Comparison of the activity profiles of two fixed combinations of regular/NPH human insulin (recombinant DNA) of different compositions with a fixed regular/NPH porcine insulin combination (PPI) in insulin-dependent diabetic individuals.

In a randomized double-blind crossover study, 10 insulin-dependent diabetic individuals were treated with a commercial brand of neutral, highly purified porcine insulin (PPI) with 30% regular and 70% NPH fractions (Mixtard, Nordisk, Denmark), and with human insulins (recombinant DNA) with 20% regular and 80% NPH fractions, and with 30% regular and 70% NPH fractions. Each of the preparations was given for 4 consecutive days. The human insulin combination with the 20% regular and 80% NPH components showed a similar activity profile as the PPI 30/70 combination. In contrast, the human insulin combination with the 30% regular and 70% NPH fractions produced substantially lower blood sugar concentrations with the associated risk of hypoglycemia.

Effects of therapy with recombinant human growth hormone on insulin-like growth factor system components and serum levels of biochemical markers of bone formation in children after severe burn injury.

Burn injury in children is associated with low bone formation and long-term bone loss. Because recombinant human GH (rHGH) may accelerate burn wound healing, and because rHGH increases bone formation and density in GH-deficient patients, we studied the short-term effects of rHGH on bone fomation, reflected by osteocalcin and type I procollagen propeptide levels in a randomized, double-blind, placebo-controlled study. Nineteen patients were enrolled and received either rHGH (0.2 mg/kg.day) or an equal volume of saline. Mean burn size and age were not different between the groups, and test substances were given from admission to time of wound healing (mean: 43 +/- 22 days). At wound healing, serum levels of insulin-like growth factor (IGF)-1 and IGF binding protein (IGFBP)-3 in the rHGH group rose to mean values of 229% and 187% of the respective means of the placebo group (P < 0.025). Serum osteocalcin concentrations remained below normal in both groups, and type I procollagen propeptide levels achieved a low normal level IGFBR-4 levels were twice that of normal on admission and doubled further at wound healing; IGFBP-5 levels were low on admission but rose to normal at wound healing. We conclude that large doses of rHGH were ineffective in improving disordered bone formation despite increasing serum IGF-1 and IGFBP-3. The rHGH-independent rise in serum levels of the inhibitory binding protein IGFBP-4 suggests a mechanism by which improved bone formation is prevented despite successful elevation of IGF-1 and IGFBP-3 in the burned child.

Percutaneous endoscopically guided gastrostomy in patients with head and neck cancer.

In 212 patients with tumors in the head and neck region the nutritional status prior to, during, and following radiotherapy, was determined by body measurements and biochemical and immunological parameters. In 165 orally fed patients the nutritional parameters deteriorated rapidly under radiation and afterwards recovered only slowly and incompletely, 31 patients requiring PEG during radiotherapy. By contrast, 47 patients with a poor initial status who had a prospectively performed percutaneous endoscopically guided gastrostomy (PEG) experienced an amelioration of their nutritional status even before radiotherapy ended. The subjective status of the patients was assessed using the Padilla quality of life index. Here, too, the PEG patients had significantly worse initial values than the orally fed patients. As with the objective indicators of nutritional status a significant deterioration was seen in the orally fed patients during radiotherapy, while the scores of the PEG patients remained constant. We consider early institution of a carefully monitored enteral feeding by PEG useful for stabilizing the nutritional status of patients with tumors in the head and neck region, and therefore recommend, when aggressive multimodal therapy is planned-and particularly if primary malnutrition is already obvious-prophylactic performance of PEG prior to the start of therapy.

Medium chain triglycerides in parenteral nutrition.

Until recently, medium chain triglycerides (MCT) have not been used in parenteral nutrition (PN) although they are considered to be ideal sources of energy on account of their biochemical properties. The tolerance and utilization of 10% fat emulsion with 75% MCT was tested on 10 healthy males after an overnight fast. During an infusion period of 6 hr the total fat supply rate was 0.12 g/kg body weight/hr. A commercial 10% fat emulsion (Lipofundin-S-10) served as control. The fat emulsion containing MCT was tolerated without any side effects. Compared with the commercial fat emulsion, the increase of triglycerides was markedly lower and clearing of the serum was completed earlier. By gas chromatographic analysis of the serum fatty acid pattern, medium chain fatty acids rapidly achieved a steady state. During infusion of the fat emulsion containing MCT, the production of ketone bodies was considerably higher although acidosis was not induced. The results obtained indicate that the fat solutions containing MCT bypass gluconeogenesis and are utilized quickly without side effects.

