Beatrice Bishop Berle

Detoxification of Long-Term Methadone Patients: Problems and Prospects

Various aspects of the detoxification of rehabilitated methadone patients are considered in the light of experience at the Albert Einstein College of Medicine-Bronx Psychiatric Center MMTP and the reports of others in the field. Patients studied met certain eligibility requirements which were thought to enhance the probability of successful detoxification. A total of 228 (10.4%) of 2,814 patients were included in the project. Sixty-three patients have completed detoxification. A follow-up on these patients indicates that 22.2% claim abstinence from all drugs and are reporting to the clinic, 47.6% claim abstinence but have not reported to the clinic, 14.3% returned to methadone maintenance, and 15.9% are lost to contact. This and other studies emphasize the importance of adequate counseling during detoxification.

The Biology of the Schizophrenic Process

I Historical Perspective - Evolution of the Concept of Schizophrenia.- II The Nature of Schizophrenia.- III Neural Substrates.- IV The Genetics of Schizophrenia.- V Pathophysiology - Biochemical Considerations.- VI Clinical Investigations.- VII Etiological Considerations..- VIII Therapy.- IX Synthesis.- Name Index.

Dilemmas in diabetes.

We may not be able to make you love reading, but dilemmas in diabetes will lead you to love reading starting from now. Book is the window to open the new world. The world that you want is in the better stage and level. World will always guide you to even the prestige stage of the life. You know, this is some of how reading will give you the kindness. In this case, more books you read more knowledge you know, but it can mean also the bore is full.

Glucagon and Other Hormones — A New Perspective

DR. UNGER: We first became interested in the possibility that the alpha and beta cells and islets of Langerhans function, not as independent neighbors in the sense that some of the cells of the hypophysis function, but rather as a single, coordinated if not coupled functional unit designed to control the flux of key nutrients into and out of cells in accordance with supply and demand. This view was based on the remarkable qualitative relationship observed between the relative concentrations of the two hormones and the known, measured, or suspected need for a particular movement of nutrients. When the need of the organism was for breakdown of macro-molecules so that the important nutrients may be surrendered, the relative concentrations of insulin to glucagon was invariably low. Conversely, when synthesis of macromolecules was appropriate, the relative concentration of insulin to glucagon was always high. More recently there has been additional support for alpha-beta cell coupling. Dr. Orel has demonstrated an anatomical basis for intercellular communication between alpha and beta cells in the islets of Langerhans in the form of junctional complexes.

The Nature of Diabetes

DR. UNGER: I think part of the dilemma that we face may be factitious and a nomenclatural dilemma resulting from inadequate definition of the term “diabetes”. This has been argued for decades. Probably within this room we would not all agree on what is “diabetes”. If, for example, one defines diabetes mellitus as a disease associated with an increased morbidity and mortality attributable to the specific vascular lesions, one identifies a population entirely different from a group of mildly hyperglycemic elderly persons who live to be 80 or more. We should consider how to sub-classify the hyperglycemic states. This, I think is what Dr. Levine was really suggesting at the end of his discussion.

Structural Aspects of Islet Cell Membranes

DR. ORCI: Despite a growing body of data on islet cell structure and function in spontaneous and experimental diabetes (100, 101 113, 114, 115), the basic lesion(s) responsible for endocrine pancreatic dysfunction in this disease remain(s) to be unraveled. Although membrane systems are known to be of major importance in the control of cellular activities, no information is so far available concerning the possible role of the membranes as a crucial factor in the impairment of islet function in diabetes mellitus. In this presentation, attention is paid to some structural aspects of such membranes in normal and diabetic animals. One of the most useful techniques in the morphological study of membranes is the freeze-fracture technique (88, 132), which exposes large areas of the inside of membranes in three-dimensional view (Figs. XVI and XVII provide a comparison of conventional and freeze-fracturing techniques) and reveals individual components of these membranes down to a macromolecular size, namely 20 to 30 angstroms. With this technique, the interior of the membranes (middle of the bilayer) is exposed (13, 109), and appears structurally differentiated into smooth areas interrupted by particles 60 to 180 angstrom in diameter (Fig. XVIII). It is now accepted that the smooth areas represent the membrane phospholipids whereas the particles constitute at least in part, the morphological counterparts of proteins (26, 34, 86, 124, 139). Together, proteins and phospholipids are the building blocks of the membrane. Membranes rich in proteins, thus functionally complex, contain numerous particles.

Macrovascular Disease — Atherosclerosis

DR. LEVINE: While small vessel disease seems to be specifically related to diabetes, what about large vessel disease, atherosclerosis? Suppose I were to postulate that insulin is really the villain in this story. We know that insulin promotes lipid formation, could it induce greater activity of the myointimal cell within the blood vessels, and therefore result in more atherosclerosis? I would say that there is fairly good evidence that the adult-onset diabetic with minimal hyperglycemia but with relatively high insulin and high fat is the one that has most of the atherosclerosis. We never seem to see a case of gangrene in a juvenile diabetic.