Measurement variability of the lateral head-shaft angle in slipped capital femoral epiphysis.

The lateral head-shaft angle as described by Southwick is used to assess the severity of slipped capital femoral epiphysis and to measure progression. Intraobserver variability in measuring the lateral head-shaft angle may influence decision making. The purpose of this study was to determine intraobserver variability in the measurement of the lateral head-shaft angle of slipped capital femoral epiphysis.

Temporary reversal by topotecan of marked insulin resistance in a patient with myelodysplastic syndrome: case report and possible mechanism for tumor necrosis factor alpha (TNF-alpha)-induced insulin resistance.

Tumor necrosis factor-alpha (TNF-alpha) is an important mediator of insulin resistance in obesity and diabetes through its ability to decrease the tyrosine kinase activity of the insulin receptor. We report here a remarkable degree of insulin resistance in a patient with adult respiratory distress syndrome and myelodysplasia.

Patient-reported experience with Velosulin human insulin in continuous subcutaneous insulin infusion.

A multicenter, retrospective survey of 339 patients with insulin-dependent diabetes mellitus was done to evaluate patient experience with Velosulin Human insulin, a regular insulin in a phosphate buffer, used in continuous subcutaneous insulin infusion. Patients had used this insulin exclusively for 3 months preceding the survey. Responses were elicited through interviews conducted by physicians or nurses.

Changes in cognitive and social functioning of diabetic patients following initiation of insulin infusion therapy.

Functional health outcomes resulting from intensive insulin regimens may differ depending upon the age of the diabetic patient. This study tested the hypothesis that health functioning is poorer for younger insulin-dependent diabetic (IDDM) patients following a change to the insulin infusion pump regimen, with progressive improvements occurring in functional health status at higher age levels. Thirty IDDM patients aged 10-47 years were administered health status instruments prior to changing to the new regimen, and again six months later.

Toxic shock syndrome from Staphylococcus aureus infection at insulin pump infusion sites. Report of two cases.

Two young diabetic females using insulin infusion pump therapy became ill with toxic shock syndrome secondary to Staphylococcus aureus infection at the insulin infusion pump site. Physicians need to be aware of this potential complication in diabetic patients using insulin infusion pump therapy so proper management can be initiated early. Infections at insulin infusion sites are common.

Insulin as a mediator of hepatic glucose uptake in the conscious dog.

The aim of this study was to determine whether a physiological increment in plasma insulin could promote substantial hepatic glucose uptake in response to hyperglycemia brought about by intravenous glucose infusion in the conscious dog. To accomplish this, the plasma glucose level was doubled by glucose infusion into 36-h fasted dogs maintained on somatostatin, basal glucagon, and basal or elevated intraportal insulin infusions. In the group with basal glucagon levels and modest hyperinsulinemia (33 +/- 2 micro U/ml), the acute induction of hyperglycemia (mean increment of 120 mg/dl) caused marked net hepatic glucose uptake (3.

Effects of pharmacologic hyperglucagonemia on plasma amino acid concentrations in normal and diabetic man.

Four normal and five insulin dependent diabetic men received a 2 h pharmacologic glucagon infusion (50 ng/kg/min) resulting in plasma glucagon levels (4400 pg/ml) similar to those seen in glucagonoma patients. In normal subjects in whom plasma insulin concentrations rose significantly (239 uU/ml) and the blood level of 15 of the 18 amino acids measured fell significantly. In contrast, in the diabetic men who secreted no insulin in response to glucagon (no rise in C-peptide levels), only 10 of 18 amino acid levels fell significantly.

Retardant effect of hyperglycemia on the rise in plasma fatty acids following insulin withdrawal in man.

The present study was undertaken to examine the influence of hyperglycemia in retarding the rise in circulating FFA noted after acute insulin withdrawal in man. The arterial FFA response to somatostatin administration was measured in the presence of (a) euglycemia and (b) hyperglycemia. In seven normal men who received somatostatin (0.

Amino acid disposition by liver and gastrointestinal tract after protein and glucose ingestion.

Hepatic uptake and gut and splanchnic output of amino acids were determined after administration of protein and glucose loads in conscious dogs with indwelling catheters in the femoral artery and portal and hepatic veins. Oral or parenteral glucose given with a beef meal blunted the rise in arterial amino acids relative to that seen with ingestion of beef alone. Gut amino acid output was considerably delayed with oral hypertonic glucose, but was unchanged with parenteral glucose and with oral isotonic glucose.

A familial glucagonoma syndrome: genetic, clinical and biochemical features.

A family with multiple endocrine neoplasia type I (MEN-I) is described in which three members had A-cell pancreatic tumors. Two of these members had classic glucagonoma syndromes. The proband, a 62 year old woman, had a high (less than or equal to 9.

Effects of insulin at two dose levels on gluconeogenesis from alanine in fasting man.

