No abstract

Summary: Oral glucose tolerance tests were carried out on 51 men with atherosclerotic peripheral vascular disease, none of whom were known diabetics or had suffered recent myocardial infarction. The plasma insulin and blood sugar responses were compared with 47 ageand sex-matched controls. There was no significant difference in obesity between the two groups. The patient group showed an increased plasma insulin response with a delay in return to fasting levels, and the blood sugar response was similar. These results suggest that hyperinsulinaemia and hyperglycaemia are often associated with atherosclerosis, and may have a role in its aetiology.

Ileostomy Diarrhoea-Ellis and CollMBDICALJOs 557advocate the precaution, used in the present case, of observing the reversed segment for some 30 minutes at operation after the anastomosis has been completed, in order to ensure that the blood supply of the reversed segment remains adequate after its vascular pedicle has been twisted through 180 degrees. SummaryThe use of a reversed segment of small intestine in the treatment of persistent profuse ileostomy diarrhoea after colectomy for polyposis coli is described. The synthetic polypeptide tetracosactrin, B1-24 (Synacthen) consists of the 24 N-terminal amino-acids of corticotrophin.Corticotrophin itself consists of a chain of 39 amino-acids, but it has been shown that biological activity resides in the first 19 amino-acids (Li et a., 1960), whereas immunological activity and species specificity reside in the region of the 25th to 39th amino-acids (Li, 1961 ;Fleischer et al., 1965). Hitherto, Synacthen has been used as a test of adrenocortical function in which the response of plasma 11-hydroxycorticosteroids (11-OHCS) is taken as an index of adrenal activity. The effect of a single intramuscular injection of aqueous Synacthen is short-lived, lasting about 90 minutes (ElShaboury, 1965). Recently a depot preparation (42,915-Ba, Ciba), Synacthen, complexed with zinc has been prepared, and we have investigated its use in normal subjects and also compared the response to Synacthen Depot and corticotrophin gel in rheumatoid and asthmatic patients. Subjects and MethodsNormal controls for the dose response studies were six healthy medical students. A number of patients on long-term intermittent corticotrophin treatment (Nelson et al., 1966) volunteered to try the new preparation, and 10 were studied as ward patients. Plasma 11-OHCS were estimated by a modification of the fluorometric procedure of Mattingly (1962). Venous blood samples for estimation of plasma 11-OHCS were drawn at V a.m. (patients) and 9 a.m. (students), after which times the Synacthen Depot was given; further blood samples were taken at 12.30 and 5 p.m. (for both patients and students), Results Normal Subjects.-A single injection of 1 mg. of Synacthen Depot had a similar effect whether given by intramuscular or subcutaneous injection (Fig. 1). There was a marked increment of 27.5 and 31.6 ttg./100 ml. respectively in the plasma 11-OHCS levels at 31 hours, and this was sustained to even slightly higher concentrations at eight hours. The levels at 10 p.m. (13 hours after injection) were still markedly devated at the time of the expected daily decline in plasma cortisol. On the second day the pattern of plasma 1 1-OHCS showed the expected fall throughout the day between 9 a.m. and 5 p.m. The dose response curves (Fig. 2) showed that with 0.

Summary. The circadian rhythm of adrenoeortieal secretion in 18 diabetic subjects was normal as judged by serial plasma 11-Ott-corticosteroid levels. Mild episodes of hypoglyeaemia induced a rise in the plasma 11-OH-eorticosteroid in 12 diabetic patients on insulin therapy.Rythme eireadien des surrdnales ehez des diabdtiques t~dsumd. Le rythme cireadien de la s6cr6tion cortieosurr6nale de 18 diab6tiques 6tait normal, comme on a pu en juger par les taux plasmatiques en sdrie des ll-OHeorticost6roides. Des @isodes d'hypoglyc6mie mod6r6e ont provoqu6 une augmentation des ll-OH-eortieost6roi-des du plasma chez 12 patients diab6tiques sous th6ra-peutique insulinique.

mittleren Serumeholesterinspiegel bei den Atherosklerotikern signiflkant h6her lagen Ms bei den Kontrollen.