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1.  Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study 
Annals of the Rheumatic Diseases  2000;59(7):539-543.
OBJECTIVES—Insulin resistance (IR) has been increasingly implicated in the pathogenesis of gout. The lipoprotein abnormalities described in hyperuricaemic subjects are similar to those associated with IR, and insulin influences renal urate excretion. In this study it was investigated whether dietary measures, reported to be beneficial in IR, have serum uric acid (SU) and lipid lowering effects in gout.
METHODS—Thirteen non-diabetic men (median age 50, range 38-62) were enrolled. Each patient had had at least two gouty attacks during the four months before enrolment. Dietary recommendations consisted of calorie restriction to 6690 kJ (1600 kcal) a day with 40% derived from carbohydrate, 30% from protein, and 30% from fat; replacement of refined carbohydrates with complex ones and saturated fats with mono- and polyunsaturated ones. At onset and after 16 weeks, fasting blood samples were taken for determination of SU, serum cholesterol (C), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TGs). Results were expressed as median (SD).
RESULTS—At onset, the body mass index (BMI) was 30.5 (8.1) kg/m2. Dietary measures resulted in weight loss of 7.7 (5.4) kg (p=0.002) and a decrease in the frequency of monthly attacks from 2.1 (0.8) to 0.6 (0.7) (p=0.002). The SU decreased from 0.57 (0.10) to 0.47 (0.09) mmol/l (p=0.001) and normalised in 7 (58%) of the 12 patients with an initially raised level. Serum cholesterol decreased from 6.0 (1.7) to 4.7 (0.9) mmol/l (p=0.002), LDL-C from 3.5 (1.2) to 2.7 (0.8) mmol/l (p=0.004), TGs from 4.7 (4.2) to 1.9 (1.0) mmol/l (p=0.001), and C:HDL-C ratios from 6.7 (1.7) to 5.2 (1.0) (p=0.002). HDL-C levels increased insignificantly. High baseline SU, frequency of attacks, total cholesterol, LDL-C and TG levels, and total C:HDL-C ratios correlated with higher decreases in the respective variables upon dietary intervention (p<0.05).
CONCLUSION—The results suggest that weight reduction associated with a change in proportional macronutrient intake, as recently recommended in IR, is beneficial, reducing the SU levels and dyslipidaemia in gout. Current dietary recommendations for gout may need re-evaluation.


doi:10.1136/ard.59.7.539
PMCID: PMC1753185  PMID: 10873964
4.  Hormonal and biochemical responses to transcendental meditation. 
Postgraduate Medical Journal  1985;61(714):301-304.
This study was designed to assess whether transcendental meditation (TM) could influence various endocrine responses in 10 experienced male meditators. Nine matched subjects, uninformed of the TM procedure, acted as controls. Meditators successfully practised their technique for 40 min in the morning while controls relaxed for this period. No significant differences emerged between these 2 groups with respect to carbohydrate metabolism (plasma glucose, insulin and pancreatic glucagon concentrations), pituitary hormones (growth hormone and prolactin) or the 'stress' hormones, cortisol and total catecholamines-although meditators tended to have higher mean catecholamine levels. Plasma free fatty acids were significantly elevated in meditators 40 min after completing the period of TM. No clear evidence was thus obtained that any of the stress, or stress-related, hormones were suppressed during or after meditation in the particular setting examined.
PMCID: PMC2418240  PMID: 3895206
6.  Hyperglycaemia in infantile gastroenteritis. 
Archives of Disease in Childhood  1984;59(8):771-775.
The prevalence and pathogenesis of hyperglycaemia were investigated in a consecutive series of 27 black infants admitted to hospital with gastroenteritis over a period of three months. Hyperglycaemia (plasma glucose concentration greater than 10 mmol/l) occurred in 15 (55%) of these patients. The pathogenesis was not clear but possible contributory factors included raised concentrations of the stress hormones pancreatic glucagon, growth hormone, and cortisol; hypokalaemia; and peripheral insulin resistance. Intravenous rehydration, without insulin, corrected the plasma glucose concentrations and restored the hormonal profile towards normal within 36 to 48 hours.
