Graves disease associated with autoimmune thrombocytopenic purpura.

Five patients with active Graves disease had moderate to severe autoimmune thrombocytopenic purpura at the time of diagnosis. Correction of hyperthyroidism and restitution of a euthyroid state by carbimazole therapy resulted in complete normalization of platelet counts.

[Hyponatraemic encephalopathy and rhabdomyolysis. Complications after preparation for colonoscopy with mannitol]. / Hyponatriämische Enzephalopathie und Rhabdomyolyse. Komplikationen nach Koloskopievorbereitung mit Mannit.

In the preparation for colonoscopy, it is necessary to drink a great deal of often hypo-osmotic fluid. Therefore, the electrolytes and intra- and extracellular water are disequilibrated. Most of the patients tolerate this without any subjective or objective symptoms. In our case, a young male patient suffered from a severe hyponatriaemia with encephalopathy for more than 48 h through the preparation for an elective ambulant colonoscopy with mannite. Furthermore, he developed a rhabdomyolysis (either through lying on the floor in coma for more than 9 h, through the hyponatriaemia itself or through compensation of the hyponatriaemia) that lasted for ca. 1 week.

Human insulin analogue [LYS(B28), PRO(B29)]: the ideal pump insulin?

The short-acting insulin analogue lispro ([LYS(B28), PRO(B29)] is absorbed from the subcutis more rapidly than soluble insulin (S). To compare the clinical effectiveness of lispro vs S, 11 Type 1 patients using continuous subcutaneous insulin infusion (CSII) therapy (6 F, 5 M, age 30 +/- 2.5 years, diabetes duration 14 +/- 1.0 years, BMI 24.0 +/- 0.8 kg m(-2), HbA1c 6.5 +/- 0.2%) were studied in an open, randomized, crossover study for 6 months (3 months lispro and 3 months S or vice versa). During lispro treatment mean fasting and 2 h postprandial blood glucose were lower compared to the S phase (fasting 6.5 +/- 0.4 vs 7.5 +/- 0.4 mmol l(-1) (NS), postprandial 6.8 +/- 0.3 vs 8.3 +/- 0.3 mmol l(-1), p = 0.03). In patients treated first with lispro HbA1c levels improved from 6.3 +/- 0.2% to 5.7 +/- 0.3%; On reversion to S HbA1c increased to 6.2 +/- 0.2%. In the group treated first with S, HbA1c fell (6.7 +/- 0.4% vs 6.5 +/- 0.3%) and then improved further to 6.3 +/- 0.3% with lispro. None of these changes were significant. There was no significant difference with respect to hypoglycaemic or other adverse events. It can be concluded that lispro in CSII therapy is safe and may improve postprandial glucose excursions.

[Lacunar cerebral infarction in a young woman]. / Lakunärer Hirninfarkt bei einer jungen Frau.

HISTORY AND FINDINGS: A 29-year-old woman was admitted to hospital with an acute right-sided hemiplegia and sensory disorders, as well as upper right quadrant anopsia. There were no other significant abnormalities. She had previously been healthy and was free of any predisposing risk factors for thromboembolism. Neurological examination elicited a homonymous right upper quadrant hemianopsia, dysesthesia of the right half of the face and hypesthesia and hypalgesia of the right side of the body. In addition there was paresis of the right arm and a positive right Babinski reflex. INVESTIGATIONS: There was no evidence for any underlying haematological, metabolic, infectious or vascular disease. Computed tomography of the head revealed a small hypodense area immediately adjacent to the posterior part of the left internal capsule, compatible with a lacunar infarction, a finding confirmed by magnetic resonance imaging and relating to the area supplied by the thalamic branch of the posterior cerebral artery. Transoesophageal echocardiography demonstrated a patent foramen ovale. TREATMENT AND COURSE: Almost complete regression of all signs occurred within two months on anticoagulation with heparin intravenously for two weeks followed by oral phenprocoumon (Quick's value 30-40%) and intensive physiotherapy. Five weeks after onset of treatment the paresis was obviously regressing and pyramidal tract signs had disappeared. Sensitivity to touch over the right half of the body was still diminished and the homonymous paracentral scotoma still present. CONCLUSION: Lacunar infarction of the brain in young patients has an excellent prognosis, as long as it is treated intensively according to its cause.