[Specialist examination in clinical chemistry. Voluntary examination for higher competence]. / Specialistexamen i klinisk kemi. Frivillig examination för ökad kompetens.

The Swedish Society for Clinical Chemistry has now completed its second board examination for voluntary specialist diploma in clinical chemistry. The first day comprised a 6 hour written examination (about 20 essay questions). The second day was an oral examination in front of five clinical chemists representing different aspects of the specialty, firstly as questions on the subject as a whole and secondly in the form of a seminar where original research work carried out by the examinee was discussed.

Type 2 diabetes. Primary vascular disorder with metabolic symptoms?

It is postulated that in the resting state insulin-dependent tissue uptake of glucose is limited by the rate of blood flow, capillary permeability, and the number of perfused capillaries in the skeletal muscles. A mathematical model, simulating these relations, is developed. According to this model, changes in the indicated parameters might cause type 2 diabetes.

Metabolism and possible health effects of aluminum.

Literature regarding the biochemistry of aluminum and eight similar ions is reviewed. Close and hitherto unknown similarities were found. A hypothetical model is presented for the metabolism, based on documented direct observations of Al3+ and analogies from other ions. Main characteristics are low intestinal absorption, rapid urinary excretion, and slow tissue uptake, mostly in skeleton and reticuloendothelial cells. Intracellular Al3+ is probably first confined in the lysosomes but then slowly accumulates in the cell nucleus and chromatin. Large, long-lived cells, e.g., neurons, may be the most liable to this accumulation. In heterochromatin, Al3+ levels can be found comparable to those used in leather tannage. It is proposed that an accumulation may take place at a subcellular level without any significant increase in the corresponding tissue concentration. The possible effects of this accumulation are discussed. As Al3+ is neurotoxic, the brain metabolism is most interesting. The normal and the lethally toxic brain levels of Al3+ are well documented and differ only by a factor of 3-10. The normal brain uptake of Al3+ is estimated from data on intestinal uptake of Al3+ and brain uptake of radionuclides of similar ions administered intravenously. The uptake is very slow, 1 mg in 36 years, and is consistent with an assumption that Al3+ taken up by the brain cannot be eliminated and is therefore accumulated. The possibility that Al3+ may cause or contribute to some specific diseases, most of them related to aging, is discussed with the proposed metabolic picture in mind.