Robert Kaye

Beta adrenergic blockade and juvenile diabetes: Acute studies and long-term therapeutic trial: Evidence for the role of catecholamines in mediating diabetic decompensation following emotional arousal†††

In comparison with normal children, the diabetic child has a significantly more rapid increase of blood ketones following injection of epinephrine. Beta adrenergic blockade with MJ 1999 removes this ketone responsiveness, presumably by interfering with free fatty acid release from adipose tissue triglyceride, and perhaps from hepatic, stores. Two diabetic preadolescent girls, who were virtually incapacitated because of repeated hospitalizations for severe diabetic ketoacidosis, were studied. A specific stress interview with one child produced marked changes in blood glucose and plasma free fatty acid concentrations, associated with significant increases in plasma concentrations of corticoids and growth hormone as well as in urinary excretion of epinephrine. Beta adrenergic blockade prior to a repeat stress interview blocked the metabolic changes without interfering with the hormonal response to stress. During a therapeutic trial with MJ 1999 for the past 12 months, the need for hospitalization for each of these children has been markedly decreased.

Persistent jaundice in infancy

I have collected the opinions of a number of pediatricians and pediatric pathologists regarding the causes of persistent jaundice during infancy. Most would discard the term “inspissated bile syndrome”, but there is less unanimity regarding the meaning of “neonatal hepatitis”, the significance of giant cells in the liver, and the value of needle biopsies. The many causes of infantile jaundice are mentioned, and hepatic physiology during the neonatal period is discussed. Finally, a program is outlined for the study of the infant with persistent jaundice. The value of the determination of the excretion of radioactive rose bengal in differentiating complete biliary atresia from other causes of jaundice is emphasized.

Streptomycin in the treatment of influenzal meningitis

Summary 1. Streptomycin is effective against H. influenzae type B in vivo as well as in vitro. 2. Eight patients with meningitis due to this organism were treated. Four recovered, three died, and in one, therapy was given up in favor of sulfonamide and serum. 3. Death in one case was associated with the appearance of drug fastness. 4. Toxic reactions encountered include: erythema, urticaria, augmentation of meningeal signs, persistence of pleocytosis, local pain on injection, and mild shock on initial administration. None of these was serious. 5. Streptomycin is worthy of further clinical trial in cases of infections due to H. influenzae type B, and also in cases of meningitis due to bacterial agents which are sensitive to this drug.

Intestinal absorption of insulin in patients with fibrocystic disease

Summary Patients with fibrocystic disease were studied in an effort to determine the extent of intestinal absorption of insulin in human subjects who lack pancreatic proteolytic enzymes. Crystalline insulin was administered intraduodenally. Resultant changes in blood glucose, plasma free fatty acids, and plasma insulin levels suggest that pancreatic enzymes do play a role in preventing insulin absorption from the human gastrointestinal tract. When considered in light of the quantity of insulin administered, however, the changes in these parameters are relatively small. This suggests that other factors may be more important in contributing to the apparent resistance to insulin absorption under these circumstances.

Disorders of Carbohydrate Metabolism in Infancy, Vol 3: Major Problems in Clinical Pediatrics

Drs. Cornblath and Schwartz have made a significant contribution to pediatric literature by preparation of this monograph. The authors are active investigators in the field which they discuss. They have succeeded in bringing together in a compact volume the pertinent physiologic, biochemical, and clinical material necessary to provide the reader with the background for effective diagnosis and treatment of this group of disorders. The discussion of the various hypoglycemic syndromes should be of particular value because of the relative frequency with which they are encountered and the systematic approach to their diagnosis and management that is presented. Readers will also benefit from the current review of certain areas in which new information has appeared with considerable rapidity and in somewhat fragmentary fashion: the various glycogen storage diseases, hereditary fructose intolerance, and the disorders of carbohydrate absorption and digestion. The volume does not consider juvenile diabetes mellitus but limits itself to