Factors predicting the blood glucose lowering effect of a 30-day very low calorie diet in obese Type 2 diabetic patients.

OBJECTIVE: To identify factors which predict the blood glucose lowering effect of monotherapy with a 30-day very low calorie diet (VLCD) in obese Type 2 diabetic patients. A responder was a priori defined as a patient with a fasting plasma glucose (FPG) level < 10 mmol/l on day 30. RESEARCH DESIGN AND METHODS: In 17 obese patients (BMI 37.6 +/- 5.6 (mean +/- SD) kg/m(2)) with Type 2 diabetes, all blood glucose lowering medication (including insulin) was discontinued on day -1 followed by a 30-day VLCD. On day 2 and 30 of the VLCD an intravenous glucose tolerance test (IVGTT) was performed. RESULTS: Of the 14 patients who completed the 30-day VLCD, eight qualified as responder. Responders and non-responders could be distinguished by day 2. Responders had a shorter duration of Type 2 diabetes and higher fasting serum insulin, C-peptide and HOMA-beta-values. In addition, responders displayed a more prominent second-phase insulin response following i.v. glucose loading and higher k-values. In a stepwise discriminant analysis, the change in FPG from day 0 to day 2 (responders +0.64 +/- 2.3, non-responders +4.15 +/- 3.3 mmol/l, P = 0.035) in combination with the area under the curve of insulin (AUC) above baseline during an IVGTT on day 2 (responders 571 +/- 236, non-responders 88 +/- 65 mU*50 min, P < 0.001), distinguished responders completely from non-responders. CONCLUSION: Preservation of the capacity of beta-cells to secrete insulin predicts a favourable metabolic response to a VLCD in obese Type 2 diabetic patients.     

Gene Probe Analysis in an Informative Family with Multiple Endocrine Neoplasia Syndrome Type 2A (MEN 2A). Improvement in Carrier Risk Estimation

Gene probe analysis of the MEN 2A locus on chromosome 10 hasbeen undertaken using the markers TB10.163, RBP 3 and TB14.34in a large kindred with familial medullary thyroid carcinomas,with or without phaeochromocytomas or primary hyperparathyroidism.A maximum LOD score of 2.97 gave strong evidence of close linkagewith zero recombination. For 12 members of the family so far not known to be affectedby any form of the disease the estimated risk of carrying thegene has been considerably decreased in all but one, whose riskhas been greatly increased.     

Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor

Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention.     

Functional hypothalamic derangement in a case of Wernicke's encephalopathy

A case of Wernicke's encephalopathy exhibited prominent signs of hypothalamic involvement, including thermoregulatory and multiple hormonal abnormalities. Features of the clinical presentation, thermoregulatory and hormonal studies are discussed.     

Relationships between volume and pressure measurements and stroke volume in critically ill patients

Objective  

To evaluate the relationships between the changes in stroke volumeindex (SVI), measured in both the aorta and the pulmonary artery, and thechanges in intrathoracic blood volume index (ITBVI), as well as therelationship between changes in aortic SVI and changes in the pulmonary arterywedge pressure (PAWP).     

Renal concentrating ability in obesity. Effect of modified fasting and the supplementation of T3, sodium chloride and carbohydrate

The renal concentrating ability (RCA) was studied in 30 obese subjects before and after modified fasting (MF) and T3 supplementation, and during hypocaloric-carbohydrate refeeding. We also studied the effect of sodium supplementation on the RCA during MF. Modified fasting induced a low T3-high rT3 state ("sick euthyroid"). During T3-supplementation plasma T3 levels increased but were in the normal range for normal weight controls. Plasma sodium, potassium, and calcium remained within the normal range during all study periods. After MF (14 days) the mean maximal urinary osmolality was significantly lower compared to prefast values both after dehydration alone (706 +/- 12 mosm/kg H2O v 975 +/- 14, P less than 0.001) and after dehydration plus sc vasopressin administration (676 +/- 19 v 899 +/- 17, P less than 0.001). After 14 days MF followed by 14 days MF + T3-supplementation plasma urea, urinary urea excretion, and the creatinine clearance were significantly greater than after MF alone as was the RCA (764 +/- 15 v 652 +/- 25, P less than 0.002). Sodium chloride supplementation increased RCA (P less than 0.02) but no additive effect of T3 and sodium chloride supplementation was observed. Severe dietary salt restriction induced a significant decline in RCA (P less than 0.005). Refeeding with carbohydrate increased plasma T3 from 79.9 +/- 7.7 to 97 +/- 7.5 ng/100 mL (NS) and decreased plasma rT3 from 0.33 +/- 0.02 to 0.27 +/- 0.02 ng/mL, (P less than 0.02); no significant change in RCA was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Spontaneous diurnal thyrotropin secretion is enhanced in proportion to circulating leptin in obese premenopausal women

CONTEXT: Recent evidence implicates leptin as an important modulator of thyroid axis activity. OBJECTIVE: The objective of this study was to study spontaneous 24-h TSH secretion and 24-h circulating leptin concentrations in obese and lean women. DESIGN: This was a prospective parallel study (2004). SETTING: This study was conducted at the Clinical Research Center (Leiden University Medical Center, Leiden, The Netherlands). PARTICIPANTS: Twelve healthy obese premenopausal women (body mass index, 33.2 +/- 0.9 kg/m2) and 11 lean controls (body mass index, 21.4 +/- 0.5 kg/m2) were studied in the follicular phase of their menstrual cycle. INTERVENTION(S): There were no interventions in this study. MAIN OUTCOME MEASURE(S): Spontaneous 24-h TSH concentrations (10-min time intervals) and secretion were calculated using waveform-independent deconvolution technique (pulse). Twenty-four-hour circulating leptin concentrations (20-min time intervals) were measured. RESULTS: Mean TSH concentration (obese, 1.9 +/- 0.2 vs. lean, 1.1 +/- 0.1 mU/liter; P = 0.009) and secretion rate (obese, 43.4 +/- 5.5 vs. lean, 26.1 +/- 2.2 mU/liter distribution volume.24 h; P = 0.011) were substantially enhanced in obesity, whereas the fasting free T4 (fT4) concentrations were similar (fT4 in obese, 15.4 +/- 1.5 vs. in lean, 16.4 +/- 1.5 pmol/liter; P = 0.147). TSH secretion was positively related to 24-h leptin concentrations (r2= 0.31; P = 0.007). CONCLUSIONS: TSH release is enhanced in the face of normal plasma fT4 concentrations in obese premenopausal women, and hyperleptinemia may well be involved in this neuroendocrine alteration.