Hypoglycemia resulting from the combination of sulfonylurea and sulfonamides is a recognized drug interaction. Hypoglycemia induced by sulfonamides alone may be encountered less frequently. Because of their structural similarities to sulfonylureas, sulfonamides are liable to facilitate hypoglycemia by increasing insulin release in susceptible individuals. Sulfonamides can potentiate the hypoglycemic effect of sulfonylurea agents when given in combination. We describe a malnourished patient with severe infection who developed hypoglycemia during high-dose trimethoprim/sulfamethoxazole therapy. Elevated C-peptide concentrations during the hypoglycemic episode indicate that hypoglycemia resulted from increased endogenous insulin secretion. As malnourished patients are prone to hypoglycemia, we suggest that they should be monitored carefully if they are on sulfonamide therapy.

. Comlekqi A, Biberoglu S, Kozan 0, Bahqeci 0, Ergene 0, Nazli C, Kinay 0, Guner G (Dokuz Eylul University, Medical School, Inciralti, Izmir, Turkey). Correlation between serum lipoprotein(a) and angio‐graphic coronary artery disease in non‐insulin‐dependent diabetes mellitus. J Intern Med 1997; 242:449‐54. Objectives: To examine the impact of diabetic state on the concentrations of lipoprotein(a) [Lp(a)] in patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and the correlation between angiographic coronary artery disease (CAD) and serum Lp(a) concentrations in NIDDM. Design: In this cross‐sectional study of 26 patients with NIDDM and 19 nondiabetic sex‐ and agematched patients who underwent coronary angiography, CAD was assessed visually using coronary artery score (CAS), and plasma Lp(a) was measured by an enzyme‐linked immunosorbent assay. Setting: The study was performed in an internal medicine clinic at a university hospital. Subjects: Twenty‐six age‐ and sex‐matched patients with NIDDM and 19 control patients without diabetes. Results: There was no significant difference between the Lp(a) concentrations of patientswith NIDDM and nondiabetic subjects (P > 0.05). When patients with NIDDM were stratified by absence or presence of CAD, patients with CAD had higher levels of Lp(a) (P < 0.05). However, there was no significant correlation between the concentrations of Lp(a) and CAS (P > 0.05). Conclusions: Diabetic state does not have any impact on Lp(a) concentrations. Lp(a) excess seems to be atherogenic in patients with NIDDM as shown in nondiabetic patients in previous studies. Although diabetic patients with CAD have higher Lp(a) concentrations than the diabetic patients without CAD, Lp(a) levels were not correlated with CAS.

In order to determine the prevalence of hepatitis C virus (HCV) infection in the Black Sea region in Turkey, 287 serum samples taken from risk groups were investigated for anti-HCV antibodies using HCV EIA system. Anti-HCV antibodies were found to be positive in 51.2% of chronic haemodialysis patients, 20.6% of probable acute non-A, non-B hepatitis patients, 4% of patients who had multiple blood transfusions, 1.5% of the health personnel, while in new haemodialysis patients anti-HCV antibodies were not found.

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In this study, we determined the prevalence of idiopathic hypercalciuria (IH) in patients with renal lithiasis, and measured the bone mineral density (BMD) and biochemical markers of bone metabolism in patients with IH. Among 85 consecutive patients with urolithiasis (40 men, 30 postmenopausal and 15 premenopausal women), hypercalciuria (urinary calcium excretion Ͼ4 mg/kg per day) was observed in 22 (11 men, 8 postmenopausal and 3 premenopausal women). These 22 patients were then classified as having absorptive or fasting hypercalciuria. In 19 of the 22 hypercalciuric patients (11 men and 8 postmenopausal women), BMD was measured by dual-energy x-ray absorptiometry and serum levels of calcium, alkaline phosphatase, parathyroid hormone, osteocalcin (OC), and urinary deoxypyridinoline (DPD) were determined. When compared with age-and sex-matched control subjects (volunteers from hospital personnel), OC and urinary DPD levels were significantly higher in the renal lithiasis patients when compared with control subjects. Ward's triangle BMD in women and lumbar BMD in men were significantly lower when compared with sex-and age-matched control subjects. Lumbar, Ward's triangle, and femoral neck BMD measurements were inversely correlated with the duration of renal lithiasis in male patients. Males also had a significant negative correlation between lumbar BMD and the urinary DPD. BMD decreases significantly in male and postmenopausal female patients with IH. Patients with renal lithiasis should be evaluated for IH, and those with IH should be screened for osteoporosis. Studies determining the clinical and lifestyle consequences of IH and its related osteoporosis should be performed. Learning Objectives:• Recall what constitutes idiopathic hypercalcuria (IH) andits prevalence in patients with renal stone disease. • Explain whether and to what degree biochemical markers of bone metabolism and bone mineral density (BMD) differed between patients with IH and control subjects in this prospective study. • Describe the relationship between BMD in patients with IH and both the duration of stone disease and bone marker levels.I diopathic hypercalciuria (IH) is characterized by excessive calcium excretion into the urine (more than 4 mg/kg per day) in patients with normal serum levels of calcium in the absence of known secondary causes of hypercalciuria. 1,2 First described by Albright, 3 it is the most common metabolic abnormality in patients with recurrent calcium nephrolithiasis, approximately 50% of patients. 1 Although the pathogeneses of absorptive (AH) and fasting hypercalciuria (FH) have not been clearly elucidated, they seem to differ from one another. 4 -6 In AH, the principal defect seems to be intestinal hyperabsorption of calcium (occurring independently of vitamin D) and is associated with normal fasting urinary calcium. In FH, fasting urinary calcium is increased as a result of a primary renal calcium leak that leads to a compensatory hyperparathyroidism. In patients with both IH and recurrent nephrolithiasis, decre...