The case notes of all admissions to a Regional Secure Unit over a 12-year period were examined. A higher proportion of females had a diagnosis of personality disorder. Women were less likely to have a prosecuted offence associated with admission but were more likely to be charged with fire-setting. Patients with personality disorder were more likely to be transferred to special hospitals. Women were nearly three times as likely as men to be transferred to maximum security and this was not accounted for by the excess of females with personality disorder. There was net movement of men out of special hospitals whereas the opposite was true for women. Possible explanations for this are discussed.
To assess the metabolic consequences of the diversion of the pancreatic venous drainage to the systemic circulation, the pancreaticoduodenal and gastrosplenic veins were anastomosed to the inferior vena cava in nine normal dogs. This procedure maintained the integrity of the entire pancreas while shunting the hormonal output ofthe pancreas to the periphery. The metabolic effects were assessed from the sensitivity to insulin during a euglycemic hyperinsulinemic glucose clamp using an insulin infusion of 800 IAU/kg per min. The studies were controlled by their duplication in seven dogs identically treated but with the pancreatic veins reanastomosed to the portal vein. No differences in systemic insulin levels or insulin sensitivity before and after surgery were seen under these circumstances. After diversion, however, basal insulin levels rose from 4.5±1.0 to 11.5±2.5 gU/ml. Basal glucose metabolic clearance rate (MCR) rose to 3.0±0.4 from 2.0±0.3 ml/kg per min. On insulin infusion, maximal stimulation of MCR within the 2-h infusion period was to 15.2±2.5 ml/kg per min preoperatively and to 7.2±0.8 ml/kg per min after diversion. Using ratios of MCR-to-insulin concentration as an index of insulin sensitivity, it was demonstrated that this index decreased by at least 50% after diversion. These data imply that portal venous drainage of the pancreas is an important factor in the determination of peripheral insulin sensitivity. (J. Clin. Invest. 92:1713-1721
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