Insulin receptor binding to monocytes and erythrocytes in gestational diabetes

Insulin receptor binding to monocytes and erythrocytes was measured at the time of diagnosis and again postpartum in 23 normal weight gestational diabetics. In 16 women, insulin receptor binding was studied after a period of dietary treatment. In patients diagnosed early in pregnancy, an increase in insulin binding to both monocytes and erythrocytes was observed during dietary treatment (p less than 0.001), while no similar changes were observed in patients diagnosed later in pregnancy. Postpartum, insulin receptor binding to erythrocytes decreased in all women compared to the time of diagnosis (p less than 0.01) while insulin binding to monocytes either decreased (p less than 0.001) or remained unchanged depending on the time of diagnosis. Insulin binding was similar in those women who remained glucose intolerant and those who returned to normal glucose tolerance postpartum. The findings indicate that factors other than insulin receptor binding are involved in the pathogenesis of gestational diabetes.     

Binding of C-reactive protein to Aspergillus fumigatus fractions

Calcium-dependent binding of C-reactive protein (CRP) to Aspergillus fumigatus was determined by enzyme-linked immunosorbent assay. A homogenate of young hyphae was fractionated by hydrophobic interaction chromatography followed by gel filtration. High CRP-binding activity was found in a fraction of mol. wt c. 500,000 which was characterised by strong binding to the hydrophobic column. Three fractions of less conspicuous CRP-binding activity were identified (c. 500 000, 150 000 and 150 000-50 000 mol. wt respectively). In these four fractions, phosphorylcholine was detected by an anti-phosphorylcholine mouse hybridoma antibody. Some CRP-binding activity in fractions with low affinity for the hydrophobic column did not correspond closely with the presence of phosphorylcholine. It is suggested that C-reactive substance in A. fumigatus is heterogeneous. The C-reactive substances did not correspond with fractions containing major antigens (470 000 and 250 000 mol. wt respectively) which elicit a strong immune response in man.     

Mitogenicity and metallothionein induction: two separate effects of zinc ions on human mononuclear blood cells

The mitogenic effect of elevated concentrations of zinc ions on human lymphocytes was found to be inhibited by the glucocorticoid hormone dexamethasone. The effect decreased progressively from complete block to partial inhibition when the culture period before the addition of dexamethasone was prolonged. In contrast, dexamethasone did not inhibit an induced formation of metallothionein in mononuclear cells. Furthermore, dexamethasone itself was found to induce small amounts of metallothionein. Apparently, the mitogenic effect and the induction of metallothionein by zinc ions in mononuclear cells occur by mutually independent mechanisms.     

Kinetic models for insulin disappearance from plasma in type I diabetic patients

We have tested whether our previous finding in normal subjects that the disappearance of insulin from plasma obeys saturation kinetics alone also applies to type I diabetic patients. In six long-term diabetic patients steady state plasma insulin concentrations resulting from constant insulin infusion at different rates were compared with the predictions of three models for the kinetics of insulin in plasma. The models allowed the existence of non-saturable (first order equation) or saturable (Micha?lis-Menten equation) mechanisms, or both. The minimal acceptable model included saturation kinetics alone in four subjects and first order kinetics alone in two subjects. The clearance of insulin in diabetic patients, calculated from the best fitting model, was 18.0 (median, range 10.0-23.7) ml X kg-1 X min.-1 versus 25.0 (18.6-47.1) ml X kg-1 X min.-1 in six normal subjects (2p = 0.008). Insulin thus disappears from plasma at a lower rate in diabetic patients than in normal subjects at physiological plasma concentrations.     

