Insulin-stimulated glucose disposal is not increased in anorexia nervosa

Insulin-stimulated glucose disposal was investigated using the euglycemic hyperinsulinemic glucose clamp technique in six women with anorexia nervosa (27.3 +/- 4.9 yr old; weight, 38.8 +/- 6.6 kg) and compared to results obtained in six normal women (22.6 +/- 1.2 yr old; weight, 58 +/- 2.5 kg) and seven obese women (26.8 +/- 7.7 yr old; weight, 92.5 +/- 13.8 kg). The glucose clamp was performed for 2 h using the Biostator and a continuous insulin infusion of 100 mU kg-1 h-1. Plasma levels of insulin were determined at 30-min intervals. Plasma levels of glucagon, FFA, glycerol, 3-hydroxy-butyrate, and alanine were measured basally. Blood glucose levels were similar in normal subjects and anorectic patients; they were slightly but significantly higher in the obese patients. The indices of insulin sensitivity measured were the MCR of glucose and the ratio of glucose infused to insulin infused (G/I). They were very similar in anorectic subjects [MCR, 13.5 +/- 2.4 (+/- SEM) ml kg-1 min-1; G/I, 5.2 +/- 0.9 mg/mU) and normal subjects (MCR, 13.5 +/- 1.7 ml kg-1 min-1; G/I, 5.2 +/- 0.4 mg/mU), but were significantly reduced in obese patients (MCR, 5.1 +/- 0.8 ml kg-1 min-1; G/I, 2.6 +/- 0.3 mg/mU; P less than 0.0025). Differences in plasma insulin among the three groups were not statistically significant. Plasma alanine levels were higher in anorectic than in normal or obese subjects, suggesting defective gluconeogenesis. Thus, insulin-stimulated glucose disposal is normal in patients with anorexia nervosa, a finding that contrasts with the previously reported increase in erythrocyte insulin receptors in this disease.

Computed tomography of gliosarcoma

Five cases of rare gliosarcoma are described with pathologic correlation. Because of its sarcomatous component, gliosarcoma tends to present as a sharply defined, round or lobulated, hyperdense solid mass with relatively homogeneous contrast enhancement and peritumoral edema. Sharp demarcation of the tumor from surrounding tissue may lead to complete removal and prolonged survival despite high malignancy. However, aggressive tumor regrowth occurs often after incomplete resection. The genesis of gliosarcoma is also discussed.

Similar metabolic effects of pulsatile versus continuous human insulin delivery during euglycemic, hyperinsulinemic glucose clamp in normal man

Seven normal volunteers were studied on two different occasions during which 4-h pulsatile (PULS: 0.8 mU X kg-1 X min-1, 7.5 min of 15) and continuous (CONT: 0.4 mU X kg-1 X min-1) intravenous (i.v.) infusions of human insulin (Actrapid HM, Novo) were randomly compared. A euglycemic glucose clamp was performed and a 3-3H-glucose infusion was used for determination of endogenous glucose production (EGP) and metabolic clearance rate (MCR) of glucose. Plasma glucose was similar in both conditions; plasma insulin was stable at about 29 mU/L (CONT) and fluctuated between 10 and 45 mU/L (mean: 28, PULS). Exogenous glucose infused was 1.137 +/- 0.058 and 1.088 +/- 0.099 g X kg-1 X 4 h-1 in CONT and PULS, respectively (NS). EGP was totally suppressed in both conditions. Glucose MCR increased similarly to a maximum of 6.71 +/- 0.19 (CONT) and 6.79 +/- 0.59 (PULS) ml X kg-1 X min-1 during the fourth hour. C-peptide plasma levels remained stable, whereas plasma glucagon, free fatty acids, and 3-hydroxybutyrate were similarly suppressed in both tests. Thus, under these conditions, pulsatile and continuous insulin infusions have similar metabolic effects. These data contrast with those of Matthews et al. (1983) who reported that, at lower plasma concentrations (5-19 mU/L), pulsatile insulin had greater hypoglycemic effect than did continuous delivery. It is concluded that pulsatile insulin shows no greater activity under normoglycemic, moderately hyperinsulinemic conditions in man.

Oxytocin augmentation of dysfunctional labor. IV. Oxytocin pharmacokinetics

Plasma oxytocin levels ([OT[p) were measured every 20 minutes during infusions of oxytocin. The initial dose of 1 mU/min was incremented, if necessary, by 1 mU/min at 40-minute intervals until sufficient contractility was obtained to effect cervical dilatation. The results demonstrated: the [OT]p rises linearly with each dose for the first 40 minutes of the infusion; there is no difference between the 40- and 60-minute sample values, suggesting that the peak [OT]p of each dose is achieved in 40 minutes; the increment in [OT]p required to produce effective contractility varies widely from 0.58 to 5.09 microU/ml; the plasma clearance rate varied from 11.2 to 32.5 ml/kg/min. Approximately 40 minutes is required for any particular dose of oxytocin to reach a "steady-state" [OT]p and the maximal uterine contractile response. The design of regimens for the augmentation or induction of labor should be based on this knowledge.

