Search

Slightly to moderately increased plasma norepinephrine levels thought to reflect increased sympathetic tone have been observed in a proportion of patients with essential hypertension (1–3). However, some authors have also reported on normal- plasma norepinephrine levels in essential hypertension (4, 5).

From 1979 to 1986, seven patients with multiple endocrine neoplasia (MEN) type IIa and three with type IIb were treated. Nine had a C-cell carcinoma, one had C-cell hyperplasia. None had hyperparathyroidism. Three patients had multiple mucous neuromas. Six patients had proven pheochromocytoma: adrenalectomy was performed in these six (unilateral or bilateral depending on whether the tumor was uni- or bilateral). All ten patients had a total thyroidectomy--three later required neck dissection for regional lymphnode metastases. One patient died from the consequences of diffuse liver metastases of a C-cell carcinoma. Extensive family screening is necessary with patients who have MEN type II, in order to discover early any occult disease carriers. In addition, MEN type II should be excluded in all patients who have C-cell carcinoma, pheochromocytoma or hyperparathyroidism.

In den letzten Jahren wurde verschiedentlich der Versuch unternommen, die Gruppe der Patienten mit essentieller Hypertonie nach ihrer Sympathikusaktivitat [3] oder nach der Hohe ihrer Reninaktivitat [2, 5] in Untergruppen zu unterteilen. Diese Differenzierung erfolgte einerseits, um Hinweise auf eine moglicherweise unterschiedliche Atiologie des Hochdruckes bei diesen Untergruppen zu erhalten, zum anderen, um Ansatzpunkte fur eine Differentialtherapie der Hypertonie zu gewinnen. Als Therapieprinzipien wurden dabei insbesondere β-Rezeptorenblocker und Diuretika eingesetzt. Patienten mit erhohter Reninaktivitat sollen nach Buhler [1] auf eine β-Rezeptorenblockade mit einer starkeren Blutdrucksenkung reagieren als Patienten mit niedrigem Plasmarenin. Auf der anderen Seite konnte von verschiedenen Arbeitsgruppen [2, 5] nachgewiesen werden, das der Hochdruck bei Patienten mit niedriger Reninaktivitat gunstiger durch eine Therapie mit Diuretika zu beeinflussen ist. Beide Therapieprinzipien, der Einsatz der β-Rezeptorenblocker sowie der Einsatz von Diuretika, gehoren heute zu der Basistherapie der Hypertonie. Um eine mogliche Abhangigkeit des therapeutischen Effekts dieser Substanzgruppen von der Reninaktivitat und dem Plasmanoradrenalin als Parameter der Sympathikusaktivitat feststellen zu konnen, wurde eine Crossover-Studie unter Verwendng eines β- Rezeptorenblockers und eines Diuretikums durchgefuhrt. Als β-Rezeptorenblocker wurde Atenolol (Tenormin), ein kardioselektiver β-Blocker ohne Intrinsic-Aktivitat verwendet, als Diuretikum kam die Kombination von Triamteren und Hydrochlorothiazid (Tri/HCT) (Dytide H) zum Einsatz.

1. An inverse relationship was found between plasma noradrenaline and reactivity to exogenous noradrenaline in normotensive subjects. 2. The relationship between plasma noradrenaline and reactivity was disturbed in age-matched patients with essential hypertension. 3. A multiple-regression analysis showed a highly significant correlation between adrenergic activity and reactivity to noradrenaline and the mean arterial blood pressure level (r = 0·91). The results suggest that adrenergic activity and pressor response to noradrenaline combined are important determinants of arterial blood pressure. 4. An inverse relationship could also be demonstrated between plasma renin activity and reactivity to exogenous angiotensin II. No difference was observed between normotensive and hypertensive subjects.

