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Metformin might reduce insulin requirement and improve glycaemia in patients with type 1 diabetes, but whether it has cardiovascular benefits is unknown. We aimed to investigate whether metformin treatment (added to titrated insulin therapy) reduced atherosclerosis, as measured by progression of common carotid artery intima-media thickness (cIMT), in adults with type 1 diabetes at increased risk for cardiovascular disease.

Study objective: To compare the effectiveness and incidence of adverse reactions with three treatment regimens for asthma in adults in the prehospital setting. Design: Prospective, randomized clinical study. Setting: Inner-city emergency medical service system providing basic and advanced life support and transport to 14 urban area hospital emergency departments. Participants: One hundred fifty-four adult asthmatic patients, 18 to 50 years old, who presented to paramedics with shortness of breath and wheezing. Results: Eligible patients were randomly assigned by the base station physician to one of three treatment groups: subcutaneous epinephrine, nebulized metaproterenol, or subcutaneous epinephrine and nebulized metaproterenol. Peak expiratory flow rate (PEFR), blood pressure, heart rate, and respiratory rate were measured before and after treatment in each patient. During a 9-month period (October 1992 through June 1993), 154 patients were enrolled in the study; 53 (34%) received epinephrine, 49 (32%) received metaproterenol, and 52 (34%) received both. There were no significant differences in patient demographics, initial vital signs, or pretreatment PEFR among the three groups. The mean difference between pretreatment and posttreatment PEFR was 73 L/min and did not significantly differ among the treatment groups. Significant changes in vital signs were seen in no treatment group. Conclusion: Nebulized metaproterenol is as effective as subcutaneous epinephrine in the prehospital treatment of adult patients with acute asthma. The combination of these two treatments offered no additional clinical benefit in the patients we studied. [Quadrel M, Lavery RF, Jaker M, Atkin S, Tortella BJ, Cody RP: Prospective, randomized trial of epinephrine, metaproterenol, and both in the prehospital treatment of asthma in the adult patient. Ann Emerg Med October 1995;26:469-473.]

The interface of a two-dimensional computer-controlled stepper-motor-driven microscope stage with an infrared microspectroscopy system is explained in terms of its usefulness in performing microscopic imaging. Images are obtained by reducing spatially specific infrared spectra to functional group maps. The maps are constructed at a given infrared absorption frequency and are a function of the intensity versus x and y spatial coordinates. The use of the technique is demonstrated through two examples of polymer characterization. Transmittance infrared spectra reduced to five images based on absorptions at 1735, 1241, 1016 (ester functionalities), 1892 (crystalline band), and 908 (vinyl unsaturation) cm−1show that a polyethylene film contains an inclusion of an acetate-containing material. Reflectance infrared spectra reduced to an image based on a ratio of the absorptions at 1738 cm−1(ester carbonyl) and 1705 cm−1(acid carbonyl) show that the streak in a film of an ethylene-acrylic acid/ethylene-methacrylate copolymer blend on aluminum foil contains more of the ester component of the blend.

A 31 year old female presented with primary infertility and gave a two year history of amenorrhea without symptoms or signs of endocrine dysfunction. Examination was normal and investigation showed low oestradiol and progesterone levels with decreased LH pulsatility. The cortisol responses were impaired following hypoglycaemic stress and a short synacthen test, but the cortisol response to a prolonged synacthen test was normal. An inadequate ACTH response to CRF testing confirmed the diagnosis of isolated ACTH deficiency. Hydrocortisone therapy was followed by an ovulatory menstrual cycle. Amenorrhea again ensued following the reduction of the steroid dose and normal menses resumed on normal steroid replacement therapy. Six hourly gonadotrophin pulsatility showed a significant increase in both pulse amplitude and mean LH and FSH levels following steroid treatment. Isolated ACTH deficiency is a rare but treatable cause of hypogonadism and infertility, and this case gives further insight on the role of cortisol on the hypothalamo-pituitary gonadal axis.