Metabolic alterations after a two-hour nocturnal interruption of a continuous subcutaneous insulin infusion

In order to evaluate the metabolic consequences of a 2-h nocturnal interruption of continuous subcutaneous insulin infusion (CSII), seven insulin-dependent diabetic patients without residual insulin secretion were investigated. The changes in blood glucose, plasma free insulin, glucagon, free fatty acids, and 3-hydroxybutyrate (3 OH-B) concentrations have been compared during two randomized tests carried out either during the normal functioning of a Mill-Hill pump from 10 p.m. to 8 a.m. (1.00 +/- 0.06 U insulin/h, keeping adequate metabolic control) or during the same conditions but with a deliberate arrest of the pump between 11 p.m. and 1 a.m. Considering the value recorded at 11 p.m. as reference, interruption of the insulin infusion resulted in: (1) a rapid (already significant after 1 h) and sustained (maximal fall: --12.5 +/- 2.5 mU/L at 3 a.m.) decrease in plasma free insulin; (2) a delayed (significant after 4 h) and linear rise in blood glucose (maximal increase: + 4.0 +/- 1.3 mmol/L at 5 a.m.); (3) an early (significant at midnight) and prolonged rise in plasma free fatty acids (+ 387 +/- 148 mumol/L at 3 a.m.); (4) a delayed (significant after 3 h) and sustained increase in plasma 3 OH-B (+ 347 +/- 88 mumol/L at 3 a.m.); and (5) no significant changes in plasma glucagon. Thus, a 2-h interruption of CSII in resting nocturnal conditions is sufficient to induce significant, delayed, and sustained metabolic alterations in C-peptide-negative patients despite good baseline blood glucose control. Resetting the pump at its basal rate is insufficient to quickly restore adequate circulating insulin levels and effectively counteract the metabolic disturbances. The efficacy of a bolus insulin injection in these conditions should be evaluated.

[Vaginal hysterectomy with bilateral adnexectomy]

102 bilateral adnexectomies in simple vaginal uterectomy (UE.A.) were researched between 1975-1980 and compared to the same number of patients who had vaginal uterectomy without adnexectomy (VK). The average age of the UE.A. was 51.9 years and of the VK 36.8 years of age. The parity of both groups was balanced. The most frequent indication for operation of both collectives was uterus myomatosus. In 52.9% we found a pathology of the ovar: In 46% benign ovarial tumor, in 4.9% ovarial tumor, in 4.9% ovarial endometriosis, in 0.9% ovarial metastasis of breast carcinoma and in 0.9% tubal carcinoma with micrometastasis at the ovar of the same side. The most frequent postoperative histological diagnosis of both groups was uterus myomatosus. The number of complications (post operative bleeding, course of fever more than 38.5 degrees C) was the same in both groups.

A 6-hour nocturnal interruption of a continuous subcutaneous insulin infusion: 1. Metabolic and hormonal consequences and scheme for a prompt return to adequate control

Interruption of a continuous subcutaneous insulin infusion, most often due to technical problems occurring during the night, is a not uncommon event whose metabolic consequences have received relatively little attention until now. We have therefore investigated the changes in blood glucose, plasma non-esterified fatty acids, 3-hydroxybutyrate, glucagon and free insulin in eight C-peptide negative Type 1 diabetic patients whose pumps were deliberately stopped between 23.00 h and 05.00 h. A control test with the pump functioning normally was carried out in each patient and the studies were randomized. Considering the values at 23.00 h as reference, interruption of the insulin infusion resulted in (1) a rapid decrease in plasma free insulin significant after 1 h and reaching a nadir of 6 +/- 2 mU/l after 6 h; (2) a rise in blood glucose which was significant at hour 3 and reached 17.4 +/- 1.9 mmol/l at hour 6; (3) a moderate increase in plasma nonesterified fatty acids which remained in the range of 700-800 mumol/l; (4) an early and linear rise in plasma 3-hydroxybutyrate, significant after 1 h and averaging 1290 +/- 140 mumol/l after 6 h; (5) a late increase (hour 5) in plasma glucagon. The second aim of our study was to provide for the patient a precise scheme of insulin supplements administered via the pump and based on blood glucose monitoring (Dextrostix - Glucometer) and semi-quantitative evaluation of ketonuria (Acetest). Resetting the pump at its basal rate at 05.00 h and giving insulin supplements (2-8 U) at 06.45 h (with the usual breakfast dose) and again at 10.00 h have proved efficacious in restoring satisfactory metabolic control by noon the day after starting the experiment. These results form practical recommendations to patients undergoing this type of accident.

