Compliance with New York State's do-not-resuscitate law at Memorial Sloan-Kettering Cancer Center. A review of patient deaths.

We reviewed the case records of 141 patients (134 with cancer and seven with acquired immunodeficiency syndrome) who died at Memorial Sloan-Kettering Cancer Center between July 11 and September 19, 1991. Do-not-resuscitate orders had been written on 115 (85.8%) of the patients with cancer and all of the patients with acquired immunodeficiency syndrome.

Do-not-resuscitate orders.

Do-Not-Resuscitate (DNR) orders were audited in October and December 1989 at the teaching hospital of the University of Florida College of Medicine in Gainesville. October audit results were presented at a medical staff meeting in November to determine if education would improve compliance. There were 22 DNR orders in October, 17 (77%) were out of compliance with hospital policy due to failure to obtain written consultation from a second attending.

Degradation of insulin and insulin-like growth factors by enzyme purified from human erythrocytes. Comparison of degradation products observed with A14- and B26-[125I]monoiodoinsulin.

An insulin-degrading enzyme has been purified from human erythrocytes. This enzyme degraded 125I-labeled insulin-like growth factor I (IGF-I) more slowly than 125I-IGF-II and degraded IGF-II more slowly than 125I-insulin. The time course of 125I-insulin degradation suggested the presence of intermediates, each of which was itself shown to be a substrate for the enzyme.

Effects of insulin and streptozotocin-diabetes on isoproterenol-stimulated cyclic AMP production in myocytes isolated from rat heart.

Isoproterenol (ISO), at concentrations of up to 10(-5) mol/L, caused a dose-dependent stimulation of cyclic AMP (cAMP) production in rat cardiomyocytes. At higher ISO concentrations, relative inhibition was seen. Insulin augmented ISO-stimulated cAMP production and appeared to mitigate the toxic effects of high ISO concentrations.

Inhibition of insulin-stimulated glucose transport by factor extracted from serum of insulin-resistant patient.

We report a 31-yr-old nondiabetic male patient with acanthosis nigricans whose hyperinsulinemia and insulin resistance could not be explained by anti-receptor antibodies or by an intrinsic defect of insulin binding to his cells. An acid-alcohol extract of the patient's serum contained a factor that inhibited insulin-stimulated glucose transport in rat adipocytes. Low levels of the factor could be detected in 9 of 13 unselected patients with non-insulin-dependent diabetes.

Elevated levels of plasma prorenin (inactive renin) in diabetic and nondiabetic patients with autonomic dysfunction.

We measured plasma inactive renin (prorenin) levels in 46 diabetic patients, 4 nondiabetic patients with idiopathic autonomic dysfunction, and 115 normal subjects. Plasma inactive renin levels were normal in the diabetic patients who had no complications (n = 6) and in those with microvascular disease (n = 8) who did not have coexistent autonomic dysfunction. Plasma inactive renin was either grossly elevated or in the upper limit of the normal range in diabetic patients with autonomic dysfunction (n = 18).

Iodine retention and thyroid dysfunction in patients on hemodialysis and continuous ambulatory peritoneal dialysis.

Povidone-iodine is frequently used as an antiseptic in patients on chronic dialysis. In order to determine if the use of povidone-iodine affects thyroid function in these patients, we measured serum iodine and thyroid hormone levels in dialysis patients prior to and following discontinuation of topical povidone-iodine antiseptics. Serum inorganic iodine levels were elevated initially in nearly 90% of the patients (19 on hemodialysis, 12 on continuous ambulatory peritoneal dialysis [CAPD]).

Vasoactive intestinal peptide inhibits insulin-stimulated glucose transport in rat adipocytes.

Patients with tumors secreting vasoactive intestinal peptide (VIP) often develop hyperglycemia and glucose intolerance. Although VIP has been reported to increase glucose output by the liver, the concentration required for this effect greatly exceeds that observed clinically. We therefore investigated the effects of VIP on insulin-stimulated glucose transport in isolated adipocytes.