Corrected transposition of the great vessels: a vectorcardiographic study.

The vectorcardiograms (VCGs) of two groups of patients with corrected transposition of the great vessels (CTGV) were studied; the first, group A, included 17 patients with CTGV in "situs solitus,", characterized by leftward orientation of the cardiac apex; the second group, group B, with three patients, presented CTGV in "situs solitus" and apex to the right. All cases had one or more associated defects: ventricular septal defect, atrial septal defect, pulmonic stenosis or tricuspid insufficiency.     

Mechanism of action of phenetylbiguanide (phenformin) in normal subjects. II. Intestinal absorption versus nonintestinal effects

Administration of phenformin to normal adult controls in a single dose of 200 mg decreased fasting blood sugar and increased the tolerance to acute oral and intravenous glucose loads and to chronic glucose infusion with lower insulin levels, suggesting an effect of the drug on blood glucose independently of its action of the rate of intestinal glucose absorption.     

Effect of estrogen administration on plasma cortisol fractions in normal and panhypopituitary females

The administration of high doses of the synthetic estrogen, ethinyl estradiol (2 mg/day) for 12 days, in five normal females (in the follicular phase of the cycle) and in five patients with panhypopituitarism (Sheehan's disease) kept on thyroid and oral cortisol (20 mg/day), produced a prompt and significant increase in total nonconjugated plasma cortisol (17-hydroxycorticosteroids) and its protein- and nonprotein-bound fractions. These studies suggest that estrogen-induced elevation of nonprotein-bound cortisol (active fraction) is maintained in patients with normal hypothalamic-pituitary-adrenal axis through reversal, partially at least, of the expected inhibition of ACTH release, probably by resetting of the negative-feedback mechanism.     

Transposition of the great arteries with posterior aorta and subaortic conus: anatomical and surgical correlation

Three hearts studied at autopsy with transposition of the great arteries and posterior aorta with isolated or predominantly subaortic conus are described. In all cases the aorta was posterior and to the right of the pulmonary trunk. In two cases it was significantly distant from the pulmonary trunk and in one it was very close. The caliber of the pulmonary trunk was larger than that of the aorta: > 2:1 in two cases and < 2:1 in one case. A well developed subaortic conus was seen in all cases and a small subpulmonary conus in one case. In the other two cases, the pulmonary valve was in fibrous continuity with the mitral valve. In all cases the aortic valve was higher than the pulmonary valve, the relative heights above the ventricles being $\text{25}\text{20}$, $\text{25}\text{30}$ and $\text{40}\text{60}\text{mm}$, respectively. The left coronary artery ran posteriorly and to the left of the pulmonary trunk in all the cases. The length of the main stem of the left coronary artery was 11, 11 and 30 mm, respectively. We discuss the significance of this type of transposition of the great arteries for techniques currently used for surgical correction.     

Evaluation of the gonadotropic responsiveness of the pituitary to acute and prolonged administration of LHFSH-releasing hormone (LHRH) in untreated patients with congenital adrenal hyperplasia

The pituitary gonadotropic responsiveness to acute and prolonged administration of $\text{LH}\text{FSH}\text{-releasing}$ hormone (LHRH) were assessed in 6 patients with untreated congenital virilizing adrenal hyperplasia (partial 21-hydroxylase deficiency). The oldest subjects had normal response in comparison to females at the midfollicular phase, to the acute infusion of 25 ug LHRH regarding both gonadotropins whereas LH secretory area was decreased during the prolonged (100 ug LHRH in 8 hours) infusion with normal FSH secretion. The two youngest subjects, with higher steroid levels in our series, were either unresponsive on both ways of testing or presented pre-pubertal response.     

Mechanism of action of phenethylbiguanide (phenformin) in man. III. Interrelationship between ethanol and phenethylbiguanide (PBG) in normal and diabetic subjects

A standard 4-hr ethanol infusion (236 mg/min) after a 3-day fast with and without phenformin (25 mg q.i.d.), with blood drawn every hour for 8 hr, was performed on five normal subjects, eight obese nondiabetics, seven obese chemical diabetics, and four nonobese diabetics. Control infusion induced in all subjects a decline in blood sugar levels during and/or after the alcohol challenge, with a parallel decrease in basal plasma insulin. Hypoglycemia and the decrease in insulin secretion were associated with increased plasma free fatty acid concentration. Addition of phenethylbiguanide (PBG) to the preparatory 3-day fast resulted in a greater drop in the blood glucose levels of the normal control subjects, obese and nonobese diabetics; in the obese nondiabetics, however, a significantly lower degree of blood glucose decrease than control was elicited. Furthermore, obese nondiabetics altered their blood glucose-insulin interaction with apparent increased responsivess of the B cells to PBG. The results suggest that effects of phenformin on blood glucose levels are more dependent on the metabolic state of the patient than on a property of the drug itself.     