Die Nebennierenszintigraphie mit 131J-Cholesterol wurde in den letzten Jahren von verschiedenen Arbeitsgruppen zur weiteren Diagnostik von Nebennieren-funktionsstorungen benutzt [1, 2, 5, 7, 9]. Cholesterol, eine Vorstufe der Nebennierenrindenhormone, zeigt nach parenteraler Gabe eine schwache, aber spezifische Anreicherung in der Nebenniere [1, 2, 7, 9]. Es konnte inzwischen gezeigt werden, das bei Verwendung optimaler Strahlungsmestechnik sich im Gegensatz zur Angiographie [11] auch die gesunden Nebennieren regelmasig darstellen lassen. Optimale Szintigramme der Nebennieren werden bei Nebennierenrindenhyperplasie als Folge einer vermehrten hypothalamisch-hypophysaren oder medikamentosen Stimulation durch ACTH beobachtet [1]. Endokrin aktive Tumoren der Nebenniere sowie metastasisches Carcinommaterial zeigen ebenfalls eine vermehrte 131J-Cholesterolanreicherung bei einer charakteristischen Suppression der kontralateralen Nebenniere [3, 7, 10].

In six patients with adrenal pheochromocytoma the tumors were localized by ultrasonography, phlebography of the adrenal glands and by estimation of plasma catecholamines selectively obtained from the vena cava and the adrenal gland veins. All tumors were localized by selective catecholamine estimation, five by ultrasonography, and four by phlebography. The smallest pheochromocytoma of 1.5 g weight was only localized by selective catecholamine estimation but not by ultrasonography or phlebography. This tumor, however, had been visualized by computed tomography. To avoid diagnostic errors by selective catecholamine estimation, it is important to withdraw blood from the adrenal gland veins prior to the injection of any radiographic contrast media, since this may result in an extremely enhanced secretion of catecholamines from the adrenal medulla.

Plasma levels of calcitonin and carcinoembryonic antigen (CEA) were determined pre-operatively and two months postoperatively in ten patients with C-cell carcinoma as part of multiple endocrine neoplasia type II. In addition, CEA was measured in extracts from 20 different phaeochromocytomas (five from patients with multiple endocrine neoplasia type II, 15 from patients with sporadic phaeochromocytoma). In comparison, CEA concentration was determined in extracts from five C-cell carcinomas of patients with multiple endocrine neoplasia type II. When correlating pre- and postoperative calcitonin and CEA levels, there was a significant linear relationship (P less than 0.001). CEA concentration in extracts from phaeochromocytomas was at the lower level of sensitivity (4.7 +/- 12.2 pg/mg tumour wet-weight). In extracts from C-cell carcinomas they were much higher (6402 +/- 4570 pg/mg tumour wet-weight). The results suggest that it is possible, in patients with phaeochromocytoma and high calcitonin levels, to differentiate by additional CEA determination between C-cell carcinoma in the course of multiple endocrine neoplasia type II and sporadic phaeochromocytoma with ectopic calcitonin liberation.

Fasting C-peptide levels and those after tolbutamide or glucose stimulation were measured in normal subjects. In patients with various hypo- or hyper-functions of the endocrine pancreas, C-peptide levels were compared with the corresponding insulin levels. In insulin-dependent maturity-onset diabetics there were both normal and elevated serum C-peptide levels. In juvenile diabetics and patients with total duodenopancreatectomy there was no measureable C-peptide. It is concluded that the half-life of C-peptide is three times that of insulin.