PMCID: PMC1628636  PMID: 6383226
7.  A host of hypercholesterolaemic homozygotes in South Africa. 
British Medical Journal  1980;281(6241):633-636.
From 1972 to 1979 34 patients with homozygous familial hypercholesterolaemia were seen in one clinic in Johannesburg. All were Afrikaners and most lived in Transvaal Province. Their epidemiological, genetic, clinical, and biochemical characteristics were studied. The course of the disease varied considerably among the 34 patients, with no fewer than six surviving into their fourth or fifth decades. In some patients arterial atheroma was severe while cutaneotendinous xanthomas were slight and vice versa. Coronary heart disease was common but peripheral and cerebral arterial disease was rare. Another prominent finding was high concentrations of low-density lipoprotein cholesterol coupled with low high-density lipoprotein cholesterol values. The prevalences of homozygotes and heterozygotes with familial hypercholesterolaemia in Transvaal Afrikaners, calculated from this group of patients, were 1 in 30,000 and 1 in 100 respectively. These figures are the highest ever reported and may help to explain why South African whites have the highest death rate from coronary heart disease in the Western world.
PMCID: PMC1714090  PMID: 7437743
8.  Adipose cell size in obese Africans: evidence against the existence of insulin resistance in some patients. 
Journal of Clinical Pathology  1979;32(5):471-474.
Aspects of adipose tissue cellularity were examined in 15 non-diabetic premenopausal African women with simple obesity living in Johannesburg. A smaller group of six non-obese Black women served as controls. Adipose tissue was obtained by biopsy from the deltoid, gluteal, and abdominal regions, and the mean fat cell size for each site was determined. Fasting plasma glucose, insulin, and lipid levels, and the glucose and insulin responses to a 100 g oral glucose load, in these subjects provided metabolic data for correlative analyses. As expected, the overall mean and regional adipocyte sizes were significantly larger in the overweight subjects. Significant regional variations in fat cell size were also seen, the gluteal region adipocytes being larger than those of other sites in both obese and non-obese women. A significant positive correlation was found between fat cell size and the percentage of ideal body weight. There was no significant relationship between adipocyte size, however, and any of the metabolic variables measured--notably basal or stimulated plasma insulin. Nearly half of the overweight women showed large adipocytes with normal plasma insulin concentrations. A proportion of African women with hypertrophic obesity do not appear to demonstrate any classical metabolic features of insulin resistance; this may be related partly to their high carbohydrate intake and unusual degree of physical activity. Our results do not, however, indicate that hyperinsulinaemia is completely absent in obese Black women.
PMCID: PMC1145709  PMID: 469004
9.  Transient hypothyroidism after withdrawal of thyroxin therapy 
Postgraduate Medical Journal  1975;51(599):665-666.
Continued administration of large doses of thyroid may not produce hyperthyroidism in euthyroid individuals. Cessation of prolonged high-dosage thyroid replacement can cause transient clinical and biochemical hypothyroidism owing to pituitary suppression. A case is recorded in which both these phenomena are well demonstrated. This case highlights these basic endocrinological principles.
PMCID: PMC2496206  PMID: 1197170
10.  Metabolic responses to selective β-adrenergic stimulation in man 
Postgraduate Medical Journal  1975;51(592):53-58.
The responses of plasma free fatty acid, glucose, lactate, insulin and growth hormone to intravenous administration of the predominantly β-2 stimulant, salbutamol, were studied in nine normal subjects. Four subjects received the predominantly β-1 blocking agent, practolol, together with salbutamol.
Salbutamol produced a marked rise in free fatty acid levels and there was also an appreciable increase in insulin values; lactate levels rose moderately and glucose values increased slightly; growth hormone levels were not affected. Practolol did not alter the free fatty acid response; it diminished but did not appear to abolish the insulin response, and it appeared to suppress the lactate and glucose rises.
Tentative proposals are made regarding the nature of the β-receptor subtypes responsible for mediating these effects; most definite is the suggestion that lipolysis is subserved by β-2 receptors. Possible clinical implications are briefly discussed.
