Evaluation of insulin resistance in non-obese subjects with impaired glucose tolerance

Insulin resistance was estimated in nine subjects with impaired glucose tolerance (IGT) and eleven healthy, age and body-weight matched controls. Glucose tolerance and insulin response were evaluated by means of a 2h-glucose infusion test. Insulin resistance was determined by measuring the steady state plasma glucose response (SSPG) to a continuous infusion of glucose (6 mg . kg-1 . min-1 or 12 mg . kg-1 . min-1), insulin, epinephrine and propranolol for 150 minutes as described previously by other authors. The endogenous insulin secretion (C-peptide) was inhibited by epinephrine and propranolol in controls and subjects with IGT irrespective of a low (6 mg . kg-1 . min-1) or high (12 mg . kg-1 . min-1) glucose infusion. Steady-state plasma levels of exogenous insulin were virtually identical in all groups studied. There were no significant differences in the pancreatic glucagon, growth hormone, FFA and glycerol response during the SSPG period between controls and subjects with IGT. In comparison to controls the mean SSPG was significantly higher in subjects with IGT (during low and high glucose infusion) suggesting the existence of insulin resistance in these subjects. A higher glucose dose as described earlier by other investigators does not provide a better discrimination of controls and subjects with IGT concerning their degree of insulin resistance. Finally, there was a direct correlation between the SSPG and glucose tolerance in the total group. In conclusion, our results have confirmed the validity of an infusion technique of glucose, insulin, epinephrine and propranolol for evaluation of insulin sensitivity in vivo. In addition, our findings have added further support for insulin resistance in subjects with IGT which is directly proportional to the degree of glucose intolerance.

[The effect of the mineral composition of the diet on cholesterol metabolic indices and the experimental correction of propranolol-induced atherogenic dyslipoproteinemia]

Rat experiments have revealed that surplus sodium chloride intake causes dyslipoproteinemia and intensifies the atherogenic action of propranolol. The new antihypertensive and antiedematous table salt substitute, as sanasole exerts its hypocholesterolemic effect. Both dietary salt mixtures eliminates the atherogenic action of beta-adrenoblocker. The application of table salt substitutes may become a convenient and effective agent against risk for atherogenesis.

Traumatic hemobilia: a complication of percutaneous liver biopsy

Two patients with hemobilia are presented. The first patient, with alcoholic liver disease, had a percutaneous liver biopsy. Subsequently he developed jaundice, with an enlarged tender gallbladder, biliary colic, and gastrointestinal bleeding. Hemobilia was demonstrated by superselective hepatic angiography and bleeding was stopped by intraarterial infusion of epinephrine and propranolol. The second patient, with primary biliary cirrhosis at an advanced stage, had a percutaneous liver biopsy followed by gastrointestinal bleeding, severe abdominal pain, and finally death. In both cases hemobilia was suggested by gastroduodenoscopy.

Barbiturate dependence in mice: evidence for beta-adrenergic receptor proliferation in brain

C57BL/6J and DBA/2J inbred mice were assayed for beta-adrenergic receptor density following seven days of chronic phenobarbital intoxication. These physically dependent mice showed a greater brain receptor density than did the control, while acute intoxication to phenobarbital produced no significant effects. C57BL/6J mice showed a higher average receptor density than did the DBA/2J mice under all conditions. These findings support the hypothesis that chronic barbiturate intoxication leads to a receptor supersensitivity which may play a role in the phenomena of functional tolerance and physical dependence.

[Study of informative value of functional tests for identification of negative ECG T-waves with the use of mathematical analysis]

The informativeness of functional tests and of their combinations was studied with reference to the differential diagnosis of the functional or organic genesis of the repolarization ECG changes. The highest informativeness was found to be achieved with the potassium and Inderal tests that permit to establish unequivocally a functional or organic genesis. A combination of the potassium and Inderal tests significantly increases the informativeness of each of these tests taken separately. The Valsalva and the orthorstatic tests are practicallt noninformative in terms of the conducted study.

[Clinical analysis for treatment of 1 080 cases of infantile hemangiomas with oral propranolol]

OBJECTIVE

To explore the indications of hemangiomas of different types by observing the clinical efficacy of oral propranolol.

METHODS

For this retrospective study from October 2009 to June 2013, a total of 1 080 cases were classified into 5 types according to their clinical characteristics. There were 338 males and 742 females. Their types were telangiectasis (n = 58), papular (n = 424), plump (n = 106), deep (n = 176) and mixed (n = 306). Propranolol was orally administered at a dose of 1.0 or 1.5 mg/kg daily (1.0 mg/kg for infants aged 2.5 months or under; 1.5 mg/kg for those aged 2.5 months or above). Dynamic observations of hemangioma size, texture or color change and adverse events during treatment were performed. Drug withdrawal was usually made after dosing for 1 year or under when there was a total regression of hemandiomas. The efficacy was evaluated on a 4-level scale.

