Diabetes mellitus and open heart surgery

A method, based on bedside determinations of blood glucose by nursing staff, was designed to control the administration of insulin to diabetic patients during and following open heart surgery. A computer-controlled intravenous infusion pump was used to deliver the insulin. Excellent control of the hyperglycaemia normally associated with open heart surgery was achieved, with 84 percent of measured blood glucose values falling within 2 mmol/litre of the target value of 6 mmol/litre. The method proved to be simple, effective, and safe.     

Exclusion from proximal 11q of a common gene with megaphenic effect on atopy

We have typed three markers on proximal 11q in 131 random families with three or more children studied for atopy. A summary map that includes the FCER1B candidate was constructed. Using a 2-locus disease model, we performed combined segregation and linkage analysis of three models, none of which suggested linkage. Nine marker loci on other chromosomes were also negative. In the regions swept by these 12 markers we cannot rule out a rare gene, perhaps of large effect, nor a common gene of small effect. However, a common gene of large effect is excluded. These results and alternative strategies are discussed in the perspective of inconsistent evidence for a major atopy gene.     

Autoantibodies to human melanocyte-specific protein Pmel17 in the sera of vitiligo patients: a sensitive and quantitative radioimmunoassay (RIA)

Lethally irradiated LEW rats reconstituted with syngeneic bone marrow and given CsA for a 4-week period develop a graft-versus-host-like disease upon withdrawal of CsA. This T cell-mediated autoimmune disease is referred to as CsA-induced autoimmunity (CsA-AI). CsA-AI-susceptible LEW rats and resistant BN rats differ greatly in the composition of their peripheral T cell compartment. To dissect the role of MHC and non-MHC genes in the development of peripheral T cell subsets in combination with susceptibility to CsA-AI the respective MHC congenic strains (LEW-1N and BN-1L) were examined for their T cell subsets and for their ability to develop CsA-AI. In this study we show that the Th1/Th2-like cell ratio as well as susceptibility to CsA-AI are under control of the non-MHC genes. This suggests that the Th1/Th2-like cell ratio is a critical determinant for development of CsA-AI. Alternatively, resistance can be attributed to lack of target organ susceptibility due to the absence of the target autoantigen in resistant rat strains. This interpretation is rejected, since both BN as well as BN-1L rats consistently develop the characteristic macroscopic and microscopic signs of CsA-AI upon adoptive transfer with autoreactive LEW-1N and LEW T cells, respectively. Therefore, it can be concluded that the non-MHC genes encode for immune deviation and thereby determine susceptibility or resistance to CsA-AI.     

A Predominantly Adrenaline-secreting Phaeochromocytoma

A 61-year-old woman who presented with diabetes, nausea, weightloss and sweating was found to have a phaeochromocytoma secretingadrenaline, with a small amount of N-methyIadrenaline. Therewas no significant increase in noradrenaline secretion. Shewas normotensive, and developed profound hypotension in responseto the -adrenergic antagonist phenoxybenzamine. These featuresare unusual in phaeochromocytoma, but similar features occurredin the very few previous reported cases of pure adrenaline-secretingphaeochromocytoma. We conclude that it is important to identifysuch patients, so that they should not be given -adrenergicantagonist drugs.     

A PHARMACODYNAMIC MODEL FOR PANCURONIUM

It has been demonstrated that a simple two-compartment kineticmodel may account for the changes in plasma concentration ofpancuronium after i.v. administration. However, it can be shownthat this simple model does not account satisfactorily for theobserved changes in muscle twitch response. By the additionof a receptor (biophase) compartment, twitch response can bereconciled with model behaviour and the characteristics resemblethose predicted by animal studies. The complete model is appliedto the problem of total renal failure, and shows that patientswith this condition are likely to be marginally resistant tosmall doses of pancuronium, with a normal rate of recovery.However, larger doses are likely to result in delayed recovery,the duration of effect increasing in a dose-dependent manner. Communications to C. J. Hull.