'True' fasting serum insulin level, insulin resistance syndrome and coronary artery disease.

BACKGROUND: Increased fasting serum insulin level not associated with hypoglycemia is considered to be a practical indicator of the insulin resistance syndrome, a frequent risk factor for atherosclerosis in industrialized countries. However, in most studies, insulin was measured by using antibodies which cross-react with proinsulin and 31/32, 32/33 split products of insulin. We re-examined the correlations between the insulin resistance syndrome and 'true' fasting serum insulin level. METHODS: We studied 242 post-menopausal women (age 63 +/- 8 years), a population in whom insulin resistance syndrome is particularly frequent. Serum insulin was measured by a recent specific microparticle immunoassay. RESULTS: There was a significant correlation between elevated 'true' fasting serum insulin level and various constituents of the insulin resistance syndrome, such as obesity, dyslipidemia (hypertriglyceridemia, increased apolipoprotein B and decreased high-density lipoprotein cholesterol and apolipoprotein A1 concentrations), increased serum glucose, uric acid levels, and plasminogen activator inhibitor type I concentration, as well as increased frequency of diabetes. There was also a correlation between insulin level and various manifestations of coronary artery disease: patients in the highest quartile of 'true' insulin level had significantly more entirely occluded coronary arteries than in the lowest one. Similarly, in the highest insulin quartile more patients had occluded arteries with lumen diameter stenoses greater than 50% (P < 0.05) and more of them had history of previous myocardial infarction approaching the level of significance (P = 0.0587) than in the lowest one. Most of these correlations were also noted in nondiabetic people. CONCLUSIONS: An increase of 'true' fasting serum insulin level is a useful practical index to identify patients with the insulin resistance syndrome exposed to increased risk of coronary artery disease.

Early prognosis of survival or death after a recent stroke by blood levels of acute-phase proteins.

From 129 patients with a recent stroke 105 survived and 24 died within 3 weeks from stroke-onset. At around 40 hours after the latter, the blood-levels of the acute-phase proteins ceruloplasmin and albumin did not forecast the death of the respective patients, but, in contradistinction, the level of fibrinogen was significantly higher in those who eventually died, than in those who survived. Therefore, a higher level of fibrinogen could be a risk-factor for death after stroke.

Chlorpromazine-induced decrease of red cell aggregability.

Starting from the assumption that binding of chlorpromazine to the erythrocyte membrane might influence th rheology of these cells, the authors studied erythrocyte aggregability and deformability by means of a filtrability test in 42 neurotics and 16 patients with personality disorders, all males, aged 20 to 27 years, clinically healthy from the somatic view point. Determinations were carried out before and 30 min after a single i.m. dose of 1 mg/kg b.w. chlorpromazine (14 patients) and before and after a 5-day oral treatment with 3 mg/day haloperidol (11 patients) or 75 mg/day chlorpromazine (33 patients). Chlorpromazine induced a significant decrease of erythrocyte aggregability after 5 days of oral treatment (p less than 0.02) the effect being more marked in the patients with relatively high initial values (p less than 0.01). The mechanism of this phenomenon and its possible implications of ESR determination and in the therapy of occlusive vascular diseases are discussed.

Erythrocyte rheology in acute cerebral thrombosis. Effects of ABO blood groups.

Within a few hours after a cerebral thrombosis in 220 patients, the flow-properties of the red blood cells (RBC) were analyzed by a filtration test that expresses quantitatively the deformability and aggregability of the RBC by the filtration indexes pT. Abnormal deformability of the RBC washed clean of plasma was found in 27.5% of the patients. Aggregability disorders, caused by the plasma trapped between the unwashed RBC, were found in 78.6% of the patients: computation of correlation coefficients between pT indexes and fibrinogen, which was found abnormally high in 88.2% of cases, demonstrated significantly that in the patients with A and B blood groups these aggregability disorders were due to fibrinogen and that they were caused by other components of plasma in patients with O and AB blood groups. All these disorders can account for blood hyperviscosity.

Two cases of choreatic syndrome caused by polycythemia vera.

Two patients with choreatic syndromes caused by polycythemia vera recovered after treatment of the polycythemia by only two venesections: this proves that the syndrome is due to reversible alterations. Investigations of the cerebral circulation in one of the patients showed that blood flow was lowest in the grey matter at the basal region of the brain: this suggests that the alterations might mainly occur there. However, investigation of erythrocyte rheology, glucose-6-phosphate dehydrogenase, serum concentrations of caeruloplasmin and serotonin, and urinary excretion of epinephrine, norepinephrine and vanillylmandelic acid gave normal results in both patients. There are therefore no indications as to the possible pathophysiology of these alterations. There are now 24 cases reported, including our 2 patients, which suggests that the association of these two diseases may not be so rare as supposed.

[Normal values of the neutrophil granulocyte adhesion test in the peripheral blood of adults]. / Valori normale ale adultului la testarea capacitatii de aderare a granulocitelor neutrofile din sîngele periferic.

After emphasizing the importance of adhesion of cells to a substrate as fundamental biological phenomenon, the authors discuss recently published data concerning adhesion of human neutrophil granulocytes and the clinical implications of its deficiency, showing the method developed in the Center of Haematology, Bucharest, based upon the Taga-Sturdza procedure and the works of Gifford and Malawista. The study included 82 young healthy subjects. The normal mean adhesion index in women was 5.10 +/- 0.34 and in men 4.61 +/- 0.27; the statistical difference between the sexes is not significant. The proportion of NBT-positive adherent cells was 40--60% in both groups.

Intrasellar abscess.

A case of intrasellar abscess in a 31-year-old male, with pituitary insufficiency, visual field and acuity disturbances, is reported. In the pus extracted at surgery E. coli and Staphylococcus haemolyticus were identified. The patient died 20 days after the operation. Necropsy revealed the fibrous capsule of an abscess in the hypophyseal region and putriform tissue at the level of the hypothalamus, with three small tumours one of which proved to be a craniopharyngioma.