Insulin and C-peptide responses to glucose load in cystic fibrosis

Immunoreactive Insulin and C-peptide responses to glucose load were estimated in patients with cystic fibrosis and in controls. Both insulin and C-peptide responses were low in cystic fibrosis patients and the changes were more marked in those with glucose intolerance. There appears to be true pancreatic hyposecretion of insulin in patients with cystic fibrosis whereas the peripheral sensitivity of insulin seems to be normal or enhanced.

Retinopathy in tropical pancreatic diabetes

In a study of the retinopathy profile of 40 patients with tropical pancreatic diabetes, a form of secondary diabetes seen in tropical countries, diabetic retinopathy was detected in 13 patients. Ten patients had background retinopathy and three patients had proliferative retinopathy requiring laser photocoagulation. In two patients, fibrous retinitis proliferans was present. Three patients had evidence of diabetic maculopathy. To our knowledge, this is the first report of severe and sight-threatening retinopathy occurring with secondary diabetes. Retinopathy in these forms of diabetes has hitherto been considered to be rare or, if present, only of a mild background type.

Appearing and disappearing CT scan abnormalities and seizures

A group of patients presenting with seizures (focal or generalised) and abnormal CT scans who, on follow up, showed complete resolution of the CT scan changes, without any treatment other than anticonvulsants, are described.

High prevalence of maturity-onset diabetes of the young (MODY) among Indians

This article describes the high prevalence of maturity-onset diabetes in the young (MODY) in an Indian clinic population of diabetic patients. MODY appears to be more common among Indians than among Caucasians. Only 27% of MODY patients had definite autosomal-dominant inheritance. In 73% the mode of inheritance was not definite. Microvascular complications were common and macrovascular complications rare. The high prevalence of MODY in this diabetes clinic might suggest an ethnic variation in diabetes.

Tropical pancreatic diabetes in South India: heterogeneity in clinical and biochemical profile

Clinical and biochemical studies were carried out in 33 patients with diabetes secondary to chronic calcific, non-alcoholic pancreatitis (tropical pancreatic diabetes) and in 35 Type 2 (non-insulin-dependent) diabetic patients and 35 non-diabetic subjects. Despite lower body mass indices, only 25% of patients with tropical pancreatic diabetes had clinical evidence of malnutrition. There was no history of cassava ingestion. Mean serum cholesterol concentration was significantly lower in the tropical pancreatic diabetic patients (p less than 0.01) in comparison with the Type 2 diabetic patients or non-diabetic subjects, due to a significantly decreased concentration of LDL cholesterol (p less than 0.01) and VLDL cholesterol (p less than 0.05). Basal and post-glucose stimulated concentrations of serum C-peptide were highest in those pancreatic diabetic patients (n = 11) who responded to oral hypoglycaemic drugs, intermediate in the majority (n = 17), who were insulin dependent and ketosis resistant and negligible in a small sub-group (n = 5) who were ketosis prone. The occurrence of microangiopathy in pancreatic diabetic patients was common and similar to that in Type 2 diabetic patients. Thus, tropical pancreatic diabetes in South India appears to be heterogeneous with respect to level of nutrition, severity of glucose intolerance, B-cell function, response to therapy and the occurrence of microvascular complications.

Ultrasonographic evaluation of the pancreas in tropical pancreatic diabetes

Ultrasonography was performed in three groups of young diabetics in the tropics, namely MODY, IDDM and tropical pancreatic diabetes (TPD). Several morphological abnormalities of the pancreas such as fibrosis and shrinkage of the gland, increased echogenicity and ductal dilatation were found in patients with TPD. It also helped to localize the site of calculi in the pancreas. MODY and IDDM patients did not show any significant changes except a slight reduction in size of the gland. Ultrasonography is a useful tool in differential diagnosis of young diabetics in tropical countries.

HLA, complement C2, C4, properdin factor B and glyoxalase types in South Indian diabetics

A series of diabetic patients from 3 centres in South India have been tested for HLA A, HLA B, BF, C2, C4A, C4B and GLO types. For insulin-dependent diabetes mellitus (IDDM) patients there was a significant increase in HLA B8, of BF F and decrease of C4 A6. No significant variation in HLA, BF, C2 or GLO frequencies was found in non-insulin-dependent diabetes mellitus (NIDDM) patients, but there was a significant decrease in C4B 1 and an increase in C4B 2. The HLA and BF association in South Indian IDDM patients is very different from that reported previously in North India.

C-Peptide responses to glucose load in maturity-onset diabetes of the young (MODY)

Pancreatic beta cell responses were measured in obese and nonobese maturity-onset diabetes of the young (MODY) patients by estimating serum immunoreactive insulin (IRI) and C-peptide (CP) during oral glucose tolerance testing (OGTT). The serum CP responses were generally low in MODY patients and more pronounced in obese patients. The IRI responses were heterogenous; some patients had normal and others low responses. It was observed that in several patients there was a relatively higher IRI concentration in comparison with the CP values, as indicated by low CP and normal IRI values. This is suggestive of altered metabolic fates of insulin and CP in the MODY patients.

Pancreatic beta cell function in offspring of conjugal diabetic parents. Assessment by IRI and C-peptide ratio

Serum C-peptide and insulin responses to oral glucose load were measured in 69 offspring of conjugal diabetic parents (OCDP). The insulin responses were varied. The non obese OCDP showed higher mean insulin levels than non obese controls while the obese OCDP did not have significant differences in the mean insulin responses compared to obese controls. The C-peptide levels were, however, low in both obese and non-obese OCDP. The IRI/CP ratios were elevated in both groups of OCDP. These results suggest that OCDP have low beta cell function and also possibly a change in the metabolism of insulin at the hepatic level, which is more pronounced in non obese OCDP.

