subsequent therapeutic dose of 131I-iodide given with lithium was accompanied by an unanticipated increase in blood 131I and, therefore, in whole body radiation, resulting in significant bone marrow depression. Although lithium may be a useful adjunct in 131I therapy of functional thyroid carcinoma, it must be used cautiously in future studies.

Scanning halftone plotter and computer-generated continuous-tone hologram

A CRT display called a scanning halftone plotter has been developed. This device can display continuous-tone pictures on a cathode ray tube and serves as the device for displaying pictorial data in digital information processing by a computer. A significant feature of this plotter is the ability to draw computer-generated holograms economically. A very simple and straightforward treatment of the theory of the computer-generated hologram is demonstrated. The simplicity in mathematical treatment is achieved mainly by use of the halftone plotter. A new algorithm for the calculation of the light propagation from object planes composing a three-dimensional object is described. Holograms consisting of nonexistent three-dimensional objects have been synthesized according to this algorithm. By use of this algorithm, the so-called hidden line problem can be solved automatically. A simple method for improving the reconstructed image quality is also described. A halftone object has been successfully reconstructed by this method. Some applications of computer-generated hologram are demonstrated.

Halftone plotter and its applications to digital optical information processing

The study of digital optical information processing by a computer has been performed. As the experimental device, a halftone plotter has been developed which is able to plot the data obtained from an electronic computer with continuous-tone on a conventional cathode ray tube. The capability of producing a halftone drawing by this plotter is useful for displaying optical information processed by a computer. The digital optical information processing studied here is based on this continuous-tone drawing and the reduction of the amount of computer time for the Fourier transform by the new algorithm of the fast Fourier transform. The fast Fourier transform has made it possible to compute in a short time the Fourier spectrum of the object, the convolution integral, the correlation function, etc., by even a middle class computer. These techniques have been applied to some examples. The simulation of filtering and the image restoration by a computer are attempted. The digitized holograms are then synthesized by a computer and are displayed by this plotter on a cathode ray tube as digitized halftone patterns. These holograms are recorded on films and are photoreduced. An image reconstruction is achieved optically for both black-and-white objects and the halftone object. The use of the halftone plotter has permitted us to simplify the theoretical background of the synthesis of a computer-generated hologram. Furthermore, any spatial filters can be made by computer processing.