The effects of human recombinant basic fibroblastic growth factor (bFGF) on the secretion, viability, proliferation, attachment and morphology of ten dispersed human clinically non-functional (NF) adenomas were examined in vitro. Four clinically NF adenomas secreting FSH and/or LH in vitrowere unaffected by 10 nmbFGF over a 4-h period. Over 4 days 10 nm bFGF stimulated LH secretion (66% and 72%, P<0·01) from two out of seven clinically NF adenomas secreting LH, whilst FSH (three tumours) and α-subunit secretion (three tumours) were unaffected. One adenoma co-secreting LH and α-subunit and one secreting LH alone were studied over 21 days; LH secretion fell progressively, but the decline was significantly less (P<0·05) with bFGF (10 nm) treatment after 14 and 21 days in both adenomas, whilst the fall in α-subunit secretion was unaffected by bFGF treatment. A 24-h GnRH test performed at the start and end of the 21-day period in one of these tumours showed an increase in both basal and stimulated LH secretion in the bFGF-treated group over control (124%, P<0·001). There was no effect of bFGF (10 nm) on viability, S-phase proliferation, attachment or morphology of adenoma cells over a 4-day period. These results suggest that bFGF has a role in tumorous LH secretion from these adenomas, but is not mitogenic (at least over 4 days) and is without effect on other parameters of in vitrodifferentiated function.Journal of Endocrinology(1995) 144,173–178

Post-thyroidectomy patients often complain of globus pharyngeus type symptoms. One of the organic pathologies recognized as causing globus pattern symptoms is goitre. We conducted a prospective questionnaire-based study in the thyroid clinic at Hull Royal Infirmary to examine the relationship between goitre, thyroidectomy and globus pattern symptoms by using the Glasgow–Edinburgh Throat Scale. A questionnaire-based study in which 41 consecutive patients due to undergo thyroidectomy prospectively completed the questionnaire pre-operatively and 12 months post-operatively. A subset of 25 randomly selected patients also completed the questionnaire three months post-operatively. Globus symptoms were not worsened by thyroidectomy at three or 12 months. Indeed two of the questioned parameters were significantly improved at three months, and six at one year (p < 0.023). In conclusion, thyroidectomy does not exacerbate globus pharyngeus symptoms. Indeed, in the absence of other clinical causes, when a patient has a World Health Organization (WHO) 2 goitre or greater, thyroidectomy may improve them.

Co-existence of pituitary adenomas and meningiomas is rare. Extensive review of the literature reveals only 32 cases with this association if meningiomas appearing after radiation therapy for pituitary tumors are excluded. There is a female preponderance and the meningiomas are usually located in the immediate vicinity of the pituitary. Although it is likely caused by chance occurrence, genetic dysregulation leading to the development of these tumors can not be ruled out.

A case of a successful induction of lactation in a commissioning mother of a surrogate pregnancy is reported. Induction of lactation was achieved with oral metoclopramide which was well tolerated. Alternative methods to induce lactation are reviewed. The advantages of breast-feeding and the relative ease with which lactation can be induced after a surrogate pregnancy would suggest that this could be offered to all commissioning mothers.

SummaryTwo cases of Cushing's disease are presented. In both cases successful treatment was followed by the development of a steroid-responsive disease condition, a seronegative arthritis in the first case and retinal vasculitis in the second. It is likely that both these conditions were unmasked by the fall in the endogenous steroid levels following the successful treatment of the Cushing's disease by trans-sphenoidal hypophysectomy.

Insulin resistance is increased in women with polycystic ovary syndrome (PCOS), and it may increase the risk of type 2 diabetes. In addition, hyperinsulinemia may contribute to androgen excess and could be a factor in the infertility associated with PCOS. This prospective, randomized, open-label study compared metformin therapy with orlistat in 21 women with PCOS. Orlistat reportedly produces significant, sustained weight loss and improves carbohydrate metabolism. After an 8-week period of dietary change, the women were randomized to receive either 500 mg metformin 3 times daily (n 11) or 120 mg orlistat 3 times daily (n 10) for 3 months.

Évaluer l’efficacité et la tolérance du liraglutide chez des patients diabétiques de type 2 (DT2) mal contrôlés avec une insuffisance rénale (IR) modérée.

Patients with active Schistosonw mansoni infection attending a medical clinic in an endemic area, 100 miles from Cairo, were asked to participate in this study. Ninety-six patients are reported, 72 of whom presented with musculoskeletal complaints. Nine of these presented with an enthesitis alone; 16 had an inflammatory peripheral polyarthritis alone; the remaining 47 were suffering from the combination of both an arthritis and an enthesitis. Alpha-I-acid glycoprotein was significantly lowered in those patients with musculoskeletal manifestations.