In vorangegangenen Untersuchungen konnte gezeigt werden, das bei normotensiven Versuchspersonen zwischen dem Parameter der sympathischen Aktivitat Plasma-Nor-adrenalin (NA) und der blutdrucksteigernden Wirkung von exogenem NA eine inverse Beziehung besteht [4]. Die Feststellung dieser inversen Beziehung basierte auf der Untersuchung von 29 Normalpersonen. In der vorliegenden Arbeit wurde untersucht, ob zwischen den genannten Parametern eine intraindividuelle dynamische Beziehung besteht, d. h. ob bei Veranderung der einen Grose eine inverse Veranderung der anderen zu beobachten ist. Um diese Frage zu uberprufen, wurden Patienten untersucht, die sich zu verschiedenen Zeitpunkten in hypo- und hyperthyreoter Stoffwechsellage befanden. Es ist bekannt, das in hypothyreoter Stoffwechsellage erhohte Plasma-NA-Werte gefunden werden [2]. Bei hyperthyreoten Patienten werden andererseits niedrig-normale Plasma-NA- Werte beobachtet [1]. Die Empfindlichkeit gegenuber exogenen Katecholaminen scheint in der der Hyperthyreose gesteigert zu sein [3], wahrend uber die Sensibilitat gegenuber Katecholaminen in der Hypothyreose keine einheitlichen Befunde vorliegen.

The effect of enflurane anaesthesia on the sympathoadrenal system, the hypothalamic-hypophyseal-adrenocortical system, and on the circulatory system was investigated in patients undergoing ophthalmic surgery. Blood concentrations of adrenaline, noradrenaline, ACTH, cortisol, and arterial blood pressure and heart rate were measured in 10 patients 30 min after premedication (I), 3-5 min after surgical incision (II), 20 or 45 min after surgical incision (III) and in 7 of 10 patients 10-15 min after extubation (IV). After conventional induction anaesthesia was maintained with enflurane (1.5-2.0%), combined with N2O/O2 2:1, and intermittent relaxation. Plasma adrenaline, ACTH, cortisol and heart rate increased significantly during operation, while plasma noradrenaline and blood pressure did not change significantly. Thus enflurane anaesthesia could not completely inhibit the increased activity of sympathoadrenal and hypothalamic-hypophyseal-adrenocortical system caused by surgical stress.

The effect of six months of treatment with 750 mg calcium dobesilate on sedimentation rate blood count, cholesterol, triglycerides, platelet aggregation factor, total protein, electrophoretic distribution of serum protein concentrations, and kinetics of intravenous albumin marked with 131I was established in 35 diabetics with a mean duration of diabetes of 9.8 years. There was significant intravascular retention of 131I albumin and significant increase of serum albumin, beta-globulins and total protein after treatment. The other parameters remained unchanged. The results are interpreted as evidence of lowering of the increased transcapillary permeability within the vascular system seen in diabetics.

Pheochromocytoma scanning using 131J-meta-benzylguanidine was done in one patient with metastasizing paraganglioma, one patient with multiple endocrine neoplasia type IIb. No activity of tumour tissue could be demonstrated in the patient with metastasizing paraganglioma, whereas the pheochromocytoma could be clearly defined in the patient with multiple endocrine neoplasia type IIa. The female with multiple endocrine neoplasia type IIb showed a suspect space-occupying lesion of the left adrenal using computed tomography. Pheochromocytoma could be excluded by 131J-benzylguanidine scanning, selective estimation of catecholamines in adrenal venous blood as well as the glucagon stimulation and clonidine suppression.

In einer fruhereri Untersuchung haben wir uber insulinpflichtige Altersdiabetiker berichtet, bei denen wir normale oder erhohte Nuchtern-C-Peptidspiegel masen. Bei einigen von diesen Patienten konnte die C-Peptidsekretion durch intravenose Injektion von Glibenclamid-Glucose stimuliert werden, andere zeigten ein starres Sekretionsverhalten [1]. Mittels insulininduzierter Hypoglycamie soll untersucht werden, ob sich die C-Peptidspiegel bei insulinpflichtigen Erwachsenendiabetikern hemmen lassen oder ob es sich um kumuliertes, aus einer geringen Restsekretion stammendes, C-Peptid handelt. Da C-Peptid vorwiegend in der Niere abgebaut wird, ware bei einer Nierenschadigung ein solcher Mechanismus denkbar. Bei den gemessenen C-Peptidspiegeln konnte es sich auch um an Antikorper gebundenes Proinsulin handeln, das mit dem Assay kreuzreagiert. In beiden Fallen durften die C-Peptidspiegel nicht durch Insulinhypoglycamie zu senken sein. Gleichzeitig wollten wir klaren, ob eine durch Hypoglycamie induzierte Adrenalinausschuttung am Mechanismus der Hemmung der C-Peptidsekretion beteiligt ist.