Effects of insulin and glucagon on plasma glucose levels and glycogen content in organs of the freshwater teleost Pimelodus maculatus

Mammalian insulin (350 IU/kg) and glucagon (2.5 mg/kg) were injected intraperitoneally into Pimelodus maculatus, a South American teleost. Extent of carbohydrate regulation was estimated through determination of plasma glucose levels, liver-somatic index, and liver and muscle glycogen contents. The effects of insulin administration, examined 6, 12, 24, 48, and 72 hr after injection, were manifested as a depletion of liver glycogen content after 12 hr and severe decrease in plasma glucose content after 24 hr; insulin had no effect on muscle glycogen or liver-somatic index. The effects of glucagon administration, examined 5, 15, 30, 90, and 360 min after injection, were a small increase in liver glycogen content after 15 min, and hyperglycemia, apparent after 30 min. Glucagon did not affect muscle glycogen or liver-somatic index. Control animals were injected intraperitoneally with saline solution. These results suggest that insulin and glucagon regulate the carbohydrate metabolism of P. maculatus by hormonal mechanisms similar to those operating in other teleost species and in mammals.     

Plasma glucagon suppressibility after oral glucose in obese subjects with normal and impaired glucose tolerance

Blood glucose, plasma insulin, and glucagon responses after a 75 g oral glucose-tolerance test were assessed in 9 normal controls, 5 obese nondiabetics (ON), 5 obese nondiabetics with fasting hyperinsulinemia (obese “resistant” nondiabetics—OR), 9 obese with impaired glucose tolerance (O-IGT), and 9 nonobese insulin-dependent diabetics (IDD). Fasting plasma glucagon concentrations were significantly higher in all groups of patients in comparison to the normal controls. Insulin secretion, evaluated in all but the IDD, was similar to normal in the ON and increased in the OR and O-IGT. Normal glucagon suppression was observed in the lean controls and ON but not in OR, O-IGT, and IDD. We suggested that the resistance to glucagon suppression after glucose load in the OR and O-IGT in the presence of increased insulin response could be an indication that the A cell participates in the relative insulin insensitivity of these subjects.     

Mechanism of action of phenethylbiguanide (phenformin) in man IV. Effect of phenethylbiguanide (PBG) on glucose tolerance and lactate dynamics in obese nondiabetic and chemical diabetic subjects

The effects of long-term administration of phenethyl-biguanide hydrochloride (PBG) on glucose tolerance (oral and IV) and lactate dynamics were studied in obese nondiabetic and chemical diabetic subjects. In the obese nondiabetic subjects, parameters of glucose tolerance—glucose curve areas and glucose disappearance rates (K_g)—were not significantly altered by PBG. However, significant elevations of immunoreactive insulin (IRI) in the oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT) were observed while being treated with PBG, suggesting some degree of “insulin resistance”. Means of blood lactate levels during the OGTT were similar before and while on PBG treatment. Lactate dynamics revealed an increased lactate pool distributed in a larger volume, without significant changes in fasting blood lactate. In the obese chemical diabetic patients, glucose curve areas during the OGTT were corrected in the PBG period, despite the presence of decreased insulin responses to glucose. In the IVGTT, similar glucose curve areas and K_g values were shown in the presence of reduced insulin responses. These changes suggest some degree of PBG-induced facilitation of glucose entry into the cell in obese chemical diabetics. Blood lactate levels in the OGTT were higher at all times during PBG treatment, including fasting values. Lactate dynamics revealed that PBG increased the endogenous production rate of lactate, with expansion of the total lactate pool and no variation in the space of distribution. Plasma lactate concentrations increased significantly. These results show different effects of PBG in obese nondiabetics and obese chemical diabetics, in relation to glucose and lactate dynamics. Furthermore it seems that its effects on lactate dynamics are only exerted in the basal metabolic state of the patients.     

