Ilana Blum

Pulmonary function in patients with Diabetes mellitus

Background: Pulmonary complications of diabetes mellitus have been poorly characterized. Although some authors have reported normal pulmonary function, others found abnormalities in lung volumes, pulmonary mechanics, and diffusing capacity. Subjects and Methods: We studied pulmonary function in a group of patients with diabetes using a combined cardiopulmonary exercise test. Twenty‐seven patients with diabetes aged 48±13 years participated in the study. Results: Overall, forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow, midexpiratory phase, were within the predicted values, but the residual volume/total lung capacity ratio was slightly elevated. Comparison by diabetes type showed nonsignificant differences in forced expiratory volume in 1 second and forced expiratory flow, midexpiratory phase. Residual volume/total lung capacity ratio was significantly elevated in type 1 patients compared with type 2. Carbon monoxide diffusion capacity (Dlco) was normal in both groups. There was no correlation between the results on pulmonary function test and duration of disease, presence of microangiopathy, or glycemic control. The Dlco was significantly lower in patients with microangiopathic changes, but not when Dlco was corrected for alveolar volume. On the cardiopulmonary exercise test, maximal workload, maximum oxygen uptake, and maximal heart rate were less than predicted, whereas anaerobic threshold and ventilatory reserve were normal. No significant differences were noted in diabetes type, and there was no correlation between parameters of cardiopulmonary exercise test and the other variables. Conclusion: Spirometric values are preserved in patients with diabetes mellitus, and there are no defects in diffusing capacity. Cardiovascular factors may account for impaired physical performance. There is no need for routine screening of pulmonary function among diabetic patients.

The influence of thyroid function on serum lipid profile.

Serum triglycerides, cholesterol, HDL-C and LDL-C levels as well as the LDL/HDL cholesterol ratio were determined in 11 patients suffering from hyperthyroidism and 7 patients suffering from hypothyroidism, and compared with those of 19 sex-and age-matched controls. In hypothyroidism a net increase of all lipid values was observed. In hyperthyroidism cholesterol and LDL-C values were reduced while those of the triglycerides and HDL-C were unchanged as compared with controls. The LDL/HDL cholesterol ratio in either group of patients was lower than in controls, the lowest being observed in thyrotoxicosis.

Propylthiouracil-induced cholestatic jaundice

The typical propylthiouracil (PTU)-linked hepatotoxicity, is known to manifest itself by hepatocellular injury with greatly increased serum transaminase values and evidence of hepatic necrosis on liver biopsy. Herewith presented is a 33-year old, thyrotoxic woman who developed cholestatic jaundice two weeks after initiation of PTU therapy. The diagnosis was confirmed by liver biopsy. A causal link between PTU treatment and the cholestatic jaundice was suggested by: the time of onset, typical skin rash and a positive migration inhibition factor (MIF) test to PTU. Awareness of this rare complication of PTU treatment may prevent the performance of unnecessary, expensive and possibly harmful diagnostic procedures.

Clinical evaluation of the effects of combined treatment with bromocriptine and spironolactone in two women with the polycystic ovary syndrome

Two women with the polycystic ovary syndrome were treated with bromocriptine (15 to 20 mg/day) in combination with spironolactone (100 mg/day). In the first woman the combined therapy induced a marked reduction of hirsutism, with ensuing ovulation and pregnancy. In the second woman, who had hyperthecosis and had been refractory to treatment with clomiphene and wedge resection, the combined therapy resulted in abolition of hirsutism, normalization of blood pressure, weight reduction, and improvement in glucose intolerance. In this patient fertility could not be established by the above treatment, but the symptomatic amelioration was so great that she accepted no further attempt to induce ovulation. In view of the marked amelioration of the polycystic ovary syndrome induced by combined bromocriptine and spironolactone treatment, this mode of therapy should receive further consideration.

Hypercalcemia in carcinoma of the breast without evidence of bone destruction: Beneficial effect of hormonal therapy

A premenopausal woman with soft tissue metastases from a carcinoma of the breast developed hypercalcemia with hypophosphatemia, reduced tubular reabsorption of phosphate, elevated urinary cyclic AMP levels and normal serum PTH levels. During the course of the disease, metastatic pleural effusion which contained high PTH levels was observed. Hormonal therapy with testosterone followed by tamoxifen induced normalization of her serum calcium concomitant with the disappearance of the pleural effusion and reduction in the size of her lung metastases. The correlation between the efficacy of antitumor treatment on pleural effusion, lung metastases, and normalization of serum calcium, as well as the elevated PTH level in the pleural effusion, suggest that this breast carcinoma secreted a PTH‐like substance.

The effect of DL-propranolol on γ-aminolevulinic acid synthetase activity and urinary excretion of porphyrins in allylisopropylacetamide-induced experimental porphyria

Abstract Experimental porphyria was induced in rats by allylisopropylacetamide. DL -Propranolol, a β-adrenergic-receptor blocking agent, significantly reduced the elevated urinary excretion of δ-aminolevulinic acid, porphobilinogen and total porphyrins. DL -Propranolol also partially prevented the increased activity of δ-aminolevulinic acid synthesis in liver homogenates of allylisopropylacetamide-treated rats. It had no effect on the above parameters in normal rats. These findings support the hypothesis that δ-aminolevulinic acid exists in two forms, a constitutive and an inducible one. In order to examine whether the action of the drug was caused by its membrane effect. D -propranolol and quinidine sulphate were used in similar sets of experiments. These drugs had no effect on the abnormal porphyrin metabolism of allylisoprpyl-acetamide-treated rats, indicating that the results obtained with DL -propranolol were not due to its membrane action.

A benign course of multicentric Castleman's disease with involvement of the spleen and bone marrow

The multicentric variant of Castlemans disease (MCCD) is associated with a rapidly progressive and fatal course. The case described herein manifested unique clinical and histological features. Initial presentation as isolated splenomegaly was subsequently followed by widespread organ involvement, including lymph nodes and bone marrow. In spite of this, the patient had a very benign course of her disease. The case serves to expand even further the already wide clinical spectrum of Castlemans disease.

Acute Delirious State After ε-Amino Caproic Acid Administration

Prior to intravenous pyelography, a patient known to have iodine hypersensitivity was injected intravenously with a bolus of 2 gm epsilon-amino caproic acid (EACA). Immediately following the injection the patient developed an acute episode manifested by a delirious state, with auditory, visual, and kinesthetic hallucinations. The entire episode lasted 8 min, and no residual psychiatric or neurologic symptoms were observed. To the best of our knowledge no such side effect of EACA has been reported so far.

Hypocalcaemia, a possible manifestation of thyrotoxicosis.

A severely thyrotoxic patient was found to have hypocalcaemia and tetany, which cleared when she became euthyroid. Cessation of treatment with propranolol and propylthiouracil resulted in a recurrence of the thyrotoxicosis and the reappearance of hypocalcaemia. Reinstitution of treatment resulted in a second remission of the thyrotoxicosis and correction of the hypocalcaemia. It is suggested that in this patient, the thyrotoxicosis was the cause of hypocalcaemia. The various pathogenetic mechanisms are discussed.

Pyrexia of unknown origin. Presenting sign of hypothalamic hypopituitarism

A 62-year-old man was admitted to hospital 10 times over 12 years because of pyrexia of unknown origin. Hypothalamic hypopituitarism was diagnosed by dynamic tests including clomiphene, LRH, TRH and chlorpromazine stimulation. Lack of ACTH was demonstrated by long and short tetracosactrin tests. The aetiology of the disorder was believed to be previous encephalitis. Following substitution therapy with adrenal and gonadal steroids there were no further episodes of fever.