Actinomycosis of the abdominal wall after cholecystectomy: transferral theory.

Abdominal actinomycosis is a rare disease caused by Gram-positive anaerobic Actinomyces bacteria. Here, we present a patient with an intrauterine contraceptive device who developed a long lasting and unexplained recurrent, painful abdominal swelling a few months after a laparoscopic cholecystectomy.

Effect of miglitol (BAY m-1099) on fasting blood glucose in type 2 diabetes mellitus.

BACKGROUND: In type 2 diabetes mellitus, fasting blood glucose values are increased due to increased glycogenolysis and gluconeogenesis. As miglitol (BAY m-1099), an absorbable alpha-glucosidase inhibitor, can inhibit glycogenolysis, we investigated whether 200 mg miglitol ingested at bedtime could decrease fasting blood glucose values. METHODS: Twelve type 2 diabetic patients participated in a double-blind, randomised, placebo-controlled, cross-over study. The study duration was 6 weeks: 2 weeks run-in, 2 test periods of 1 week with 2 weeks of wash-out in between. During run-in and wash-out periods placebo tablets were used. Fasting blood glucose (FBG), insulin (FIRI), C-peptide (FCP), glucagon (FG), pyruvate and alanine were measured at the start of the study, at the end of the run-in and wash-out periods, and at the 6th and 7th day of each test period. RESULTS: Both during miglitol and placebo no effects on FBG (12.2 +/- 2.5 vs. 12.2 +/- 2.5 mmol/l), FIRI (80 +/- 34 vs. 82 +/- 35 pmol/l), FCP (1110 +/- 303 vs. 1043 +/- 304 pmol/l), FG (20 +/- 13 vs. 20 +/- 10 pmol/l), pyruvate (101 +/- 28 vs. 112 +/- 30 mumol/l) or alanine (440 +/- 87 vs. 465 +/- 133 mumol/l) were observed. CONCLUSIONS: Miglitol 200 mg taken at bedtime for 1 week has no influence on hepatic glucose production.

alpha-Glucosidase inhibition by miglitol in NIDDM patients.

OBJECTIVE: To determine the efficacy of the alpha-glucosidase inhibitor miglitol (BAYm 1099) regarding the starch content of food. RESEARCH DESIGN AND METHODS: Thirty-six non-insulin-dependent diabetes mellitus (NIDDM) subjects were studied in a double-blind randomized study comparing treatment with a single dosage of 100 mg miglitol or placebo and a single-blind crossover comparison of three test meals in which the carbohydrate contained either 30, 50, or 70% starch, and quantities of fat and protein were kept constant. RESULTS: Postprandial blood glucose excursions were reduced by approximately 50% with miglitol after all test meals. In contrast, after miglitol treatment, maximum postprandial serum C-peptide and insulin values reached the same levels as after placebo treatment, although the time to reach these maximum levels was delayed. Free fatty acid values decreased after both miglitol and placebo similarly. Twenty-eight untoward events in 15 patients were reported in the miglitol treatment group and 11 events in 7 patients in the placebo treatment group. CONCLUSIONS: Miglitol reduces postprandial blood glucose excursions independent of the starch content of the meal. Because no effects were found on incremental postprandial maximal levels of serum insulin and C-peptide, it may be that miglitol exerts, in addition to a delay of intestinal carbohydrate absorption, extraintestinal effects as well, particularly effects on disposition of glucose or anti-insulin counterregulatory factors.

Calcium entry blockers and their effects on glucose metabolism.

Calcium entry blockers have been used for cardiovascular disturbances such as angina pectoris and hypertension. Calcium is, however, involved in the release of several hormones. The process of insulin secretion by the pancreatic beta-cells is dependent on calcium. Thus, calcium-entry blockers may interfere with insulin secretion. This effect has been confirmed in vitro in isolated islets as well as in animal studies. A few case reports describe the deterioration of glycaemic control or development of frank diabetes mellitus during treatment with nifedipine or diltiazem. In general, however, there are no important negative effects of calcium-entry blockers on glucose tolerance, either in non-diabetic persons with hypertension, or in patients with diabetes mellitus. Hence, these drugs appear to be a good choice for use in diabetic patients with cardiovascular diseases.

[Immigrants with abdominal pain: familial Mediterranean fever?]. / Buitenlanders met buikpijn: familiaire mediterrane koorts?

Three patients of Turkish origin with recurrent abdominal complaints and fever are presented. All had consanguineous parents and two were brothers. Biochemistry and haematology were normal except for a high sedimentation rate. With reference to these patients, some aspects of the diagnosis and the therapeutic approach of familial Mediterranean fever are discussed. In patients of Turkish origin who complain of abdominal pain, familial Mediterranean fever should probably be considered more often.