The aim of this study is to see whether changes in insulin need and in sensitivity to exogenous insulin occur in insulin-dependent diabetics receiving 3 daily non-isocaloric meals (at 0630, 1200 and 1730). In 9 type I diabetics submitted to the artificial pancreas control the insulin administered/dietary carbohydrates index (I/C) after breakfast (2.4 +/- 0.5) was significantly higher than after lunch (0.8 +/- 0.1) and after supper (0.84 +/- 0.1) (p less than 0.01). A trend to the reduced insulin sensitivity in the morning was also observed in fasting periods, when it was calculated as the ratio between blood glucose and insulin administered (BG/I): differences of BG/I however were not significant. It was concluded that diurnal variations of insulin sensitivity do occur in type I diabetic subjects, with an increment of insulin requirement in the morning.

Blood Glucose↗

PubMedDate not supplied

Prehepatic portal hypertension: experience with 88 cases.

Although prehepatic portal hypertension (PHPH) is less common than intrahepatic portal hypertension, it gives rise to more serious diagnostic and therapeutic problems than the latter. From their experience of 88 cases, the authors feel that it is necessary for a correct approach to PHPH to derive a classification useful throughout the clinical course of these patients. They distinguish PHPH due to extrinsic obstruction from PHPH due to intrinsic obstruction, and subdivide these two classes according to etiologic, pathologic and hemodynamic criteria. A series of principles has been developed, in answer to the problems related to each of these classes, as an aid in the prevention of portal hypertension relapse.

Cholestasis, Extrahepatic↗

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[Heterogeneity of antimicrosomal autoantibodies in chronic hepatitis C virus infection and delta hepatitis].

Microsomal antigen autoantibodies are typical of type 2 autoimmune hepatitis, and a strong association with chronic hepatitis C virus (HCV) infection has been reported in certain geographical areas. These autoantibodies have been denominated LKM-1 to differentiate them from those associated with thienylic acid-induced hepatitis (LKM-2) and from those seen in patients with chronic delta hepatitis (LKM-3). To investigate the antigenic specificity of autoantibodies associated with chronic hepatitis C and delta, we analyzed 52 LKM-1 positive serum samples from patients with chronic hepatitis C and 17 LKM-3 positive serum samples from patients with chronic delta hepatitis by indirect immunofluorescence and Western blotting (immunoblotting). Reactivity of subjects with chronic hepatitis C was heterogeneous: only 5 out of 52 LKM-1 positive patients, tested by Western blot, recognized a single protein of 50 kD, previously identified by Manns et al. with an immunogenic epitope of cytochrome P450IID6. Thirteen of the 52 patients also reacted with a 70 kD microsomal protein, and 12 out of 52 reacted only with a 59 kD protein. Twenty-two sera, notwithstanding the high titer in immunofluorescence, did not evidence any reactivity when tested by Western blot. The same sera tested positive in LKM-1 ELISA when solubilized human microsomal proteins were used. Fourteen out of 17 LKM-3 positive sera from patients with chronic hepatitis delta recognized a 55 kD microsomal protein in Western blot; three sera, HCV and HIV positive, did not react with any protein by Western blot. None of these sera was positive in ELISA LKM-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibody Specificity↗

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An unusual case of ileal tuberculosis: only ascites at presentation and absence of caseous necrosis and granulomatous inflammation on biopsy.

An unusual case of ileal tuberculosis presenting with only ascites, without evidence of previous or active pulmonary tuberculosis, and absence of caseous necrosis and granulomatous inflammation is discussed. Diagnosis was established on biopsy specimens of ileocaecal region collected at colonscopy: acid-fast bacilli and positive culture for Mycobacterium tuberculosis. Parenteral nutrition, surgery and antituberculous drug treatment resulted in a complete recovery of the patient.

Adult↗

PubMedDate not supplied

Mycobacterial diseases and HIV infection.

OBJECTIVES: Evaluation of the incidence of mycobacterial diseases in patients infected with human immunodeficiency virus (HIV) and analysis of survival after diagnosis of mycobacteriosis. METHODS: Retrospective analysis of clinical and laboratory data of HIV-infected patients admitted in our hospital from January 1st, 1985 to March 31st, 1992. RESULTS: We observed 82 infections in 81 patients with an increase in the annual percentage from 2.2% to 6.4%. M. tuberculosis more than atypical Mycobacteria was found in patients with pulmonary infection (p = 0.03). Forty patients had a previous diagnosis of acquired immunodeficiency syndrome (AIDS) and 24 evolved in AIDS because of mycobacterial infection. We observed infection due to M. tuberculosis in patients with advanced HIV-infection (20/27 patients with tuberculosis had CD4+ cell count < 200/cm3). Mean survival after diagnosis and treatment was 329 days with better survival in patients with CD4+ cell count > 200/cm3 (p = 0.03). We did not find a statistically significant difference in survival between patients with tuberculosis and other mycobacteriosis. CONCLUSIONS: Mycobacterial infections are increasing in HIV-infected patients, and tuberculosis is observed also in patients with advanced immunodeficiency. Survival is influenced by the severity of immunodeficiency more than by the mycobacterial species.

