On the diabetogenic effect of growth hormone in man: effects of growth hormone on glucagon and insulin secretion

Abstract. The effects of human growth hormone (GH) on glucose homeostasis and the secretion of insulin and glucagon was investigated in eighteen healthy subjects. GH (40 μg/kg) was given as a 30 min i.v. infusion and was followed immediately, or after 60 min, by either a glucose infusion, or an i.v. L-arginine infusion or i.v. insulin (005 IU/kg).
An insulin-like effect of GH was seen about 15 min after the start of the GH infusion, and became a diabetogenic action 90 min later. Basal and glucose stimulated insulin secretion were suppressed 60 min after the start of the GH infusion, while insulin response to i.v. L-arginine, on the whole, was uninfluenced. Basal glucagon as well as glucagon response to arginine or hypoglycaemia were uninfluenced by GH. GH did not alter the degree of hypoglycaemia reached after i.v. insulin, whereas the rapidity of blood glucose fall was significantly decreased. The restitution of blood glucose after its nadir was not modified by the hormone.
These results demonstrate that the diabetogenic action of GH is not mediated by GH effects on glucagon secretion, and that GH is of little importance in the acute counter-regulation of insulin-induced hypoglycaemia.     

U22, a Protocol to Quantify Symptoms Associated with Supraventricular Tachycardia

Background: The main indication for ablation of supraventricular tachyarrhythmias (SVTA) is symptomatic relief. Specific paroxysmal symptoms cannot be quantified with general measures of quality of life, such as with the SF-36 questionnaire. U22 is a new protocol which measures the effects of arrhythmia on well-being, the intensity of discomfort during an episode, the type and temporal characteristics of dominant symptoms, and the duration and frequency of episodes. Discrete 0–10 scales are used. Unlike SF-36, U22 can be used in individual patients.
Methods: U22 and SF-36 protocols were used in the symptomatic evaluation of 88 patients (mean age = 49.6 ± 16.4 years; 43 men), who underwent catheter ablation of SVTA.
Results: The U22 scores (SD) for (a) well-being (10 being best), (b) effects of arrhythmia on well-being (10 being worst), and (c) discomfort during arrhythmia (10 being worst) were 5.6 (2.7), 7.5 (2.8), and 8.0 (2.4), respectively. For comparison, the physical and mental component summaries of SF-36 were 45.3 (11.0) and 45.2 (12.1), respectively, slightly lower than the expected normal of 50. The intensity of dominant symptom scored by U22 was 9.7 (1.2), 10 being worst. In 29% of patients ≥4 symptoms were equally dominant. Multiple dominant symptoms in U22 were associated with a low general well-being in SF-36.
Conclusion: We found U22 useful to quantify symptoms associated with SVTA.     

Progressive joint destruction in a human immunodeficiency virus-infected patient with rheumatoid arthritis

This article reports the case of a 63-year-old patient with rheumatoid arthritis (RA) whose symptoms of RA improved after the occurrence of a secondary human immunodeficiency virus (HIV) infection; however, the HIV infection did not affect the histologic parameters of joint destruction to the same extent as it did the clinical symptoms. Histologic and immunohistologic joint examinations of this patient revealed an ongoing production of cartilage- and bone-degrading enzymes by macrophages and fibroblasts, without the presence of T cells. These findings demonstrate that progressive joint destruction in RA can occur in the absence of T cells. Moreover, our results support the hypothesis that both T cell-dependent and T cell-independent pathways play a significant role in the pathogenesis of RA.     

A Qualitative Analysis of Patient-Centered Dentistry in Consultations with Dental Phobic Patients

Dental phobia is regarded as one of the greatest obstructions to adequate dental care. It has long been established that fearful dental patients are particularly sensitive to dentists' behavior and performance of dental care. There is a need for the establishment of a systematic theory of dentist-patient communication and new methods analyzing how dentists interact with their patients. In this qualitative study, thirty semi-structured interviews were conducted in 1998 and 1999 with five dentists (three male and two female). Dentists consulted on two occasions with 15 newly enrolled, consecutive dental phobic patients (2 male and 13 female) in a Swedish clinic specializing in the treatment of odontophobia. The time interval between consultation one and two was approximately 2-3 weeks. Analysis of the transcribed interviews was based by the principles of Grounded Theory. The study identified one core category, "Holistic perception and understanding of the patient", two categories, "The dentist's positive outlook on people" and "The dentist's positive view of patient contact", and six further subcategories. Findings support previous models of patient-centered medicine and contribute to a better understanding of how patient-centered dentists interact with dental phobic patients.     

The Influence of Some Central Nervous Depressants on the Reciprocal Inhibition Between the Two Retinae as Manifested in Retinal Rivalry1

The influence of drugs on retina1 rivalry between a horizontal and a vertical bar was studied with the aim of finding pharmaco-logical agents which might become useful in the treatment of suppression and amblyopia in squint, Amytal, bromural, chloral, ethyl alcohol, phenobarbital and trional can weaken or abolish retinal rivalry. Under the influence of these drugs, completely simultaneous perception of the two dis-parate objects may occur. I n less pronounced cases only a decrease in depth of suppression of the momentarily subjugated image is observed. Together with the decrease in intensity of rivalry the drugs cause a decrease in the frequency of alternation. If, in the normal state, there is an imbalance between the two competing pictures, one of them being dominant more than half of the time, the degree of imbalance usually increases when rivalry is weakened under the influence of the drugs. Morphine in one case caused a marked increase, in two other cases uncertain decreases in rivalry. 3-methyl-5.5-diphenyl-hydan-toin (one case) had no effect on rivalry.     

