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Biomedical subjects

B I Joffe

Publications and source records attributed to B I Joffe.

At least 91 records · Page 5Linked to original sources
PubMed1984

Comparison of the metabolic responses to alpha-adrenergic stimulation in asthmatics and non-asthmatics after clonidine.

The role of the alpha-adrenergic system in the pathogenesis of asthma is investigated. We administered 150 micrograms oral clonidine to a group of patients with relatively mild asthma and a group of non-asthmatic subjects, and compared their responses by measuring plasma levels of growth hormone (GH), immunoreactive insulin, potassium and glucose. There was no significant difference between the groups in respect of any of these variables, nor was there a significant difference in the blood pressure responses. However, 3 of the asthmatic subjects demonstrated marked hyper-responsiveness of the plasma GH levels after clonidine. It is possible that increased alpha-adrenergic responses may be more frequently demonstrable in a group of severe asthmatics or by means of an alpha-agonist which is more potent and less selective than clonidine. Alternatively, the 3 hyper-responsive individuals may represent a subgroup of asthmatics in whom alpha-adrenergic overactivity is an important pathogenetic mechanism.

Adult↗
PubMed1984

The 8-hour metabolic profile after drinking ethanol.

The acute metabolic changes after drinking ethanol have been studied in 11 fasting, healthy, nonobese, medical students, 6 of whom consumed 40 g ethanol diluted with 750 ml of a sugar-free soft drink over 1 h. The other 5 drank the same volume of soft drink alone. Blood levels of ethanol, glucose, immunoreactive insulin and growth hormone were measured over the ensuing 8 h, as well as the plasma concentrations of prolactin, cortisol and triiodothyronine. After ingesting ethanol, the mean plasma glucose concentration declined, but not to hypoglycemic levels (the nadir was 3.9 mmol/l at 6 h), insulin levels fell gradually and the mean growth hormone concentration showed a modest late rise. Other hormones did not change significantly. We conclude that, in the particular setting examined, the oral administration of ethanol does not cause hypoglycemia or other adverse effects on carbohydrate metabolism.

Adult↗
PubMed1984

Hormonal profile after insulin-induced hypoglycemia in chronic calcific pancreatitis. Pancreatic, pituitary and adrenal responses.

The present investigation defined the pattern of pancreatic, pituitary and adrenal responses after insulin-induced hypoglycemia in chronic calcific pancreatitis (CCP) related to alcohol abuse, and assessed the role of some of these hormones in the counterregulation of blood glucose. We studied 6 Black men with recently diagnosed CCP, all showing radiological evidence of pancreatic calcification and normal glucose tolerance, as well as 7 matched nonobese male controls. After a standard iv insulin tolerance test inducing marked hypoglycemia, patients with CCP showed significantly impaired mean plasma pancreatic glucagon and pancreatic polypeptide responses compared to the controls. Mean basal plasma somatostatin levels tended to be higher in chronic pancreatitis and remained so throughout the test without altering consistently; in the controls somatostatin peaked significantly at 30 min. Concerning extrapancreatic hormonal changes, plasma growth hormone, prolactin and total catecholamines responded normally in CCP, but plasma cortisol rose to significantly higher levels than controls at 60 and 120 min after the injection of insulin. This, coupled with the brisk output of catecholamines, may have prevented the heightened sensitivity to insulin anticipated because of their hypoglucagonemia. We conclude that patients with CCP show impaired pancreatic hormone release after insulin hypoglycemia with the exception of somatostatin; there is also an excessive rise in plasma cortisol, possibly related to the long standing abuse of alcohol in the past.

Adrenal Glands↗
PubMed1984

Hyperglycaemia in infantile gastroenteritis.

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.

Child, Preschool↗
PubMed1984

Alcohol-potentiated reactive hypoglycaemia depends on the nature of the carbohydrate ingested at the same time.

Alcohol may provoke reactive hypoglycaemia when drunk with a sucrose mixer (gin and tonic) but not in the form of a starch-based beverage. In the present study alcohol-potentiated reactive hypoglycaemia was shown to depend on the nature of the carbohydrate ingested together with the alcohol. When 14 men (9 normal weight and 5 obese) aged between 20 and 50 years consumed a 50 g glucose load together with 50 g ethanol over an hour, their early plasma insulin response was significantly higher and their later fall in plasma glucose significantly lower than after drinking the same amount of a starch solution (maize meal) and alcohol. In four subjects (3 of them non-obese) plasma glucose concentrations dropped below 2.8 mmol/l after drinking the glucose-alcohol solution. Obesity seemed to be associated with features of peripheral insulin resistance. We conclude that the common social custom of drinking alcohol together with a simple sugar mixer should probably be modified.

Adult↗
PubMed1983

HLA antigens in White and Black South African diabetics.

The HLA A and B specificities in 72 Whites with type 1 or juvenile-onset diabetes mellitus (JOD), 53 Blacks with type 1 diabetes or JOD and 52 Blacks with type II or maturity-onset diabetes (MOD) were determined and compared with those in 278 Whites and 311 Blacks who were not diabetic. In Whites with JOD, frequencies of HLA A1 and B8 antigens were significantly increased, whereas those of the A3 and B17 antigens were reduced. Blacks with JOD had an increased frequency of HLA B8. By contrast, in Blacks with MOD the antigen frequencies were not significantly altered. The D-locus antigens Dw3 (DRw3) and Dw4 (DRw4), which bear the strongest associations with JOD in Whites, need to be examined in Black South African diabetics.