Oxytocin augmentation of dysfunctional labor. III. Multiparous patients

The effectiveness of a specific oxytocin regimen characterized by a small dose, a slow rate of oxytocin incrementation, and a specific computer-defined goal of contractile activity was evaluated. The group managed by this protocol was compared with a similar group of multiparous patients managed by the same physicians using their own choice of oxytocin therapies and electronic monitoring of intrauterine pressure. The patients managed by protocol and computer had shorter mean durations of time from onset of treatment to complete cervical dilatation and received smaller mean doses of oxytocin than the control group of patients. The most significant factor determining these results was the rate of incrementation of the oxytocin dose.

Oxytocin augmentation of dysfunctional labor. II. Uterine activity data

The intrauterine pressure data obtained from oxytocin-treated patients in dysfunctional labor, managed by a specific oxytocin regimen and a computer-defined goal of uterine activity, are analyzed. Questions asked concern the efficacy of the computer diagnosis of hypocontractility, the quantity of uterine activity needed to effect cervical dilatation, and the effectiveness of the quantitative data as an aid in selecting the necessary dose. The false positive diagnostic rate was one of 45 and the false negative, one of 42. The results demonstrate that there were no statistically significant differences between the computer-defined goal of activity and that associated with cervical dilatation if the dose used was permitted the time to accomplish its maximum effect. Quantitation of uterine contractility provided the information necessary to select the dose of oxytocin associated with cervical dilatation in approximately 75% of the patients.

Circadian profiles of blood glucose and plasma free insulin during treatment with semisynthetic and biosynthetic human insulin, and comparison with conventional monocomponent preparations

Sixteen hospitalized insulin requiring diabetics treated with a single daily subcutaneous injection were randomly allocated either to a mixture of porcine Actrapid + Lente MC or a mixture of Regular + NPH-Biosynthetic human insulin (Study 1). In Study 2, 10 patients receiving two daily insulin injections were treated at random with either porcine Actrapid + Monotard, or Actrapid + Monotard-Semisynthetic human insulin or Regular + NPH--Biosynthetic human insulin. Once an optimal insulin regimen was obtained, circadian blood glucose and plasma free insulin profiles (7-9 time points) were determined with the two (Study 1) or three (Study 2) insulin preparations, keeping the doses of insulin constant. In Study 1 no significant difference in blood glucose (BG) or plasma free insulin (FIRI) profiles was observed. The mean daily blood glucose, the mean amplitude of glycaemic excursions (MAGE), the index of blood glucose control (M-value of Schlichtkrull), as well as the postbreakfast increases in blood glucose and mean free IRI, were similar with both types of insulin. In Study 2, BG and FIRI profiles were also similar, except for a significantly lower (p less than 0.02) BG at 8.30 p.m. with both human insulins. No significant differences were found in free IRI at that time. Mean BG, M index, MAGE and mean FIRI were similar but the postbreakfast increase was significantly smaller with SHI. In conclusion, the pharmacokinetics of animal monocomponent, semisynthetic and biosynthetic human insulin appear similar, but evening BG control was better with both types of human insulins given twice daily.

Oxytocin augmentation of dysfunctional labor. I. Clinical data

The effectiveness of a specific oxytocin dosage regimen and a specific computer-defined initial goal of a contractile activity is compared to groups of similar nulliparous women managed by the same physicians who used their own choices of oxytocin therapy and electronic monitoring of the intrauterine pressure. The patients managed by a specific regimen and a computer-defined therapeutic goal had oxytocin stopped or the dosage reduced because of concerns with fetal distress or, less frequently, hypercontractility, had shorter intervals from the initiation of oxytocin to full dilation, required smaller doses to accomplish cervical change, and received smaller maximum doses of oxytocin. The most significant factor determining these results was the rate of incrementation of the oxytocin dose.

Inorganic phosphate-insulin relationships in normal subjects and in patients with moderate glucose intolerance

The relationship between serum insulin and serum inorganic phosphate levels was investigated in normal subjects (NGT) and in patients with moderate impairment of glucose tolerance (IGT1 with subnormal and IGT2 with excessive insulin secretion) fasting and after oral glucose. Insulin and phosphate fasting levels were similar in all groups. In NGT subjects, a significant correlation between fasting insulin and inorganic phosphate levels are observed. In NGT and in IGT1 subjects, oral glucose administration was followed by a fall in serum phosphate level that was well correlated with the total insulin released. The phosphate fall was severely impaired in IGT2 patients, despite the increased insulin secretion. The plasma ionized calcium levels remain unchanged throughout the OGTT. The present results support the hypothesis that in IGT1 patients a reduced glucose-induced insulin release and in IGT2 patients, a peripheral resistance to insulin action could be the determinant of impaired glucose tolerance.

Effect of phosphate omission on the glucose-induced insulin release in vitro in fed and fasted rats

Isolated perfused rat pancreases from fed and 20-h fasted rats were used to investigate the effect of phosphate omission on the insulin response to 16.7 mmol/l glucose. The insulin response to continuous glucose stimulation was biphasic. Both phases were significantly reduced when pancreases were perfused in the absence of extracellular phosphate in fasted, but not in fed rats.