Plasma fibrinogen in diabetes mellitus

Plasma fibrinogen was measured in 285 diabetics (age range 15-85 years) and 209 controls (age range 23-74 years). Plasma fibrinogen concentration showed a positive skew distribution and an approximate normal distribution was obtained by log transformation. The mean log plasma fibrinogen in the diabetics was significantly increased (p less than 0.0001). Patients treated with a sulphonylurea (n = 81) had the highest mean log plasma fibrinogen concentration and this was significantly higher than in patients treated with insulin (n = 76; p less than 0.01), biguanides (n = 28; p less than 0.01) or sulphonyluera plus biguanides (n = 38; p less than 0.05). The biganide treated group had the lowest mean log plasma fibrinogen concentrations. No correlation was found between plasma fibrinogen and blood glucose, duration of diabetes or the presence of complications. Subjects with proliferative retinopathy (n = 38) had a similar mean plasma fibrinogen to those with background retinopathy (n = 55). Twenty-two maturity onset diabetics treated with a sulphonylurea and followed prospectively showed a significant increase in plasma fibrinogen after five months (p less than 0.0001), while a control diet treated group showed no alteration in plasma fibrinogen. It is concluded that plasma fibrinogen is significantly increased in diabetics and apart from age, the main factor related to the increase is treatment with sulphonylureas. It remains speculative whether this association has any correlation with long term cardiovascular morbidity.

Bullous pemphigoid antigen. II. Isolation from the urine of a patient

This report concerns the isolation of bullous pemphigoid antigen from the nondialyzable urinary components of a patient with the disease. The isolation was accomplished by ion exchange chromatography and gel filtration. Pemphigoid antigen was found to be a basic glycoprotein that on SDS gel electrophoresis showed two major bands, one in the 18,000 m. w. region and the second with a m. w. of 74,000. Between these two bands, two additional bands appeared; one of 35,000 daltons and the other of 68,000 daltons. The 18,000 m. w. band was eluted from the gel and rerun on SDS gels. These gels showed the 18,000 m.w. band and also the appearance of the 35,000 and 74,000 m.w. bands. This finding indicates that urinary pemphigoid antigen may exist both as a single monomeric form and in polymeric aggregates.

Gray-scale ultrasound: utility preoperatively and postoperatively in a patient with obstructive jaundice

We present a case of obstructing calculi of the common bile duct diagnosed by ultrasonography. Postoperatively, a sterile abscess due to bile leakage at the distal common bile duct developed, and was also diagnosed by ultrasound Ultrasonography was useful in following the course of clearing of the bile collection. Preoperative ultrasound evaluation of the jaundiced patient should be followed by postoperative sonography, especially if complications occur.

Radionuclide venography of the lower extremities and inferior vena cava by continuous injection and moving bed gamma camera technique

Radionuclide venography has proved to be a tedious procedure because of the need for multiple imaging set-ups with coordinated, repeated injections of radionuclide. The use of a moving bed gamma camera has shortened the procedure. This method enables the entire sapheno-femoral-iliac-caval system to be visualized in continuity on a single film. The moving table top system also adequately imaged the suspected areas of thrombi or endothelial damage on the post-exercise study on a single film.

The effects of deliberate hypotension and foot down tilt on the incidence of deep vein thrombosis during plastic surgical operations: a pilot survey

The incidence of postoperative deep vein thrombosis (DVT) has been investigated in a group of 88 patients undergoing plastic surgical operations on the head and neck, and upper limb. Fifty-two cases were operated upon in the foot-down tilt position and 36 were horizontal. With the effects of blood pressure ignored as a possible contributory factor, the incidence of thrombosis in the latter group was 8-3% and was slightly higher in the tilted group (11-5%). Of those who were hypotensive, 3 developed DVT out of 41 (7-3%) who were tilted; whilst in the 11 who were normotensive and tilted 3 developed DVT, an incidence of 27-3%. Of those who were normotensive and operated flat the incidence of deep vein thrombosis was 8-0%, while in those subjected to a foot-down tilt it was 27-3%. The hypothesis has been advanced that frequent inflation and deflation of the cuff used for monitoring blood pressure in the hypotensive patients may release fibrinolytic activity and explain these differences. Age, sex and operative duration were not found to have an effect. It is concluded that the incidence of postoperative deep vein thrombosis in patients undergoing plastic surgical operations is lower than that found in general surgery, and is not worsened by deliberate hypotension.

