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SummaryAn oral glucose tolerance test was performed in patients who had undergone truncal vagotomy and pyloroplasty, bilateral selective vagotomy and pyloroplasty, or highly selective vagotomy without a drainage procedure at least six months earlier. The results were compared with those from patients with chronic duodenal ulcer before operation. In all three groups of patients after vagotomy more rapid rates of rise of blood glucose and higher peak concentrations were observed than in patients who were tested before operation. These differences were statistically significant only in patients who had undergone truncal or selective vagotomy with pyloroplasty and were probably due to more rapid rates of gastric emptying after these operations.Plasma insulin concentrations were lower after truncal vagotomy than after selective or highly selective vagotomy, the difference between truncal vagotomy and highly selective vagotomy being statistically significant. Truncal vagotomy resulted in a diminished insulin response to oral glucose, which could have been due to vagal denervation of the pancreas or, more probably, impaired release of small-bowel hormones which normally augment the pancreatic insulin response.

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The volume of Leydig cells (Vw) has been measured histometrically, using biop-;sies, in a retrospective series of 50 cases of 'chromatin-positive Klinefelter's syndrome. The mean Vui was 0.82 ml, which is within normal limits. It therefore appears that there is no hyperplasia of these cells in this condition. The only very high VM appeared to be the result of removal of the other testis ten years earlier. Three cases with very low Via showed marked evidence of androgen deficiency. (J Clin Endocr 33: 517, 1971)

Summary Glucose tolerance and insulin secretion have been measured in twenty-three obese maturity-onset diabetics (twelve high-insulin secretors and eleven lowor normal-insulin secretors) on first presentation and after 10 weeks on a low-calorie diet. There was a significant improvement in glucose tolerance alone, when the results were compared with those from diabetics not on any form of treatment. Thereafter nine of these subjects (five high-insulin secretors and four low- or normal-insulin secretors) continued on the dietary therapy alone, and eleven of the remaining fourteen subjects (six high-insulin secretors and five low- or normal-insulin secretors) continued on the low-calorie diet with the addition of fenfluramine, and their glucose tolerance and insulin secretion were measured again after a further 10 weeks. The remaining three subjects were no longer studied. The nine subjects continuing on the diet alone showed maintenance of the improvement in glucose tolerance achieved during the first 10-week period with no significant change in insulin secretion. The eleven subjects placed on fenfluramine in addition to the diet also showed maintenance of the improvement in glucose tolerance achieved during the first 10-week period with a significant decrease in insulin secretion in the six high-insulin secreting subjects and no significant change in insulin secretion in the five lowor normal-secretors.

Summary: Insulin secretion tests were carried out before and after treatment in patients with severe congestive heart failure. Before treatment the plasma insulin level and the insulin secretion response to intravenous tolbutamide were significantly reduced in all patients. In patients who made a good clinical recovery the plasma insulin level and the insulin secretion response were significantly improved. Patients who had a poor response to medical treatment showed little improvement in their insulin secretion test. This suppression of insulin secretion is probably due to the reduced blood flow to the pancreas together with a high level of circulating catecholamines.