PMCID: PMC2495720  PMID: 1114148
12.  Triamcinolone-augmented glucose tolerance in non-diabetic patients with chronic pancreatitis 
Postgraduate Medical Journal  1974;50(579):25-28.
Seven non-diabetic patients with chronic pancreatitis were shown to have a diminished acute insulin secretory response after intensive beta cell and intravenous tolbutamide stimulation. In an attempt to unmask their ‘latent’ diabetic state, triamcinolone-augmented glucose tolerance tests were performed some days after documenting normal standard 50 g oral glucose tolerance tests. A matched group of non-diabetic controls was similarly investigated. Although the steroid-augmented glucose tolerance tests showed marked impairment in the patients, becoming frankly diabetic in three cases, the normal control subjects reacted in a similar though less striking fashion. There was no significant difference between the mean glucose values in the two groups. The ability of patients with chronic pancreatitis to maintain normal glucose tolerance in the face of diminished insulin output is commented on. We conclude that, as an ancillary investigation for diagnosing chronic pancreatitis, the triamcinolone glucose tolerance test is unreliable.
PMCID: PMC2495501  PMID: 4464496
13.  Prevalence of hepatitis B surface antigen and antibody in white and black patients with diabetes mellitus. 
Journal of Clinical Microbiology  1976;4(6):467-469.
The prevalence of hepatitis B surface antigen (HBSAg) and antibody (anti-HBS) was determined in 531 white and 519 black diabetic outpatients and in appropriate white and black control populations. There was no difference between the prevalence of either HBSAg or anti-HBS in either the white or black diabetics and that in the white and black controls. These findings make it unlikely that the vast majority of patients with diabetes mellitus have either an increased susceptibility to infection by the hepatitis B virus or an impaired ability to clear the virus once they are infected.
PMCID: PMC274506  PMID: 1002826
14.  Evolution of diabetes mellitus in a case of Friedreich's ataxia 
A 12 year old girl with Friedreich's ataxia, in whom progression from chemical to severe insulin-dependent diabetes mellitus occurred over a two year period, is presented. During the phase of subclinical diabetes her plasma immunoreactive insulin response to oral glucose was markedly increased, but when she became symptomatic gross insulin deficiency had supervened. This report draws attention to the unusual disorders of carbohydrate metabolism and insulin secretion that may occur in a variety of neurological conditions.
PMCID: PMC494349  PMID: 4714111
15.  Effect of oral hypoglycaemic agents on glucose tolerance in pancreatic diabetes 
Gut  1972;13(4):285-288.
The short-term therapeutic effect of oral hypoglycaemic agents has been assessed in 12 patients with symptomatic diabetes secondary to chronic pancreatitis (pancreatic diabetes). In six patients who had moderate to severe carbohydrate intolerance, associated with severe insulinopaenia during arginine infusion, the potent sulphonylurea chlorpropamide produced no change in the fasting blood glucose level after two weeks of treatment. This contrasted with the significant reduction produced in a matched group of maturity-onset primary diabetics. The six patients with milder diabetes, and a greater (although still subnormal) insulin secretory capacity, showed an improvement in oral glucose tolerance during the first hour following glucose administration while on chlorpropamide. When the biguanide phenformin was substituted for chlorpropamide in five of these patients, a statistically insignificant improvement in glucose tolerance was observed during treatment.
Applications of these findings to the practical management of pancreatic diabetes are briefly considered.
PMCID: PMC1412160  PMID: 5033843
16.  Metabolic Responses to Oral Glucose in the Kalahari Bushmen 
British Medical Journal  1971;4(5781):206-208.
The plasma glucose, immunoreactive insulin, and growth hormone levels after a 50-g oral glucose load have been measured in 15 adult Bushmen subjects living in the Kalahari region of Southern Africa. Compared with 10 non-obese white controls, they showed relative glucose intolerance and significantly impaired insulin secretion. Growth hormone responses showed no significant differences between the two groups. Factors such as inadequate or unusual nutrition and stress do not appear to account completely for the abnormalities in carbohydrate metabolism observed in the Bushmen. Of interest are the clinical and hormonal similarities that seem to exist between the Bushmen and the Central African Pygmies.
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PMCID: PMC1799259  PMID: 5115571

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