Gas-liquid chromatographic measurement of guanidino acids

We present a method for separating and measuring guanidino acids by gas-liquid chromatography. Compared to ion-exchange techniques, this system is faster, more sensitive, requires smaller sample volumes, is independent of colorimetric reactions, and permits simultaneous determination of both amino and guanidino acids. N-Trifluoracetyl-n-butyl esters are formed and then are separated by using a column containing a mixed silicone liquid phase coated on Chromosorb W-HP. Analytical recoveries from plasma ranged from 86 to 112% and were done without prior protein precipitation. Speculations as to the cause of this interference by protein include coprecipitation, protein-binding, and cyclization of the guanidines in the acids used for denaturation. Evidence presented suggests that all three occur: ultrafiltrability is diminished in the presence of protein and nuclear magnetic resonance demonstrates cyclization of some of these esters.

Optic nerve hypoplasia with hypopituitarism. Septo-optic dysplasia with hypopituitarism

Four children had optic nerve hypoplasia with hypopituitarism, and their clinical picture varied with age. The newborn had apnea, hypotonia, seizures, hyopglycemia, and prolong jaundice. The young infant had defective vision, behavioral delay, hypotonia, and seizures. Except for a mildly receding lower jaw and a high-arched palate, the appearance of the patients was not unusual. The fasting blood glucose level was mildly depressed. In two cases the liver was palpable and results of liver function tests were abnormal. The older child, who was blind and mentally retarded, had growth failure. The extent of the pituitary hormone deficiencies was variable, including diabetes insipidus. The septum pellucidum was not invariably absent. Clinical and pathological findings indicate that the brain lesion might be more diffuse than hitherto recognized. Early recognition of this syndrome and timely intervention might diminish serious sequels.

Carotenemia in mentally retarded children. I. Incidence and etiology

The incidence and etiology of carotenemia in mentally retarded children were examined. Fasting serum carotenoid and vitamin A levels were measured in 77 profoundly mentally retarded children aged 3 to 19 years who were receiving a standard diet containing 2000 IU of carotene (expressed in terms of vitamin A activity) and supplemented by 2000 IU of vitamin A daily. Seventeen of the 77 patients had serum carotenoid levels of more than 300 mug./ml. The particulate size of food had a significant inverse relationship to serum carotenoid levels and was an important factor in determining carotenemia. The serum vitamin A level was also higher in children on homogenized diet than in those on pureed feeds, while the lowest level was noted among patients on a chopped diet. Besides particulate size of food, other factors may also be operative in determining carotenemia.

The problem of routine circumcision

One hundred male infants were studied at the Kingston General Hospital, Kingston, Ontario, to determine the incidence and complications of routine circumcision. The parents were also interviewed concerning the reason for operation.In these 100 infants, complications, usually minor, were very common, and included hemorrhage (35), meatal ulcers (31), infection (eight), phimosis (one) and meatal stenosis.The reasons given for operation were prophylactic-to avoid the psychological trauma of later operations for infection, phimosis and "troubles" (40), cleanliness (11) and phimosis (four). The remaining cases were for social and other non-medical reasons. Attitudes of parents and physicians regarding circumcision varied from firm belief in its value to a casual approach. One-half of the babies had partial circumcisions, confirming previous suspicions that non-Jewish males frequently had partial operations. Partial operations do not always guarantee cleanliness and probably do not eliminate the risk of penile carcinoma in all cases, if smegma is carcinogenic. Routine circumcisions spare a few children psychologically traumatic operations at a later date and relieve parents of anxiety about the future of the uncircumcised child. This should be balanced against the complications which, although usually minor, may occasionally be serious.Between 1961 and 1962, at the Kingston General Hospital, 349 (48%) of 727 male newborn babies were routinely circumcised.