Glucose-resistant hypoglycemia in inanition

Three patients had starvation-related hypoglycemia that was not responsive to the infusion of glucose. The patients resembled fatal cases of hypoglycemia seen very rarely in victims of kwashiorkor. None of the patients had a history of drug ingestion, nor was there any evidence of endocrine insufficiency. Two of the patients had low serum insulin levels. Complete postmortem examinations were done for all three patients and there was no evidence of islet cell abnormalities or of malignant neoplasms. A syndrome of severe hypoglycemia refractory to therapy, that was occasionally seen, in years past, in starved individuals is confirmed. The mechanisms underlying the disorder are obscure, but a failure of glycogenolysis, neoglucogenesis, or overproduction of insulin appear unlikely possibilities. It is postulated that cells normally impermeable to glucose, when serum insulin levels are low, become permeable in some severely starved patients, for reasons unknown.     

Application of air sampling and ion-mobility spectrometry to narcotics detection: a feasibility study

A feasibility study of the application of air sampling and ion-mobility spectrometry (IMS) for detection of heroin and cocaine concealed in letter mail showed that a unique IMS signature is associated with each type of drug and that a number of IMS peaks can be used as markers for the presence of drugs. No false reading for cocaine or heroin resulted when innocent items were monitored. Near real-time performance with sampling and analysis times of less than 30 seconds was achieved for the simultaneous detection of cocaine and heroin. The method proved to be a reliable tool for the fast screening of suspect items. Preliminary tests also showed that the method has potential for use in detecting the drugs in suitcases and on people.     

β-Endorphin/β-lipotropin release and gonadotropin secretion after acute exercise in physically conditioned males

Summary β-endorphin (β-EP) andβ-lipotropin (β-LPH) concentrations were measured in the basal state and after acute exercise for 15 min or until exhaustion in 6 physically conditioned male volunteers. Serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and prolactin were also measured in the basal state. In addition, the concentrations of the gonadotropins (LH and FSH) were determined after exercise and the gonadotropin response to gonadotropin releasing hormone was assessed before and after exercise. The data show that acute exercise stimulates the release of bothβ-EP andβ-LPH which return to base-line levels within 60 min after exercise. This is in contrast to our previously described results in physically unconditioned male volunteers in whom onlyβ-LPH release was noted after exercise. Serum LH concentrations declined after exercise reaching nadir values between 60 to 150 min after exercise. As we previously reported in physically unconditioned male volunteers, serum FSH concentrations did not change with exercise and the gonadotropin response to LRH stimulation was uninfluenced by exercise. Serum testosterone and prolactin concentration were within the normal range for healthy adult males. We speculate that the difference inβ-EP release with exercise in physically conditioned and unconditioned males represents a difference in processing of the opioid precursor molecule (pro-opiomelanocortin, POMC) in the two groups.     

Combination chemotherapy of diffuse histiocytic lymphoma with cyclophosphamide, adriamycin, vincristine and prednisone (CHOP).

Twenty-three patients with diffuse histiocytic lymphoma who had not had prior chemotherapy were treated with CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone). Sixteen of these patients had previously been treated with radiation therapy. Nine of these 23 patients had a pathologically documented complete response at the conclusion of CHOP with an overall complete response rate of 39%. In patients whose disease was confined to lymph nodes, the complete response rate was 7 of 8 or 88%, while in patients with stage IV disease, only 2 of 15 or 13% had complete responses. Although prior radiation therapy could not be demonstrated to be an adverse prognostic factor in this small series, it could have accounted for the low overall complete response rate noted. Complete response in this series was well sustained with an actuarial relapse-free survival of 75% and an actuarial survival of 89% at two years. No complete responses occurred in five patients who had received prior chemotherapy.     

Anovulatory effect of a LHRH antagonist in women

The antagonistic analog of LHRH, NAc-D-p-C1-Phe^1,2, D-Trp³, D-Phe⁶, D-Ala¹⁰-LHRH was administered intramuscularly in a dose of 2 mg to ten normally ovulating women on day 12 of the menstrual cycle. Ovulation was inhibited in six patients, and two more presented an insufficient corpus luteum. No pregnancies were recorded in this series. In those patients who did not ovulate, it was demonstrated that the LHRH analog abolished the midcycle surge of both LH and FSH. Luteolysis evidenced by the rapid decline in progesterone levels was present in 2 cases. Bleeding pattern showed a tendency to delayed menses. The morphological findings in endometrial biopsies of 6 women exhibited mild proliferation. Further research along these lines is necessary for appraisal of this approach to birth control.     

Endoscopy in patients with malignant conditions of the gastrointestinal tract.

