Diabetes offers a serious bar to any kind of operation, and injuries involving open wounds, haemorrhage, or damage to the blood vessels are exceedingly grave in subjects of this disease. A wound in the diabetic patient will probably not heal while the tissues appear to offer the most favourable soil for the development of putrefaction and pyogenic bacteria. The wound gapes, suppurates, and sloughs. Gangrene readily follows an injury in diabetics, and such patients show terrible proneness to the low form of erysipelas, and cellulitis." (Treves, 1896.) The advent of insulin revolutionized the treatment of diabetic patients undergoing surgery, a revolution that was extended by the discovery of antibiotics. Nonetheless, in unpractised hands surgery can still be disastrous for diabetics in terms of both morbidity and mortality. Even in good centres surgery carries a significant mortality and morbidity. Wheelock and Marble (1971) reported a 3.7% mortality in a series of 2780 patients studied between 1965 and 1969, while Galloway and Shuman (1963) had a 3.6% mortality and 17.2% morbidity in 667 cases. In the same period Alieff (1969) reported a 13.2% mortality. In diabetics undergoing renal transplantation there was two to four times the mortality compared with nondiabetics (Kjellstrand et al., 1972). The major causes of mortality and morbidity were and still are myocardial disease and infection. Obviously these are important in non-diabetics as well as in diabetics, but in the latter, poor control of diabetes with its attendant disturbances of electrolyte and intermediary metabolism will inevitably exacerbate these problems. Myocardial infarction itself is more likely to be mortal in diabetics (Soler et al., 1974) while resistance to infection is diminished in poorly controlled diabetes (Bagdade, Nielson and Bulger, 1972). Wound healing is also said to be impaired. Diabetics undergoing surgery tend to be a highrisk group. Three-quarters or more-of surgical

No abstract

The metabolic effect of infusing 1.0-1.5 litre of Hartmann's solution to normal subjects and those with maturity onset diabetes has been studied during surgery. It was found that the use of Hartmann's solution after operation was associated with a 7.5 mmol litre-u increase in plasm glucose concentration compared with an increase of 2.1 mmol litre-1 in diabetic patients who received no i.v. fluids. In non-diabetic subjects who received Hartmann's solution the increase was 2.5 mmol litre-1. It is suggested that Hartmann's solution may be metabolically disadvantageous in diabetic patients.

Summary Plasma electrolytes, glucose and insulin concentrations were measured and serial electrocardiograms performed during the intravenous infusion of salbutamol to five women in premature labour. The plasma potassium (mean±standard error) fell from 3·5±0·l to 2·7±0·l mmol/l, and the glucose and insulin rose by 4·2±0·7 mmol/l (72·13 mg/100 ml) and 26·5 mU/l respectively. The maximum fall in potassium, and the rise in glucose and insulin occurred two hours after starting the infusion. No changes in other electrolytes were found. Electrocardiograms showed no signs of hypokalaemia. Highest pulse rates (148·4 beats per minute) occurred at two hours but no arrhythmias were observed.

SUMMARY A 50-year-old Asian male presented with a left sixth nerve palsy, left temporal pain, and rapidly deteriorating visual acuity in the left eye. A high resolution CT scan and magnetic resonance scan showed a left retro-orbital enhancing lesion extending from the lateral margin of the cavernous sinus on to the greater wing of the sphenoid and into the left orbit. Arteriography was normal. On high dose steroid therapy there was total resolution of the lesion. The value of imaging techniques in this condition is discussed.