Spontaneous hyperinsulinism resulting from a tumour of the islets of Langerhans is not a common condition, and the diagnosis is easily overlooked. Failure in diagnosis usually results in the early death of the patient, while diagnosis followed by operative removal of the tumour cures the majority of patients.Nicholls (1902) first described an adenoma of the islet cells of the pancreas, but this was an incidental finding at necropsy and no clinical details of the case were recorded. Following the discovery of insulin, Harris (1924) suggested that symptoms might be caused by excess secretion of the hormone, and the first demonstration of an insulin-secreting tumour was by Wilder et al. (1927); they explored the pancreas of a doctor, aged 40, who had suffered from attacks of spontaneous hypoglycaemia for eighteen months, and found a carcinoma in the tail of the pancreas with metastases in the liver. The cells of the carcinoma bore a striking resemblance to islet cells, and insulin was extracted from one of the liver metastases.The first successful operative removal of an insulinsecreting tumour was by Roscoe Graham in 1929(Howland et al., 1929, who found a small tumour in the body of the pancreas of a woman of 52 who had a seven-years history of attacks of spontaneous hypoglycaemia. The tumour was composed of islet cells, and as it lacked a capsule it was thought possibly to be a carcinoma, but no metastases were found. This lack of a capsule has been a feature of a number of islet-cell tumours subsequently studied, and is not now regarded as an indication of malignancy. Another successful operation was performed at about the same time, for Harvey Cushing (1930), in his Lister Lectures on neurohypophysial mechanisms, mentioned that a small islet-cell adenoma which had caused recurrent attacks of hypoglycaemia had recently been removed in his clinic. Since then the condition has attracted much attention in the United States, no fewer than 38 cases being reported from the Mayo Clinic in twenty years (Lopez-Kruger and Dockerty, 1947), while reviews have been published on both medical (Crain and Thorn, 1949) and surgical aspects of the problem (Howard et al., 1950).In Great Britain the number of reported cases is comparatively small. Apart from Nicholls's early pathological observation, the first report is that of Barnard (1932), who found an islet-cell adenoma at the post-mortem examination of a patient in whom the diagnosis had been suspected clinically but who had declined further investigation or operation; postmortem reports have also been published by Cairns and Tanner (1933)

1. The antioxidant thioctic acid (TA) has been used in the treatment of diabetic neuropathy and recent studies have suggested that TA also has pancreatic and peripheral effects that improve glucose transport and metabolism. In the present study, the metabolic effects of TA were evaluated in rodent models of insulin resistance (fructose-fed Sprague-Dawley rat) and insulin deficiency (streptozotocin (STZ)-induced diabetic rat). Oral and intravenous glucose tolerance tests (OGTT and IVGTT, respectively) were performed in conscious rats after treatment with 50 mg/kg per day TA or vehicle for 5 days. 2. Fructose feeding for 7 days induced insulin resistance and impaired glucose tolerance and hypertriglycerideaemia. Treatment of fructose-fed rats with TA had no significant effect on fasting or stimulated glucose levels or on fasting triglyceride concentrations (e.g. the area under the curve for glucose (AUCglu) following OGTT was 1233 +/- 67 and 1284 +/- 59 in fructose-fed rats treated with either TA (n = 12) or vehicle (n = 12), respectively). Similarly, TA had no significant effect on IVGTT profiles in fructose-induced insulin resistance. 3. Low-dose STZ (80 mg/kg, i.p., over 2 days) induced hyperglycaemia, but TA had no significant glucose-lowering effects in STZ-diabetic rats (AUCglu (OGTT) following oral administration was 5507 +/- 27 and 5450 +/- 27 in TA (n = 12) and vehicle-treated (n = 12) rats, respectively). Nor did pretreatment with TA affect the diabetogenic response to STZ. 4. In contrast with previous in vitro studies reporting favourable metabolic effects of TA, the present study shows that after short-term oral therapy there are no significant improvements in glucose tolerance in rodent models of insulin resistance and insulin deficiency. Thioctic acid is unlikely to be of therapeutic benefit as an anti-diabetic drug in clinical practice.

Section 675 of immediate benefit to a gastriticmucosa or to a gastric ulcer. It might reduce the acidity in a man with a duodenal ulcer, but he suspected that there would be an increased morbidity in ten to twenty years' time. Many citizens of the United States were now undergoing this method of treatment, and he believed that those on this side of the Atlantic would be wise to act as the unfrozen control series until the Americans reported, as he was sure they would, the long-term effects of the method. Operations in the upper abdomen were not easy in patients with ankylosing spondylitis. High dissections of the stomach, as in carcinoma and operations on the hiatus, were particularly difficult and were certainly not cases for the tyro. He had carried out partial gastrectomy on 3 patients with this disease and had been impressed with the excellent way in which these unfortunate but courageous people had tolerated the post-operative period. He quite agreed with Professor Ellis's decision to treat this case surgically.

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