Structure and activity of the B-chain of insulin

Despentapeptide (B26-30)-insulinamide (B25) prepared by a semisynthetic procedure was found to have about 65% of the hypoglycaemic activity of natural insulin. In contrast, the binding of the modified insulin analogue to insulin specific receptors was markedly increased. The discrepancy between the loss of biological potency and the apparent increase in binding affinity for membrane receptors reveals that not all of the biological activity of insulin is regulated by the receptor-binding system. The tetrapeptidamide of the B-chain of insulin (Arg-Gly-Phe-Phe-NH2) was clearly shown to have both insulin-like and insulin-potentiating actions in vivo although it had no effect on insulin receptor function in vitro. Evidence suggests that the small peptide fragment of insulin may be internalized and acts at the post-binding site(s) of the glucose metabolic pathway in target tissues. The present data support the general concept that insulin may exert its complex molecular actions through internalized hormonal fragment as well as the transmembrane mediators generated from receptor binding.

Pectus excavatum from chronic upper airway obstruction

Two patient with enlarged adenoids and tonsils had cardiopulmonary distress and pectus excavatum. In both patients, the cardiorespiratory difficulty and the pectus deformity were relieved by removing the obstructive adenoids and tonsils. This observation supports the hypothesis that upper airway obstruction can cause a chest wall deformity. In a patient with cardiorespiratory distress and pectus excavatum, upper airway obstruction should be considered.

Partial obstruction of endotracheal tubes in children: incidence, etiology, significance

We examined 99 endotracheal tubes removed from 81 pediatric patients to determine the incidence of partial endotracheal tube obstruction and predisposing factors. The overall incidence of obstruction was 20.2% (20/99); 14 of the 20 obstructed tubes were occluded less than 50%. General anesthesia during the period of intubation was the only factor significantly associated with an increased incidence of obstruction (p less than 0.05). There was no correlation of obstruction with duration of intubation, the presence of a Murphy-eye side hole, or small tube size. Among the 71 tubes from patients who received general anesthesia, a tube size of 4 mm or less was associated with an increased incidence of obstruction (p less than 0.05). Pressure-flow curves for three different sizes of endotracheal tubes were constructed to determine the increase in resistance produced by different degrees of obstruction. At flow rates that approximated those found in children during quiet breathing, the resistance of tubes that were 50% obstructed was 4 times greater than that found in unobstructed tubes.