Biomedical subjects
C H Walsh
Publications and source records attributed to C H Walsh.
Mineralocorticoid and glucocorticoid status in idiopathic haemochromatosis.
OBJECTIVE: A number of studies have suggested that both primary (Addison's disease) and secondary adrenal failure may be caused by idiopathic haemochromatosis. There is little information on mineralocorticoid secretion. We have assessed the mineralocorticoid and glucocorticoid status of patients with idiopathic haemochromatosis. DESIGN: Cross-sectional study. PATIENTS: Eighteen males and one female with confirmed idiopathic haemochromatosis were investigated. Seven of the subjects had hepatic cirrhosis and three had hypogonadotrophic hypogonadism. MEASUREMENTS: A short Synacthen (tetracosactrin) test was undertaken in addition to an overnight metyrapone test and an insulin stress test. In addition, plasma aldosterone (PA) and plasma renin activity (PRA) were measured in a group of patients in the basal state and again in the upright position. RESULTS: The short Synacthen test, overnight metyrapone test and insulin stress test were normal in all subjects. The PA, PRA, and PA/PRA ratios in the upright position were not significantly different in the patients with idiopathic haemochromatosis compared to control subjects. CONCLUSION: In this patient population, no abnormality of either the pituitary adrenal axis or mineralocorticoid status was detected. Adrenocortical dysfunction is likely to be exceptionally rare in idiopathic haemochromatosis.
Hyperthyroidism associated with acute suppurative thyroiditis.
Acute suppurative thyroiditis is a rare condition with potentially serious complications. It has been suggested that hyperthyroidism may be a feature in occasional cases but this has been poorly documented. We describe a patient in whom acute suppurative thyroiditis caused transient hyperthyroidism.
Pinacidil, a new vasodilator, in the treatment of mild to moderate essential hypertension.
Twenty three patients with essential hypertension who were uncontrolled on diuretic and/or beta-receptor antagonist therapy were treated additionally with the vasodilator, pinacidil, in an open study. Significant reduction in mean blood pressure was achieved. Supine and erect systolic and diastolic blood pressure fell by 44/25 mmHg and 37/24 mmHg respectively over the study period of 12 weeks. Side-effects such as dizziness, headache, facial flushing and mild oedema were experienced by 10 patients during the study, all of which were mild and transient and did not require withdrawal from pinacidil therapy. Pinacidil is an effective and well tolerated agent in the treatment of essential hypertension.
Picking the right practice for yourself.
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Hyponatraemia in a general hospital.
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Low-dose insulin treatment of hyperosmolar diabetic coma.
The effect of low-dose hourly i.m. injections of insulin has been studied in the treatment of 17 episodes of hyperosmolar non-ketoacidotic diabetic coma compared with 26 episode of hyperosmolar ketoacidosis occurring in patients over 40 years of age. The fall in blood sugar was satisfactory in the majority of episodes of both types of coma and there was no evidence that patients with hyperosmolar non-ketoacidotic coma were more sensitive to insulin. The excess mortality in the non-ketotic group (47%) compared with the ketoacidotic group (16%) was not due to uncontrolled diabetes.
The multiple flora of diabetic foot ulcers.
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Is it time you incorporated?
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Dupuytren's contracture--a survey of a hospital population.
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Very pure porcine insulin in clinical practice.
In a one-year follow-up study the insulin dose in diabetic patients using very pure porcine insulin was compared with that in patients using conventional preparations. The dose of insulin used to obtain diabetic control was reduced by 7% in 108 patients treated solely with very pure porcine insulin from the start of insulin treatment when compared with 108 matched patients who had received conventional insulins. In 117 patients whose treatment had been changed from conventional bovine or bovine-porcine insulin to very pure porcine insulin the dose was reduced by 9%. A further 511 patients receiving conventional insulins were examined for local cutaneous or subcutaneous abnormalities at insulin injection sites. Lipoatrophy was found in 49 of these patients (10%), but not in patients using very pure porcine insulin. The results confirm that very pure porcine insulin reduces the insulin dose needed to maintain diabetic control and may resolve or prevent local reactions such as lipoatrophy. Long-term advantages in reduced antigenicity to insulin and contaminating peptides remain to be established.
Plasma arginine vasopressin in diabetic ketoacidosis.
Plasma Arginine Vasopressin (AVP) was measured serially in 10 patients during the first 24 hours of treatment of diabetic ketoacidosis. AVP was elevated in all cases initially, ranging from 4.0--122.0 pmol/l, the basal level in healthy hydrated subjects being 1.57 +/- 0.59 pmol/l (+/- 1 SD). The levels fell progressively during the course of treatment. While there was no evidence that the massive increases in AVP noted in this study were associated with water overload it remains to be determined whether the high levels observed have any significant metabolic or haemodynamic role in this disorder.
Diabetes mellitus in idiopathic haemochromatosis.
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Proliferative retinopathy in a patient with diabetes mellitus and idiopathic haemochromatosis.
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Diabetes mellitus and coeliac disease: a clinical study.
Fourteen adults in whom diabetes mellitus and coeliac disease coexist, are described. In no patient was coeliac disease diagnosed (biopsy proven) before the age of 28 years. Diabetes was recognized before coeliac disease in all except one. Diabetic control was very unstable and hypoglycaemia particularly troublesome before treatment with a gluten free diet. Following gluten restriction, insulin requirement increased in six patients, and diabetic control became more stable. Diarrhoea due to coeliac disease in a patient with coexisting diabetes, may be mistakenly diagnosed as 'diabetic diarrhoea'. However, certain clinical and laboratory features should arouse suspicion that the diarrhoea is not of diabetic origin. These included a history of gastrointestinal symptoms preceding the diagnosis of diabetes, the occurrence of repeated hypoglycaemia, absence of neuropathy, anaemia, low serum folate, low serum albumin and a malabsorption pattern on small bowel radiography. A definitive diagnosis of coeliac disease can be made only jejunal biopsy. The opportunity to diagnose coeliac disease in adult diabetics will usually fall to the diabetologist and wider use of jejunal biopsy in diabetics with chronic or recurrent diarrhoea is suggested.
Diabetic ketoacidosis following glucagon therapy in acute pancreatitis. A case report.
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Menstruation and control of diabetes.
Seventy per cent of the patients aged 45 years or under and suffering from diabetic ketoacidosis who were seen in one diabetic clinic over five years were women. The association of menstruation with ketoacidosis was assessed over two and a half years, and it was found that menstruation was associated with ketoacidosis more often than would be expected by chance (P less than 0-01). Two hundred women were interviewed and 76 observed that menstruation changed their diabetic control. Fifty-three found that control deteriorated and hyperglycaemia occurred, while 23 found that control improved and hypoglycaemia was a common problem. Menstruation appears to be an important factor in influencing control of diabetes. The mechanism of the changes observed has not yet been determined, but it seems to be a subject worthy of further investigation.
The effect of cigarette smoking on blood sugar, serum insulin and non esterified fatty acids in diabetic and non diabetic subjects.
The effect of cigarette smoking on carbohydrate metabolism has been investigated in 10 diabetic and 18 non-diabetic subjects. All were habitual smokers. Neither the fasting plasma sugar nor the plasma sugar response to an oral glucose load was significantly altered by smoking. Serum insulin, free fatty acids, cholesterol and triglyceride were measured in 10 non-diabetic patients, and were not significantly altered by smoking. It is concluded that in habitual smokers at least, cigarette smoking does not impair carbohydrate metabolism. In addition, it seems that smoking before or during oral glucose tolerance test is unlikely to influence the diagnostic value of the test.