A modified M-mode ultrasound echo system had been employed to study blood-vessel geometry of the intact femoral artery before and after Norepinephrine (NE) infusion. 14 patients with juvenile IDDM aged below 35 years and 11 healthy subjects participated in the study. In the diabetic group, wall distensibility (delta D/delta P) was reduced (p less than 0.01) at control conditions. After NE infusion, wall distensibility decreased in both groups (p less than 0.01). The decrease of wall distensibility is due to an increase in pulse pressure (delta P) (p less than 0.002) in the diabetic group and a reduction of pulsatile diameter (delta D) (p less than 0.02) in the normal group. Increased stiffening of the arteriaL wall after NE infusion with progressive reduction of wall strain (delta D/Dd) is the typical finding in the normal group. No change of wall strain was observed in the diabetic group. The functional alteration of the diabetic femoral artery may be described as diminished resistance of the arterial wall to the distending force of rising blood pressure.

Bone density was measured in 18 patients with hypogonadotropic hypogonadism (3x Kallmann syndrome, 15x IHH) and in 16 patients with hypergonadotropic hypergonadism (16x Klinefelter syndrome) which had never been treated with a hormone therapy.

Der biogenetische Vorlaufer des Insulins ist das Proinsulin. Durch enzymatische Spaltung entsteht daraus jeweils ein Molekul Insulin und ein Molekul C-Peptid. Da beide Proteine in aequimolaren Mengen gebildet werden, kann man vom Serum-C-Peptidspiegel auf den Insulingehalt des Serums schliesen und umgekehrt. Dieses ist von Bedeutung bei Patienten, die Insulin spritzen, und bei denen man deswegen die endogene Insulinproduktion nicht messen kann.

Biochemical and radiological results, surgical technique and its results were critically analysed in a retrospective study of 154 operations on the adrenals in 127 patients, operated on between 1957 and 1980. There were no complications in 95 patients. In the remaining 32, both intra- and postoperative complication rate was greater after extraperitoneal than transabdominal approach to the adrenals. Postoperative mortality was 6%, but since 1967 only two patients have died in the postoperative period. Thromboembolic phenomena were the main cause of death, patients with Cushing's disease most commonly having this complication.

Die primare Nebennierenrindeninsuffizienz ist eine relativ seltene Erkrankung, deren Vorkommen in einer amerikanischen Obduktionsstatistik mit 4 auf 100000 angegeben wird [1]. Auch in einer epidemiologischen Studie aus England wird ihr Auftreten gleich hoch eingeschatzt [4].

Urinary catecholamines and urinary excretion of vanillylmandelic acid confirmed the diagnosis of phaeochromocytoma in ten patients. In two of seven a modified glucagon test significantly aided confirmation of the diagnosis. In all patients the tumour was localised both by catecholamine determination in blood from the vein draining into the inferior vena cava (IVC) and by adrenal phlebography. Site of the adrenal tumour was definitively determined by the high catecholamine level in the adrenal veins and by phlebography. Three extra-adrenal tumours, a thoracic and two abdominal ones, were localised by high catecholamine levels in blood from other veins draining into the IVC. Vanillylmandelic acid determinaion was unreliable in the diagnosis of small phaeochromocytomas.

Selective venous blood sampling was performed in 89 patients with hypertension (14 pheochromocytoma, 10 Conn's syndrome, 8 Cushing's disease, 57 essential hypertension). We looked for diagnostic criteria and the valuability of blood sampling from the adrenal veins in such diseases. Defining a norepinephrine concentration of more than 8,000 ng/l as pathological, we had an accuracy of 94.6%. Defining an aldosterone concentration of more than 1,400 pg/ml as pathological, we had an accuracy of 97.4%. In Cushing's disease this method was not very helpful due to overlapping results.

