Insulin autoimmunity as a cause of hypoglycemia

"Autoimmune" hypoglycemia is a syndrome consisting of fasting hypoglycemia, hyperinsulinemia, and insulin-binding antibodies in a patient who has never been exposed to exogenous insulin. The stimulus for insulin-antibody formation and the mechanism of the hypoglycemia in this condition remain unknown. Three patients with this rare syndrome had severe hypoglycemia of limited duration. Two had received a drug containing a sulfhydryl group (methimazole and penicillamine) as treatment for an autoimmune disorder (Graves' disease and rheumatoid arthritis, respectively). A third patient who underwent surgery for a suspected insulinoma was found to have pancreatic beta cell hyperplasia. Drugs containing a sulfhydryl group may have a role in the etiology of the syndrome. Additionally, our findings suggest a relationship between circulating insulin antibodies and beta cell hyperplasia.

Abnormal excretion of oestrogens in complicated pregnancies

The tremendous interpatient variations that occur for oestrogen excretion during pregnancy are largely overcome by expressing results in terms of relative concentrations (i.e., as percent of total oestrogens excreted). Specimens of urine from 28 pregnant patients with a variety of complications were assayed for their oestrogen content by an "oestrogen profile" technique and the results thus expressed were compared with those from 20 normal pregnancies. Statistically significant changes are shown in the group of patients in the "above" normal range (normal range = normal mean +/- 3 X SE) for five oestrogens (oestrone, 2-hydroxyoestrone, 2-methoxyoestrone, 2-hydroxyoestradiol, and 2-hydroxyoestriol) and "below" the normal range for one oestrogen (oestriol). When the means of the oestrogen values for the different groups of patients were examined, two things became obvious; firstly, only patients with hypertension showed these changes, and secondly, two additional oestrogens (16-hydroxyoestrone and 16-epioestriol) were excreted in large amounts by the normotensive "high risk" patients. A comparison of the two methods of expressing oestrogen assay results is made quantitatively (as milligrams per day) versus relatively (as percent of total oestrogens excreted), and advantages and disadvantages of each are discussed.

Acute syphilitic optic neuritis

Two patients experienced acute unilateral visual loss as a manifestation of early infectious (secondary) neurosyphilis. In both cases, optic disc swelling was preceded by the development of a characteristic rash accompanied by mild signs of meningeal inflammation. Other signs of ocular inflammation, such as uveitis or retinal vasculitis, were absent. Optic neuritis may occur as a manifestation of the meningeal inflammation that can accompany secondary syphilis. In such patients, it is important to confirm involvement of the CNS and to institute appropriate antibiotic therapy.

Treatment of psoroptic mange with avermectins

Good control of Psoroptes cuniculi was achieved in rabbits treated with various avermectin analogues by topical application or by subcutaneous injection of the 22,23-dihydroavermectin B1.

Cholecystokinin-like peptides in brain and intestine of obese-hyperglycaemic mice

Cholecystokinin-(CCK) like peptides have been measured in the brain and small intestine of ob/ob hyperglycaemic mice and lean littermates. CCK-like peptides were measured by radioimmunoassay employing an antiserum to CCK octapeptide (CCK 8) and gastrin 17 I125 label. Although this antiserum detects gastrin with equal affinity to CCK, concomitant assay of tissue extracts with a gastrin specific antibody failed to reveal any detectable gastrin. Extracts of brain and small intestine showed levels of CCK of 96 +/- 12.6 pmol g-1 and 45 +/- 6.1 pmol g-1 in the obese mice; 101 +/- 8.7 pmol g-1 and 36 +/- 2.5 pmol g-1 in the lean mice. These were not significantly different. It has been suggested that CCK may be a satiety factor and it has been reported that there is less CCK in brain of obese mice compared with lean mice. This study has failed to confirm the previous finding and indicates that, in this animal model, tissue levels of CCK probably do not modulate appetite.

Effects of a chemotactic factor, N-formylmethionyl peptide, on adherence, superoxide anion generation, phagocytosis, and microtubule assembly of human polymorphonuclear leukocytes

FMLP promoted microtubule assembly in PMNs at concentrations which were chemotactic for the cells. At higher concentrations than those required for chemotaxis, FMLP enhanced the adherence of PMNs to nylon glass fibers. With colchicine, PMN adherence was inhibited, but upon exposure to FMLP, PMN adherence could be restored. The effect of FMLP on PMN adherence was transitory and was no longer evident by 5 min. At concentrations similar to those employed in the adherence studies. FMLP induced the cells to briefly generate O-2, since ferricytochrome C reduction was no longer evident by 5 min. Pretreatment of the PMNs with cytochalasin B enhanced the release of O-2 by PMNs exposed to FMLP. On the other hand, there was no effect of FMLP on phagocytosis of C3-coated particles. These results suggest that FMLP induces responsive cells to develop a hyperadherent plasma membrane which is largely independent on microtubule control. Since oligopeptides similar of AMLP are formed in bacteria, it is likely that the action of N-formylated peptides is important in regulating the inflammatory response.

Radioimmunoassay of secretin in serum

A radioimmunoassay for the measurement of immunoreactive secretin has been developed. The assay is specific and sensitive so that 2.8 fmol/ml can be measured. Basal secretin levels in man are generally undetectable and a protein-rich meal does not elicit a secretin response. However, the intraduodenal instillation of HCl leads to a prompt rise in circulating immunoreactive secretin and exogenous secretin administered intravenously is easily and accurately measured.

The preparation of pregnancy urine for an estrogen profile

A method is described for purifying the estrogen content of pregnancy urine with little loss of the labile estrogens. The procedure makes use of the initial 50-fold purification effected by their precipitation whith ammonium sulphate, with simultaneous elimination of most urinary corticosteroids and 50--60% of urinary ketosteroids. It also employs the antioxident ascorbic acid as an additive in most stages of the procedure. The mild organic-solvent-HIO partition system of Brown is used for separating the strongly polar, 2including all "labile" estrogens, and of the weakly polar estrogens, from neutral steroids. The remaining neutral steroid still interfering with the assays were removed by an ascorbic acid treated ion exchange resin (AG 1). The final residues were revealed by mass-spectroscopy to consist almost solely of estrogens. Gas-liquid chromatography in which just 2 chromatograms are required yields a total of 12 "estrogen" peaks (for 12 estrogens which are excreted in amounts greater than 0.1 mg/day) in normal pregnancy urine, including all the known labile estrogens. Identification as estrogen for all but a few minor peaks of the gas chromatogram was obtained by mass-spectroscopy. The practical significance of the method lies in the fact that some labile estrogens are much more important in the estrogen metabolism of pregnant and nonpregnant women than heretofore generally thought.

Fluidotherapy: evaluation of a new heat modality

The development of a new heat therapy modality (fluidotherapy) consisting of a bed of solid particles suspended in air is reported. Measurements of time integrated heat absorption by a hand immersed in the fluidotherapy unit at 120F (48.9C), a whirlpool at 105.2F, and a paraffin bath at 126F show the average heat absorption to be 17.2, 5.6 and 4.8 BTU respectively during a 15-minute treatment.