An AM1 molecular orbital study of alpha-D-glucopyranose and beta-maltose: evaluation and implications

Chemical reactivity and other characteristics of alpha-D-glucopyranose and beta-maltose were evaluated within a semiempirical molecular orbital (AM1) framework. Theoretically generated structures compared well to those determined by X-ray crystallographic techniques. Calculations suggested that the secondary hydroxy functions (OH-2 and OH-3) of the mono- and di-saccharides were more acidic than the primary alcohol (OH-6), which is consistent with experimental findings. In addition, the enhanced reactivity of the OH-3 locus, which is observed upon OH-2 alkylation of the object sugars, was rationalized in terms of increased OH-3 acidity. The chemical behavior of the monomers examined may be insightful in explaining the reactivity of glucopyranose polymers.

Diabetes mellitus and hypertension based on the family history and 2-h postprandial blood sugar in the Ann-Lo district (northern Taiwan)

From July 1988 to June 1990, we performed an epidemiological study on the prevalence of hypertension and diabetes mellitus (DM) in the Ann-Lo district, a suburban area of Northern Taiwan. One third of the population in the district was randomly sampled. A total of 9087 persons were screened with 67.4% participating. Following completion of the questionnaire blood pressure, 2 h postprandial blood sugar were determined. DM was defined when the blood sugar was over 200 mg/dl or the subject had a diabetic history. Hypertension was defined if the systolic blood pressure was over 160 mmHg or the diastolic blood pressure over 95 mmHg. Statistical comparisons were performed with a chi-square test, analysis of covariance, stepwise multiple regression and Pearson correlation matrix. In this study, the prevalence rate of DM was 2.6% and of hypertension was 6.4%. For those patients 40 years or older, the prevalence rate for DM was 8.0% and for hypertension was 19.7%. The prevalence of hypertension was 24.8% in overt diabetes and 5.2% in the normal subjects. Analysis of the data between risk factors of DM revealed that DM correlated with age, body mass index, hypertension, smoking, family history of DM and correlated negatively with education. Hypertension correlated with gender, alcohol intake and smoking, sugar level, age and body mass index. The prevalence rate of diabetes and hypertension were quite high in the district and this study pointed out the important risk factors for hypertension and DM in Taiwan.

Hepatic injury during propylthiouracil therapy in patients with hyperthyroidism. A cohort study

OBJECTIVE

To evaluate the incidence, severity, and course of propylthiouracil-induced hepatic injury in patients with hyperthyroidism.

DESIGN

Cohort study.

SETTING

Outpatient clinic of a university-based hospital.

PATIENTS

Fifty-four patients with normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values and a definite diagnosis of hyperthyroidism.

INTERVENTION

Treatment with propylthiouracil, 300 mg/d for 2 months followed by 100 to 150 mg/d for 3 months and a subsequent maintenance dose of 100 mg/d.

MEASUREMENTS

Liver biochemical tests were studied before therapy and 2 months and 5 months after starting propylthiouracil therapy. The patients were monitored with clinical evaluation and weekly liver biochemical tests after AST or ALT levels became abnormal. Serologic markers of hepatitis A, B, C, and delta virus infection were also studied when appropriate.

RESULTS

Fifteen (28%; 95% CI, 16% to 42%) of the 54 patients showed ALT elevations 2 months after propylthiouracil therapy. The mean peak ALT level for these patients was 1.35 mu kat/L (range, 0.65 3.85 mu kat/L). None of these patients had symptoms or hyperbilirubinemia. Liver biopsy in three patients showed mild perivenular focal necrosis or ill-defined granuloma composed of foamy histiocytes with ceroid pigment and mild fatty metamorphosis. Despite continued propylthiouracil therapy at a reduced dose, ALT levels returned to normal in 13 of 15 patients in the following 3 months. None of these ALT elevations resulted from hepatitis A, B, C, or delta virus infection. No statistical difference was seen in the pretreatment characteristics between patients with and those without ALT elevation, except that the former had a higher pretreatment T4 level (270 +/- 12.9 compared with 237 +/- 7.72 nmol/L, P = 0.027) and T3 level (7.22 +/- 0.72 compared with 5.85 +/- 0.39 nmol/L, P = 0.048).