RESULTS

Rank test results showed no significant differences between 5 types during the changes of lesions (χ² = 1.738, P > 0.05). Changing of lesions occurred 8.0 (3.7, 16.2) hours after dosing in telangiectasis type, whereas 6.5 (4.1, 14.3) hours in papular type, 7.0 (5.5, 12.7) hours in plump type, 7.5 (3.8, 11.3) hours in deep type and 6.5 (4.2, 13.4) hours in mixed type. After a follow-up of 6 months to 2.5 years, there were 378 grade IV case (35.00%), 574 grade III case (53.15%), 120 grade II cases (11.11%) and 8 grade I cases (0.74%). And there were significant differences between patients of different types (P < 0.05). Patients of deep type had the best grade IV curative effect rate of 59.09% (104/176) , then papular type of 51.25% (162/316) and telangiectasis type of 26.41% (112/424).

CONCLUSION

As a first-line treatment for hemangioma, propranolol shows excellent efficacies for patients of deep, mixed, plaque and papular types.

[Expression of serum and urinary vascular endothelial growth factor-A and epidermal growth factor-like domain 7 in proliferating hemangioma treated with propranolol]

OBJECTIVE

This study aims to investigate the expression levels of serum and urinary vascular endothelial growth factor-A (VEGF-A) and epidermal growth factor-like domain 7 (EGFL7) in proliferating infantile hemangioma patients under propranolol treatment.

METHODS

Propranolol (0.5-2 mg x kg(-1)) was orally administered to 30 infants every day for 4-8 months. The Achauer method was used to measure the tumor radius and thus evaluate the clinical curative effects of the treatment. Enzyme-linked immunosorbent assay was used to measure the serum and urinary concentrations of VEGF-A and EGFL7 at 0, 4, and 12 weeks after the treatment.

RESULTS

The treatment response was excellent in 2 patients, good in 11, moderate in 14, and poor in 3. Serum VEGF-A (335.692 pg x mL(-1) ± 136.146 pg x mL(-1)) was high before the treatment and then significantly decreased after 4 weeks (264.853 pg x mL(-1) ± 122.120 pg x mL(-1)) and 12 weeks (211.345 pg x mL(-1) ± 104.035 pg x mL(-1)) of treatment (P < 0.05). Urinary VEGF-A (76.234 pg x mL(-1) ± 24.169 pg x mL(-1)) was high before the treatment and then significantly decreased after four weeks (56.454 pg x mL(-1) ± l6.111 pg x mL(-1)) and twelve weeks (34.728 pg x mL(-1)) ± 12.656 pg x mL(-1)) of treatment (P < 0.05). Serum and urinary EGFL7 also decreased after the treatment, showing a positive relationship with VEGF-A.

CONCLUSION

Propranolol can be safely and effectively used to treat proliferating infantile hemangiomas. This treatment can reduce the peripheral serum and urinary concentrations of VEGF-A and EGFL7 in affected children.

Own experience in the treatment of infantile haemangiomas with propranolol - preliminary results

BACKGROUND

Infantile haemangiomas are the most common vascular tumours in children. Since 2008 the application of propranolol has been a promising therapy in the management of haemangiomas.

AIM OF THE STUDY

Analysis of the patients with infantile haemangiomas treated with propranolol.

MATERIAL AND METHODS

Between June 2009 and December 2010 in Department of Pediatric Surgery and Oncology Medical University of Lodz, 35 children with infantile haemangiomas (29 females and 6 males) were treated with propranolol. Therapy was initiated in age of 2-15 months (mean 4.5). All infantile haemangiomas were in a proliferative phase. In 27 children lesions were located in the head and neck, 2 of them were located in the orbital region and 3 penetrated into the orbit. In 5 children haemangiomas were located in the trunk, with 3 in the perineum and 3 in limbs. In 2 children the PHACE Syndrome was diagnosed. In one of these cases exploratory laparatomy revealed jejunal haemangiomatosis. The indication for propranolol application was impairment of physiological functions in 23 cases, cosmetic defect in 8 and ulceration in 4. The duration of treatment was 4 to 12 months (mean 7.5-months). The change of haemangioma volume, density and colour were evaluated. Reduction of ˝ haemangioma volume was assessed as very good response, 1/3 as good response, and 1/4 as poor.

RESULTS

In 7 patients therapy has been finished. In all cases decrease in density, volume and fading was observed. Very good result was achieved in 27 patients, good in 5, poor in 3. Recurrence of haemangioma appeared in two patients after termination of treatment. A spectacularly good result was achieved in the child with PHACE syndrome and in one with jejunal haemangiomatosis.

CONCLUSIONS

Propranolol therapy is safe and effective in children with infantile proliferating haemangiomas. It can be the treatment of choice in cases with impairment of physiological functions or severe cosmetic defect. Election and therapy of the children should be carried out in highly reference centres.