Harvey C. Knowles

Observations in Hyperthyroidism of Abnormal Glucose Tolerance and Other Traits Related to Diabetes Mellitus

Studies were made of glucose tolerance and other characteristics related to diabetes in fifty-one patients with hyperthyroidism. Glucose tolerance compatible with diabetes was present in 57 per cent of patients when toxic and 30 per cent on return to euthyroidism. Histories of family diabetes in both sexes and of heavy babies delivered by the women were obtained more frequently than expected in the general population. Reasons are given to suggest a genetic relation between hyperthyroidism and diabetes.

Pituitary Hormone Response to Head Injury

Measurements of the serum levels of pituitary hormones were made in six patients with uncomplicated head injury. Samples were obtained at 4-hour intervals for 72 hours to evaluate diurnal rhythms. Three of the six patients revealed elevations of serum growth hormone (GH) and prolactin, but no trends could be established. Likewise, three patients had marked elevations of luteinizing hormone and lesser elevations of follicle-stimulating hormone, but no pattern was discernible. The level of thyroid-stimulating hormone was stable and remained in the normal range throughout. GH was measured after intravenous glucose loading. A paradoxical rise reverted to normal at the late follow-up evaluation. It is suggested that the abnormal levels were related to abnormal hypothalamic function rather than to pituitary damage.

Emergency Diagnosis of Upper Digestive Tract Bleeding by Roentgen Examination Without Palpation (“Hampton Technic”)

Gross hemorrhage from the upper digestive tract is a serious and dramatic event. The early recognition of the cause and site of bleeding determines the treatment and may be lifesaving. While the source of the hemorrhage can often be suspected from the history and physical findings, the patients condition may preclude adequate interrogation or examination. Hemorrhage may occur without symptoms which might offer a clue as to its cause. Moreover, even with a clear-cut peptic ulcer history, it is helpful to know whether the ulcer is gastric or duodenal, since gastric ulcers usually bleed more severely and are more likely to require emergency surgical intervention (1, 2, 14). Recent advances in the medical and surgical management of patients with hemorrhage from esophageal varices (10, 11, 12) and peptic ulcer (8, 9, 15) make it imperative that the source of bleeding be determined during the acute episode. A knowledge of the exact location of the lesion will also be of great help to the surgeon if operation b...