We have determined the effect of insulin infused at 1 and 5 mU/kg/min on gluconeogenesis from alanine in 48-hr fasted men. The conversion of alanine to glucose was measured by the arterial-hepatic venous catheterization technique combined with the infusion of 14C-alanine. During insulin infusion, euglycemia was maintained by variable glucose infusion.

The effect of somatostatin on the intestinal transport of glucose in vivo and in vitro in the rat.

The possibility that somatostatin has a direct inhibitory effect on intestinal D-glucose absorption was studied in rats using intact intestinal loops and everted jejunal segments. Somatostatin infusion in vivo produced a significant fall in plasma glucose concentration (P less than 0.001) and a fall in pooled plasma insulin concentration to 51% of control values.

Effect of hyperglycemia independent of changes in insulin or glucagon on lipolysis in the conscious dog.

In the face of fixed basal levels of insulin (9 microunits/ml) and glucagon (63 pg/ml) maintained by the infusion of somatostatin and replacement amounts of the two pancreatic hormones, the mean arterial plasma glucose concentration was elevated from 102 to 217 mg/dl by continuous glucose infusion. Hyperglycemia resulted in a significant decrease in the arterial blood glycerol (35%) and plasma free fatty acid concentrations (46%). The drop in the blood glycerol level was paralleled by a decline in hepatic glycerol uptake indicating that hyperglycemia did not alter the fractional extraction of glycerol by the liver.

Effect of glucose, independent of changes in insulin and glucagon secretion, on alanine metabolism in the conscious dog.

To study the effects of hyperglycemia on the metabolism of alanine and lactate independent of changes in plasma insulin and glucagon, glucose was infused into five 36-h-fasted dogs along with somatostatin and constant replacement amounts of both insulin and glucagon. Hepatic uptakes of alanine and lactate were calculated using the arteriovenous difference technique. [14C]Alanine was infused to measure the conversion of alanine and lactate into glucose.

Lack of a role for glucagon in the disposal of an oral glucose load in normal man.

The present study was undertaken to determine the role of glucagon in determining the disposition of an oral glucose load in normal man. To accomplish this, the plasma glucose response to an oral glucose load was determined in four normal men who were studied on two occasions. During one study, glucagon (3 ng/kg.

Splanchnic metabolism of alanine in intact man. Effects of somatostatin and somatostatin plus insulin.

We examined splanchnic metabolism of alanine in 15 normal males under three sets of conditions: infusion of saline (control studies); infusion of somatostatin (SRIF) (bihormonal deficiency of insulin and glucagon); and infusion of somatostatin plus insulin (selective glucagon deficiency). Net splanchnic alanine uptake (NSAU) remained stable over 2 h during infusion of saline. Infusion of SRIF was associated with a fall in estimated hepatic plasma flow (EHPF) whether or not insulin was infused concomitantly.

Hyperglycemia per se (insulin and glucagon withdrawn) can inhibit hepatic glucose production in man.

We examined the effect of hyperglycemia per se on net splanchnic glucose balance. In 2 groups of normal postabsorptive men who had undergone hepatic vein catheterization, somatostatin was administered to block endogenous insulin and glucagon secretion. Exogenous glucose was infused in both groups to maintain euglycemia for 2 h in one group (n = 7) and to induce hyperglycemia of 220-240 mg/dl after 30 minutes of euglycemia in the second group (n = 4).

Glucose metabolism in intact man: the responsiveness of splanchnic and peripheral tissues to insulin.

Man controls his blood sugar concentration within rather narrow limits, despite wide latitude in the content and timing of meals. Man does not eat constantly; rather, he alternates between periods of "feasting" and "fasting." It is a useful generalization that the metabolic environment is altered such that forces promoting substrate storage are dominant during the postprandial period and forces that encourage substrate mobilization are prominent during food-free intervals.

Persistent stimulatory effect of glucagon on glucose production despite downregulation.

The rise and subsequent return to basal of glucose production (Ra) during a constant glucagon infusion ("downregulation") has suggested to some workers that glucagon's effects are evanescent. To examine whether glucagon displays persistent biological activity even after downregulation, 6 healthy males received an 8 hour infusion of somatostatin and glucagon, with 3H-3-glucose to measure glucose turnover. Ra rose from 2.

Glucose disposal during insulinopenia in somatostatin-treated dogs. The roles of glucose and glucagon.

The first aim of this study was to determine whether the plasma glucose level can regulate hepatic glucose balance in vivo independent of its effects on insulin and glucagon secretion. To accomplish this, glucose was infused into conscious dogs whose basal insulin and glucagon secretion had been replaced by exogenous intraportal insulin and glucagon infusion after somatostatin inhibition of endogenous pancreatic hormone release. The acute induction of hyperglycemia (mean increment of 121 mg/dl) in the presence of basal levels of insulin (7+/-1 muU/ml) and glucagon (76+/-3 pg/ml) resulted in a 56% decrease in net hepatic glucose production but did not cause net hepatic glucose uptake.