[Flocculation of NPH insulin]. / Floculación de la insulina NPH.

In the past decade, human insulins have been substituting animal insulins, offering the advantage of its lesser antigenic capacity. One of the most clinically important problems with human NPH insulins is its tendency to flocculate. We present four diabetic patients who, after using flocculated human NPH insulin, encountered a deterioration in the metabolic control of their diabetes, and in two of them, there were bouts of diabetic Ketoacidosis "without any other apparent causal factors". Among those causes favoring flocculation are movement during transport, high temperatures, and probably leaving the vial open for an excessively long period of time, as with the extraction of multiple doses. Physicians, educators, diabetics, and their relatives should be informed of this phenomenon. Diabetics, especially those who carry insulin with them, should carefully inspect their vials before each injection to detect signs of flocculation.

Nocturnal prolactin and growth hormone levels in children with complex partial and generalized tonic-clonic seizures.

This study measures whether there is a rise in the secretion of nocturnal prolactin and growth hormone (GH), during the delta phase of the first sleep cycle in children who are suffering from either complex partial or generalized tonic-clonic seizures. The findings are compared with those obtained in the control group of patients which is made up who suffer from pseudoseizures. There is a moderate but significant rise in the nocturnal prolactin plasma level in both types of infantile seizures. No significant difference was found in the GH.

[Diagnostic use of the GRF test in the study of GH secretion]. / Utilidad diagnóstica del test de GRF en el estudio de la secreción de GH.

A good response after an intravenous bolus of GRF-1-29 NH2 in patients with hypopituitary dwarfism localities the site of the GH-deficiency in the hypothalamus (GRF deficiency). These patients could be treated with GH and GRF. Never the less some patients with hypothalamic responses after TRH don't respond after GRF. Probably these non responders need GRF in pulsatile or prolonged administration and T4 substitution before and during the test if TSH is also deficient. At least some cases without GRF response can be accepted as pure pituitary only GH would be effective.

[Tests for studying the secretion of growth hormone. Update]. / Pruebas de estudio de la secreción de hormona de crecimiento. Puesta al día.

Some tests to study the growth hormone secretion have been analysed. According to our own experience and to the present criteria the physiologic tests seem to be more suitable than the pharmacologic ones. In case of discordant results, those obtained in physiologic tests completed with the clinical data and if necessary with biologic probes are conclusive. The availability of GRF will allow the treatment of some cases of dwarfism of hypothalamic origin, that in our opinion are more frequent than those of pituitary origin. Otherwise the gene studies will contribute to the understanding of some cases of genetic dwarfism and make possible an appropriate genetic counseling.

[Toxic epidermal necrolysis (Lyell's syndrome) caused by piroxicam, with fatal outcome from disseminated aspergillosis]. / Necrolisis epidérmica tóxica (síndrome de Lyell) por piroxican, con evolución fatal por aspergilosis diseminada.

A case of Lyell Syndrome provoked by ingestion of an antirheumatic drug (Piroxicam) is commented. The evolution under treatment with steroids and broad spectrum antibiotics was excellent but once recovered from this, the patient died subsequently to a systemic infectious process caused by an Aspergillosis with pulmonary involvement and secondary affectation of the kidneys, brain liver, and heart. The hepatic involvement during the acute stage is discussed and evaluated (increase of transaminases), amylasemia, amylasuria, anemia and thrombopenia which persisted throughout the process and presumably conditioned the evolution of the disease.