The effect of lipohypertrophy at injection sites on insulin absorption has been studied in 12 insulin-dependent diabetic patients. The clearance of 125I-insulin from sites with lipohypertrophy was significantly slower than from complementary nonhypertrophied sites (% clearance in 3 h, 43.8 +/- 3.5 +/- SEM) control; 35.3 +/- 3.9 lipohypertrophy, P less than 0.05). The degree of the effect was variable but sufficient in several patients to be of clinical importance. Injection-site lipohypertrophy is another factor that modifies the absorption of subcutaneously injected insulin.

The natural history of erectile impotence in diabetic men has been defined in a 5-year prospective study of 466 patients initially aged 20-59 years. Of the 275 who were originally potent, 78 (28%) have become impotent. Five features present at first interview were found to be independently predictive of the subsequent development of impotence; age (p less than 0.0001), alcohol intake (p less than 0.0001), initial glycaemic control (p = 0.03), intermittent claudication (p = 0.04) and retinopathy (p = 0.05). The development of impotence was also significantly associated with the appearance of neuropathic symptoms (p = 0.003) and poor glycaemic control in the intervening 5 years (p = 0.01). Only 11 out of 128 (9%) of those originally impotent regained potency; they were young, had short duration of diabetes, and often features of psychogenic impotence. Those with impotence originally but no clinically apparent micro/macrovascular or neuropathic diabetic complications developed retinopathy (p = 0.001) and neuropathy (p = 0.01) more frequently than their comparable potent counterparts. It is concluded that diabetic impotence rarely reverses, that it is strongly associated with neuropathic and vascular complications of diabetes, and that moderation of alcohol consumption and improvement of glycaemic control are possible preventative factors.

Potassium permanganate (KMnO4), a powerful oxidizing agent, is readily available without prescription. Tissue contact produces coagulation necrosis and the lethal consequences of oral ingestion are well described, with most deaths because of airway oedema and obstruction or circulatory collapse. Whilst systemic toxicity is reported, its mechanism is unclear. We describe a case of suicidal ingestion of KMnO4 followed by acute hepatorenal toxicity resulting in the death of the patient. The clinical course bore close resemblance to that of severe paracetamol overdose. We discuss the pathogenesis of the systemic toxicity of KMnO4 and postulate that it is due to oxidative injury from free radicals generated by the absorbed permanganate ion. We recommend that N-acetyl cysteine be given within the first few hours to all patients with potassium permanganate poisoning.

Fluid and crystalized intelligence differences among high-fit, young; high-fit, old; low-fit, young, and low-fit, old groups were investigated before and after an exercise program. The high-fit group had higher fluid intelligence than the low-fit group. Likewise, the young group scored higher than the old group. The four groups scored higher at the posttest on two of the fluid intelligence subtests of the Cattell Culture. Fair Intelligence Test. No differences were observed on crystallized intelligence. It is uncertain how biological factors and psychological changes, either individually or in combination, produce differences in cognitive functioning due to physical fitness.