Two hundred and fifteen consecutive upper gastrointestinal endoscopies were performed. It is evident that the patient population in our setting is quite different when compared with that of a general hospital. The incidence of both gastrointestinal hemorrhage and unknown primary malignant tumor is high. In this group of patients, malignant lesions of the stomach were the most common problem encountered. Primary malignant tumors of the stomach account for the diagnoses in approximately 20 per cent of our patients. Fifty per cent of the patients with cancer of the stomach demonstrated invasion of the lower part of the esophagus or esophagogastric junctional area. The accuracy of endoscopic biopsy was correct in 83 per cent of the patients with malignant tumors of the stomach detected by scopic examination. Thirteen per cent false-negative biopsies occurred from infiltrating diffuse lesions. Endoscopy established the diagnosis of carcinoma of the stomach in one-third of the patients with adenocarcinoma of unknown primary source.     

Plasma concentrations of atrial natriuretic peptide, arginine vasopressin and hormones of the renin-angiotensin system in patients with end-stage renal disease

Plasma concentrations of atrial natriuretic peptide (ANP), arginine vasopressin (AVP), plasma renin activity (PRA) and aldosterone, were measured before and after 3 h of hemodialysis in 9 patients with end-stage renal disease on maintenance hemodialysis. Hormone concentrations were also determined in the same patients on a separate occasion after 1 h of ultrafiltration (UF). Plasma concentrations of ANP were significantly higher in the patients with ESRD than in a normal reference population and declined after both 1 h and 3 h of hemodialysis. Plasma concentrations of ANP failed to exhibit a significant decline after 1 h of UF. Plasma AVP concentrations were not significantly different after either hemodialysis or UF, while plasma aldosterone concentrations fell with hemodialysis. The decline in plasma aldosterone concentrations paralleled the decrease in dialysis-induced fall in serum potassium concentrations. There was no correlation between the blood pressures, heart rate, interdialytic weight gain and estimated fluid overload and any of the hormones measured except for the plasma renin activity (PRA) which correlated significantly with the systolic blood pressure. The data suggest that ANP may not be a major factor in blood pressure regulation in normotensive patients with ESRD and its elevation in patients with ESRD is most likely due to fluid overload and atrial distention as well as a possible reduction in its metabolic clearance in renal insufficiency. The fall in plasma ANP following hemodialysis is not due to its removal by dialysis but is most likely due to a reduction in ANP production caused by dialysis-induced correction of hypervolemia.     

Influence of certain dietary fibers on serum and tissue cholesterol levels in rats.

Pectin, carragheenan, agar gum arabic, cellulose and wheat bran were each fed to rats at a level of 5 to 7% to examine their effect on serum, liver and tissue cholesterol levels. Diets (casein-sucrose diet containing 10-15% soybean oil, or skim milk-wheat flour diet containing 10-15% soybean oil) supplemented with either 0, 0.2, or 0.5% cholesterol were used to test the possibly dietary interactions. Among the fibers tested, pectin displayed the most hypocholesterolemic effect. In some experiments, pectin lowered the level of cholesterol in the serum, liver, and aorta, but it elevated body cholesterol levels. Carragheenan was inconsistent in lowering serum cholesterol levels and tended to increase liver and carcass cholesterol levels. These results probably suggest that pectin and carragheenan can affect the distribution of cholesterol within the body. Gum arabic and agar did not lower serum cholesterol levels and in one case gum arabic elevated them. Furthermore, in some experiments they elevated liver body cholesterol levels. It appears that feeding of gum arabic and agar probably resulted in an expansion of the whole body cholesterol pool. Feeding of wheat bran or cellulose had no significant effect on either serum or liver cholesterol levels. The study indicates that the effect of dietary fiber is dependent on the composition of the diet. Furthermore, while some fibers such as pectin may exhibit a hypocholesterolemic effect in rats, other fibers such as gum arabic and agar may actually elevate serum or tissue cholesterol levels.     

Antenatal diagnosis of genodermatoses

The technics of fetoscopy and fetal skin biopsy have expanded our capabilities for antenatal diagnosis of certain hereditary skin disorders (genodermatoses). The fetus and placenta can be visualized directly and skin biopsy specimens can be obtained for light and electron microscopic studies, tissue culture, and biochemical analysis. These technics have been utilized successfully in the prenatal diagnosis or exclusion of epidermolysis bullosa, epidermolytic hyperkeratosis, and harlequin ichthyosis in fetuses known to be at risk for these disorders, and they offer tremendous potential for prenatal diagnosis in a variety of other genodermatoses. Studies of tissue obtained by this procedure will undoubtedly expand our knowledge of the morphogenesis and biochemistry of fetal skin and will provide needed baseline data for the further development of these technics.