Extreme leucocytosis: not always leukaemia.

Three patients were analysed for an extreme leucocytosis (>50x10(9)/l) because leukaemia was suspected. In all three patients the leucocytosis proved to be caused by a leukaemoid reaction. This reaction was associated with a hepatic angiosarcoma in the first patient, with a Salmonella infection in the second patient and with a necrotic leg abscess in the third patient. Retrospectively, 25 patients with a leukaemoid reaction were identified in our hospital during a four-year period. Besides leukaemia, a leukaemoid reaction, which often has a dismal prognosis, should be considered in patients with an extreme leucocytosis.

Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: a prospective study in unselected diabetic patients.

OBJECTIVE: Data on the prevalence of abnormal gastric emptying in diabetic patients are still lacking. The relation between gastric emptying and dyspeptic symptoms assessed during gastric emptying measurement has not yet been investigated. The aim was to investigate the prevalence of delayed gastric emptying in a large cohort of unselected diabetic patients and to investigate the relation between gastric emptying and gastrointestinal sensations experienced in the 2 weeks before and during the test meal, prospectively. RESEARCH DESIGN AND METHODS: Gastric emptying was evaluated in 186 patients (106 with type 1 diabetes, mean duration of diabetes 11.6 +/- 11.3 years) using 100 mg (13)C-enriched octanoic acid added to a solid meal. RESULTS: Gastric emptying was significantly slower in the diabetic subjects than in the healthy volunteers (T(50): 99.5 +/- 35.4 vs. 76.8 +/- 21.4 min, P < 0.003; Ret(120 min): 30.6 +/- 17.2 vs. 20.4 +/- 9.7%, P < 0.006). Delayed gastric emptying was observed in 51 (28%) diabetic subjects. The sensations experienced in the 2 weeks before the test were weakly correlated with the sensation scored during the gastric emptying test. Sensations assessed during the gastric emptying test did predict gastric emptying to some extent (r = 0.46, P < 0.0001), whereas sensations experienced in the previous 2 weeks did not. CONCLUSIONS: This prospective study shows that delayed gastric emptying can be observed in 28% of unselected patients with diabetes. Upper gastrointestinal sensations scored during the gastric emptying tests do predict the rate of gastric emptying to some extent and sensation experienced during daily life does not.

The role of sulfation in thyroid hormone metabolism.

Sulfate conjugation is a significant metabolic reaction for thyroxine and especially so for triiodothyronine and lower iodothyronines in rats. Triiodothyronine sulfation has also been demonstrated in humans. Sulfation accelerates the deiodinative breakdown of iodothyronines by the type I iodothyronine deiodinase in liver and thus represents a rate-limiting step in one of the elimination pathways of thyroid hormone.

Serum triiodothyronine sulfate in man measured by radioimmunoassay.

In humans deiodination and perhaps glucuronidation are important pathways of thyroid hormone metabolism. In animals, sulfation plays an important role in T4 and especially in T3 metabolism, but little is known about sulfate conjugation of thyroid hormone in humans. In this study we used a specific T3 sulfate (T3S) RIA to address this question. Eight normal subjects were given oral T3 (1 microgram/day.kg BW) for 7 weeks. During the fifth week they also received propylthiouracil (PTU; four doses of 250 mg/day) for 2 days and during the seventh week iopanoic acid (IOP; 1 g/day) for 3 days. The mean pre-T3 serum iodothyronine values were: T4, 92 +/- 6 (+/- SE) nmol/L; rT3, 0.24 +/- 0.02 nmol/L; T3, 2.30 +/- 0.10 nmol/L; and T3S, less than 0.1 nmol/L (at or below the detection limit of the RIA). After 4 weeks of T3 administration the mean serum values were: T4, 39 +/- 6; rT3, 0.11 +/- 0.01; T3, 5.31 +/- 0.39; and T3S, 0.10 +/- 0.01 nmol/L. After 2 days of PTU administration, mean serum T4 increased to 48 +/- 7 (P less than 0.005), rT3 to 0.20 +/- 0.03 (P less than 0.025), and T3S to 0.13 +/- 0.01 nmol/L (P = NS), but serum T3 did not change (4.91 +/- 0.35 nmol/L). The effect of IOP was more pronounced; after its administration for 3 days the mean serum T4 was 49 +/- 8 (P less than 0.001), rT3 was 0.48 +/- 0.09 (P less than 0.005), and T3S was 0.29 +/- 0.04 nmol/L (P less than 0.005), and serum T3 decreased to 3.95 +/- 0.25 nmol/L (P less than 0.005). The T3S/T3 ratio was increased by PTU from 0.018 +/- 0.003 to 0.024 +/- 0.004 (P less than = NS) and by IOP to 0.055 +/- 0.007 (P less than 0.005). In conclusion, 1) serum T3S is virtually undetectable (less than 0.1 nmol/L) in normal subjects; 2) low serum T3S concentrations are detected in humans given T3; 3) serum T3S in T3-treated subjects is increased by inhibition of type I deiodinase activity with PTU and especially IOP; and 4) in comparison with previous estimates of the serum T3S/T3 ratio in rats, the low ratio in humans may indicate that sulfation is not an important mechanism of T3 metabolism in humans and/or the kinetics of plasma T3 and T3S differ in humans and rats.

Development of a radioimmunoassay for triiodothyronine sulfate.

This paper is the first description of a radioimmunoassay (RIA) for triiodothyronine sulfate (T3S). Rabbits were immunized against T3S coupled to bovine serum albumin using carbodiimide. All animals produced antibodies to T3S but also even higher titers of T3 antibodies. Ka values for binding of T3 and T3S to these antisera varied between 2 x 10(10) and 8 x 10(10) M-1. One of the antisera (#8193) was selected for use in the T3S RIA because of a high titer of T3S antibodies (final dilution 1:50,000), a high sensitivity to T3S (less than 2.5 fmol/tube), and a low crossreactivity by T3 (0.4%). This RIA provides a tool for the study of the importance of sulfation as a metabolic pathway for T3.