HORMONAL CHANGES IN NONCIRRHOTIC MALE ALCOHOLICS DURING ETHANOL WITHDRAWAL

Serum concentrations of iodothyronines, cortisol, prolactin,testosterone and the respective tropic hormones were measuredin 32 noncirrhotic male alcoholics, aged 28–51 years,at the end of a long drinking period and subsequently duringethanol withdrawal over 1–2 weeks. Seven men had testicularatrophy. On admission one patient had high values for serumthyroxine (T4) and free thyroxine index (FT4I). A blunted responseof serum thyrotropin (TSH) to thyrotropin-releasing hormone(TRH) was found in 9 men. Apart from a blunted TSH-responsein one man the abnormalities disappeared during the first weekof alcohol abstinence. Simultaneously the mean levels of serumT4, FT4I, triiodothyronine, free triiodothyronine index andreverse triiodothyronine were reduced by 12, 14, 5, 8 and 21%,respectively, and the mean of the maximum TSH-response to TRHwas increased by 55%. At the time of stopping drinking two menhad high morning values and six an abnormal diurnal rhythm ofserum cortisol. High serum ACTH-levels associated with normalserum cortisol concentrations were found in 12 men. During thefirst week of alcohol abstinence the mean morning values forserum cortisol and ACTH were reduced by 18 and 42%, respectively.The serum ACTH-levels remained high in 6 men but the abnormalitiesin cortisol secretion disappeared. On admission four men hadlow serum concentrations of testosterone which were normalizedduring ethanol withdrawal over one week. At the same time themean level of serum testosterone was increased by 19%. Mildhyperprolactinaemia found in 7 patients on admission disappearedin 4 men during the first week of ethanol withdrawal. Duringthe second week of alcohol abstinence no further changes wereoccurring in the hormonal parameters studied. The present study indicates that clinically significant hormonalchanges are only occasionally seen in chronic alcoholic menwithout liver damage. Whether high serum ACTH-levels in chronicalcoholics without hypercortisolism indicate an ethanol-inducedACTH-resistance remains to be determined by further studies.     

Stopping Insulin Treatment in Middle-aged Diabetic Patients with High Postglucagon Plasma C-Peptide

ABSTRACT We studied the successfulness of stopping insulin treatment in middle-aged diabetic patients aged 45–64 with a high postglucagon C-peptide level and the effects of this change on glycaemic control, serum lipids and lipoproteins. Insulin treatment was successfully stopped in 15 of our 22 patients who satisfied the inclusion criteria for the study and were selected on the basis of a computer file including practically all diabetic patients treated with insulin in the Kuopio University Central Hospital region (population base 250000 inhabitants). Insulin therapy was restarted in seven patients during the first 3 months after discharge. During the following 9 months insulin therapy was restarted in another three patients so that after a 1-year follow-up period half of the diabetic patients whose insulin therapy was stopped had been switched back to insulin. Insulin therapy was seldom successfully stopped if the postglucagon C-peptide value was under the limit of 1.0 nmol/l. Glycaemic control did not change during the follow-up, although there was a significant weight loss in diabetic patients. No changes were observed in serum lipids or lipoproteins with the exception of LDL cholesterol, which showed a significant reduction during the 3-month follow-up. In conclusion, insulin therapy can often be successfully stopped in patients with postglucagon C-peptide over the limit of 1.0 nmol/l without worsening of glycaemic control and without unfavourable changes in serum lipid and lipoprotein levels.     

Diseases Mimicking Thrombosis of the Limb – A Retrospective Radiological Study

To demonstrate misinterpretation of phlebography findings we present 14 cases, which were first diagnosed as deep vein thrombosis, but later turned out to be caused by expansive processes around veins, e.g. popliteal cyst, haematoma, muscle necrosis and abscess.     

ACUTE LIVER FAILURE AND ENCEPHALOPATHY (REYE'S SYNDROME?) DURING SALICYLATE THERAPY

ABSTRACT: Sillanpää, M., Mäkelä, A.-L. and Koivikko, A. (Department of Paediatrics, University of Turku, Turku, Finland). Acute liver failure and encephalopathy (Reye's syndrome?) during salicylate therapy. Acta Paediatr Scand, 64: 877, 1975.–A case of hepatotox-icity and encephalopathy (Reye's syndrome?) associated with salicylate therapy is presented and the aetiology of this syndrome is discussed. Hepatotoxicity developed with salicylate serum concentrations not exceeding therapeutic serum levels. The importance of controlling serum salicylate concentration and transaminase activity particularly during the first fourteen days of therapy is emphasized.     

