Plasma glucagon in diabetes of haemochromatosis: too low or too high?

Glucagon secretion before and during arginine infusions was tested in 11 patients with diabetes associated with haemochromatosis. The results were compared with those obtained in six normal subjects and five patients with haemochromatosis but normal glucose tolerance. The patients with haemochromatosis, regardless of glucose tolerance, exhibited higer level of plasma immunoreactivity for glucagon (antiserum 30-K) suggesting hyperglucagonaemia. However, additional analysis revealed that a considerable amount of this glucagon immunoreactivity was due to cross-reacting material of high molecular weight, the levels of which were significantly higher in patients with idiopathic haemochromatosis. When this was deducted from the total immunoreactivity measured, the resulting values for true glucagon concentrations were similar to those of normal subjects. The data suggest that (1) patients with idiopathic haemochromatosis, whether or not associated with diabetes, exhibit plasma glucagon levels comparable with those of normal subjects; (2) the plasma of the same patients contains significantly more high-molecular-weight substances reacting with glucagon antiserum 30-K than is present in plasma of normal subjects; and (3) 'hyperglucagonaemia' may be erroneously suggested when glucagon is measured with certain antisera reputed to be specific for glucagon.

[Liver tumors and oral contraceptives]

Benign liver cell tumors in young women are reported with increasing frequency. An association between benign tumors and oral contraceptive use was first suggested in 1973 by Janet Baum. During the past ten years we have observed 15 benign liver cell tumors, all of the focal nodular hyperplasia type. Ten of the 15 women were taking or had taken oral contraceptives. This association was found not to be statistically significant (0.06 greater than p greater than 0.05). We also diagnosed 2 liver cell carcinomas in women who had taken contraceptives.

[Cimetidine in the treatment of duodenal ulcer (author's transl)]

In a double-blind trial of patients with duodenal ulcer at three centres the healing rate after a four-week course of treatment (1 g cimetidine daily) was 79% (30 out of 38 patients), compared with 58% (23 out of 40 patients) on placebos. Cimetidine did not effect subjective symptoms or the need for antacids to relieve pain, except for a minor beneficial effect on diurnal ulcer symptoms during the second week of treatment. Results of long-term administration suggest that cimetidine at 400 mg daily prevent s relapses, but the possibility of an increased relapse rate after cimetidine withdrawal can not as yet be excluded.

[Therapy of duodenal ulcer using cimetidine]

55 patients with endoscopically confirmed duodenal ulcers received either cimetidine (26 patients) or placebo (29 patients) in a double-blind trial. At four weeks, 85% of the patients treated with cimetidine and 62% of those receiving placebo had endoscopically healed ulcers. This difference is not statistically significant. However, patients on cimetidine showed a more rapid and statistically significant reduction in the size of their ulcers.

[Thrombosis of the suprahepatic veins (Budd-Chiari syndrome) and polycythemia. A propos of 1 case]

A case is described of Budd-Chiari syndrome associated with polyglobulism in a 31-year-old subject. The connexion between Budd-Chiari syndrome and polyglobulism as a secondary symptom or a sign of a myeloproliferative syndrome is discussed.

[Diagnosis of pyloro-duodenal ulcer by means of radiology and endoscopy]

Study of 100 cases of duodenal ulcer has revealed disagreement between radiologic and endoscopic findings. In 20 percent of cases the disagreement was minor (e.g. deformed duodenum - ulcer, deformed duodenum - scar, etc.). In 5 percent of cases they were major (e.g. normal - ulcer). The percentage of discrepancies, which were to the advantage of endoscopy, was lower than in the reports of JENNI and KAWAI, probably because our heterogeneous radiologic material was reviewed beforehand by two radiologists. The specific merit of endoscopy is that it makes it possible to observe superficial and sub-radiologic lesions of the mucosa, localize the ulcer with greater precision and detect deformation of the pylorus. Radiology affords better evidence of certain deformations.