The diagnosis of phaeochromocytomas is based on the clinical features and on the hormone findings in the peripheral blood. Localisation, however, depends on radiological methods. Pneumoperitoneum was abandoned, because of its low accuracy, in favour of arteriography; lately, suprarenal phlebography has been available for the localisation of phaeochromocytomas. Our experience in nine patients with operatively confirmed phaeochromocytomas is described. Together with venous sampling from the caval system and the suprarenal veins for catecholamine estimations, it was possible to localise all tumours correctly. One tumour lying in the sympathetic chain in the thorax was correctly localised by hormone estimation. Our experience suggests that suprarenal phlebography represents a reliable method for localising phaeochromocytomas which carries a low risk and is to be preferred to arteriography.

Epinephrine, norepinephrine, ACTH and cortisol plasma levels as well as heart rate and blood pressure were studied in 32 patients undergoing ophthalmic surgery. Epinephrine levels rose significantly during nitrous oxide anesthesia and also during enflurane-nitrous oxide anesthesia, whereas they fell slightly during halothane-nitrous oxide anesthesia. Norepinephrine levels remained unchanged. ACTH and cortisol levels increased during all three types of anesthesia. During nitrous oxide and enflurane-nitrous oxide anesthesia, heart rate and blood pressure were elevated, halothane nitrous oxide anesthesia was associated with an increased heart rate but not with increased blood pressure.

The relationship between sympathetic responsiveness and the blood pressure reduction induced by long-term beta-blockade was assessed in patients with essential hypertension. The increase in plasma noradrenaline concentration during physical exercise was used as an index of sympathetic responsiveness. The cardioselective beta-blocker, atenolol, was given to 16 patients with sustained benign essential hypertension for five weeks at a dose of 200 mg/day. Atenolol induced a marked decrease in blood pressure and pulse rate during recumbency, orthostasis and exercise concomitant with a marked increase in plasma noradrenaline concentration (p less than 0.0125) and a pronounced decrease in plasma renin concentration (p less than 0.01). The ratio of plasma noradrenaline during exercise to the base line concentration correlated significantly with the subsequent decrease in mean arterial blood pressure induced by beta-blockade (r = 0.840; p less than 0.001). A less significant correlation was observed between the plasma renin concentration and the subsequent decrease in mean arterial pressure (r = 0.542; p less than 0.05). The results obtained indicate that sympathetic responsiveness is an important determinant of blood pressure response to beta-blockade induced by atenolol.

It is well established that in sera of totally duodenopancreatectomized dogs after complete insulin deprivation an immunoreactive glucagon can be found, which is indistinguishable from the pancreatic glucagon, and which can be stimulated by oral glucose and i.v. arginine as well. In four duodenopancreatectomized patients we found, after 26 h insulin deprivation, normal and elevated basal levels of IRG which were not stimulated by intravenous arginine but by oral glucose. Dilution tests of the sera before glucose stimulation showed immunological properties different from pancreatic standard glucagon, whereas in sera after stimulation immunoidentity with pancreatic standard glucagon could be demonstrated. Gel chromatography of the sera after stimulation yielded at least three immunoreactive peaks, the first over 30 000 daltons, a second eluting in the region of insulin, and a third of about 2000 daltons. True glucagon (3500 MW) could not be clearly demonstrated.

Seit die Moglichkeit besteht, die Parathormonkonzentration im Plasma direkt zu bestimmen, konnen die weitaus meisten Kalziumstoffwechselstorungen an Hand von relativ wenigen basalen Laborwerten diagnostiziert werden. Dies setzt jedoch voraus, das die Bestimmungsmethode eine eindeutige Trennung von normalen und pathologischen Werten zulast. Fur den Normalbereich des Parathormons (PTH), der von 0–12 pMol/1 reicht, ergibt sich ein annahernd linearer Verteilungstyp der Meswerte, mit Haufigkeitsgipfel an der unteren Grenze und einer kontinuierlichen Abnahme der Haufigkeit in Richtung des oberen Bereiches.

