Hemoglobin A1c levels in children and adolescents with diabetes mellitus

Hemoglobin A1c (HbA1c) was measured as an indicator of glucose control in 180 children and adolescents with diabetes mellitus who received two daily injections of insulin as part of a highly structured treatment program. A total of 426 HbA1c determinations was made in the group of 180 patients. HbA1c values were elevated in most patients despite the aggressive treatment. The HbA1c level was very elevated at diagnosis, fell to near normal after 60-90 days of insulin therapy, increased gradually, and reached a plateau after approximately 4 yr duration (at about twice the level in normal subjects) (mean +/- SEM, 10.0 +/- 0.2% and 5.34 +/- 0.07%, respectively). Mean insulin dose (U/kg/24 h) paralleled both HbA1c and duration of diabetes. The relationship between endogenous insulin secretion and glucose control was examined in those patients with diabetes for longer than 5 yr. Patients were separated into three groups based on HbA1c levels: those with HbA1c less than 9% (N = 22), between 9 and 11% (N = 26), and greater than 11% (N = 28). Serum C-peptide and glucose concentrations were measured 2 h after a standard breakfast in those patients in the "low" and "high" HbA1c groups (mean HbA1c values 8.2% and 12.7%, respectively). C-peptide was detectable in all patients and the mean C-peptide levels did not differ significantly in the two groups, although postprandial glucose concentrations were significantly lower in the "low" HbA1c group (means +/- SEM, 96 +/- 11 and 211 +/- 21 mg/dl, respectively; P less than 0.001).

Metabolism and mutagenicity of N-nitroso-2-methoxy-2,6-dimethylmorpholine in hamsters

N-Nitroso-2-methoxy-2,6-dimethylmorpholine (MeNDMM) was derived from the cyclic form of N-nitroso-(2-hydroxypropyl)(2-oxopropyl)amine (HPOP), a proposed proximate pancreatic carcinogen for the hamster. MeNDMM was metabolized in vivo by noninbred Syrian golden hamsters to HPOP, which was excreted in urine. In vitro metabolism produced HPOP by cytochrome P450-mediated oxidative demethylation. MeNDMM and HPOP were similarly mutagenic in the Ames Salmonella typhimurium assay, in which hamster liver preparations were used for metabolic activation. MeNDMM, due to its metabolism to HPOP, is probably also a pancreatic carcinogen in the hamster.

Male students in the health sciences: a comparison with female health science students and male university students

Increasing numbers of males are entering the health sciences, particularly Physiotherapy. Fifteen males commencing such courses were compared with 252 female students and 30 male university students. Their backgrounds, career aspirations and attitudes were investigated in an attempt to explain their career choices and consider possible future effects on the health professions. Male health science students were older, came from large families of lower socio-economic status and were more likely to aspire to leadership positions than female students. None of the characteristics of females who enter male-dominated occupations were found to distinguish males making atypical career choices. It is suggested that the findings have implications for the future of Physiotherapy, particularly in regard to leadership positions.

Lack of effect of bromocriptine on ACTH levels in patients with bilateral adrenalectomy for pituitary-dependent Cushing's syndrome

Bromocriptine lowers plasma ACTH levels in patients with pituitary-dependent Cushing's syndrome. It seemed possible that the drug would also be effective in patients who had been adrenalectomised for the disease. The effect of 5.0 mg of bromocriptine on plasma ACTH and prolactin levels in 13 patients, bilaterally adrenalectomised for pituitary-dependent Cushing's syndrome, was therefore studied. In only one patient was a fall in plasma ACTH observed. This may be of doubtful significance since marked spontaneous fluctuation in plasma ACTH levels were found in the five patients tested. Bromocriptine lowered the plasma prolactin in all of the patients, including two with hyperprolactinaemia.

Upper gastrointestinal endoscopy- a survey of patients' impressions

One hundred and forty patients were followed-up within one year of upper gastrointestinal endoscopy. The incidence of disease, complications and influence of findings on treatment are outlined.

The preventability of "bloody taps" in second trimester amniocentesis by ultrasound scanning

In 856 patients over a 6-year period, amniocentesis was performed in the midtrimester for prenatal genetic counseling. The use of ultrasound scanning of the gravid uterus prior to the procedure reduced the incidence of bloody taps threefold and the withdrawal of grossly bloody amniotic fluid by fourfold. The best results (7.6% overall and 2.0% grossly bloody taps) were obtained when the procedure was performed by an operator not only experienced and adept at intrauterine manipulation but who had training and experience in ultrasonography as well. These results contrast favorably with that of operators utilizing but not trained in ultrasound scanning (36% overall, 8% grossly bloody taps) and of those who had the uterus "mapped out" by a sonographist but performed the amniocentesis later in their offices (18% overall, 12.1% grossly bloody taps). Other advantages of prior sonography are also discussed.

Reliable in vivo model for latent herpes simplex virus reactivation with peripheral virus shedding

A long-sought laboratory model, a reliable system for in vivo reactivization of latent herpes simplex infection with peripheral shedding of active virus, is present. Results demonstrate that surgical stimulation of latently infected rabbit trigeminal ganglia induces peripheral release of infectious herpes simplex virus. Virus could be cultured from the tear film in 83% of the stimulated animals' eyes within 48 h.

