Splenic abscess caused by Peptostreptococcus species, diagnosed with the aid of abdominal computerized tomography and treated with percutaneous drainage and antibiotics: a case report.

We describe herein a 63-year-old patient with a splenic abscess due to Peptostreptococcus spp., diagnosed with the aid of abdominal computerised tomography and treated with ultra-sound guided percutaneous drainage and antibiotics. The bacteriological characteristics of splenic abscesses are discussed.

Elevated skeletal muscle blood flow in noncomplicated type 1 diabetes mellitus: role of nitric oxide and sympathetic tone.

Capillary hyperperfusion precedes and contributes to the occurrence of diabetic microangiopathy. Vascular tone is regulated by the balance of vasodilating and vasoconstricting factors, of which nitric oxide (NO; an endothelium dependent vasodilator) and norepinephrine (NE; a potent vasoconstrictor), respectively, are of primary importance. To investigate the role of these factors in hyperperfusion, we measured forearm blood flow (FBF) in 50 patients with noncomplicated type 1 diabetes (DP) and 50 healthy control subjects (CS) under baseline conditions and during intrabrachial infusion of N(G)-monomethyl-L-arginine (L-NMMA), an endothelium-dependent vasoconstrictor, and acetylcholine (ACh), an endothelium-dependent vasodilator. Furthermore, we determined arterial plasma NE concentration at baseline and then determined alpha-adrenergic receptor sensitivity by measuring FBF response to intra-arterially infused NE. We found that basal FBF was increased in DP (2.9+/-0.1 versus 2.0+/-0.1 mL. min(-1). dL(-1) in CS; P<0.01). L-NMMA caused a similar vasoconstriction in both groups (28.5+/-1. 7% in DP versus 31.2+/-2.2% in CS; P=NS). Maximum blood flow during infusion of ACh was not different (23.3+/-1.9 mL. min(-1). dL(-1) in DP versus 20.1+/-1.6 in CS). Arterial plasma NE concentrations were significantly decreased in DP (0.57+/-0.03 versus 0.81+/-0.05 nmol/L in CS; P<0.01). The vasoconstrictive effect of NE was increased in DP (slope log dose-response curve, 31.3+/-1.5 versus 24.3+/-1.8 in CS; P<0.01). We conclude that basal FBF is increased in noncomplicated type 1 diabetes. We found no evidence of a disturbance of basal or stimulated NO production. Arterial plasma NE concentrations are decreased in noncomplicated type 1 diabetes. This may explain the vasodilatation at baseline and the increased vascular response to intra-arterially NE.

Nocturnal blood glucose profiles in patients with type 1 diabetes mellitus on multiple (> or = 4) daily insulin injection regimens.

The aim of the study was to examine nocturnal blood glucose profiles in Type 1 diabetic patients on multiple (> or = 4) daily insulin injections. Nocturnal blood glucose profiles were evaluated in 31 patients collecting blood samples half-hourly from 23.00 till 07.30 h, while they were asleep. Nocturnal episodes of hypoglycaemia (blood glucose < 3.0 mmol l-1 occurred in 29% of these nights; 67% of episodes were asymptomatic. In the early night (23.00-01.00 h), five episodes occurred with a median duration of 1 h. In the early morning (04.00-07.30 h) seven episodes occurred with a median duration of 3 h. No hypoglycaemia was noted from 01.00 to 04.00 h. Bedtime glucose levels appeared to predict 'early night' hypoglycaemia but not 'early morning' hypoglycaemia. Fasting glucose levels < 5.5 mmol l-1 were indicative of preceding 'early morning' hypoglycaemia. There was a large intra-individual variation in nocturnal blood glucose profiles. It is concluded that daily monitoring of bedtime and fasting blood glucose levels may be both more reliable and convenient for the prevention of nocturnal hypoglycaemia than periodic testing of blood glucose at 03.00h as is often advised. Setting a target of > 5.5 mmol l-1 for fasting blood glucose may decrease the frequency of nocturnal hypoglycaemia.

Partial unilateral phrenic nerve paralysis caused by a large intrathoracic goitre.

Intrathoracic goitres may cause a variety of symptoms caused by compression of the trachea, neural structures, blood vessels and the oesophagus. A case history is presented of a patient with a recurrent goitre after subtotal thyroidectomy who displayed partial unilateral phrenic paralysis, which subsided after a second subtotal thyroidectomy. Compression of the phrenic nerve appears to be a very rare manifestation of an intrathoracic goitre and thus far has never been reported.

Comparative effects of two different multiple injection regimens on blood glucose control and patient acceptance in type 1 diabetes.

