The extent of the renal contribution to postabsorptive endogenous glucose production (EGP) in humans is controversial. We measured EGP in the absence of the liver during the anhepatic phase (AH) of liver transplantation in five patients (aged 46.4 ± 10.2 years, two women). Stable labeling of plasma glucose (PG) was achieved for a 2-h period before the AH by primed continuous infusion of di-deuterated 6,6 . These data show that postabsorptive nonhepatic glucose production in humans may contribute to greater than one-third of overall EGP, increasing when required, and that it is associated with a stress response and increased gluconeogenic substrate availability. We conclude that extrahepatic tissues, most notably those of the kidney, make a significant contribution to EGP in humans. Diabetes 4 9 :4 5 0-456, 2000

Objective: Glandular cell abnormality (GCA) in Pap smears is uncommon. Detection is important as the possibility of underlying high-grade lesions is greater in this entity than in atypical squamous cells of undetermined significance. This study was undertaken with an aim to correlate GCA cases with histology, scrutinize its mimics and identify cytologic features to segregate significant lesions from benign. Study Design: A total of 22,618 conventional Pap smears were retrospectively analyzed. In all, 74 GCA cases were identified, correlated with histology and reevaluated using parameters based on architectural pattern, cellular features and background. Results: This study revealed 15 false positives. On review, 11 cases [1 adenocarcinoma, 5 atypical glandular cells (AGC), not otherwise specified, 5 AGC, favor neoplasia (FN)] were recategorized as reactive. Of 9 cases reported as cervical intraepithelial neoplasia on histology, cytodiagnosis in 5 was revised from AGC-FN to high-grade squamous intraepithelial lesion involving glands. Initial overall cytohistology concordance was 79.7%. Reevaluation of the smears, based on stringent cytomorphological criteria, enhanced overall agreement to 94.59%. Conclusions: A diagnosis of AGC has considerable clinical implications. Dissociated atypical cells, nuclear membrane, architecture and chromatin pattern are the key distinguishing features between neoplastic and benign lesions.

The action profile of lispro is not attenuated by mixing lispro with NPH in the syringe immediately before injection. The advantages are available to those individuals who need to combine types of insulin before injection to achieve optimal diabetes control.

Thyroid peroxidase antibodies (TPO) and TSH receptor antibodies (TRAB) sometimes co-exist in patients with Graves disease (GD) but not always. Some studies have suggested a functional and prognostic role for TRAB but the phenotypic characteristics of the patient with positive TPO (with or without TRAB) and the infl uence of TPO on the clinical course of GD are not known.We therefore set out to examine the demographic and clinical profi le of patients with GD to assess for any association between TPO antibody expression (with or without TRAB) and the clinical course of the disease.We reviewed the health records of 14 patients with GD who were being followed up in the endocrine Clinic in East Kent between 2010 and 2011. Patients were divided into TPO-ve and TPO+ve groups and demographic and clinical data collected. Data are expressed in %, mean + SD and a p value of 0.05 was deemed signifi cant 9 Patients were TPO+ve . They were predominantly female (89%) and younger compared to the TPO-ve group. A positive family history was present in 60% TPO+ve patients but in none of the TPO-ve patients. TPO+ve patients were treated for longer and had 30% relapse rate within 12months of discontinuing therapy and 20% needed radioactive iodine therapy (RAI) early. None of the TPO-ve relapsed nor required RAI. TRAB was also higher in the TPO-ve patients This study has demonstrated that the presence of TPO in Graves disease results in a phenotype of patients with a more aggressive disease pattern that occurs mainly in females and younger age group, takes longer to treat and has a higher relapse rate compared to TPO -ve patients. This fi nding has practical implications for the management of GD but larger studies will be required to confi rm the fi ndings. Putting patients f irstEast Kent Hospitals University NHS Foundation Trust NHS

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