Effects of a behavioral weight loss program stressing calorie restriction versus calorie plus fat restriction in obese individuals with NIDDM or a family history of diabetes.

OBJECTIVE: The aim of this randomized trial was to compare the effects of a behavioral intervention focusing on either calorie restriction alone or calorie plus fat restriction on weight loss and changes in lipids and glycemic control in individuals with non-insulin-dependent diabetes mellitus (NIDDM) or a family history of diabetes. RESEARCH DESIGN AND METHODS: We recruited 44 obese women with NIDDM and 46 obese women with a family history of NIDDM and randomly assigned these subjects to calorie restriction (CAL) or to calorie plus fat restriction (CAL + FAT). All subjects participated in a 16-week behavioral weight loss program, with training in diet, exercise, and behavior modification. Subjects assigned to the CAL condition were given a 1,000-1,500 kcal/day goal and self-monitored calories consumed. Subjects assigned to the CAL+FAT condition had the same calorie goal, but were also given a fat goal (grams of fat/day), to produce a diet with < 20% of calories from fat; this group monitored both calories and fat grams. RESULTS: Among NIDDM subjects, weight loss of the subjects in the CAL+FAT condition was significantly greater than subjects in the CAL condition (7.7 vs. 4.6 kg) and the CAL+FAT condition group also maintained their weight loss better at the 1-year follow-up (5.2 vs. 1.0 kg). Significant decreases in glucose, high-density lipoprotein (HDL) cholesterol, and total cholesterol were seen after 16 weeks of treatment among NIDDM subjects; these changes were similar in CAL and CAL+FAT groups, but a greater proportion of subjects in CAL condition required oral hypoglycemic medication. At the 1-year follow-up, all parameters had returned to baseline. No significant differences in weight loss or physiological changes were seen between CAL and CAL+FAT conditions in subjects with a family history of diabetes. CONCLUSIONS: These results suggest that using the combination of calorie and fat restriction may help promote weight loss in obese NIDDM patients. No other long-term benefits of this regimen were observed.

[CT-guided celiac ganglion block. The authors' own experience]. / Blocco del ganglio celiaco mediante guida TC. Esperienza personale.

Celiac plexus neurolysis is considered an effective technique for relieving abdominal cancer pain. CT yields accurate anatomical detailing, thus allowing the indirect location of the celiac plexus and the planning of needle trajectory and positioning. September 1992 to December 1993, twenty-eight celiac plexus neurolyses for pain relief were performed in 26 patients (13 men and 13 women), 17 through the anterior and 11 through the posterior access. These patients had been referred to our department for pain management. Forty-eight hours after alcoholization, 20 patients (71%) had complete pain regression and their analgesic treatment was thus discontinued. 36% of the patients did not need any analgesics for 30 to 169 days. No neurologic complications were observed. Only transient orthostatic hypotension requiring no treatment developed in all our patients during the first 24 hours after the block. To conclude, we believe celiac plexus alcoholization under CT guidance to be a safe and effective technique for relieving abdominal pain due to cancer or benign conditions. We prefer the anterior approach because it is better accepted by the patients and more easily performed by the operators.

Flow cytometric analysis of growth hormone-secreting pituitary adenomas.

Flow cytometric DNA analysis was performed on samples of paraffin-embedded and fresh adenomatous pituitary tissue removed from 16 patients with growth hormone (GH)-secreting pituitary adenomas. Histograms consistent with aneuploidy were found in 5 of 16 patients. The flow cytometric patterns on fresh and paraffin-embedded tissues yielded similar results. Ploidy did not correlate with the clinical course or the endocrine profiles in these patients. We conclude that flow cytometric DNA analysis can detect aneuploidy in adenomatous pituitary tissue, but it does not predict the clinical course of GH-secreting adenomas.

Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients.

OBJECTIVE: To examine the effects of caloric restriction, independent of differences in weight loss, on improvements in glycemic control, fasting insulin, and insulin sensitivity. RESEARCH DESIGN AND METHODS: We randomized 93 obese type II diabetic patients to two different degrees of calorie restriction (1,674 or 4,185 kJ/day; 400 or 1,000 kcal/day) and compared the changes in fasting glucose, fasting insulin, and insulin sensitivity that resulted from a comparable reduction in body weight (11% of initial body weight). Insulin sensitivity was assessed using the minimal model analysis of frequently sampled intravenous glucose tolerance tests. RESULTS: Despite equal weight losses, subjects in the 1,674 kJ/day (400 kcal) condition had lower fasting glucose levels (7.61 vs. 10.13 mM, P = 0.03) and greater insulin sensitivity (1.79 vs. 1.13, P = 0.04) after weight loss than did subjects in the 4,185 kJ/day (1,000 calorie) condition. Subjects were restudied 15 weeks later when both groups were consuming a 4,185 kJ/day (1,000 kcal/day) diet. Subjects who increased from 1,674 to 4,185 kJ (400 to 1,000 calories) had worse fasting glycemic control in spite of continued weight loss, whereas subjects who remained on 4,185 kJ (1,000 calories) throughout had further improvements in both blood glucose and insulin sensitivity with increased weight loss. CONCLUSIONS: Both degree of calorie restriction and magnitude of weight loss have independent effects on improvements in glycemic control and insulin sensitivity.

Endothelin-1 gene expression in human pheochromocytoma.

We examined expression of human endothelin-1 (ET-1) in adrenal tissues removed from five patients with pheochromocytomas and two patients with aldosterone-producing adenomas. The pheochromocytomas contained a 2.3 kilobase ET-1 transcript, which was not found int he aldosteronomas. Constitutive expression of ET-1 varied in magnitude among the pheochromocytomas but was generally at a low level. Immunohistochemical staining of the pheochromocytomas with an antiserum to human ET-1 showed the presence of immunoreactive ET-1 as well. The presence of ET-1 messenger ribonucleic acid and ET-1 immunoreactivity in human pheochromocytomas suggests a possible paracrine role for this peptide in human chromaffin cells.

The oxytocin secretory response during suckling in the hypoosmolar lactating rat.

Secretion of oxytocin into the peripheral circulation of rats is stimulated by suckling and inhibited by hypoosmolality. We compared the oxytocin secretory response to suckling in 1 week post partum lactating rats rendered hyponatremic for 48 h to matched lactating normonatremic cohorts. Pituitary content of oxytocin and peripheral oxytocin secretory responses to suckling were equivalent in normonatremic and hyponatremic animals. We conclude that induction of sustained hyponatremia for 48 h does not inhibit suckling-induced oxytocin release in lactating rats.

Amyloid deposits in a prolactin-producing pituitary adenoma.

A 33 year old woman was diagnosed at surgery with a PRL-producing pituitary adenoma containing spherical amyloid. Circulating PRL in this patient was immunologically and chromatographically similar to classical 20,000-dalton PRL. PRL staining within the tumor was confined to the adenoma cells and was not found within the amyloid deposits. Immunohistochemical staining of the pituitary amyloid deposits was negative for calcitonin gene-related peptide and islet-amyloid polypeptide. Pituitary amyloid may be different from amyloid in other endocrine tissues.

[Mid-term effects of 1-carnitine on the lipidogram of rabbits with surgically denervated heart]. / Effetti nel medio termine della 1-carnitina sul lipidogramma di coniglio con cuore chirurgicamente denervato.

L-Carnitine induces reversibility upon the lipid-graph of a rabbit with a surgically denerved heart after 90 days since it reduces the percentage of stearic acid but also increases thoroughly linoleic acid that notoriously has a plastic and regulatory effect on the heart.