An 2 7 Frauen und 11 Mannern mit Akromegalie wurde die Knochendichte in Single-Photonenabsorptionstechnik am proximalen (uberwiegend Kompakta) und distalen (uberwiegend Spongiosa) Mespunkt des Unterarms untersucht. Die Knochendichte lag dabei am proximalen Mespunkt im zu erwartenden Altersnormbereich, am distalen Mespunkt war sie deutlich erhoht (p < 0,001). Die mit quantitativer Computertomographie gemessene Spongiosa der Lendenwirbelsaule fanden wir uber das Alter hinaus vermindert. Als Ausdruck eines gesteigerten Knochenabbaus fanden wir das Hydroxyprolin im Urin erhoht, wahrend sich das Osteocalcin als Marker der Osteoblastenaktivitat invers dazu verhielt.

The follow-up of Graves' ophthalmopathy was analysed regarding to clinical and chemical data on the one hand and to dependence on different therapeutic alternatives on the other. 297 patients (44 +/- 14 years, 249 female, 48 men) were observed with inclusion of data from the history and clinical data as well (computer tomography and orbital sonography). At the onset of therapy 253 patients were hyperthyroid, 36 euthyroid and eight showed hypothyroidism. The staging was: I 13, II 54, III 113, IV 95, V five, VI eight patients. The HLA-typing in 89 patients showed the following results: B8 in 32%, DR3 in 42%, B8 as well as DR3 in 24% of the patients. In about 50% of the cases there were raised microsomal and in about 18% there were raised thyroglobuline antibodies. 63% of the patients received immunosuppressive medication: corticosteroids in 100% (more than one time in 43%), cyclosporine A in 11%, ciamexone in 10%, other non-steroid immunosuppressants in 5% of the cases. The retrobulbar irradiation was performed in 9%, and total thyroidectomy in 7%. During therapy the inflammatory process was clearly ameliorated, however exophthalmos and diplopia were more resistant to treatment. In the group of patients with combined cyclosporine and prednisone therapy and in the group of patients with total thyroidectomy and partly retrobulbar radiotherapy, significant differences were observed regarding to visual acuity and Hertel values. None of the therapies applied constitutes an optimal treatment with the regard to the long-term course. Under therapy an improvement can be reached, but no complete healing.

Nach der Nierenarterienstenose ist das Phaochromozytom die zweithaufigste chirurgisch kurable Ursache einer arteriellen Hypertonie. Aufgrund einer Haufigkeitserrechnung aus der Mayo-Clinic kann mit vier Fallen auf 10000 Hypertoniepatienten gerechnet werden [16].

Slightly to moderately increased plasma noradrenaline levels thought to reflect increased sympathetic tone have been observed in a proportion of patients with essential hypertension [1, 2, 3]. However, some authors have also reported on normal plasma noradrenaline levels in essential hypertension [4, 5].

Die Pathogenese der essentiellen Hypertonie ist noch weitgehend unklar. Zwei Mechanis-men, die in der Entstehung eines Hochdruckes eine entscheidende Rolle spielen konnen, sollen an dieser Stelle naher untersucht werden. Zum einen ist bekannt, das bei einem Teil der Patienten mit essentieller Hypertonie ein erhohter Aktivitatszustand des sympathischen Nervensystems vorliegt [1]. Zum anderen wurde wiederholt festgestellt, das ein Teil der Patienten mit essentieller Hypertonie eine gesteigerte Empfindlichkeit gegenuber pressorisch wirkenden Substanzen, insbesondere Noradrenalin, aufweisen [3]. Experi-mentell konnte nachgewiesen werden, das nach Ausschaltung des Sympathikus durch Denervierung die Empfindlichkeit eines Gefases gegenuber Noradrenalin stark zunimmt [4]. Bei Noradrenalinexcess andererseits, wie er bei Patienten mit Phaeochromocytom vorliegt, ist die pressorische Wirkung von exogen zugefuhrtem Noradrenalin deutlich reduziert [2]. Es ist demnach denkbar, das sich die Gefasreagibilitat gegenuber Noradrenalin umgekehrt propqrtional zum Noradrenalinspiegel bzw. zur Sympathikusaktivitat verhalt. In der vorliegenden Untersuchung soil die Beziehung zwischen Noradrenalin-reagibilitat und Aktivitatszustand des sympathischen Nervensystems naher untersucht werden.