Nursing care in a combined adolescent medical-psychiatric unit

In spite of the problems we have encountered in combining adolescent medical and psychiatric patients, we have found this to be a workable model. In summary, several areas are important in making this model functional: staff interest in both medical and psychiatric patients, in-service programs particularly in psychiatry, and open communication between health care givers. Certainly one of the most positive aspects of this unit is that it provides an environment which allows for easier adjustment to the community after hospitalization. Avoidance of such terms as "mental hospital," "crazy person" is less traumatic to the adolescent patient and his family.

Renal effects of guanabenz: a new antihypertensive

In order to determine the effects of guanabenz upon renal function, clearance studies were performed on hypertensive volunteers during sustained steady-state water diuresis. The data reveal an acute fall in renal hemodynamics and a marked reduction in sodium excretion during the 3rd and 4th hour after administration. Tha antinatriuresis was due to decreased filtration and enhanced distal nephron reabsorption of sodium, principally in association with secretion of potassium. Chronic administration of guanabenz for one week produced a sustained reduction in blood pressure, but there was no change in either body weight or 24-hour urinary sodium excretion. Repeat clearance studies revealed no change with either renal hemodynamics or sodium clearance. The data suggest that the acute antinatriuresis is a transient hemodynamic event and chronic therapy with guanabenz will not be complicated by sodium retention, a feature characteristic of other antihypertensive agents.

Renal failure, hemodialysis, and nafcillin kinetics

Nafcillin (N) pharmacokinetics was studied in 27 subjectswith and without renal failure (RF) (determined by endogenous creatinine clearance, Ccr). Elimination rate constants (K) were calculated from serial serum levels of N measured from 2 to 12 hr after a single 500-mg intramuscular injection. Only 4 of 9 hemodialysis patients had measurable levels of N at 24 hr. The K values for the groups with normal renal function,moderate RF, severe RF, and on hemodialysis were 0.477 hr(-1), 0.432 hr (1), 0.369 hr(-1), and 0.306 hr (-1), respectively...

Heterogeneity of the alpha subunit of tubulin and the variability of tubulin within a single organism

When tubulins obtained from particular microtubules of the sea urchin (ciliary doublet A tubules, flagellar doublet microtubules, and mitotic microtubules) are analyzed by electrophoresis in a polyacrylamide gel system containing sodium dodecyl sulfate and urea, heterogeneity of the alpha subunit, and differences between the tubulins are revealed. The alpha subunit of tubulin from mitotic apparatus and from A microtubules of ciliary doublets is resolved into two bands, while the alpha subunit of flagellar doublet tubulin gives a single band. The mitotic and ciliary tubulins differ in the mobilities of their two alpha species, or in the relative amounts present, or both. The existence of differences between the tubulins has been confirmed by a preliminary analysis of their cyanogen bromide peptides.

Responses of muscle spindles in a tortoise

Responses were recorded from muscle spindles in the extensor digitorum longus muscle of the freshwater tortoise Chelodina longicollis. Most spindles showed no resting discharge unless the muscle was stretched up to a millimetre beyond the minimum body length. The firing rate then increased by 2-5 imp./sec/mm extension. All spindles were relatively insensitive to the rate of change of muscle length. The dynamic index was small and increased in direct proportion to the rate of stretch. Stimulation of selected filaments of the nerve produced a response from the spindle that was attributed to intrafusal contraction. A comparison of the response of the spindle to muscle stretch with the response during simultaneous stretch and stimulation of a motor filament revealed two distinct types of behaviour. In the first, a dynamic effect, motor stimulation greatly increased the response of the spindle to the velocity component of stretch. Other filaments had a static action: an increase in firing of the spindle with the muscle at constant length, but little change in the response to the velocity component of stretch. Stimulation of up to 7 different filaments produced an effect on a spindle. When the motor effects for a given spindle could be clearly characterised, they were all static or all dynamic. Both static and dynamic effects on the one spindle were seen only rarely.

Concentrations of free glucogenic amino acids in livers of rats subjected to various metabolic stresses

1. The concentrations of alanine, aspartate, glutamate, glutamine and serine plus threonine have been measured by enzymic methods in ;quick-frozen' livers from normal, starved, alloxan-diabetic and phlorrhizin-treated rats. 2. The hepatic concentrations of alanine and serine plus threonine were decreased in rats starved for 48hr. Treatment of these rats with phlorrhizin resulted in a rapid fall (within 2(1/2)hr.) in the concentrations of all the glucogenic amino acids except serine plus threonine, which increased. The pattern for alloxan-diabetic rats was similar to that for phlorrhizin-treated animals, except that here serine plus threonine also decreased in concentration. 3. The effects of anoxia on the hepatic concentrations of the glucogenic amino acids are reported. 4. Inhibition of glutamate-pyruvate transaminase in vivo by l-cycloserine resulted in the accumulation of alanine in situations involving high rates of gluconeogenesis from endogenous amino acids. 5. Measurements of the concentrations of the reactants of the glutamate-pyruvate transaminase and glutamate-oxoglutarate transaminase systems in various metabolic states suggest that they are both at or near equilibrium in rat liver. 6. New enzymic methods are described for the determination of serine plus threonine and alanine.