CONCLUSIONS

Propylthiouracil-induced subclinical liver injury is common and is usually transient and asymptomatic. Therapy with propylthiouracil may be continued with caution in the absence of symptoms and hyperbilirubinemia.

[Cushing's syndrome with pregnancy. Report of three cases]

Cushing's syndrome with pregnancy is rare, and only about 60 cases have been reported. In the recent 4 years, 3 cases were diagnosed in Chang Gang Memorial Hospital. They presented with serious maternal complications early in the second month of pregnancy, including hypertension, proteinuria and lower leg edema. Unfortunately it was not diagnosed until the 20th week of pregnancy. They had the same hormone profile as other Cushing's syndrome patients who were not pregnant. Under the supportive treatment they had outcomes of two premature deliveries and one still birth. Just after delivery all patients received left adrenalectomy and pathology showed adenoma. All of them had good recovery courses. According to the literature, early treatment (surgical operation, medical treatment, or irradiation) could decrease maternal morbidity and fetal loss rate.

[Using 131I-MIBG and 99mTc-MDP bone scan for localization of rare extra-adrenal pheochromocytomas: report of 2 cases]

It is difficult, but important, to diagnose extra-adrenal pheochromocytomas before surgery. Failure to recognize the existence and nature of an extra-adrenal pheochromocytoma can cause life-threatening problems even in a minor surgical operation. We present two rare cases of extra-adrenal pheochromocytomas which were detected by 131I-MIBG scintigraphy. One of them was intrapericardial, and the other was a vesical pheochromocytoma. We used a combined 99mTc-MDP bone scan and 131I-MIBG scintigraphy to locate the pheochromocytomas. Both cases of extra-adrenal pheochromocytoma were correctly diagnosed preoperatively and successfully resected in the subsequent operations.

[Low dose radioiodine treatment of papillary thyroid carcinoma in a child--a case report]

The thyroid carcinoma is rare in children and the optimal management is rather controversial. We report a case of a 7-year-old boy who had right neck masses and proved to be papillary thyroid carcinoma after near-total thyroidectomy. Post-operative 20 mCi radioiodine-131 (I-131) ablation scan, lung metastasis was suspected but the chest X ray was normal. After being lost to follow up for 4 years, the patient returned with the complaints of cough; the chest X ray was still normal. He then received 5 treatment with low dose (30 mCi) I-131 therapy and continued thyroxine replacement. Progressive decrease both of the thyroglobulin level and the intensity of radioactivity of lung were noted. After a total doses of 193 mCi I-131 therapy, neither pulmonary fibrosis nor bone marrow suppression was seen. Although the low dose (< or = 30 mCi) I-131 therapy was recommended, it was limited for the ablation therapy of the remnant thyroid tissue. Upon consideration of economics and the convenience of not being admitted to the isolation room, the low dose I-131 therapy seems feasible for children with thyroid carcinoma with systemic disease. However, the long term efficacy needs further evaluation.

A new method for the estimation of the aqueous solubility of organic compounds

Using a semiempirical quantum chemical method (AM1), various properties (dipole moment, charge distribution, geometrical parameters, etc.) of 331 compounds were calculated. Various linear functions of these properties and their combinations were fitted to reproduce experimental aqueous solubilities. An 18-parameter function was derived that is reasonably simple, yet appears to be able to describe the aqueous solubilities of a wide range of organic compounds. The parameter set is essentially the one used in a recent similar study of octanol-water partition coefficients. The derived equation has important predictive value.

Apolipoprotein levels in normolipidemic non-insulin-dependent diabetes mellitus

The purpose of this study was to examine the change in apolipoprotein and lipoprotein levels in patients with normolipidemic untreated non-insulin-dependent diabetes mellitus (NIDDM). Fifteen untreated, non-obese male NIDDM patients without hyperlipidemia were chosen, and 15 healthy subjects, matched for age, sex, body weight, alcohol consumption and cigarette smoking served as the control group. We observed that the concentrations of plasma total cholesterol (TC), triacylglycerol (TG) and very low density lipoprotein cholesterol (VLDL-C) were identical in both NIDDM and control groups. The levels of low-density lipoprotein cholesterol (LDL-C) were slightly increased in the diabetic group, but the difference did not reach statistical significance in our study. High-density lipoprotein cholesterol (HDL-C) was lower in the NIDDM group than in the controls. Significantly increased TC/HDL-C and LDL-C/HDL-C ratios were found in NIDDM patients compared with controls. The apolipoprotein A-I (apo A-I) and apolipoprotein A-II (apo A-II) levels were decreased in NIDDM patients, while the apolipoprotein B (apo B) level remained similar to that of the control subjects. The ratio of apo A-I/apo B was decreased significantly in the NIDDM group. Our results suggest that NIDDM patients are at higher risk of coronary heart disease, even if they remain normolipidemic.

