Tetany and osteolysis in light chain myeloma with amyloidosis.

A patient is described with light chain myeloma and amyloidosis in whom 2 unusual complications occurred, diffuse osteolytic lesions and tetany. These observations extend the previously recognized clinical spectrum of this disorder.

T cell subpopulation dynamics following insulin-induced hypoglycaemia in normal subjects.

Using monoclonal antibodies OKT3, OKT4 and OKT8, T lymphocyte subpopulations were determined in eight normal male volunteers. One month later, the T cell populations were again measured before and during an insulin stress test. Compared to the month before, there was a statistically significant reduction in the numbers of OKT4 cells (P less than 0.01) in the basal sample. Administration of insulin produced a statistically significant rise in the numbers of total lymphocytes and in each of the T cell subpopulations at 30 and/or 60 min (P less than 0.01) when compared with the basal values. It was also noted that in some of the subjects, the sum of OKT4 and OKT8 cells was greater than the number of OKT3 cells after insulin administration. This suggests that under certain circumstances T cells in circulation may express both the helper and suppressor cell antigen. Insulin stress test is associated with increased production of stress hormones in response to the hypoglycaemia, and the observed lymphocyte changes may be mediated via these hormonal alterations.

Longitudinal study of thyroid function in acutely ill elderly patients using a sensitive TSH assay-defer testing until recovery.

A prospective longitudinal study of thyroid function was conducted in 180 consecutive admissions to an acute geriatric unit. The rest strategy included assay of TSH and TRH testing when appropriate. On admission TSH was suppressed (less than 0.1 mU/l) in 17 patients (9.4%) and elevated (greater than 4.0 mU/l) in 8 (4.4%). Follow-up of these initial abnormalities showed resolution in almost all cases. Our findings suggest that acute illness may interfere with the hypothalamic-pituitary-thyroid axis, causing either temporary suppression or stimulation of TSH release. Although no new cases of thyroid disease were diagnosed, the prevalence of established dysfunction was 3.3% (2.7% hypothyroid; 0.6% hyperthyroid). To avoid misleading results, testing of thyroid dysfunction should be delayed until recovery from illness.

Transfer from animal insulins to semisynthetic human insulin: a study in four centres.

The effects of transfer from animal insulin to semisynthetic human insulin on glycaemic control, insulin dose and anti-insulin antibodies were investigated in a total of 108 patients at four centres in a double-blind controlled study of eight months duration. Six months after transfer from porcine to human insulin there was a mean (+/- SE) increase in pre-breakfast blood glucose of 1.1 +/- 0.6 mmol l-1 (vs a reduction of 1.6 +/- 0.7 mmol l-1 in controls) (p less than 0.01), and a mean increase of pre-lunch blood glucose of 0.9 +/- 0.7 mmol l-1 (vs a reduction of 1.14 +/- 0.7 mmol l-1 in controls) (p less than 0.05). Six months after transfer from bovine to human insulin, there were no significant changes in blood glucose. Glycated haemoglobin showed no significant change six months after transfer from either bovine or porcine to human insulin. Hypoglycaemic symptoms, the total daily insulin dose, and the ratio of short- to intermediate-acting insulin did not change significantly after transfer from either bovine or porcine to human insulin. Transfer from bovine to human insulin resulted in a significant decline in anti-human insulin antibodies (mean (range): 50.5(14.8-125)% of initial levels), vs controls (113(43.4-234)% of initial levels; p = 0.034), and a non-significant decline in anti-bovine insulin antibodies (52.2(25.8-111)% vs 81.7(42.5-128)%; p = 0.082).