Treatment of central corneal ulcers by à chaud transplantation of organ culture preserved donor tissue

In the period 1979-83 a total of 232 penetrating corneal transplantations were performed with organ culture preserved donor material. Forty-two operations were made à chaud for central corneal ulcerations. The results of these interventions are reported and discussed. The surgery presented no serious problems and on first post-operative day the anterior chamber was reformed in all cases, and pain was relieved. Patients were confined to bed only for 1 day. Graft deswelling was slightly retarded compared to planned surgery, but all functioning grafts obtained normal thickness. The overall graft survival rates after 6, 12 and 18 months were 66, 53 and 48%, respectively. For herpetic ulcers the survival after 18 months was 49% and for non-herpetic ulcers 47%. The grafts failed in all cases where it had been necessary to employ grafts of more than 10 mm. This latter group was comprised of the non-herpetic cases; were they excluded, the graft survival rate would increase to 60%. Among cases with a clear graft the median visual acuity after 18 months was 0.33 (range less than 0.1-0.67). Excluding cases with a non-corneal cause of visual reduction, the median visual acuity was 0.4 (range 0.33-0.67). It is concluded that grafting can be successfully employed in the treatment of central ulcers, as it not only restitutes tissue integrity, but also preserves useful vision.     

Inability to elicit vagal responses from the acid-infused esophagus of pigs

Acid application in the esophagus and esophageal distension were undertaken in pigs. One group (n = 9) had operatively induced esophagitis. The other group (n = 7) was normal. We found no discrepancy between the groups neither in inspiratory pressure nor in expiratory PCO2 nor in plasma concentrations of pancreatic polypeptide. The results indicate inability to elicit vagal responses from the acid-infused esophagus of pigs.     

Comparisons between CK-B and other clinical indicators of cardiac contusion following multiple trauma

The activity of creatine kinase (CK) and creatine kinase B(CK-B) was measured in 17 patients with injuries to multiple organ systems, including the chest. The patients were closely observed for clinical signs of disturbed cardiac function by means of serial ECG, continuous monitoring of cardiac rhythm, daily cardiac auscultation, serial chest roentgenography and monitoring of central hemodynamic parameters. No statistically significant difference in CK and CK-B activity was found between the group of patients with normal cardiac function and the group with disturbed cardiac function. The CK-B activity was markedly elevated, but CK-B activity relative to CK activity was normal in both groups during the first 7 days after the trauma. The authors conclude that the significance of these enzymes' serum activity, measured with the immunoinhibition method, is diagnostically doubtful not only as regards cardiac contusions, but also in other cardiopathy preceding or following major trauma.     

Postoperative pain relief with high-dose epidural buprenorphine: a double-blind study

Forty-five patients scheduled for major abdominal or intrathoracic surgery were assigned at random to two different groups. One group received 0.3 mg and the other 0.9 mg of buprenorphine epidurally to abolish postoperative pain. The first dose was given immediately upon arrival in the ICU, irrespective of pain. Subsequent medication was given on demand. The duration of action and side-effects were recorded. Both doses produced excellent and long-lasting pain relief, but no statistically significant difference was found between the groups, with regard to either the duration of action or the occurrence of side-effects.     

Blood loss in transurethral prostatectomy: Epidural versus general anaesthesia

The peroperative and postoperative blood loss was determined in 36 patients undergoing transurethral prostatectomy (TUR-P) using a photometric method. Seventeen patients were randomly allocated to epidural and 19 patients to general anaesthesia. No significant differences were found between the two groups in the total blood loss peroperatively, the corrected blood loss peroperatively (ml/g/min) or the blood loss postoperatively. The systolic blood pressures were equal in the two groups and no correlation between blood loss and blood pressure was demonstrated. The blood loss per g resected tissue was fairly constant and independent of prostatic weight, but bleeding per minute operating time increased significantly with prostatic size. As the total peroperative blood loss increases with operating time, rapid surgery is a possibility of reducing blood loss in TUR-P. Visual estimation of blood loss during TUR-P of larger glands was unreliable with underestimates of about 100 per cent in one third of the patients, when bleeding exceeded 400 ml. Therefore we recommend an accurate determination of blood loss during resection of larger glands.