C-peptide response to glucagon in patients with non-insulin-dependent diabetes mellitus

To understand pancreatic beta cell function in patients with non-insulin-dependent diabetes, we analyzed C-peptide response to glucagon in 101 nonketotic patients with onset of diabetes at over 25 years of age and duration of diabetes of more than one year. The fasting serum C-peptide values (FCP), maximal incremental (delta CP) and 6-minute (6'CP) serum C-peptide values after 1 mg of intravenous glucagon administration were not related to age at diagnosis (r = 0.12, 0.06 and 0.10, respectively), duration of diabetes (r = 0.15, 0.05 and 0.10, respectively), fasting plasma glucose concentrations (r = 0.01, 0.18 and 0.12, respectively) or glycohemoglobin (HbA1c, r = 0.13, 0.22 and 0.16, respectively). In contrast, they showed a clear positive correlation with body mass index (BMI, r = 0.36, 0.52 and 0.41, p < 0.001). In order to evaluate the beta cell function in patients with different responses to treatment modalities, a subgroup of 45 patients was divided into three groups: diet successes (DS, n = 14), oral hypoglycemic agent (OHA) successes (OS, n = 19) and OHA failure (OF, n = 12). Among the three groups, patients in the OF group had the longest duration of diabetes (9.4 +/- 1.9 years) and the lowest BMI (19.3 +/- 1.0 kg/m2). Serum C-peptide responses to glucagon were different in the three study groups. Patients in the DS group had the highest response and patients in the OF group had the lowest response. However, the differences in mean FCP, delta CP and 6'CP among the three groups were not statistically significant, and there was a wide overlap of individual C-peptide values.(ABSTRACT TRUNCATED AT 250 WORDS)

Diverse point mutations result in glucose-6-phosphate dehydrogenase (G6PD) polymorphism in Taiwan

Glucose-6-PHOSPHATE dehydrogenase (G6PD; EC 1.1.1.49) deficiency is the most common human enzymopathy, affecting more than 200 million people worldwide. Although greater than 400 variants have been described based on clinical and biochemical criteria, little is known about the molecular basis of these G6PD deficiencies. Recently, the gene that encodes human G6PD has been cloned and sequenced, which enables us to examine directly the heterogeneity of G6PD at the DNA level. During the past 10 years, we examined the G6PD activity in 21,271 newborn Chinese infants (11,400 males and 9,871 females) and identified 314 (2.8%) males and 246 (2.5%) females having low G6PD activity. The G6PD gene from 10 randomly selected affected individuals and their relatives was polymerase chain reaction (PCR) amplified, subcloned, and sequenced. Our results indicate that at least four types of mutation are responsible for the G6PD polymorphism in Taiwan. The first type of mutation (487 G----A) was found in an affected Chinese with a G to A change at nucleotide 487, which results in a (163)Gly to Ser substitution. The second type of mutation (493 A----G) is a novel mutation that has not been reported in any other ethnic group and was identified in two affected Chinese. This mutation causes an A to G change at nucleotide position 493, producing an (165)Asn to Asp substitution. Interestingly, the 487 G----A and 493 A----G mutations create Alu I and Ava II recognition sites, respectively, which enabled us to rapidly detect these two mutations by PCR/restriction enzyme (RE) digestion method. The third mutation (1376 G----T) was found in four affected Chinese. This mutation causes a G to T change at nucleotide position 1376 that results in an (459)Arg to Leu substitution. The 1376 G----T mutation seems to be the dominant allele that causes G6PD deficiency in Taiwan. Finally, two affected Chinese were identified as having the fourth mutation (1388 G----A). This mutation causes a G to A change at nucleotide 1388 that produces an (463)Arg to His substitution. Our studies provide the direct proof of the genetic heterogeneity of G6PD deficiency in the Chinese populations of Taiwan and the PCR/RE digestion method is suitable for simultaneous detection of the 487 G----A and 493 A----G mutations.

