Garfield G. Duncan

The local and systemic effects of cream on blood coagulation: a physiological basis for early feeding in gastrointestinal bleeding.

Summary A review of the development of the concept of early feeding in gastrointestinal bleeding is presented. Evidence is presented to show that cream increases the coagulability of the blood and exhibits properties of a local hemostatic agent. In addition it may be expected to inhibit motility, depress secretion and buffer gastric acid. The early feeding of milk and cream in gastrointestinal bleeding would appear to be justified on a physiological basis.

Charcot joints and infectious-vascular lesions of bones in diabetes mellitus

Abstract 1.1. Patients with diabetes mellitus may develop destructive lesions of the bones of the foot, demonstrable by roentgen ray examination, of two types: gradual dissolution of the tarsal bones and their articulations (the Charcot joint), attributable to diabetic neuropathy; rarefaction of the phalanges and metatarsals secondary to chronic infection in the adjacent soft tissues and arterial insufficiency. 2.2. Four illustrative cases of Charcot joint in diabetes mellitus are reported, two of which showed, in addition, the second type of bony lesion.

CLINICAL EXPERIENCES WITH CHLORPROPAMIDE: A DOUBLE‐BLIND STUDY

To determine the clinical effectiveness of chlorpropamide as a hypoglycemic agent, a double-blind trial was conducted in the diabetic outpatient clinic a t Pennsylvania Hospital. After completion of the trial, the patients were asked to continue in a follow-up study of the drug. The response to chlorpropamide as measured by the eventual state of diabetic control during the follow-up period was then compared with the results obtained during the trial and also with the control obtained with previous diabetic therapy. The results of this study indicate that chlorpropamide is a potent hypoglycemic agent that produced excellent control of diabetes in most patients.

Clinical Value of a Simple Qualitative Test for Plasma Acetone in Diabetic Coma

On a country-wide basis most patients in diabetic coma are treated by general practitioners. It is not at all to their discredit that, in their broad basis of medical understanding, they may not be familiar with highly technical details in the management of diabetic coma, treatises on which have an unavoidable aura of complexity. One of the objectives of specialists, in my opinion, should be to provide those physicians, who see most patients in diabetic coma, with a plan for diagnosis and therapy which is as simple as a complex subject can be presented and yet has the support of experimental and clinical application under controlled conditions. To philosophize a moment—is it not true that most writings from specialists are directed to other specialists in the same field and is it not so that specialists are prone to forget that for one patient treated under circumstances oozing with electrolytes, logarithms, and so forth, there are many who must be treated under relatively primitive conditions? I wish to present an illustration of an attempt to provide for the general practitioner a simple plan which applies in the management of diabetic coma. It provides (a) a means of making an early and differential diagnosis which will permit earlier treatment and the advantages which ensue, (b) a means of appraising the degree of ketosis and hence a guide to initial therapy, (c) indications of returning sensitivity to insulin, which has proved a more reliable clue than any other in our hands, and hence is of value in the prevention of overtherapy and (d) a differentiating indication of significance in the nephropathies and in patients comatose from causes other than ketosis and notably from hypoglycemic reactions. The pathologic physiology of the development of

Enhancement of penicillin blood levels in man by means of a new compound, caronamide.

T HE efficacy of penicillin as a therapeutic agent is impaired by its rapid excretion in the urine, which prevents the attainment and maintenance of high concentrations in the plasma. Relatively large doses must be administered in order to obtain detectable concentrations of penicillin in the blood stream, and massive doses of penicillin heretofore have been necessary if higher plasma concentrations are required. The primary objective of penicillin therapy is the maintenance of therapeutic concentrations of the drug in body tissues, and it is assumed that the higher the concentration of penicillin in the plasma, the higher will be the concentration in the tissues. The commonly accepted minimal effective therapeutic level is 0.03 unit of penicillin per cc. of plasma,’ but certain disease conditions, specifically subacute bacterial endocarditis and osteomyelitis may require much higher levels for curative effects. Attempts to obtain high plasma concentrations (high tissue concentrations) of penicillin include: (1) increase in the dosage; (2) more frequent administration at shorter intervals; (3) variation in the route of administration; (4) attempts to slow the rate of absorption from the site of injection and (5) partial inhibition of the renal excretion of penicillin. This report will describe a new approach to the problem of inhibition of excretion of penicillin by the kidneys by utilizing to advantage the properties and characteristics of a new compound, caronamide, which is a white, crystalline powder with the following structural formula:

The relationship between hypertension and coronary occlusion.

