Autoregulation by glucose of hepatic glucose balance: Permissive effect of insulin

To study the pathways involved and the effect of insulin on the autoregulation of hepatic glucose balance, isolated hepatocytes from normal, diabetic and treated diabetic rats were incubated with varying concentrations of glucose (100–400 mg/dl) with and without pyruvate (10 mM). Net glucose production or utilization was calculated from the change in media glucose concentrations before and after incubation, net glycogenolysis by the change in tissue glycogen levels before and after incubation, net glycolysis by following the incorporation of glucose-C¹⁴ into lactate C¹⁴ and gluconeogenesis by the difference in glucose production in the presence and absence of pyruvate. Hepatocytes from control and insulin-treated animals manifested autoregulation of glucose balance. Glucose modulated the glycogen and glycolytic pathways but did not affect gluconeogenesis. In hepatocytes from diabetic rats, there was no autoregulation, tissue glycogen was unmeasurable both before and after incubation, glycolysis was markedly curtailed and gluconeogenesis was increased. It may be concluded that (1) glucose autoregulates its own production or utilization by modulating the glycogen and glycolytic pathways, (2) autoregulation is lost in severe diabetes leading to fasting hyperglycemia, and (3) insulin has a permissive effect on the autoregulation of glucose balance by maintaining the rate-limiting enzymes, glycogen synthase and glucokinase, so that glucose can exert its effect on these pathways.     

Complications of diagnostic laparoscopy in Dallas: a 7-year prospective study

The complication rate for diagnostic laparoscopy reported in the literature is very low (1.07%, 0.3%, and 0.03% for minor and major complications, and deaths, respectively). A prospective study of the complications of diagnostic laparoscopy by 17 gastroenterologists in the Dallas-Fort Worth metropolitan area is reported. In 603 laparoscopies performed during a 7-year period, there were 31 (5.1%) minor complications and 14 (2.3%) major complications requiring surgery or transfusion. These rates are five- and sevenfold higher (p less than 0.01) than are reported in retrospective series in the literature. There were three (0.49%) deaths in this series. It is concluded that retrospective studies have underestimated the complication rate of laparoscopy. However, despite the higher complication rate found in this prospective study, laparoscopy appears to be as safe or safer than other methods of establishing a tissue diagnosis under direct vision in intraabdominal diseases.     

Munchausen's syndrome: A successfully treated case

A case history of a 33-year-old woman with a diagnosis of Munchausen's syndrome is presented with a review of the literature about this bizarre syndrome. We recommend that patients so diagnosed be committed to mental hospitals and treated in a structured program combining behavior modification and dynamic therapy, which proved to be an effective tool in the patient we describe. We believe this form of treatment is warranted because patients incur heavy expenses and lose many work hours when treated as outpatients for this otherwise intractable condition.     

Relationship between Platelet Count and Cardiotomy Suction Return

A simple, inexpensive, accurate method of measuring the amount of blood returned by the cardiotomy suction system was devised and calibrated. Preoperative and postoperative platelet counts were obtained in 76 patients with congenital heart disease in whom the amount of cardiotomy suction return was measured. The mean percentage of total perfusate returned by the cardiotomy suction system was 8.9%. Both postoperative platelet count and the percentage change between preoperative and postoperative platelet counts correlated with the amount of blood returned by the cardiotomy suction system, time on bypass, and the percentage of total perfusate aspirated by the system.     

Pericardial tamponade,a new complication of amyloid heart disease

With advancing age of the population and with echocardiographic means of diagnosis, amyloid disease of the heart is of increasing clinical interest. Advanced age, restrictive myocardiopathy, arrhythmias, and conduction disorders are familiar features of this disease. A 92 year old man with past history of hemiblock followed by complete heart block and transvenous pacemaker was admitted to the hospital because of increasing fatigue and the abrupt development of dyspnea. Examination revealed paradoxic pulse, markedly elevated central venous pressure, and echocardiographically demonstrated large pericardial effusion. Shortly after admission signs of tamponade developed; 1,000 ml of pericardial fluid was removed with prompt relief of dyspnea and disappearance of paradoxic pulse and return of central venous pressure to normal. However, dyspnea soon recurred and subsequent hemodynamic measurements indicated increased right ventricular and left ventricular filling pressures. Echocardiography revealed no recurrent effusion or ventricular hypokinesis. Left ventricular ejection fraction by radionuclide ventricutogram was 64 percent. Echocardiography revealed ventricular wall thickening, normal chamber size, and glittering, sparkling myocardial echoes. On postmortem examination, there was extensive myocardial amyloidosis. There was no evidence of constrictive pericarditis or recurrent effusion. The unique aspect of this case was the combined presence of restrictive myocardiopathy and pericardial tamponade. To our knowledge, no previous case of tamponade due to amyloid heart disease has been reported.     

The severity of psychiatric disorder

Evaluating the severity of psychiatric illness is important, but it involves many implicit hypotheses and models. To investigate empirically characteristics entering into judgements of severity, a representative sample of 217 patients hospitalized for the first time for functional psychiatric illness was studied. Results indicated that psychotic symptoms and bizarre disturbed behavior were more associated with severity than were depression, anxiety, and other nonpsychotic symptoms. There was a strong relationship between severity and a psychotic/non-psychotic dichotomy, but relatively little relationship between severity and diagnostic categories. Severity was also related to certain measures of chronicity and social function.     

Effect of an inhaled corticosteroid on methacholine airway reactivity

Methacholine airway reactivity was studied in seven asthmatic patients before and at the end of 4 mo of beclomethasone dipropionate therapy, as well as in a control group. There was no statistically significant change in reactivity in either group, suggesting that a change in airway cholinergic receptor activity is not part of the mechanism of action of corticosteroids in asthma.     

Carotid body resection. Controversy--confusion--conflict

Carotid body resection has been the subject of controversy since it was introduced. Numerous analyses, both favorable and unfavorable, have been published. Most papers have dealt with unilateral carotid body resection; a few reports of bilateral carotid body resection have appeared. A critical review of the literature is presented in an attempt to resolve the confusion and conflict related to carotid body resection and to evaluate the wide differences of opinion between its supporters and opponents.