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No abstract

Circadian variations in blood glucose, plasma insulin and human growth hormone response were studied in six healthy males who received 100 gm. oral glucose loads at 6 a.m., noon, 6 p.m., and midnight. The tests were conducted at seven day intervals, and each was preceded by a ten hour fast. During the three days before each test the subjects received meals containing no less than 300 gm. carbohydrate per day. Blood samples were drawn at 0, 15, 30, 60, 90, 120, and 180 minutes. A clear circadian variation occurred in the blood glucose levels, with lower values in the morning and higher values at 6 p.m. and midnight. The insulin profiles showed a trend toward lower afternoon and night values, with a noon peak. The afternoon insulin-glucose ratios were significantly lower. HGH values were inconsistent and tended toward higher afternoon and night basal levels. The results confirm the existence of a circadian variation in the blood glucose response to oral glucose loads in healthy men. This might in turn result from a circadian variation in the insulin response, probably secondary to changes in the pancreatic β cell sensitivity to glucose. This basic mechanism is believed to sustain the conditioning influence of other hormones, HGH being one of them.

We present 7 cases of splenic abscess collected in our hospital from 1980 to 1988 as well as a review of 227 cases of the world literature. The signs and symptoms are nonspecific in all of them, fever being the most constant. Computed tomography scan followed by sonography were demonstrated to be the best methods of diagnosis. The treatment carried out on all of our patients was splenectomy followed by antibiotic coverage. Two of them died 15 days after the operation due to persistence of the septic state. In our review of the literature, we observe a rise in the population at risk for splenic abscess due to an increase in the use of immunosuppressive agents, to the higher survival of leukemic patients, and to the great incidence of drug abuse among others. Nevertheless, the advances in the use of sonography and computed tomography scan have made possible a more accurate diagnosis, therefore making possible an earlier treatment and a better prognosis. We believe that the treatment of choice is splenectomy with conservative treatment used only in specific cases where surgery represents a high risk for the patient.

The knowledge of the different modalities of management is especially relevant in patients with multicentric paragangliomas. In every case, benefits and potential risks of all treatment options may be taken into consideration for every individual patient.