Effect of fat emulsions containing medium-chain triglycerides and glucose on ketone body production and excretion.

The parenteral application of fat emulsions containing medium-chain triglycerides results in an increase of ketone bodies as expression of the rapid metabolism of medium-chain triglycerides. Although ketoacidosis could not be watched, it should be of advantage to reduce the ketonemia. This might be reached by application of carbohydrates. The simultaneous infusion of glucose--given to 10 healthy persons--together with a 10% fat emulsion containing 75% medium-chain triglycerides almost completely inhibited the increase of ketone bodies in serum and its urinary excretion. Other prosperous metabolic effects, eg, the rapid clearance of the triglycerides from the serum were not affected by this regimen.

New diagnostic and therapeutic possibilities in manifest idiopathic hemochromatosis.

Up until recently in clinical practice suspected hemochromatosis with a pathological iron-screening test (plasma iron, percentage transferrin saturation, serum ferritin, desferrioxamine-induced urinary iron excretion) made a liver biopsy necessary. Today, as a first step, the density of the liver parenchyma can be measured by means of computed tomography. Normal findings obviate the need for laparoscopy. Since the late forties weekly or twice weekly phlebotomy has been the sole form of treatment for manifest idiopathic hemochromatosis. In the mid-sixties the hopes placed in chelating substances (desferrioxamine) were not fulfilled, because the plasma half-life (only 7-10 minutes) of this drug was too short. Even with several daily injections only a small amount of iron was removed from the body tissue (10-25 mg daily urinary iron excretion). The introduction of portable infusion pumps in the late seventies offered us a new possibility of administering desferrioxamine by subcutaneous injection (Propper et al., 1976). Until that time such treatment was successfully used only in the field of pediatrics to treat secondary transfusion hemochromatosis in thalassemia. In one case of idiopathic hemochromatosis with severe organic involvement (right heart failure, repeated esophageal hemorrhage and bronzed diabetes) we had to achieve rapid iron elimination, and for this purpose we used continuous long-term desferrioxamine administration by means of a portable infusion pump (Autosyringe) in addition to phlebotomy. Since, particularly in the critical initial phase of treatment when heart failure was always threatening, great care had to be exercised in the use of phlebotomy, iron removal was achieved largely by desferrioxamine administration (daily up to 240 mg iron elimination in urine and stools).(ABSTRACT TRUNCATED AT 250 WORDS)

[Total parenteral nutrition in the home of 498 patients with tumor diseases]. / Totale parenterale Heimernährung bei 498 Patienten mit Tumorerkrankungen.

Results of home parenteral nutrition in cancer patients were evaluated by analyzing files from 498 individuals. The predominant malignancies were cancer of the stomach (44% in men, 29% in women), the colon or the ovaries, respectively. Most patients (71%) admitted to home parenteral nutrition were severely malnourished, based on a Broca-Index of 0.8 or less. The majority (78%) of these subjects gained weight while on home parenteral nutrition. The remainder 22% continued to loose weight. Median survival was 64 (one to 720) days.

[Weight reduction, statins or fibrates? How to reach lipid goal values in diabetic patients]. / Abspecken, Statine oder Fibrate? Wie Sie bei Diabetikern die Lipid-Zielwerte erreichen.

Diabetics have a greatly increased risk for cardiovascular disease. At the center of the pathogenesis is the elevated blood sugar, insulin resistance and hyperinsulinemia. Treatment must therefore be aimed at controlling glucose metabolism (HBA1c < 7.0%) and lipid metabolism (LDL conc < 100 mg/dL, triglycerides < 150 mg/dL). Blood pressure should not exceed 130/85 mmHg. In addition to changes in lifestyle--low-fat, calorie-controlled diet and increased physical activity--lipid-lowering medication can rarely be done without. On the basis of the results of large interventional studies, the CSE inhibitors are particularly to be recommended. While the domain of the fibrates is the lowering of triglycerides, no comparative data on the usefulness of this group of substances are currently available.