Excerpt After many decades of intensive experimental and clinical research in hypertension all over the world, there is still no agreement as to the causes and effects of hypertension or as to the ...

The comparative clinical effectiveness of tolbutamide and acetohexamide

Abstract Fifty-nine diabetic patients were selected at random and divided into two groups in order to compare the clinical effectiveness of tolbutamide and acetohexamide. Thirty-four (Group 1) were from a public diabetic clinic and 25 (Group 2) were from a private practice. The patients in Group 1 were older, more obese, and had more associated diseases and more complications of diabetes than those in Group 2. Four patients were removed from the study because of intervening complications, one because of a medical problem, and three because of probable drug sensitivity. The average dose of tolbutamide required for Group 1 was 1 Gm. and for Group 2, 0.452 Gm. When acetohexamide was substituted, it was needed in half the amounts of tolbutamide, i.e., 0.534 Gm. for Group 1 and 0.261 Gm. for Group 2. In 31 per cent of the patients (17 of 55), the degree of control improved with acetohexamide administration. This improvement appeared to be related not only to the effectiveness of the drug per se but to the fact that a single morning dose sufficed, instead of multiple doses required for tolbutamide. The results of the study indicate that acetohexamide effects improved control on smaller dosage and with more reliability and economy than tolbutamide.

Clinical Potential of Chlorophenoxyisobutyrate (CPIB: Clofibrate) in the Management of Hypercholesterolemia—A Preliminary Report.

Excerpt Preliminary clinical observations of clofibrate A therapy in 24 patients—obese and nonobese, diabetic and nondiabetic—exhibiting hypercholesterolemia with and without an associated hypertri...

Clinical Experience with Chlorpropamide in the Treatment of Diabetes

Oral therapy for diabetes is no longer a novelty. The apprehension concerning potential harm in the early stages of the treatment with the sulfonylurea compounds has decreased, but concern about the possibilities of accruing deleterious effects after continuous therapy for long periods remains, as might be the case with any new therapy. For the most part, reports on the effectiveness of these drugs deal with the many diabetic subjects who do not need drug therapy as well as the small percentage who do. This tends to foster rather than dissipate confusion. A grouping of the diabetic population according to their needs for, and likelihood of favorable response to, oral therapy indicates that: 1. Approximately 80 per cent of diabetic patients are overweight when they seek treatment for their diabetes. Control of the diabetes is readily achieved by reducing the caloric intake. Oral therapy is a needless but effective therapy for most of these patients. If employed it should be looked upon as a supplementary and temporary measure and one to be abandoned as soon as the weight reduction regimen maintains control of the diabetes. Unfortunately, the successful control of the diabetes by oral therapy in this segment of the diabetic subjects tends to detract from the importance of reduced caloric intake and, as a result, oral therapy and the overweight state are permitted to prevail. Indeed, the problem of obesity tends to increase. 2. Approximately 5 per cent of the diabetic population are juvenile diabetics in whom the oral therapy cannot replace insulin, hence is not indicated. 3. An additional 5 per cent at least is comprised of adults who have the juvenile type of diabetes, in which cases the sulfonylurea compounds also are ineffective. In effect, approximately 90 per cent of diabetics either do not need or do not respond to oral sulfonylurea compounds.

Oral Hypoglycemic Agents: Panel Discussion

PRESIDENT REED: The panel will discuss some of the new oral hypoglycemic agents. I take this opportunity to introduce Dr. Arthur R. Colwell, St., of Northwestern University Medical School, who will moderate the program. DR. COLWELL: The release is imminent for general use of a sulfonamide compound which, when given by mouth, has unquestioned ability to lower blood sugar values both in normal and in many diabetic subjects. All are properly interested in several major points. How does the substance act? How should it be used in treatment? Are there risks in its use? What is its relationship, if any, to insulin? This panel will endeavor to provide answers to these and other questions. If there is disagreement among us it will reflect the difficulties which have been encountered in trying to find reliable answers to many important questions, particularly concerning mechanisms of action. A great deal of experimental and clinical data has been accumulated during the last two years or so concerning the sulfonylurea compounds. The experts at my side are well-informed concerning them and have contributed generously to their study. To start the discussion, I will ask each of the panelists to give us a brief orientation on certain aspects of the subject. For the most part, this will concern the sulfonylurea compounds, and specifically tolbutamide, which is marketed under the trade name of Orinase, the only compound available now clinically in this country. Dr. Root, will you give a brief historical background and identification of these compounds?