Roy Shires

Intravenous fat tolerance in obese Africans with varying grades of carbohydrate tolerance

An intravenous fat tolerance test (IVFTT) was performed and fasting plasma lipid values determined in 12 healthy normal weight, 18 obese non-diabetic, 9 obese chemical diabetic and 10 obese symptomatic diabetic African subjects. Their insulin responses to an oral glucose load were also determined. Mean plasma triglyceride levels were similar in the normal weight and obese non-diabetic groups but were significantly raised in the two diabetic groups, being highest in the symptomatic diabetics. The fractional removal-rate of an intravenous injection of the fat emulsion Intralipid was significantly less in each of the obese diabetic groups compared with the normal weight or obese non-diabetic group. There was a significant negative correlation in all but the symptomatic diabetic group between the fasting triglyceride level and the rate constants for the IVFTT. These results suggest that the rate of triglyceride clearance is an important determinant of the basal plasma triglyceride concentration in urban African subjects.

Metabolic studies in acute asthma before and after treatment.

We studied the metabolism and hormone profile of 9 patients with moderately severe acute asthma before treatment, and again 10 min after intravenous aminophylline (250 mg) or the selective beta-adrenergic stimulant hexoprenaline (5 microgram) intravenously. Compared with basal values in normal subjects the untreated asthmatics had statistically significant raised mean plasma pancreatic glucagon, free fatty acid (FFA) and glucose levels in the plasma and a significantly depressed mean plasma potassium level. Insulin, growth hormone, cortisol, thyrotropin and ketone body levels were normal. The only significant changes after therapy were a further fall in plasma potassium in the hexoprenaline-treated patients and a rise in the mean lactate concentration of the group as a whole. The clinical implications of these findings are briefly considered.

Tumour-induced osteomalacia: a curable condition

Osteomalacia is a condition characterised by failure of bone mineralisation. While abnormalities of vitamin D supply, metabolism or action are the most common and well-known causes, chronic phosphate deficiency, due to either insufficient input (intake or absorption) or renal losses are also important causes of rickets or osteomalacia.1 Hypophosphataemia also commonly co-exists with vitamin D deficiency, pursuant to secondary hyperparathyroidism. Other causes include chronic calcium deficiency, hypophosphatasia, fluoride and aluminium excess. In respect of chronic hypophosphataemia-associated rickets/ osteomalacia, the commonest aetiology is X-linked dominant hypophosphataemia, XLH, (1:20000 births).1 Others include Fanconi syndrome, autosomal dominant hypophosphataemic rickets (ADHR) and tumour-induced osteomalacia (TIO).2

Call for closure of Folateng private wards in public hospitals in southern Gauteng

The facilities available in southern Gauteng for severely ill patients with diseases related to internal medicine are currently under severe pressure. Central and regional hospitals in this region have frequently had to close to admissions because their bed occupancies have exceeded 100%. This problem started in 2013 and has become progressively worse. The reasons for this crisis are not difficult to understand: (i) there is a very high burden of illness in the population served by these public hospitals, including communicable (HIV/AIDS, tuberculosis) and non-communicable (cardiac, pulmonary, metabolic, oncological) diseases; (ii) Gauteng is the most populous province of South Africa, with just over 12 million people; and (iii) despite this ever-increasing burden of illness, a decision was taken some years ago to close a number of public health facilities such as Hillbrow and Kempton Park hospitals. In addition, a significant number of public healthcare beds were privatised for use by patients with medical aids - Folateng private wards. It is no wonder that our existing public hospitals are overwhelmed.

Double jeopardy: hypoglycaemia and advanced hepatocellular carcinoma

Abstract Nonislet cell tumour-induced hypoglycaemia is an uncommon, but serious complication of malignancy. The aetiopathogenesis is largely as a result of tumoral overproduction of incompletely processed insulin-like growth factor-II. We describe the case of a 30-year-old black male patient who presented with recurrent hypoglycaemic episodes in the absence of diabetes or any medications known to cause hypoglycaemia. Extensive investigations revealed that the hypoglycaemia was the result of an advanced hepatocellular carcinoma.

SEMDSA 2009 @ The Wanderers (18–20 June 2009)

The forthcoming SEMDSA congress promises to be a memorable academic event. Not only do we have an excellent faculty of eminent invited speakers attending, but have also had an enthusiastic response from local scientists based on the large number of abstracts received.

2005 Endocrinology and NOF Congress, 9–12 April 2005

The 2005 SEMDSA (Society for Endocrinology, Metabolism and Diabetes of South Africa) and National Osteoporosis Foundation (NOF) conferences will be held this year in Sandton on 9 - 12 April 2005.