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Patients with noninsulin-dependent diabetes mellitus (NIDDM) have both preprandial and postprandial hyperglycemia. To determine the mechanism responsible for the postprandial hyperglycemia, insulin secretion, insulin action, and the pattern of carbohydrate metabolism after glucose ingestion were assessed in patients with NIDDM and in matched nondiabetic subjects using the dual isotope and forearm catheterization techniques. Prior to meal ingestion, hepatic glucose release was increased (P less than 0.001) in the diabetic patients measured using [2-3H] or [3-3H] glucose. After meal ingestion, patients with NIDDM had excessive rates of systemic glucose entry (1,316 +/- 56 vs. 1,018 +/- 65 mg/kg X 7 h, P less than 0.01), primarily owing to a failure to suppress adequately endogenous glucose release (680 +/- 50 vs. 470 +/- 32 mg/kg X 7 h, P less than 0.01) from its high preprandial level. Despite impaired suppression of endogenous glucose production during a hyperinsulinemic glucose clamp (P less than 0.001) and decreased postprandial C-peptide response (P less than 0.05) in NIDDM, percent suppression of hepatic glucose release after oral glucose was comparable in the diabetic and nondiabetic subjects (45 +/- 3 vs. 39 +/- 2%). Although new glucose formation from meal-derived three-carbon precursors (53 +/- 3 vs. 40 +/- 7 mg/kg X 7 h, P less than 0.05) was greater in the diabetic patients, it accounted for only a minor part of this excessive postprandial hepatic glucose release. Postprandial hyperglycemia was exacerbated by the lack of an appropriate increase in glucose uptake whether measured isotopically or by forearm glucose uptake. Thus as has been proposed for fasting hyperglycemia, excessive hepatic glucose release and impaired glucose uptake are involved in the pathogenesis of postprandial hyperglycemia in patients with NIDDM.

Chemical analyses and balance trials with rats of 17 foods showed marked differences in protein quality. According to an in vitro procedure true protein digestibility was high (around 90%). The same was also the case for the in vivo values with the exception of two legumes, beans and chick peas, which were digested to a markedly lower degree when compared to the in vitro values. The assumed reason for this is discussed. Due to extensive differences in the amino acid composition of the 17 samples BV varied considerably with the lowest value (45.5) of rice-wheat gluten breakfast cereal. Energy digestibility was generally high. Amino acid digestibility determined in vivo followed the pattern of the corresponding protein digestibility, although marked differences occurred from one amino acid to another in the same food.

The dietary habits and metabolic status of 14 selected ambulant type-1 diabetics, who were previously treated with conventional insulin therapy, were investigated over a period of 2 years under intensified insulin injection therapy. In this, multiple doses of regular insulin in combination with intermediate-acting insulin were injected daily and the regular metabolic controls as well as adjustment of the insulin dosage were undertaken by the patients themselves. Whereas conventional insulin therapy made exclusive use of intermediate-acting insulin, 41% of the daily dose in the intensified insulin injection therapy was regular insulin. The total daily insulin dose of 51 +/- 12 U/d was therefore not significantly different from that in the conventional insulin therapy (49 +/- 10 U/d). During the intensified insulin injection therapy the usual diabetic diet was relaxed in several aspects: neither the daily intake of fat, protein and calories, nor substitution in the diet using exchange lists was specified. Despite this liberalization HbA1c values decreased significantly from 9.3 +/- 1.2% to 7.8 +/- 0.7% (P less than 0.05) and blood lipids remained in the normal range. The results of this retrospective investigation lead to the conclusion that despite some measure of diet liberalization, selected, trained, type-1 diabetics of normal body weight and without primary dyslipoproteinaemia can attain good metabolic control under intensified insulin injection therapy.

The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 percent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 percent of that in the serum.