AIDS-Related Opportunistic Infections↗

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Metabolic effects of metformin addition to chronic glibenclamide treatment in type 2 diabetes.

In a randomized double-blind cross-over study the addition of metformin to chronic glibenclamide treatment was assessed conventionally (plasma glucose profile and HbA1c measurement) and with an euglycaemic-hyperinsulinaemic glucose clamp in ten non obese (body mass index 22.3 +/- 0.5 (+/- SE)kg.m-2) Type 2 diabetic patients with poor metabolic control. Metformin (500 mg twice a day) or placebo were added in randomized sequence for 6 weeks to their usual sulphonylurea treatment (glibenclamide 5 mg three times a day, before meals). On the last day of each administration period, an euglycaemic (glucose 5.5 +/- 0.5 mmol.l-1), hyperinsulinaemic (insulin 698.1 +/- 22.9 pmol.l-1) clamp was performed, together with a study of insulin binding to circulating monocytes. Metformin reduced fasting glucose levels (6.1 +/- 0.4 vs 6.4 +/- 0.4 mmol.l-1, P = 0.036), mean daily plasma glucose concentrations (9.2 +/- 0.4 mmol.l-1, P < 0.001), and HbA1c (8.7 +/- 0.3 vs 9.3 +/- 0.2%; P = 0.027). No variations were registered in fasting plasma insulin or body weight. A significant reduction of basal hepatic glucose production (12.8 +/- 2.7 vs 33.9 +/- 4.5 mumol.kg-1 min-1, P < 0.001), together with an increase in glucose utilization during the clamp (33.4 +/- 2.8 vs 25.9 +/- 1.1 mumol.kg-1.min-1, P = 0.033), was found after metformin, whereas residual glucose production during insulin infusion did not change. Insulin binding to circulating monocytes was higher after metformin (4.8 +/- 0.9 vs 3.2 +/- 0.6%, P = 0.020), while the lipaemic profile showed a reduction in triglycerides (1.2 +/- 0.1 vs 1.7 +/- 0.3 mmol.l-1, P = 0.039) and an increase in HDL-cholesterol (1.3 +/- 0.1 vs 1.0 +/- 0.1 mmol.l-1, P = 0.004) without variations in total cholesterol. These findings offer further evidence that metabolic control is improved after biguanide addition to sulphonylurea treatment, and support the hypothesis that biguanides improve insulin sensitivity both at the hepatic and peripheral (muscular) levels, as well as triglyceride metabolism.

Aged↗

PubMedDate not supplied

Plasma insulin detection in the study of prediabetic subjects.

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Glucose Tolerance Test↗

PubMedDate not supplied

[Postoperative chylous ascites: its etiology and treatment].

Postoperative chylous ascites is a rare clinical condition that occurs as a consequence of disruption of the abdominal lymphatics after retroperitoneal dissection. Generally the management is conservative based on a low fat diet and total parenteral hyperalimentation. However, such therapy requires weeks to months before resolution of the ascites. On the other hand, surgical approach is associated with a high failure rate to ligate leaky lymphatics. The Authors, therefore suggest a surgical resolution of the ascite with the use of fibrin glue to occlude rapidly and permanently the lymphatics ruptured.

Chylous Ascites↗

PubMedDate not supplied

["Acute scrotum" caused by torsion of the hydatid of Morgagni].

By "acute scrotum" is meant a sudden, painful tumefaction in one or both testicles with local and systemic symptomatologies. It can be caused by spermatic cord torsion in about 50% of cases in paediatric age, while in adults such a cause is much rarer. In addition to the clinical examination, Doppler, eco colour-Doppler and scintigraphy with 99mTc pertecnetate may be of use even though these investigations are not often immediately employable. In addition, as the hours pass, the damage caused to the gonad becomes irreversible; this, of course, influences therapeutic conduct. Starting from the description of a recently observed case of torsion of Morgagni's hydatid, the authors discuss the importance of differential diagnosis to protect the vitality of the testicle and show that surgical exploration, in cases where a definite aetiological diagnosis is missing, is the preferable and most rational therapeutic choice.

Acute Disease↗