Aortic dissecting aneurysm and aorta-right atrial fistula as a late complication of coronary surgery

We recently evaluated and treated a patient with an aortic dissecting aneurysm associated with an aorta-right atrial fistula as a late complication of coronary artery bypass surgery.     

Aortic stenosis associated with systemic lupus erythematosus

Hemodynamically significant valvular lesions have been rarely reported sequelae of Libman-Sacks endocarditis complicating systemic lupus erythematosus (SLE). Furthermore, embolic phenomena associated with these vegetations have not been clearly documented. We present a report of critical aortic stenosis associated with SLE in a patient who had received corticosteroid treatment for several years. An embolus, histologically identical with the aortic valve vegetation, was found in the left anterior descending artery at necropsy. There was no evidence of rheumatic heart disease, bacterial endocarditis or a bicuspid aortic valve. Recent reports suggest an increased incidence of significant valvular dysfunction in patients with SLE who have received long-term corticosteroid treatment.     

Transition from open to laparoscopic ALPPS for patients with very small FLR: the initial experience

Background

Laparoscopic ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) has previously been reported but has been the authors' default option since 2015 in patients with small future liver remnant.

Effect of verapamil on regional coronary and myocardial perfusion during acute coronary occlusion

To elucidate the mechanism of action of the calcium antagonist verapamil, S-T segment mapping, retrograde coronary flow and regional coronary resistance were studied in 28 dogs subjected to acute coronary occlusion. Retrograde coronary flow was measured directly through catheterization of the distal occluded coronary artery. Regional coronary resistance was calculated by dividing mean distal coronary pressure by coronary flow. Verapamil (0.8 mg/kg) administered intravenously to eight dogs 30 minutes before coronary occlusion significantly reduced S-T segment elevation as compared with occlusion alone (p < 0.025); heart rate and diastolic pressure were also reduced (p < 0.05) but systolic pressure remained essentially unchanged. When verapamil was given to seven dogs within 30 minutes after coronary occlusion, there was a significant increase in retrograde coronary flow (p < 0.05) and a decrease in regional coronary resistance (p < 0.05). Simultaneously, heart rate and heart rate-blood pressure product declined significantly (p < 0.05), suggesting a reduction in myocardial oxygen consumption. Systolic blood pressure was unaltered, and diastolic pressure decreased only transiently. In 13 control dogs there was no significant change in any of these variables during the observation period. Thus, verapamil during acute coronary occlusion protects the ischemic myocardium by both increasing perfusion and reducing myocardial oxygen consumption.     

Lipolysis and the antilipolytic effect of insulin in adipocytes from rats adapted to a high-protein diet

Free fatty acid (FFA) mobilization during fasting was investigated in rats fed a high-protein, carbohydrate-free (HP) diet (70% casein, 8% fat, wt/wt) or a balanced diet (66% carbohydrate, 17% casein, 8% fat) for 30 to 40 days. In vivo, rats on the HP diet showed reduced rates of plasma FFA increase during fasting. Their blood sugar remained unchanged and was higher than that of control rats 24 hours after removal of food. In the fed state, serum insulin levels were smaller in HP-fed rats but did not differ significantly in the two experimental groups during fasting. In vitro, the rates of glycerol and FFA release by epididymal fat pads obtained from fasted rats were similar in rats consuming the HP diet. Fat cells isolated from rats on the HP diet also had reduced rates of basal lipolysis. Furthermore, they showed a significant increase in responsiveness to the lipolytic action of noradrenaline and an increase in both sensitivity and responsiveness to the inhibitory effect of insulin on noradrenaline-stimulated lipolysis. Adipocytes from HP-fed and control rats had mean diameters of 51 and 60 mu, respectively, and estimated average volumes of 90 and 142 pL. On the basis of existing data on the correlation between size and lipolytic activity of fat cells, the smaller size of the adipocytes from HP-fed rats might account for the lower rate of basal lipolysis but not for the increased response to the hormones. The increased sensitivity of fat cells to the antilipolytic action of insulin may have been an important factor in the reduced lipomobilization during fasting in rats under the high-protein regimen.