DIABETES MELLITUS AND ADDISON'S DISEASE IN AN ADOLESCENT FEMALE

Abstract. Matsaniotis, N., Tzortzatou-Stathopoulou, F., Thomaidis, Th., Karakatsani-Kerasioti, Z., Theodoridis, Ch. and Dacou-Voutetakis, C. (First Department of Paediatrics of Athens University, "Aghia Sophia" Children's Hospital, Athens, Greece). Diabetes mellitus and Addison's disease in an adolescent female. Acta Paediatr Scand, 70: 949, 1981.-This short report describes a 16-year-old female who presented with Addison's disease 6 years after diabetes mellitus had been diagnosed. The possibility of both conditions being present should be borne in mind whenever an unexplained reduction of insulin requirements is noted, especially if this is accompanied by cutaneous pigmentation. The metabolic interrelationships of the two conditions are briefly discussed.     

Some considerations on middle ear cholesteatoma in ‘foreign workers’*

The treatment of cholesteatoma in patients without a permanent residence or in medically underdeveloped countries presents a serious problem in middle ear surgery. Methods which erradicate disease safely and reduce the risk of recurrence to a minimum are necessary. We differentiate 3 clinical types of cholesteatoma: 1 Retraction of Shrapnell's membrane or in the postero-superior quadrant with very little cholesteatoma lateral to the ossicles. A transcanal technique is used to evert the cholesteatomatous pocket into the meatus intact, followed by reconstruction of the outer attic wall. 2 Circumscribed cholestatoma lateral and often also medial to the ossicles. Combined approach tympanoplasty is used in such cases. 3 Marginal perforations with large cholesteatomas, situated medial to the ossicular chain. For these ears, classical radical mastoidectomy is the method of choice. (Radical mastoidectomy also has to be performed in all cases of type II, where luxation of the matrix in toto has failed.) Results: No recurrence has been detected in cases where follow-up was possible.     

Sensing Through the Esophagus for Temporary Atrial Synchronous Ventricular VDD Pacing

The purpose of this study was to evaluate the effectiveness and safety of temporary VDD pacing using an esophageal electrode for sensing of the atrial electrogram. We studied 15 patients, 8 men and 7 women, aged 77 ± 2 years (mean ± SE, range 61–90), with severe atriovenfricular (AV) conduction disturbances. A 24-hour beat-to-beat ECG analysis was used to evaluate the effectiveness of the pacing system and special tests were performed to test the stability of pacing and sensing. The system performed satisfactorily in 12 of the 15 patients. The 24-hour Holter ECG monitoring revealed the following percentages of beats: 96.32 ± 0.5 VDD, 2.92 ± 0.6 VVI, and 0.14 ± 0.05 paced beats resulting from pseudosensing. All the latter were single, with no bigeminy or salvos. The results of the stability tests were as follows: the percentage of VDD beats was significantly lower than the 24-hour mean when the patient lay on his right side (92.8 ± 0.5, P < 0.001), during the swallowing of liquids (91.26 ± 0.4, P < 0.001) and soft foods (84.2 ± 1.4, P < 0.001), and during coughing (94.2 ± 0.6, P < 0.001). The percentage of VVI type beats increased in these four cases (6.7 ± 0,5, 7.2 ± 0.3, 13.2 ± 1.2 and 4.8 ± 0.4, respectively, P < 0.001 in each case). The percentage of ectopic beats due to pseudosensing did not change significantly during any of the tests. These results indicate that the method described is a safe and effective technique for temporary VDD pacing.     