Serum uric acid concentrations in offspring of conjugal diabetic parents

Serum uric acid concentrations were measured in offspring of conjugal diabetic parents, in diabetic patients, and in matched nondiabetic controls. The mean uric acid level in offspring of conjugal diabetic parents was significantly higher than in the controls and diabetic patients (P less than 0.001 in the nonobese and P less than 0.05 in the obese). Diabetic patients did not show significant differences in the serum uric acid concentration compared to the controls. The elevated level of serum uric acid in offspring of conjugal diabetic parents could possibly be an early biochemical marker of diabetes.

Hepatic extraction of insulin in non-insulin dependent diabetes. Comparative study of obese and non-obese patients

Changes in the secretion and metabolism of insulin were measured by estimating serum C-peptide and insulin and their ratio during oral GTT in 30 non obese and 12 obese NIDDM patients. The mean IRI and CP responses were low in both groups of patients, compared to weight-matched controls. The reduction in CP was more marked than the reduction in IRI. The molar ratio of insulin and CP was found to be elevated in the patients, probably indicating reduced hepatic and peripheral extraction of insulin. It was noted that the elevated IRI/CP ratio was a 1) a common feature in NIDDM, irrespective of the body weight, 2) it is present even under basal conditions when the insulin levels are the lowest, 3) it appears to be independent of the concentration of insulin reaching the liver, and 4) obese patients appear to have an exaggerated defect compared to their non obese counterparts.

Increased LDL cholesterol in non-insulin-dependent diabetics with maculopathy

Serum cholesterol and its various lipoprotein fractions and triglycerides were measured in 50 non-insulin-dependent diabetic patients, 25 without retinopathy (group A) and 25 with diabetic maculopathy (group B) initially before control of diabetes, and again, after achieving good metabolic control. The lipid parameters were also estimated in 25 healthy non-diabetic subjects. The groups were well matched for sex, age, duration of diabetes and body weight. Mean serum total cholesterol and LDL cholesterol levels were significantly higher in group B when compared to group A, before and after achieving good metabolic control of diabetes (p less than 0.001). Mean total/HDL cholesterol and mean LDL/HDL cholesterol ratios were also significantly increased in group B as compared to group A (p less than 0.01) both before and after good diabetic control in these patients. Mean serum HDL and VLDL cholesterol and triglyceride concentrations were similar in groups A and B. The mean serum lipid concentrations in the diabetic patients without retinopathy (group A) were comparable to those of non-diabetic subjects.

Pancreatic beta-cell function in tropical pancreatic diabetes

Individuals with tropical pancreatic diabetes (TPD) have features of malnutrition and insulin-dependent diabetes but do not exhibit ketosis on withdrawal of insulin. Fasting and postglucose C-peptide responses were assessed in TPD and compared with noninsulin-dependent (NIDDM), insulin-dependent (IDDM), and control groups, matched for body weight. The C-peptide concentrations were lower in TPD in comparison with the controls and NIDDM patients but were significantly higher than in classical IDDM. It is likely that the higher C-peptide is responsible for the ketosis resistance in these patients.

Uncommon presentations in neuroblastoma

Two cases of neuroblastoma with unusual presentation are reported. In the first case it presented as a general swelling of the head and in the second case it presented as generalized pains in the bones particularly the pelvis and left leg.

Symptomatic vertebral haemangiomas

Twelve cases of symptomatic vertebral haemangioma are reported in respect of their clinical presentation and radiological findings. One patient was only 10 years old, the youngest patient ever reported. Less commonly known findings of associated paravertebral mass and the displacement of the thoracic paraspinal line are discussed.

Urethral diverticulum in male subjects: report of 5 cases

We present 5 cases of urethral diverticulum in male subjects, of which 2 were congenital and 3 were acquired. Of these diverticula 4 were in the anterior urethra, while 1 was in the posterior urethra. One congenital diverticulum contained multiple calculi.

The thoracic paraspinal line: further signficance

Three hundred and seventeen cases which included 100 normal individuals have been studied for roentgen significance of the thoracic paraspinal line (TPL). The descending thoracic aorta greatly determines the course and configuration of the TPL. In a right-sided aorta, the TPL is seen on the right side as a mirror image of a left-sided TPL. Lateral deviation of the TPL and descending aorta occur as an ageing process. In systemic hypertension where there is an aortic unfolding, the TPL also unfolds and the degree of TPL deviation has a fair degree of linear relationship with the severity and duration of hypertension in young individuals. Most cases of mitral valvular disease show lateral deviation of the TPL and descending aorta. In these cases the enlarged left atrium displaces the descending aorta and hence the posteromedial border of left lung posterolaterally tangential to the vertebral column resulting in deviation of the TPL and aorta. Perioesophageal spread of carcinoma of the oesophagus into the posterior mediastinum is indicated by changes in pleuro-oesophageal interface and TPL. Mediastinal lymphadenopathy in cases of testicular tumours may be detected by discovery of TPL deviation on frontal radiographs of the thoracic spine. In extradural masses such as granulomas, abscesses and metastatic deposits, the TPL shows a localised bulge corresponding to the clinical and myelographic level of spinal compression.

Peripheral retinal cryotherapy as a treatment for neovascular glaucoma

This treatment does have a place in the management of the established conditions because, when it is successful, some guiding vision is maintained; this is potentially important, as a central retinal vein thrombosis may affect the second eye. Restoring a normotensive eye has other long-term advantages; it is cosmetically better, and is unlikely to lead to a degenerate cornea, which would otherwise occur, and might lead to late endophalmitis.