The influence of retrograde oxygen persufflation (ROP) on renal adenine nucleotide, glucose and lactate contents was examined in canine kidneys during up to 5 days of hypothermic preservation. Organs with or without predamage in 30-min normothermic ischemia were preserved and the results compared to kidneys after hypothermic ischemic storage (HIS): ROP preservation resulted in a significantly higher maintenance of cellular energy-rich substances than in HIS with even normal adenine nucleotide contents and energy charge potentials for the first 24 h. As in HIS preservation of normal kidneys, where the total adenine nucleotide content (SAN) paralleled the loss of viability for the first 1-2 days, in ROP were SAN and even the lactate content also correlated to renal viability for 2-3 days. But in contrast to this correlation, which would favor adenine nucleotide determinations for viability testing, in predamaged kidneys no correlation of SAN or lactate with renal viability was found during HIS or ROP. Thus the determination of cellular energy-rich adenine nucleotides and lactate accumulation confirms the superiority of ROP over HIS preservation. But the SAN or lactate tests lose their prognostic value for posttransplant renal viability if normothermic ischemia precedes the preservation period.

More than one million cases of child abuse and neglect come to attention of child protection agencies each year. During the course of investigating these cases, social workers are charged with protecting the child while assessing whether or not abuse or neglect has actually occurred. Child welfare philosophy also dictates that at the same time the investigation is being conducted, the social worker strives to maintain the family intact, if at all possible. One way to address this dual responsibility of protecting the child while working towards family stability is through the provision of services during the investigation. The purpose of this paper is to identify the services that are provided during the course of a child abuse and/or neglect case investigation. The paper also identifies the barriers that exist both within an agency and within the external community that discourage the provision of services to children and families. The findings of this research show that in the majority of cases services are not provided during the investigation. In those case investigations where services are provided, a much broader range of services are considered for provision than are actually delivered. The research also found that placement is the most frequently provided service; however, only one-third of those children in placement receive any clinical services while in placement. Finally, this study found that the greatest barrier to service provision is a lack of evidence necessary to intervene in the home situation.

10 of 20 workers in an envelope-making factory developed contact dermatitis. The cause was dibutyl maleinate, which was added to a polyvinylacetate glue. Dibutyl maleinate is a strong sensitizer and should be withdrawn from industrial use.

In man, a decrease in plasma glucose concentration results in a compensatory increase in hepatic glucose release. Studies in vitro have suggested that a low glucose concentration per se may directly stimulate hepatic glucose release, an effect often referred to as autoregulation. Whether autoregulation occurs in man in response to a physiologic decrement in blood glucose is not known. Therefore, seven healthy, nonobese subjects were studied on two occasions to determine the role of autoregulation in mediating the increase in glucose production that accompanies a physiologic decrement in plasma glucose concentration. On both occasions, plasma glucose concentrations were clamped successively at 95, 65, and 95 mg/dl for 2 h each. Insulin (approximately 14 microU/ml) and glucagon (approximately 70 pg/ml) were maintained constant on both occasions by an infusion of somatostatin and insulin. Phentolamine and propranolol also were infused on one occasion to produce combined alpha- and beta-adrenergic blockade. In the absence of adrenergic blockade, glucose production increased by approximately 1.3 mg/kg X min when the plasma glucose concentration was decreased from 95 to 65 mg/dl and decreased by approximately 1.5 mg/kg X min when glucose was increased from 65 to 95 mg/dl. In the presence of adrenergic blockade, the increase and decrease in glucose production averaged 0 and 0.5 mg/kg X min, respectively, representing 70-100% inhibition. We conclude that, in the presence of low physiologic insulin concentrations, autoregulation is not a major contributor to the hepatic response to a physiologic decrement in plasma glucose concentration in man.

Dietary and metabolic variables were investigated in 48 unselected, nonobese Type 1 (insulin-dependent) diabetic patients before and 3 mo after changing from (a) traditional insulin and diet therapy to (b) intensified insulin plus simplified diet therapy. HbA1c levels declined significantly from 9.04 +/- 0.25% with therapy (a) to 8.34 +/- 0.16% with therapy (b) (p less than 0.005). During (a), 58% of all patients used a personal diet plan, but only 15% of them performed food exchange according to the traditional diet prescription. Their eating habits remained unchanged during (b). Since improved metabolic control in this study could be obtained without adherence to traditional diet schedules, a simplification of the traditional diabetes diet prescription seems justified for nonobese Type 1 diabetic patients on intensified insulin therapy.