In a randomized cross-over study we compared blood glucose control and patient acceptance of a 12-week basal-prandial regimen with short-acting insulin before meals and isophane (NPH) insulin at bedtime (4 injections) with a scheme with a second injection of isophane (NPH) insulin before breakfast (5 injections). Forty-three Type 1 diabetic patients (age 37 +/- 11 (+/- SD) years, duration of diabetes 15 (range 2-48) years, 26 males and 17 females) completed the study. Mean daily blood glucose was 8.6 +/- 2.4 mmol l-1 at baseline, and 8.1 +/- 2.2 mmol l-1 after the four-injection period and 7.9 +/- 2.0 mmol l-1 with five-injections (NS). HbA1c after 12 weeks was not different with the two treatments (6.6 +/- 1.1 vs 6.5 +/- 0.9%), neither was fasting blood glucose (9.6 +/- 4.2 mmol l-1 with 4 injections, and 9.0 +/- 4.4 mmol l-1 with 5 injections). Daily insulin dose did not differ between regimens (55 vs 56 U day-1). No differences in number or severity of hypoglycaemic events were observed. After the study, 13 patients preferred to continue the 5-injection regimen, and 21 patients preferred 4 injections. Treatment satisfaction with either regimen was equally high. It is concluded that dividing the intermediate-acting insulin into a morning and an evening dose did not lead to an improvement in blood glucose control in these moderately-controlled Type 1 diabetic patients.

Actions and interactions of delta 5-androstene-3 beta, 17 beta-diol and 17 beta-estradiol in the immature rat uterus.

delta 5-Androstene-3 beta, 17 beta-diol (Adiol), in a dosage of 1000 microgram/24 h injected ip into immature female Wistar rats (21-23 days old), induced 72 h after the injection the same elevations of uterine weight, cytosol protein, nuclear DNA, cytosol estrogen and progesterone receptors, and nuclear estrogen receptor levels as did 17 beta-estradiol (E2) in a dosage of 2.5 microgram/24 h. Adiol appeared to translocate the estrogen receptor and induce the synthesis of estrogen and progesterone cytosol receptors in a manner almost identical to that of E2. Studies on the metabolism of tritiated Adiol ruled out the possibility that the estrogenic effects of Adiol might be mediated by conversion to E2. Small doses of Adiol (100 microgram), which alone did not result in estrogenic effects, enhanced the effect of 2.5 microgram E2 on uterine weight and progesterone receptor levels, whereas a dosage of 100 microgram dihydrotestosterone neither enhanced nor inhibited the uterine growth induced by 2.5 microgram E2. A role for the androgen receptor in the synergism between Adiol and E2, therefore, appears to be ruled out. When Adiol in a dosage of 1000 microgram was administered together with 2.5 microgram E2, there was no important difference compared to either steroid alone up to 6 h. Thereafter, a very pronounced and prolonged secondary wave of translocation of the E2 receptor to the nucleus occurred which can explain the synergism between E2 and Adiol that became apparent in the same time interval. This secondary wave of translocation is most likely related to the persistent presence of both Adiol and E2 at the time of replenishment of the cytosol receptor (3-6 h after the injection). It is concluded that delta 5-androstene-3 beta, 17 beta-diol acts in the immature rat uterus like a fully potent estrogen with a complete lack of antiestrogenic effects. In this respect it differs from androgens like testosterone and dihydrotestosterone which can display both estrogenic and antiestrogenic activities.

Intercellular transport of steroids in the infused rabbit testis.

PIP: Tritiated-pregnenolone and tritiated-testosterone were infused via the testicular artery into the rabbit testis in situ, in order to determine if steroids can pass the "blood-testis barrier". After various periods of infusion (5-60 minutes) the testis were frozen cryostat sections were cut and freeze-dried. Interstitium and tubules were isolated by micro dissection and radioactivity per mcg dry weight was measured in both tissue compartments. Radioactive steroids could be isolated from the interstitial tissue as well as from the seminiferous tubules. Levels of radioactivity in the testes after infusion of tritiated-pregnenolone varied from 4 to 50% of the infused dose and were found to be dependent on the type of perfusion medium and the duration of the perfusion. Separation and identification of the radioactive steroids after infusing tritiated prognenolone showed that pregnenolone and testosterone were the major radioactive steroids in both interstitium and seminiferous tubules. After infusion with tritiated-testosterone, both tritiated-testosterone (77%) and tritiated-androstenedione (23%) were dound in the seminiferous tubules. It is concluded that steroids can be transported from the Leydig cells to the seminiferous tubules.^ieng