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Two putative sympathetic nervous system (SNS) markers, noradrenaline and neuropeptide Y (NPY) were related to 24-h ambulatory blood pressure (BP) in 59 normotensive subjects, 34 non-insulin-dependent diabetics, and 25 controls. Plasma NPY levels were not significantly different between the two groups [non-insulin-dependent (NIDDM) diabetes mellitus 4.33 (3.25-5.78), controls 5.68 (3.39-6.97) p=0.26] as were those of noradrenaline (1.51+/-0.69 versus 1.78+/-0.55; p=0.053). There were correlations, controlled for age and obesity, of plasma NPY with clinic and night time diastolic BP in the control group only (r=0.49 [p=0.013] and r=0.48 [p=0.023] respectively). No similar correlation was found in the NIDDM group, or between plasma noradrenaline and blood pressure in either group. No correlation was found between plasma insulin and NPY or noradrenaline levels. There is a weak independent relationship between NPY and blood pressure in normotensive nondiabetics but not in NIDDM subjects. We found no evidence for the hypothesis that insulin modulates blood pressure through activity of the SNS.

Platelets take up and store noradrenaline and adrenaline in proportion to plasma concentrations and may, therefore, provide an integrated index of sympathoadrenomedullary arousal. Plasma and platelet catecholamine concentrations were measured in 290 European and 155 Asian subjects, and were related to blood pressure, insulin levels, and social class. Plasma noradrenaline concentrations correlated with systolic and diastolic blood pressure in both ethnic groups (r = 0.20-0.30), and these levels were significantly elevated in hypertensive subjects (P < 0.003). In Europeans, but not in Asians, these relationships remained significant after adjusting for age and gender, and were independent of the relationship between insulin and blood pressure. There were much weaker relationships between platelet catecholamine concentrations and blood pressure, which were dependent on age and gender as covariates. In neither ethnic group was there any relationship of either plasma or platelet catecholamine concentrations with insulin concentrations, body mass index, or glucose intolerance. European subjects in manual occupations had significantly higher concentrations of plasma noradrenaline than those with nonmanual occupations. The findings suggest a significant role for the sympathetic nervous system in the determination of blood pressure, but do not provide evidence for a connection between hyperinsulinemia and sympathetic nervous system activity. The role of platelet catecholamines as an epidemiological marker of stress has not been supported.

Defects of both sodium-hydrogen exchange (NHE) and sodium-lithium countertransport (SLC) have been described in subjects at increased risk of coronary heart disease (CHD). Sodium transport is linked to the regulation of cell volume, intracellular pH and cell growth, which may explain aspects of this association. However, impaired growth in early life is also linked to adult CHD, and 'programmed' alterations of cell behaviour are postulated to be responsible for this. In this study, therefore, we examined whether NHE or SLC in adults are predicted by anthropometric measures at birth, as well as being associated with insulin resistance syndrome (IRS) variables in adulthood. Red cell SLC was measured in 26 adults, and NHE in dermal fibroblasts from another 15 subjects characterized anthropometrically at birth. SLC activity correlated with LDL cholesterol, triglycerides and urate (r=0.42 - 0.49; 0.05P0.01), but not birth anthropometry. NHE V(max) correlated with plasma insulin (r=0.80; P0.001), but birth weight was unrelated to V(max), K(m) or Hill coefficient for H(i)(+). However, pH(i) correlated with birth weight (r=0.74; P=0.002), insulin sensitivity (r=0.52; P0.05), fasting glucose (r=-0.52; P0.05) 2 h insulin (r=0.51; P0.05) 2 h glucose (r=-0.54; P0.05). In conclusion, red cell SLC is related to IRS variables, but not with birth weight measures. In contrast, low intracellular pH(i) is related to both low birth weight and adult insulin resistance, suggesting it might be a 'programmed' cell phenotype, although this is not apparently explained by altered NHE kinetics.

A series of 50 patients treated with total cystectomy for transitional cell carcinoma is reported. The cases are grouped according to the histologic type and stage of the carcinoma. Forty-three patients had anaplastic carcinomas, of which 32 had invaded more than half of the bladder musculature (Stages P3 and P4). Twelve patients came to operation despite the presence of recognised distant metastases. Nine primary deaths occurred among 38 patients treated with radical surgery. When five years had elapsed, 8 of 29 patients were alive (28 per cent), of whom one had a recurrence in loco. The conclusion is drawn that cystectomy is best suited to tumours which have invaded to a depth of more than half the bladder musculature, or those with perivesical infiltration (Stage P3). However, the results hitherto recorded with supervoltage radiation are somewhat better than those obtained with cystectomy. The problems attached to urinary diversion following total cystectomy are considered briefly. Uretero-ileo-cutaneo...

Ninety-three patients for whom a colorectal operation was planned had their bowel prepared mechanically by orthograde irrigation. The tube was sited in the duodenum via the pylorus under X-ray and TV control. The procedure was discontinued in 2 patients (2%), 15 patients (16%) experienced nausea and vomiting, while 76 patients (82%) experienced no discomfort. The mean duration of the irrigation was 216 min (90-476 min) and the mean volume of fluid used 10.21 (5.0 -15.0 1). There were no significant differences between pre-irrigation and post-irrigation blood chemistry. Twenty-three patients developed postoperative abdominal wound sepsis (26.7%), 4 (4.7%) had an intraabdominal abscess; 9 out of 12 patients (75%) had perineal wound sepsis. Escherichia coli and Bacteroides were the dominant species cultured from colorectal mucosa during operation as well as from infected abdominal and perineal wounds. Although the irrigation technique seems to clean the bowel to a degree not previously seen, this in itself is no guarantee of avoiding post-operative wound sepsis after colorectal operations.

Of 5000 patients with skeleton tuberculosis, 85 also had chest tuberculosis (= 1.7%). Chest tuberculosis in most cases begins with local pleural tuberculosis originating from a former moist pleurisy. The 5th rib is preferably involved, occasionally several ribs simultaneously. The gradual development of the abscess of the thoracic wall is mostly not recognized. Abscess incision only does not lead to recovery. Fistulas will be the result. Partial resection of the involved rib together with local decortication of the pleura is according to our experience the optimal therapy to obtain good results.