The effect of bombesin on insulin, pancreatic glucagon, and gut glucagon was investigated in eight healthy volunteers and two pancreatectomized patients. Bombesin, infused iv at the constant rate of 5 ng kg-1 min-1, produced a sharp and statistically significant rise in the plasma insulin concentration. The peak was reached at 5 min (26 +/- 2.17 microU/ml; P less than 0.005 vs. basal values), followed by a prolonged and statistically significant (P less than 0.05) decrease in blood glucose. Pancreatic glucagon rapidly rose to a maximal value of 80.5 +/- 7.6 pmol/liter (P less than 0.005 vs. basal values). In contrast with the prompt increase in insulin and glucagon plasma levels, the peak in gut glucagon concentration (55.8 +/- 4.6 pmol/liter; P less than 0.005 vs. basal values) was reached 30 min after bombesin infusion was discontinued. In the two pancreatectomized patients, bombesin induced an increase in gut glucagon concentrations only. The results presented indicate that bombesin acts directly on the A and B cells of the pancreas, influencing glucose homeostasis; however, more complex mechanisms seem to be involved in gut glucagon secretion.
Diffuse idiopathic skeletal hyperostosis (DISH) is an ossifying systemic enthesopathy which involves not only the spine but which may also appear in other sites. Degenerative, inflammatory and metabolic factors have been reported for a possible pathogenic role in the new bone growth that characterises DISH. In the present study peripheral bone mineral density (BMD) has been measured in patients affected by DISH and the results compared to those of a control group. Forty-two patients (33 females and 9 males) affected by DISH and 84 controls (66 females and 18 males) were examined. All subjects underwent radiological study of the lumbar and dorsal spine and the pelvis. BMD was evaluated using dual-energy X-ray absorptiometry and the examination was performed in the distal radius. In DISH patients the mean value of BMD was significantly higher than in controls (P50.002), even when it was referred to sex subgroups. Statistical analysis showed significant differences between both the two male groups (P50.002) and the two female groups (P50.01). In the two female subgroups (DISH patients and controls) BMD was significantly inversely related to age and to the duration of the postmenopausal period. The present study showed higher BMD in DISH patients than in the control group.
artrite reumatoide (AR) colpisce fra lo 0,3 e l'1% della popolazione e in Italia il numero dei pazienti è stimato pari a 410.000 casi (1). Per impostare una corretta indagine sulla valutazione dei costi assistenziali per l'AR è necessario, anzitutto, definire il numero dei ricoveri/anno che si verificano in una casistica di pazienti con tale affezione. A tal fine si potrebbe prendere in considerazione un certo numero di pazienti e accertare quanti ricoveri si verificano in un determinato anno; tuttavia questo metodo non darebbe risultati attendibili in quanto generalmente i pazienti affetti da AR non ricorrono all'ospedale tutti gli anni, ma saltuariamente in rapporto alle diverse fasi della malattia. Per tale motivo abbiamo osservato un certo numero di pazienti per molti anni e accertato il numero di ricoveri per AR che si era complessivamente verificato. STIMA DELLA FREQUENZA ANNUALE DEI RICOVERIPer definire il numero medio annuo di ricoveri abbiamo selezionato, grazie alla collaborazione del Dipartimento di Terapia Medica-Sezione Reumatologia dell'Università di Roma "La Sapienza", dell'Associazione dei Malati Reumatici del Lazio e di alcuni Reumatologi che operano in strutture specialistiche del Lazio (ospedaliere ed ambulatoriali del SSN), 100 pazienti con AR e con anzianità minima di malattia di 10 anni.
The diazoxide infusion test (600 mg i.v. over a 1-hour period) was performed in 12 patients bearing single benign islet B-cell adenoma and in 6 normal subjects. Blood glucose, plasma insulin and glucagon concentrations were measured every 15 min during the infusion and thereafter up to 150 min. In insulinoma patients, blood glucose levels failed to increase significantly while in the control group a significant rise starting from 30 min persisted throughout the test (p < 0.05 or less). Plasma insulin mean levels decreased significantly in normal subjects from 30 to 60 min (p < 0.05), while they were significantly suppressed in hypoglycemic patients from 15 to 120 min (p < 0.02). Diazoxide administration induced in the normal group a significant decrease in glucagon levels (p < 0.02 from 30 to 150 min) whereas no such suppression occurred in patients. In our experience, insulin response to diazoxide infusion in patients with insulinoma may provide additional information for diagnosis.
Seven patients with interposition of a jejunal tract between the esophagus and stomach or duodenum (EP group) and ten healthy normal volunteers have been submitted to an oral glucose load (OGTT) to clarify the significance of glucagon-like polypeptides (GLI) induced by glucose in carbohydrate metabolism. Blood glucose (BG) and GLI plasma levels were significantly higher in the EP group than in the normal one (p less than 0.01), respectively 30, 60, 90 min for BG and during all the test for GLI. The fasting immunoreactive glucagon (IRG) plasma levels were significantly lower in patients than in normals (p less than 0.05) whereas a marked and significant increase was observed in the EP group (p less than 0.01) from 90 to 240 min. The precocious stimulation of jejunal mucosa and the rapid intestinal transit which occur in these patients may explain the elevated GLI (probably glicentin) plasma levels. The rise in IRG plasma levels might be due to the enzymatic transformation of glicentin. The role of these types of glucagon on carbohydrate metabolism is still to be fully clarified.
An oral glucose tolerance test (OGTT) has been performed in a group of patients with partial gastrectomy before and after transforming the anastomosis from Billroth type II (B II) into Billroth type I (B I). Glucose tolerance was normal in both groups. The statistically significant differences in blood glucose (BG) values observed at 30 min between B I and normals and at 30, 60 and 90 min between B II and normals occur without concomitant changes in insulin (IRI) plasma levels. In the course of the test a marked rise (statistically significant from 30 to 180 min) in glucagon-like immunoreactants (GLI) plasma levels was noted in B II patients and has been attributed to the rapid intestinal transit. Otherwise, the restoration of duodenal passage induced a clear decrease of GLI levels which returned to normal values. Increased immunoreactive glucagon (IRG) plasma levels in B II group do not seem to be due to cross-reactivity with GLI. The raised BG levels occurring in B II cannot be attributed either to a reduced insulin secretion or to an increase in biologically active components of glucagon.
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