Howard S. Traisman

Islet-Cell-Surface Antibodies in Juvenile Diabetes Mellitus

Using an indirect immunofluorescence test on suspensions of viable, insulin-producing islet cells from rats, we found that 32 per cent (28/88) of insulin-treated patients with juvenile diabetes have islet-cell-surface antibodies in their circulation. These antibodies also occurred in four of nine children with glucose intolerance, in one of 24 healthy children and in nondiabetic children with thyroid disorders. In the diabetic children, the immunofluorescent reaction was inhibited by preadsorption of serum to islet cells but was little affected by preadsorption to rat hepatocytes or erythrocytes or to acetone powders of various rat tissues, including pancreas. These results show that organ-specific, nonspecies-specific antibodies reactive with the cell surface of the islet cells can be present in serum from diabetic children, and provide an approach to investigation of immunopathological aspects of diabetes mellitus.

Somatomedin Activity and Diabetic Control in Children with Insulin-Dependent Diabetes

To test the hypothesis that somatomedin activity is influenced by diabetes and its metabolic regulation, the relationship between somatomedin activity and diabetic control as assessed by hemoglobin A1C was investigated in 40 children with insulin-dependent diabetes. An inverse correlation between hemoglobin A1c and serum somatomedin activity was statistically significant. The data suggest that abnormalities of linear growth, which can occur in children with poorly controlled diabetes, may involve abnormalities in net somatomedin activity.

Thumb- and finger-sucking: A study of 2,650 infants andchildren

Summary A study of finger- and thumb-sucking and related factors in 2,650 infants and children has been statistically analyzed and clinically evaluated. The pertinent literature has been briefly reviewed.

Joint Contractures in Patients with Juvenile Diabetes and Their Siblings

Six hundred fifteen children (310 with diabetes, 106 nondiabetic siblings, and 199 nonsibling controls) were examined for the presence of joint contractures. Forty children had contractures: 8.4 per cent of those with diabetes and 4.6 per cent of those without diabetes. Contractures were present, however, in 9.4 per cent of nondiabetic siblings, and only 2 per cent of nonsibling controls, suggesting a familial tendency to joint contractures. The older the patient, the more likely he was to have contractures. There was no correlation with sex, race, or age at onset of the disease.

Somatomedin activity in the Mauriac syndrome

7. Sirinavin S, and McCracken GH: Primary suppurative myositis in children, Am J Dis Child 133:263, 1979. 8. Blair DC, Carroll M, and Silva J: Localization of infectious process with gallium citrate Ga 67, JAMA 230:82, 1974. 9. Hopkins GB, Kan M, and Mende CW: Early 67 Ga scintigraphy for the localization of abdominal abscesses, J Nucl Med 16:990, 1975. 10. Gelrud LG, Arseneau JC, Milder MS, Kramer R J, Swann 11. SJ, Canellas GP, and Johnston GS: The kinetics of 67 gallium incorporation into inflammatory lesions: Experimental and clinical studies, J Lab Clin Med 83:489, 1974. Webster EW, Alper NM, and Brownell GL: Radiation dose in pediatrics nuclear medicine and diagnostic X-ray procedures, in James AE, Wagnon HN, and Cooke RE, editors: Pediatric nuclear medicine, Philadelphia, 1974, WB Saunders Company, p 34.

Diabetes mellitus and its effects on menarche.

In a combined mail and medical record survey of 121 non-diabetic and 90 diabetic girls greater than or equal to 9 years of age, the mean age of menarche in the control non-diabetic population was 13.0 +/- 1.2 years and 13.4 +/- 1.2 years in the diabetics. The diabetic group was divided into those whose onset was before or after age 11 years (DM less than 11, DM greater than or equal to 11). The DM greater than or equal to 11 group had a mean menarchal age of 14.0 +/- 1.2 years and the DM less than 11 group, 13.1 +/- 1.2 (p less than 0.005). The DM greater than or equal to 11 group also differed significantly from the control group. The difference between the two groups suggests that the onset of diabetes near the onset of puberty may have a more disruptive effect on hypothalamic-pituitary-gonadal axis maturation that does the prepubertal onset of diabetes.

Fluorinated corticosteroid toxicity in infants.

An 11-month-old girl died from complications of Cushings syndrome. The latter was the result of routine topical and periocular dosages of fluorinated corticosteroids following corneal homografts for sclerocornea.

Scrotal Swelling in the Schönlein-henoch Syndrome

Testicular and scrotal hemorrhage is uncommon in the Schönlein-Henoch syndrome. The diagnosis of testicular torsion is difficult to make when it is complicated by vasculitis of the testis. Since both conditions can occur simultaneously, torsion of the testis must be considered and surgical exploration performed whenever acute testicular pain and swelling occur during the course of the Schönlein-Henoch syndrome. Two patients with this syndrome as well as scrotal and testicular involvement are described.

Standard Parameters of Diabetic Control: Are They Reliable?

To evaluate the reliability of the tradional methods to assess short-term control of diabetes, 25 children with insulin-dependent diabetes were studied with a 24-h glucose profile in addition to the traditional assessment techniques. Patient compliance was elminated as much as possible from the experimental design. The correlation of the routine methods with the 24-h glucose profile was excellent, and a scoring system for control was empirically derived. The single method of assessment that correlated best with the overall control score was the traditional daily urine test. In 6 of the 25 subjects studied, relative hypoglycemia was observed, occurring asymptomatically at night, and was followed by a hyperglycemic rebound. Traditional assessment techniques did not detect this event. Five additional patients had symptomatic daytime hypoglycemia. We conclude that the traditional daily urine tests are adquate indicators of day-to-day control in most diabetic patients, given adquate compliance. Our data also suggest that asymptomatic nocturnal hypoglycemia occurs frequently in children with diabetes, although clinical proof is difficult in the absence of a 24-h glucose profile.

Blood Lipid and Protein Levels in Juvenile Diabetes Mellitus

In recent years much emphasis has been placed upon the relationship of hyperlipemia to the development of atherosclerosis. The tendency for vascular disease to develop prematurely in patients with diabetes mellitus is well known. Therefore, it seemed pertinent to study the serum lipid and protein levels in patients with juvenile diabetes mellitus in whom there was no clinical evidence of arterial disease. Our findings are presented herewith and discussed in the light of other reports. CLINICAL MATERIAL AND METHODS Fifty patients with juvenile diabetes mellitus were studied in private practice and in the diabetes outpatient clinics and hospitals from which this paper originates. The severity of the diabetes, degree of control, and duration of the disease varied with each patient. There were twenty-four males and twenty-six females, ranging from nineteen months to sixteen years of age. The shortest duration of the disease was three weeks and the longest was eleven and one-half years. The patients were divided into two groups: those whose duration of diabetes was less than five years, and those who had diabetes longer than five years. There were fifteen males and sixteen females in the former group, and nine males and ten females in the latter group. None of the patients was hospitalized specifically for this study. All patients received Lente or NPH insulin, alone or in combination with Regular Insulin. In a few instances, mixtures of the Lente insulins were administered. The daily insulin dose was given in one injection before breakfast. The patients received a weighed diet of approximately 3 to 4 gm. of protein per kilogram of body weight, with a protein to fat to carbohydrate ratio of approximately 1:1:2. Activity was unrestricted. These patients tested their urine three to five times a day. Estimation of clinical control was based on the patients well-being, freedom from symptoms, and a normal gain in weight. If acetone appeared