Nitrogen metabolism and insulin requirements in obese diabetic adults on a protein-sparing modified fast.

A protein-sparing modified fast (PSMF), which is a total fast modified by the intake of 1.2-1.4 gm. protein per kilogram ideal body weight (IBW), fluids ad libitum, and vitamin and mineral supplementation, allows effective control of carbohydrate metabolism and hunger. It reduces serum glucose and insulin concentrations in obese diabetic patients and increases free fatty acid and ketone body concentrations; ketonuria appears within 24-72 hours. When this fast was applied to seven obese adult-onset diabetics who were receiving 30-100 units of insulin per day, insulin could be discontinued after 0-19 days (mean, 6.5). In the three patients who had extensive nitrogen-balance studies, balance could be maintained chronically by 1.3 gm. protein per kilogram IBW, despite the gross caloric inadequacy of the diet. The PSMF was tolerated well in an outpatient setting after the initial insulin-withdrawal phase had occurred in the hospital. Significant improvements in blood pressure, lipid abnormalities, parameters of carbohydrate metabolism, and cardiorespiratory, symptoms were associated with weight loss and/or the PSMF. For diabetics with some endogenous insulin reserve, the PSMF offers significant advantages for weight reduction, including preservation of lean body mass (as reflected in nitrogen balance) and withdrawal of exogenous insulin.

Are malignant melanoma time trends explained by changes in histopathological criteria for classifying pigmented skin lesions?

The incidence of malignant melanoma in developed countries has been rising rapidly in recent years. Its causes and the reasons for this trend are uncertain. Changes in histopathological criteria for classifying pigmented skin lesions could explain the rising incidence rates. With support from the International Agency for Research on Cancer, this hypothesis is explored but not substantiated for time trends in the South Western Region, United Kingdom.

A week in the life of a comprehensive corporate medical department.

By expanding traditional services and instituting nontraditional ones, a property structured corporate medical department is practical and cost-effective for sites with as few as 250 employees. The Corporate Medical Director of Avtex Fibres, Inc. oversees a department serving several thousand employees and kept a diary for HCM to show how it works. Along with the Company's Health Care Manager, he describes Avtex's health care structure. In the next issue of HCM, they will detail management's philosophy, departmental costs, savings and money-making potential, and offer guidance to organizations interested in establishing or expanding their own medical departments.

The effect of pre-emptive acupuncture treatment on analgesic requirements after day-case knee arthroscopy.

The role of acupuncture analgesia in the management of postoperative pain is yet to be clearly evaluated. We conducted a prospective, double-blind, randomised controlled study to evaluate the effect of acupuncture pretreatment on the analgesic requirement after knee arthroscopy. Forty-two patients presenting for unilateral knee arthroscopy were randomly allocated to receive a standard anaesthetic with or without acupuncture (given after the induction of anaesthesia). Visual analogue pain scores, time to first postoperative analgesia and total analgesia requirement in the first 24 h were recorded. There was no significant difference between the two groups in any of the outcome measures. We conclude that acupuncture analgesia has no additional effect when given under anaesthesia to patients undergoing knee arthroscopy.