Die Funktionsdiagnostik des Hypophysenvorderlappens ist mit Hilfe der synthetischen Releasing-Hormone wesentlich erweitert und verfeinert worden [1]. Erstmals ist es moglich geworden, Storungen im hypothalamo-hypophysaren Bereich naher zu lokalisieren. Daruber hinaus besteht heute die Moglichkeit, alle Partialfunktionen des Hypophysenvorderlappens mit geeigneten Stimulationstest zu erfassen und an Hand der Ansprechbarkeit differenziertere Aussagen uber eine Schadigung des Hypothalamus und der Hypophyse zu machen. Von besonderem Wert ist die hierdurch gegebene Moglichkeit, zu erkennen, ob das Bemuhen um eine selektive Adenomextirpation mit Hilfe moderner neurochirurgischer Techniken [2–4] den gewunschten Erfolg hatte. Auch durften Verlaufskontrollen mit Stimulationstests es wesentlich erleichtern, Rezidive von endo-krinologischer Seite zu erfassen. Schlieslich muste auch die Substitutionsbedurftigkeit und das Ausmas der notwendigen Substitution besser erwogen werden konnen [5].

Tumour weight was compared with maximal vanillylmandelic acid and catecholamine excretion in 24-hour urine in 21 patients with phaeochromocytoma. The tumour weight correlated both with vanillylmandelic acid (r = 0.805, P less than 0.001) as well as urinary catecholamine levels (r = 0.725, P less than 0.001). Normal vanillylmandelic acid excretion was found in seven patients; urinary catecholamine levels were abnormal in all patients. The Katecult test was additionally performed in ten patients, with nine positive results.

Jedes vom Organismus als Aggression empfundene Geschehen fuhrt zu einer Aktivitatssteigerung der Hypothalamus-Hypophysen-Nebennierenachse. Durch die Untersuchungen von Cannon [1] und Levi [5] sowie neue Arbeiten von v. Euler [2] und anderen wurden die quantitativen Beziehungen zwischen verschiedenen Stresformen und der Antwort des sympatho-adrenergen Systems naher untersucht.

Plasma adrenaline, noradrenaline, blood pressure and heart rate were determined in 10 normotensive and 10 hypertensive patients undergoing ophthalmic surgery under electrostimulation anaesthesia. Venous blood samples for the determination of the catecholamines by a spectrofluorometric method were taken 30 min after premedication and 45 min after surgical incision. The catecholamine concentrations showed no significant differences neither by comparing the normotensive patients with the hypertensive patients nor by comparing the values during operation with them after premedication in each group. However, in the hypertensive patients blood pressure showed a higher increase during operation than in the normotensive patients.

Percutaneous transhepatic portal vein catheterisation with blood sampling from the various areas of drainage, especially the pancreatic veins, was undertaken in seven patients with insulinoma to diagnose its site. In six patients measurement of serum-insulin levels revealed an abrupt rise in the vascular area later found to drain the area of the insulinoma. Insulin measurement in one patient with insulinoma in the head of the pancreas falsely indicated an islet-cell tumour in the region of the tail of the pancreas. C-peptide concentration in serum followed the concentration of insulin, but did not show such a marked rise. The method of percutaneous transhepatic portal vein catheterisation with selective blood sampling for the measurement of hormonal concentration was superior to ultrasound, computer tomography or coeliacography for determining the site of the tumour.