An extended version of a novel method for the estimation of partition coefficients

Using the semi-empirical AM1 method, 302 compounds have been studied and equilibrium properties calculated. Functions based on linear combinations of subsets of calculated properties have been fit to the 1-octanol-water partition coefficients. The best such semi-empirical approach function has 18 parameters, has a standard deviation of 0.306, and seems to describe the partition coefficients of the 302 compounds. The predictive power of the function was tested and found to be good. Since this new version is based on a much larger number of, and structurally more varied, compounds and uses an improved, new function, we expect it to be a very useful method to predict partition properties of a wide variety of compounds.

Assessment of the association of HLA-DR 3/4 heterozygotes with diabetes mellitus and non-diabetic diseases

To evaluate the disease association with HLA-DR 3/4 heterozygotes, 1,074 subjects, who had been analyzed consecutively for HLA-DR antigens for organ transplantation or to study the disease association with HLA from June 1984 to June 1986, were enrolled in this study. Of these subjects, 278 had diabetes, 168 were healthy controls or donors, and 628 had other diseases. Of the 1,074 subjects, 35 subjects (3.2%) were DR 3/4 heterozygotes and 1,039 subjects (96.7%) were non-DR 3/4 heterozygotes. Among the 35 DR 3/4 positive subjects, 23 were diabetic (65.7%), two were healthy donors (5.7%), 10 had other diseases (28.5%) such as recurrent abortion (n = 3), hepatoma (n = 2), Graves' disease (n = 1), idiopathic hypoparathyroidism (n = 1), IgA nephropathy (n = 1), uveitis (n = 1) and gout (n = 1). Among the 23 DR 3/4 positive diabetics, 19 (82.6%) had insulin-dependent diabetes mellitus (IDDM), three (13.0%) had non-insulin-dependent diabetes mellitus (NIDDM), and one (4.3%) had maturity onset diabetes of the young (MODY). When these DR 3/4 positive diabetics were compared with the other disease and control/donor groups, significant increases in the relative risk were seen for IDDM patients (RR = 32.61, 43.80, respectively, p < 0.001). No significant association could be seen for NIDDM and MODY patients. In those non-diabetic patients positive for DR 3/4, there was no significant association with DR 3/4 heterozygotes. These findings suggest that: 1) DR 3/4 positive subjects are highly associated with IDDM; and 2) there is no significant association of DR 3/4 with NIDDM, MODY and other non-diabetic diseases.

Effect of estrogen on the serum level of thyroglobulin

Thyroglobulin has been widely accepted as a useful parameter for monitoring the recurrence of differentiated thyroid carcinoma. In thyroid cell cultures, it has been reported that estrogen may stimulate the tgb gene which controls synthesis of thyroglobulin by the thyroid follicular cell. Since the serum estrogen levels of women fluctuate during the menstrual cycle, pregnancy and menopause, thyroglobulin may be unreliable in the follow-up of recurrence of differentiated thyroid carcinoma in females if it can be affected by estrogen in vivo. In order to clarify the effect of estrogen on thyroglobulin, the sera of 16 men, 42 women and 20 children were collected and divided into seven groups. Their serum estradiol and thyroglobulin levels were 17.7 +/- 1.8 pg/mL (mean +/- SEM) and 17.1 +/- 1.6 ng/mL, respectively in 20 children, 26.7 +/- 4.1 pg/mL and 12.9 +/- 1.2 ng/mL, respectively in 16 males, 151.6 +/- 20.4 pg/mL and 13.7 +/- 4.2 ng/mL, respectively in five females on the 10th to 14th days of the menstrual cycle, 16.7 +/- 1.8 pg/mL and 15.2 +/- 2.1 ng/mL, respectively in 12 postmenopausal females, 530.0 +/- 131.0 pg/mL and 14.2 +/- 1.8 ng/mL, respectively in eight pregnant women in the first trimester, 3613.9 +/- 1014.2 pg/mL and 12.0 +/- 1.6 ng/mL, respectively in seven pregnant women in the second trimester and 9246.0 +/- 694.5 pg/mL and 16.4 +/- 2.0 ng/mL, respectively in 10 pregnant women in the third trimester. The serum estradiol levels were significantly different (p less than 0.005) among these seven groups, but the serum thyroglobulin levels were not (p = 0.25). Therefore, serum thyroglobulin levels are not affected by estrogen.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of glucose-6-phosphate dehydrogenase (G6PD) mutations by DNA amplification and allele-specific oligonucleotide probes

