Richard V. Clark

Postoperative Management of Diabetes Mellitus: Steady-State Glucose Control With Bedside Algorithm for Insulin Adjustment

An algorithm was developed to determine whether an individualized insulin infusion could maintain plasma glucose in a desirable steady state after surgery. In 24 patients, insulin was provided according to a “glucose-feedback” formula to maintain plasma glucose between 120 and 180 mg/dl (6.7–10.0 mM). Initial plasma glucose was elevated, 218 ± 16 mg/dl (mean ± SE 12.1 ± 0.9 mM), but reached the target range after 8 h and remained steady for the rest of the study period. Insulin requirements varied considerably, 0.5–5.0 U/h. Infusion rates were correlated with initial plasma glucose but not with previous insulin dose, HbAlc, or percent ideal body weight. Although insulin needs cannot be predicted, plasma glucose can be maintained in a desirable range after surgery via a simple formula suitable for implementation by general ward nurses.

Male Reproduction: Fertility

Male infertility is defined as the inability to induce a pregnancy with unprotected intercourse with a presumably fertile female partner for a minimum period of 1 year (Sherins & Howards, 1986). Infertility involves a couple and, therefore, can be based on male factors, female factors, or both. A variety of clinical settings can be associated with infertility, and often patients are unaware of any existing abnormality. A male factor is suspected when the female partner shows a normal menstrual cycle with ovulation, adequate duration of the luteal phase, patency of the oviducts, and lack of pelvic pathology, especially endometriosis or tubal adhesions. When evaluating a patient with spinal cord injury, as with any male with infertility, a directed history and physical examination with assessment of reproductive hormone levels and semen characteristics from the basis of evaluation (Table 1). Male factor infertility is suggested if the male has an abnormal semen analysis, with a low sperm count, poor motility, or abnormal morphology (Clark & Sherins, 1986). As is discussed, it is difficult to select minimal criteria for any of these values below which fertility is impossible, unless considering azoospermia or necrospermia (Silber & Rodriguez-Rigau, 1981). Evidence of hormonal abnormalities may indicate testicular failure, although most infertile men have normal reproductive hormone levels. Paraplegia or quadriplegia are associated with an increased incidence of prostatitis and elevated