The Sydney System: Epidemiology and natural history of chronic gastritis

Chronic gastritis is a common disease which forms an important background to the pathogenesis of several gastric diseases. In most instances, gastritis seems to be a bacterial (microbial) disease. It begins as long-lasting, chronic inflammatory reaction directed against Helicobacter pylori (HP), or occasionally against other spiral bacteria, which colonize in the space between the surface epithelium and the mucous layer. Gastritis may, irrespectively of the HP-related or HP-independent origin, progress to an atrophy (chronic gastritis with atrophy) in the underlying mucosa. Prevalence of gastritis increases with increase in age, but great variations exist in the age-specific prevalence and in mean age of onset of the gastritis in different populations. A high rate and an early onset of the HP-related gastritis associates with low socio-economic status. Chronic gastritis, and the gastritis with atrophy in particular, may interfere with the function of the affected gastric mucosa, and may subsequently increase or decrease the risk of some gastric diseases, such as cancer and peptic ulcer. Both antral and corpus gastritis with coexistent severe atrophic changes have been shown to be associated with an increased risk of gastric cancer. In addition, gastritis seems to also play an important role in the pathogenesis of peptic ulcer. Virtually all patients with DU and GU have coexisting and preceding gastritis. The cumulative risk of ulcer has been estimated to be high in subjects with gastritis, but, in contrast, to be low in subjects who have normal gastric mucosa.     

Mexiletine for the Management of Ventricular Arrhythmias in Ischemic Heart Disease

Mexiletine, a type IB anti arrhythmic agent, has recently been released in the United States for use in the oral treatment of ventricular arrhythmias. It is as effective as other group IB and LA drugs, and less effective than group 1C agents such as propafawne, flecainide, and amiodarone; however, it has the advantage of being associated with fewer serious adverse effects. Mexiletine will control ventricular tachycardia in patients with drug-resistant arrhythmias in 20–30% of cases; in unselected populations it may abolish VT in 50–96%. It is recommended that mexiletine be combined with beta blockers and/or group IA drugs for treating resistant arrhythmias. Efficacy may be increased and adverse side effects reduced through use of smaller dosages and combination therapy.     

Automatic Atrial Threshold Measurement and Adjustment in Pediatric Patients

Background: Automatic threshold measurement and output adjustment are used as default settings in modern pacemakers. The purpose of the study was to assess Atrial Capture Management (ACM) of Medtronic pacemakers in pediatric patients. Methods: Forty children were enrolled in two centers. Median age was 9.8 years (range 0.8–17.5 years). Half had undergone surgery for congenital heart defects; 45% of patients had an epicardial atrial lead. The pacing indication was atrioventricular block in 82% of patients and sinus node disease in 18%. Manually determined atrial thresholds and ACM measurements were compared. Results: ACM measurements were within the expected variation in 37/40 (93%) of the patients. In one patient the threshold was 0.625‐V lower manually than with ACM. One patient had too high an intrinsic atrial rate for ACM to be able to measure threshold. The mean threshold at 0.4 ms was 0.69 ± 0.32 V manually and 0.68 ± 0.35 V with ACM (two‐tailed paired t‐test, P = 0.52) in all patients. The mean difference was 0.012 V (95% confidence interval: ?0.027, 0.053). The mean endocardial threshold was 0.70 ± 0.36 V manually and 0.69 ± 0.38 V with ACM; epicardial threshold was 0.67 ± 0.27 V manually and 0.68 ± 0.32 V with ACM. The difference between the measurements was 0.012 V for endocardial and 0.014 V for epicardial leads. No atrial arrhythmias due to ACM measurements were observed. Conclusions: ACM measures atrial thresholds reliably in pediatric patients with both endocardial and epicardial leads, allowing its use in both. Constant high intrinsic atrial rate may prevent automatic threshold measurement in young children. (PACE 2010; 33:309–313)     

ENZYMES OF CATECHOLAMINE METABOLISM IN THE BRAINS OF RAT STRAINS DIFFERING IN THEIR PREFERENCE FOR OR TOLERANCE OF ETHANOL

The activities of the catecholamine-synthesizing and inactivatingenzymes were determined in whole brains of two pairs of ratstrains differing in their genetically-determined behaviouralresponses to ethanol. The alcohol-tolerant (AT) rats did notshow any significant differences in enzyme activities when comparedwith the non-tolerant (ANT) strain. The activity of tyrosinehydroxylase was found to be significantly higher in brains ofthe alcohol-preferring (AA) rats, than in those of the alcohol-non-preferring(ANA) strain.