We have recently identified that at least four types of mutation are responsible for the glucose-6-phosphate dehydrogenase (G6PD) polymorphism in the Chinese of Taiwan. Two mutations (487 G-->A and 493 A-->G) occurring at nucleotide position 487 and 493, respectively, create Alu I and Ava II recognition sites which enabled us to directly examine these two mutations by PCR/restriction enzyme (RE) digestion. However, the other two mutations (1376 G-->T and 1388 G-->A), which do not generate any recognizable restriction sites, were detected by DNA sequencing method which is not suitable for rapid diagnosis. Using the PCR technique, we have successfully developed a simple and rapid method for the detection of 1376 and 1388 mutations. This method involves the selective amplification of a DNA fragment from human G6PD gene with specific oligonucleotide primers, followed by hybridization with allele-specific oligonucleotide (ASO) probes. Using the PCR/ASO and PCR/RE methods, we have successfully examined two families and 20 unrelated subjects with G6PD deficiency. Our results indicate that the PCR/ASO method is suitable for the rapid determination of 1376 and 1388 mutations. The combined use of PCR/ASO and PCR/RE methods will be suitable for rapid diagnosis of four known G6PD mutations in Chinese.

Localization of obscure gastrointestinal bleeding by technetium 99m-labeled red blood cell scintigraphy

When a bleeding source from the gastrointestinal (GI) tract cannot be identified with conventional diagnostic studies, it is known as GI bleeding of an obscure origin. In the past three years, in vivo Technetium 99m-labeled red blood cell scintigraphy (RBC scan) has been added to our armamentarium for the diagnosis of obscure GI bleeding. Out of a total of 26 cases, the bleeders could be detected in 12 or 46.2% by RBC scan. The time required ranged from 15 minutes to 24 hours (median, one hour). In 14 patients with active bleeding during the scan period, 11 had positive scans (sensitivity, 78.6%). In 12 patients with inactive bleeding, 11 had negative scans (specificity, 91.7%). Angiography was conducted in nine cases, with all showing negative findings; however, six of them had a positive focus by RBC scan. Laparotomy was performed in seven scan-positive patients, and in three scan-negative patients because of a positive Meckel's scan (two cases) or recurrent bleeding (one case). Of the 12 scan-positive patients, incorrect localization was noted in two patients due to rapid transit of the labeled RBC in the small bowel. False localization could be prevented by shortening the sequential imaging interval. It is concluded that an RBC scan is a very sensitive and safe tool for detection of GI bleeding of an intermittent nature, because the bleeder can be monitored for 24 hours after a single injection. It can be used as a preangiographic screening test and to guide the surgeon in surgical planning or decision-making.(ABSTRACT TRUNCATED AT 250 WORDS)

Glucocorticoid activity and structure activity relationships in a series of some novel 17 alpha-ether-substituted steroids: influence of 17 alpha-substituents

A series of non-fluorinated glucocorticoids, cortienic acid analogs with a 17 beta-chloromethyl ester and various 17 alpha-ether functions, were tested for their affinity to the rat-lung type-II glucocorticoid receptor. The relative binding affinity of a set of 9 compounds was determined in a competitive experiment with [1,2,4-3H]triamcinolone acetonide. The highest binding affinities were observed with the 17 alpha-propoxy and butoxy analogs which were 1.3 times more active than the standard dexamethasone. Quantitative analysis of the results suggested that steric factors and lipophilicity of the side-chain were the major parameters affecting receptor affinity. Representative members of the series were compared to betamethasone 17 alpha-valerate in a vasonstriction test. The results paralleled those of the receptor binding experiment, indicating that the new steroids have good skin-permeation properties and good glucocorticoid activity.

