Magnesium content of the human heart.

Although changes in the body's magnesium status have been linked to ischemic heart disease, sudden death and arrhythmia, there is as yet no recommended, established procedure for evaluation of magnesium homeostasis. We therefore explored the relationship between the magnesium content of the heart and that of serum, lymphocytes and skeletal muscle in 50 men undergoing cardiac surgery, using biopsies from the right auricula, right atrium and skeletal muscle and simultaneously drawn venous blood for measurement of lymphocyte and serum electrolyte concentration. Median magnesium values (mumol/g wet weight) were 7.42 (3.98-8.89) in skeletal muscle, 5.49 (3.44-7.66) in right auricula and 5.80 (2.60-7.53) in right atrium. The magnesium concentration in skeletal muscle was found to correlate with that in right auricula (r = 0.46, p less than 0.01) and right atrium (r = 0.43, p less than 0.01), whereas values in serum and lymphocytes showed no correlation with the heart's magnesium content. When myocardial biopsy is not available, skeletal muscle magnesium concentration seems to be the best predictor of the human myocardium's magnesium status.

Thoraco-pleural actinomycosis presenting like diffuse pulmonary embolism.

Actinomycosis is an uncommon infection. The regions mostly involved are the cervico fascial area, the thorax and the abdomen. The thoracic variety accounts for approximately 15% of the cases. Clinical pictures of pulmonary neoplasm, abscess, and empyema have been described. Misleading symptoms often delay the right diagnosis. The present study describes a case of actinomycosis with pleuro-pulmonary involvement. A 48-year woman had been well until two and a half years previously, when she developed symptoms suggestive of pneumonia. When referred to a medical clinic with thoracic pain and tiredness, pulmonary embolism was suspected. Inhalation and perfusion scintigraphy showed several perfusion defects. There were several relapses, with clinical pictures suggestive of pulmonary embolism, before an abscess in the left axilla appeared. Drained pus showed no growth of Actinomycetes. Correct diagnosis of the true cause was only possible by direct microscopy. Possible symptoms and the diagnostic difficulties when Actinomycetes is involved are discussed.

Comparison of continuous subcutaneous insulin infusion with multiple insulin injections using the NovoPen.

Twenty-one patients with insulin-dependent diabetes mellitus (IDDM) participated in a 20-week randomized cross-over comparison of continuous subcutaneous insulin infusion (CSII) with intensified conventional treatment (ICT) using the NovoPen. The Medix or the Auto-Syringe pumps were used for CSII and, during ICT with NovoPen, conventional plastic syringes were used for injections of intermediate-acting insulin at bedtime. At entry HbA1c, was 8.7 +/- 0.4% (mean +/- SE) in CSII patients and 8.8 +/- 0.5% in the ICF group. HbA1c declined significantly in both groups (ICT 7.6 +/- 0.2%; CSII 7.6 +/- 0.2%) though there was no significant difference between the responses. Overall mean blood glucose was slightly but significantly lower during CSII than during ICT (CSII: 7.6 +/- 0.2 mmol/l; ICT: 8.7 +/- 0.4 mmol/l, p less than 0.05). The number of hypoglycaemic episodes did not differ significantly between patients treated with NovoPen and CSII. At the end of the study, a questionnaire revealed that all but one patient preferred ICT with NovoPen to conventional therapy. Given the choice for future treatment, 6 patients chose CSII, 12 patients preferred ICT with NovoPen and 1 was unsure.

HLA associations in insulin-dependent diabetes mellitus diagnosed during pregnancy.

Sixty out of 63 patients with insulin-dependent diabetes mellitus (IDDM) diagnosed during pregnancy in the Diabetes Centre at the Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen, were re-examined 2-16 years after diagnosis. Fourty-six patients were currently insulin-treated and the remaining 14 patients were all severely glucose intolerant. HLA-typing was carried out in 41 of these patients. The HLA phenotype distribution showed a highly significant difference from that of non-diabetics but was similar to that seen in IDDM not related to pregnancy. Thus, pregnancy may constitute a special trigger mechanism for IDDM, but the subsequent pathogenic mechanisms are probably the same as those involved in other cases of IDDM.

Outcome of the glucagon test depends upon the prevailing blood glucose concentration in type I (insulin-dependent) diabetic patients.

The outcome of 97 paired glucagon and meal tests was related to the prevailing fasting blood glucose concentrations on the two test days. At blood glucose concentration less than 7 mmol/l both the C-peptide responses and the maximal (6 min) C-peptide concentrations during the glucagon tests were significantly lower than the corresponding values found during the meal tests. During the glucagon tests, a direct relationship was found between the responsiveness of the pancreatic beta-cells and fasting blood glucose values when these were between 3 and 7 mmol/l. No significant difference was found between the outcome of the two tests when the fasting blood glucose concentration was greater than 7 mmol/l. The results indicate that the outcome of the glucagon test in Type I patients depends upon the prevailing fasting blood glucose concentration and that the predictive value of the glucagon test as to how the beta-cells will respond to a meal during everyday life is low when fasting blood glucose is less than 7 mmol/l.