Patients treated by the proposed ACL reconstruction technique showed on average good to excellent long-term results. A meniscal lesion at the time of ACL tear was highly predictive for less favourable outcome.

Aims Most people with Type 1 diabetes have low levels of persistent endogenous insulin production. The Diabetes Control and Complications Trial showed that close to diagnosis preserved endogenous insulin was associated with lower HbA1c, hypoglycaemia and complication rates, when intensively treated. We aimed to assess the clinical impact of persistent C‐peptide on rate of hypoglycaemia and HbA1c in those with long duration (> 5 years) Type 1 diabetes. Methods We conducted a cross‐sectional case–control study of 221 people (median age 24 years) with Type 1 diabetes. We confirmed ongoing endogenous insulin secretion by measuring C‐peptide after a mixed‐meal tolerance test. We compared self‐reported hypoglycaemia (n = 160), HbA1c, insulin dose and microvascular complications (n = 140) in those with preserved and low C‐peptide. Results Stimulated median (IQR) C‐peptide was 114 (43, 273) pmol/l and < 3 (< 3, < 3) pmol/l in those with preserved and low C‐peptide respectively. Participants with preserved C‐peptide had lower reported monthly rates of hypoglycaemia, with 21% fewer symptomatic episodes, 5.9 vs. 7.5 [incidence rate ratio (IRR) 0.79, P = 0.001], and 65% fewer asymptomatic episodes, 1.0 vs. 2.9 (IRR 0.35, P < 0.001). Those with preserved C‐peptide had a lower insulin dose (0.68 vs. 0.81 units/kg, P = 0.01) but similar HbA1c (preserved 69 vs. low 67 mmol/mol, P = 0.06). Conclusions Adults with Type 1 diabetes and preserved endogenous insulin production receiving usual care in the UK have lower daily insulin doses and fewer self‐reported hypoglycaemic episodes, but no difference in HbA1c. This is consistent with non‐intensive treatment in previous studies, and suggests a need to consider therapy intensification to gain full benefit of preserved endogenous insulin.

with the following history :-Six months previously she noticed a swelling in the abdomen, just above and to the right of the umbilicus. Shortly afterwards she had attacks of abdominal pain which often made her faint ; she became very weak, and took to bed. She then began to vomit two or three times a week, as a rule directly after taking food, and the vomiting continued up to the time of admission into the hospital. The vomiting relieved her pain.She had never noticed any blood in the vomit. For the last three months she had been getting more and more constipated, and she had been losing weight.Condition on Admission.-Patient was emaciated. Pulse 80. Respiration 20. Temperature 98.6". Abdomen : Coils of intestine could be seen, and there was a hard nodular tumour to be felt just above and to the right of the umbilicus, and a second nodular mass was felt in the left part of the epigastrium.A third tumour could be felt below the right costal border which worked with respiration and could be grasped between the hands placed in the loin.A test meal was given, with the following result : Total acidity 0'053 per cent, combined HC1 0.050 per cent, free HC1 0.007 per cent ; no lactic acid.Urine : acid, sp. gr. 1020 ; no albumin : no sugar.An Operation was performed by Mr. Hey Groves on February 21. A median incision was made extending from the ensiform cartilage to the umbilicus, and the peritoneal cavity opened. Immediately, a large nodular and cystic tumour was seen projecting over the lesser curvature of the stomach. The tumour was found to be contained in the lesser sac of peritoneum, which was opened. The tumour was then easily brought out of the abdomen, and from the shape and anatomical relations, was found to be the pancreas. The whole of the organ was polycystic, the cysts varying in size from a cherry-stone to a currant, those in the body and head being larger than those in the tail. No normal pancreatic substance could be found. Examination of the right kidney showed that it too was polycystic, the upper pole consisting of six or seven cysts ; the lower part of the organ appeared to be normal. The stomach, liver, and left kidney were normal.The abdomen was closed without further operation. Clinically this case presented a very close resemblance to one of cancer of the There were pain, emaciation, and vomiting, with the formation of The tumour above and to the right of the navel resembled stomach. epigastric tumours.