Infection initiated by the RNA pregenome of a DNA virus

We describe experiments demonstrating that after transfection into permissive cells, the RNA pregenome of an avian hepadnavirus, the duck hepatitis B virus, is infectious. Using a Sindbis virus expression vector, we showed that cytoplasmic synthesis of the pregenome resulted in hepadnaviral DNA synthesis. Moreover, complete infectious virus was produced from cells transfected with hepadnaviral pregenomic RNA. We conclude that the pregenome of hepadnaviruses can express all the proteins required for DNA synthesis as well as serve as a template for reverse transcription and that DNA resulting from pregenome expression can be utilized to establish a productive infection in pregenome-transfected cells.

Agranulocytosis associated with anti-thyroid drug in patients with Graves' thyrotoxicosis--report of 11 cases

Retrospective analysis of 11 Chinese patients with Graves' thyrotoxicosis developing agranulocytosis during anti-thyroid treatment was done. Seven of them received methimazole and 4 received carbimazole. None of the 11 patients had taken propylthiouracil. The major chief complaints were high fever (100%), chillness (91%), and sore throat (73%). The duration of drug treatment prior to the detection of agranulocytosis ranged from 13 to 63 days (mean +/- 1SE: 33.1 +/- 16.1). At the time of agranulocytosis detected, the peripheral leukocyte counts were 0.5 to 2.1 X 1000/mm3 (mean +/- 1SE: 1.05 +/- 0.47 X 1000/mm3), absolute neutrophil counts 0 to 450/mm3 (mean +/- 1SE: 54.27 +/- 132.12/mm3), and hemoglobin 8.2 to 15.9 g/dl (mean +/- 1SE: 11.85 +/- 2.24 gm/dl). Three of the 11 patients had positive bacterial blood cultures. The recovery time of absolute neutrophil counts above 500/mm3 ranged from 3 to 25 days (mean +/- 1SE: 10.5 +/- 6.6) after discontinuation of antithyroid drugs. Mortality was found in 2 of them (18%).

Acute basophilic leukemia. A case report

A case of acute nonlymphocytic leukemia (ANLL) with primitive basophilic differentiation is presented. The patient had no antecedent history or concomitant presence of chronic myelogenous leukemia. The leukemic blasts constituted 83% of the peripheral white blood cells and more than 90% of the marrow nucleated cells. Cytoplasmic vacuoles were found in some leukemic cells. About half the leukemic cells showed a few azurophilic granules stained with Wright's stain, whereas exhibited a faint pinkish hue around the cells without cytoplasmic granules (water-soluble granules) by Riu's stain. The cytoplasmic granules failed to be stained with peroxidase but stained positively with toluidine blue. The former result could lead one to misclassify the case as lymphoid leukemia, but the characteristic finding of basophilic cells in Riu's stain should direct one to make the diagnosis of ANLL with basophilic differentiation. The cytochemical findings of this case suggested that basophilic differentiation should be considered when leukemic cells show peroxidase-negative granules. Riu's stain and toluidine blue stain are useful to make the correct diagnosis.

Preliminary experience with growth factor and porcine graft-young collagenous wettable membrane in the treatment of chronic diabetic ulcer

Chronic ulcers are well-known complication of diabetes mellitus, often compounded by infection. Healing of lesions is problematic in some cases using conventional treatment. We have treated a group of six hospitalized diabetic patients with chronic ulcer by a combined regimen consisting of metabolic control, parenteral antibiotics, growth factor and porcine graft-young collagenous wettable membrane (YCWM) treatment. Five of our uncontrolled group had their ulcers improved at 87 +/- 37.6 hospital days after 45.8 +/- 20.2 days of growth factor and YCWM treatment. In conclusion, growth factor and porcine graft-YCWM therapy may be promising as an alternative choice in treatment of chronic diabetic ulcer.

Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer

Gastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium-diethylene penta-acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter. Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year.

Bone changes in hyperthyroidism--a preliminary study

Thyrotoxicosis may cause osteopenia and lead to increased risk of fractures. From July 1988 to March 1989, 88 hyperthyroid patients and 65 age, sex matched normal controls were enrolled for lumbar spine bone mineral density (BMD) study. Significantly lower BMD values can be found in premenopausal hyperthyroid women (1.233 gm/cm2 vs 1.317 gm/cm2, p less than p less than 0.05). In the group of thyrotoxicosis, no linear correlation can be found between BMD and the degree of hyperthyroidism (N = 84, r = 0.01 and N = 74, r = 0.054 as comparing BMD to T4 and T3, respectively). After treatment with antithyroid drugs (ATD) for 3 months, BMD did not change significantly (1.258 gm/cm2 vs 1.242 gm/cm2, p = 0.02) in the hyperthyroid patients. Therefore, premenopausal hyperthyroid women have lower BMD than premenopausal euthyroid women. The treatment of hyperthyroidism after 3 months' course did not increase lumbar spine BMD.