INFANTILE SPASM AND TUBEROUS SCLEROSIS

ABSTRACT. Haglund, M., Bergvall, U., Theorell, K. and Troell, S. (Departments of Paediatrics and Diagnostic Radiology, Huddinge Hospital, Huddinge, Sweden). Infantile spasm and tuberous sclerosis. Acta Paediatr Scand, 70:751,.–During the years 1976–78, infantile spasm was diagnosed in a total of 12 children. In 4 of these patients the diagnosis tuberous sclerosis was established with the aid of computed tomography (CT). The advantages of CT examination in children with infantile spasm is discussed, especially the possibility to detect tuberous sclerosis at an early stage.     

Effects of Metoprolol on the Counter-regulation and Recognition of Prolonged Hypoglycemia in Insulin-dependent Diabetics

ABSTRACT. The effect of metoprolol on the counter-regulation of prolonged hypoglycemia was studied in eight insulin-dependent diabetics. Insulin was given as an i.v. infusion of 2.4 U/h over 180 min alone, or together with metoprolol (3.0 mg i.v. bolus followed by an i.v. infusion of 4.8 mg/h) in random order. Blood glucose, counter-regulatory hormones, hypoglycemic symptoms and the cardiovascular responses were assayed over 240 min. Metoprolol did not significantly modify the blood glucose levels. The plasma levels of free insulin, however, were elevated by approximately 20% (p<0.01) by metoprolol during hypoglycemia and the plasma concentrations of epinephrine, norepinephrine, growth hormone and cortisol were enhanced by the drug. Sweating was increased by metoprolol, while other symptoms were unaltered. We conclude that metoprolol administered acutely does not aggravate prolonged hypoglycemia in diabetics with blunted response of glucagon. Moreover, exaggerated responses of counter-regulatory hormones, provoked by metoprolol, may compensate for the inhibitory effect of this drug on insulin clearance.     

Effects on glucose tolerance,insulin secretion,insulin-like growth factor 1 and its binding protein,IGFBP-1, in a randomized controlled diet and exercise study in healthy,middle-aged men

Abstract. Objectives . To study the effects of advice on diet, exercise and their combination on oral glucose tolerance (OGTT), insulin secretion, insulin-like growth factor-1 (IGF-1) and its binding protein, IGFBP-1. Design . A 6-month, randomized, controlled intervention study. Setting . Primary health care centres in Sollentuna, Stockholm and the Department of Medicine, Karolinska Hospital, Stockholm, Sweden. Subjects . One hundred and fifty-seven normoglycaemic healthy men, mean age 46 years, range 35–60 years, with slightly to moderately raised cardiovascular risk factors. Interventions . Advice on diet (D, n = 40), exercise (E, n = 39) a combination of both (DE, n = 39) and a control group (C. n = 39). Main outcome measures . An OGTT, insulin secretion, IGF-1 and its binding protein, IGFBP-1. Results . The number of pathological OGTTs in the intervention groups decreased from 42/118 to 33/118 whilst the number in the control group did not change. Fasting insulin levels decreased in groups E and DE from 8.8–7.4 mU L^?1 (P < 0.01) and from 8.3–6.7 mU L^?1 (P < 0.01), respectively. Accordingly, the insulin area under the curve decreased from 5278 to 4828 (P < 0.05) in group E, and from 5482 to 4809 (P < 0.01) in group DE. IGF-1 only increased in group D. The most prominent changes were noted for IGFBP-1, which increased in all three intervention groups and to the highest degree in group DE (from 33.7–42.6 μg L^?1, P < 0.001). Conclusions . A combination of increased exercise and improved diet, as well as increased exercise alone, favourably affect glucose and insulin homeostasis in middle-aged men with moderately elevated cardiovascular risk factors. The most marked changes were noted for IGFBP-1, possibly suggesting a decreased insulin secretion and an enhanced insulin sensitivity.     

Cells in Human Adipose Tissue Developing into Adipocytes

ABSTRACT Sedimentable cells from human adipose tissue of different origins were cultured under conditions when cell multiplication was prevented but lipid filling optimized (suspension culture). In this way an estimation was obtained of the number of in vivo determined adipose precursor cells (preadipocytes) which were not filled with lipid. Under these conditions no cells from adult, non-obese subjects developed to adipocytes. Cells developing to adipocytes constituted less than 0.02% and 1% of adipocytes in tissues from obese adults and from children, respectively. It was concluded that in vivo determined adipocyte precursor cells (preadipocytes, lipid-free fat cells) are not present in a significant number in human adipose tissue either from adults or from children as tested with the method employed, allowing detection of a large number of such cells in adipose tissue from small rats.