6－甲氧基正丁苯酞在大鼠肝微粒体中的代谢研究

报道了用ＧＣ／ＭＳ方法及衍生化技术研究６甲氧基正丁苯酞（ＭＢＰ）在大鼠肝微粒体中的代谢转化结果。６甲氧基正丁苯酞在苯巴比妥（ＰＢ）诱导的大鼠肝微粒体中主要转化为３羟基、γ羟基取代物，６羟基正丁苯酞与一个环氧化代谢产物     

6－甲氧基正丁苯酞的体内代谢转化研究

大鼠用６－甲氧基正丁苯酞（ＭＢＰ）灌胃，收集０～２４ｈ尿液，经酶水解、提取浓缩、衍生化处理后用ＧＣ／ＭＳ分析。在大鼠０～２４ｈ尿液中，６－甲氧基正丁苯酞原药含量很低，主要以代谢物形式存在，依次为Ｃ－６脱甲基产物、Ｃ３－Ｃα环氧化物、γ－羟化物、β－羟化物以及两个次级代谢产物。６－甲氧基正丁苯酞体内代谢结果与其在肝微粒体中代谢结果基本一致。     

The atherogenic plasma remnant-like particle cholesterol concentration is increased in the fasting and postprandial state in active acromegalic patients

BACKGROUND: Premature atherosclerosis is a clinical feature in untreated acromegaly. Increased postprandial lipoprotein remnant levels are associated with premature atherosclerosis. In most studies, remnants have been measured indirectly using retinyl esters (RE) as a chylomicron core label. Remnants can also be directly quantified by immunoseparation using monoclonal antibodies to apolipoprotein (apo) AI and apo B100 to remove nonremnant lipoproteins. Cholesterol is quantified in the remaining apo E-rich remnant fraction (RLP-C). OBJECTIVE: The aim of the present study was to investigate the role of postprandial lipaemia in patients with acromegaly to further define abnormalities leading to increased susceptibility for atherosclerosis. PATIENTS: In a case-control study, the plasma postprandial lipoprotein remnant fraction (RLP-C and RE) were analysed in six patients with active acromegaly [two females, four males; aged 53 +/- 9 years; body mass index (BMI), 29 +/- 4 kg/m2] and in six normolipidaemic control subjects (matched for age, gender, BMI and apo E genotype). They underwent an oral vitamin A fat loading test. RESULTS: Baseline plasma triglycerides (TG) were not significantly different in patients (1.75 +/- 0.71 mM) and controls (1.15 +/- 0.46 mM). Lipoprotein lipase activity was significantly lower in patients than in controls (108 +/- 21 vs. 141 +/- 19 U/l, respectively; P < 0.05). Baseline plasma apo E levels were higher in patients (60.8 +/- 7.9 mg/l) than in controls (48.3 +/- 5.9 mg/l; P < 0.05). No differences were found in the area under the postprandial TG curve (AUC-TG), the incremental AUC-TG (DeltaAUC-TG) and AUC-RE in the Sf < 1000 remnant fraction. However, fasting plasma RLP-C concentrations, isolated by immunoseparation, were increased in patients with active acromegaly (0.41 +/- 0.13 mM) compared to control subjects (0.20 +/- 0.07 mM; P < 0.05). Incremental postprandial RLP-C response (corrected for fasting values) was also significantly elevated in patients (2.14 +/- 1.19 mM/h/l) compared to controls (0.86 +/- 0.34 mM/h/l; P < 0.05). In both groups, the maximal RLP-C concentration was reached between 2 and 4 h. CONCLUSIONS: In conclusion, the atherogenic postprandial remnants, represented by RLP-C, were significantly elevated at baseline and in the postprandial period, whereas the larger-sized remnants, represented by retinyl esters (Sf < 1000), were not different from controls. The disturbances in the postprandial RLP-C response increased the susceptibility for premature atherosclerosis as observed in patients with acromegaly.     

Non-drug related asystole associated with anaesthetic induction

A patient is presented where routine venepuncture associated with anaesthetic induction resulted in bradycardia and asystole. The case highlights the need for special caution with, and ECG monitoring throughout induction for, patients with a history of syncope. It also demonstrates the need for caution when attributing cardiovascular events during induction to the effect of the induction agents used.     

A radioimmunoassay study and comparison of seasonal variation in plasma triiodothyronine and thyroxine concentrations in normal healthy persons

The serum triiodothyronine (T3) and thyroxine (T4) concentration of healthy persons remains almost constant for at least ten months. Fresh serum and serum frozen for two years were compared. The mean difference in T3 concentration is negligible, only 3 ng/100 ml. The radioimmunoassay has a Between Assay Coefficient of 6.3% and is therefore reliable. Results can be obta