Outcome following radioactive iodine therapy in Graves' disease

One hundred and fifty three patients with Graves' hyperthyroidism treated with I-131 from March 1984 to September 1988 were analyzed. The dose of I-131 was given according to the formula: 100 microCi/gm x estimated thyroid size (gm) x 100/24 hr I-131 uptake (%) The mean dose was 5.41 mCi and the maximum dose was 7 mCi. After one year of follow up, 45 patients (29.4%) were euthyroid, 35 patients (22.9%) became hypothyroid, and 73 patients (47.7%) were persistently hyperthyroid. Discriminant analysis of pretreatment variables suggested that those patients who were still hyperthyroid at the end of the first year had significantly larger goiter size, and higher serum T4 and T3 levels. Men had greater incidence of relapse. Besides, those who had received antithyroid drug before I-131 therapy had a significantly higher incidence of failure. As compared with previous studies, our report had a significantly higher incidence (22.9%) of hypothyroidism one year after I-131 therapy, which may be due to recognition of subclinical hypothyroidism through TSH assay.

Heterosexual transmission of hepatitis delta virus in the general population of an area endemic for hepatitis B virus infection: a prospective study

A prospective study was conducted in 268 consecutive patients with overt hepatitis to examine the transmission of hepatitis delta virus (HDV) in the general population of an area hyperendemic for hepatitis B virus (HBV) infection. The patients were interviewed extensively for potential risk factors associated with transmission. Of the 203 patients with type B hepatitis, 34 (30 men, 4 women) showed serologic evidence of acute HDV infection (HDV+ group), while the other 169 did not (HDV- group). Of the 30 HDV+ men, 27 (90%) had had sexual intercourse with prostitutes within 3 months of admission, while only 31 (22.7%) of the 136 HDV- men, 8 (17.4%) of the 46 men with non-A, non-B hepatitis and 5 (8.3%) of the 60 control men had done so (P less than .001). Of the 4 HDV+ women, 1 was a prostitute and another was the wife of a patient with active HDV infection. There was no significant difference in exposure to other risk factors among these groups of patients. The results suggest that heterosexual exposure, particularly prostitute contact, is the most important route of HDV transmission in the general population of this area endemic for HBV infection.

Effect of dietary therapy on pancreatic beta cell function in noninsulin-dependent diabetes mellitus

Twenty-four noninsulin-dependent diabetics, who were newly diagnosed or had discontinued therapy for at least 10 months, were studied for the effect of dietary therapy on pancreatic beta cell function. The mean fasting plasma glucose (176 +/- 14 vs 212 +/- 16 mg/dl, p less than 0.01) and glycosylated hemoglobin (HbA1c, 8.6 +/- 0.5 vs 9.4 +/- 0.6%, p less than 0.001) decreased significantly after 1 month of dietary control, although there was no significant change in mean body weight (57.4 +/- 2.0 vs 57.7 +/- 2.0 kg, p greater than 0.5). The mean incremental serum C-peptide (delta CP) response to oral glucose stimulation (OGTT) increased (4.6 +/- 0.6 vs 3.5 +/- 0.7 ng/ml, p less than 0.01), but that to intravenous glucagon (GT) did not (2.5 +/- 0.2 vs 2.7 +/- 0.2 ng/ml, p greater than 0.1). In 12 patients whose glycemic control improved after dietary treatment, there was a good correlation between the decrement in fasting plasma glucose and the increment in delta CP response to OGTT (r = 0.66, p less than 0.05).

IN CONCLUSION

after 1 month of dietary therapy in noninsulin-dependent diabetics, (1) the serum C-peptide response to OGTT, but not to GT, improved; (2) the beta cell secretion increased only in those patients with improved glycemic control; (3) there was a good correlation between glycemic control and beta cell function.