Adult↗
PubMed1982

Effect of drinking bottled beer on plasma insulin and glucose responses in normal subjects.

Alcohol may provoke reactive hypoglycaemia when drunk with a sucrose mixer ('gin and tonic') but does not do so when taken in the form of a starch-based beverage like sorghum beer. We examined the hypoglycaemic potential of bottled beer (Lion Lager; South African Breweries), which differs from sorghum beer in that it contains less carbohydrate (polysaccharides and simple sugars) and has a higher alcohol content. After an overnight fast 5 Black men each drank 2 litres of Lion Lager over an hour. Over the ensuing 5 hours their plasma insulin, glucose and alcohol concentrations were compared with the responses previously documented before and after consuming the same volume of sorghum beer or a 100 g control carbohydrate solution. Bottled beer elicited a prompt but short-lived rise in plasma insulin (mean +/- SEM, 37 +/- 7 mU/l at 1 hour), which was significantly greater than that produced by sorghum beer but less sustained than after drinking the control carbohydrate solution. After drinking bottled beer plasma glucose levels fell to a mean nadir of 3,6 mmol/l at 2 hours (compared with 5,4 mmol/l for sorghum beer), thereafter slowly returning to the basal value, while a substantial rise in the blood alcohol concentration occurred. We conclude that the development of alcohol-induced reactive hypoglycaemia is largely determined by the nature of the carbohydrate ingested together with alcohol.

Adult↗
PubMed1982

Treatment of homozygous familial hypercholesterolaemia with probucol.

Ten patients with homozygous familial hypercholesterolaemia were treated with the recently introduced drug probucol (Lurselle; Mer-National) for 15-21 months. Xanthomas regressed or disappeared in most patients, angina lessened in two-thirds of cases and the ECG improved in half of those with pretreatment abnormalities. The mean fall in serum total cholesterol levels after 18 months of therapy was 27%. High-density lipoprotein cholesterol levels fell transiently in the early months of therapy but then returned to the pretreatment range. Plasma probucol levels varied between 20 micrograms/ml and 90 micrograms/ml, indicating good compliance, but did not correlate with the clinical or hypocholesterolaemic responses. Probucol was well tolerated by child and adult patients. The effects of probucol in this therapeutically resistant disorder were better than expected. Considered in relation to efficacy, safety, tolerance and convenience probucol appears to be the most satisfactory treatment for homozygous familial hypercholesterolaemia currently available.

Adolescent↗
PubMed1982

Treatment of homozygous familial hypercholesterolaemia with portacaval shunt.

Thirteen patients with homozygous familial hypercholesterolaemia (HFH) were treated with portacaval shunt operations. One patient died postoperatively and the others were followed for 2-6 years. The main beneficial effects were regression of xanthomas and sustained falls in serum total and LDL cholesterol levels of about 18% in the majority of cases, sustained rises in HDL cholesterol values in most patients, and the long period of survival after the operation without further deaths or serious cardiac complications. Other favourable effects were improvement of angina pectoris, ejection systolic múrmurs or electrocardiograms in some cases. Growth and development of patients after the operation were normal and there were no clinical or biochemical signs of liver damage or portal systemic encephalopathy. Apart from the patient who died, negative or adverse effects of the operation included shunt closure causing portal hypertension and bleeding varices in 1 case, unsatisfactory clinical responses in half the patients, small or unsustained falls in serum total cholesterol in one third of cases, and failure of total cholesterol to fall below 12.0 mmol/l in any patient. Enlargement of the spleen appeared to be an invariable consequence of the operation and possible reasons for this are discussed. Finally the place of portacaval shunts in the management of HFH is reviewed.

Adolescent↗
PubMed1982

Nonspecific blinding of insulin to gamma globulin in the serum of black patients with hepatocellular carcinoma and other forms of liver disease.

The study was prompted by the apparent detection of insulin antibodies in a black patient with HCC and recurrent hypoglycemia who had never received insulin. It consisted of two parts. Initially the sera of 30 individuals (six normoglycemic HCC patients, three with HCC and recurrent hypoglycemia, 11 patients with noncancerous liver diseases, and 10 healthy black controls) were analyzed for the presence of insulin (and glucagon) antibodies by precipitating the bound, labeled hormone with ethanol and also by the technique of radioimmunoelectrophoresis. In the nine HCC patients, binding of 125I-insulin averaged 13% by ethanol separation and 0.018 mU/ml with radioimmunoelectrophoresis, levels that were similar to those of patients with noncancerous liver disease and significantly higher than those of the healthy controls. Mean binding of 125I-glucagon was 11% in HCC sera. Serum binding of labeled hormones correlated significantly with IgG concentrations in the patients. The second part of the study attempted to define the nature of insulin binding in HCC and other forms of liver disease. After confirmation of the increased serum binding of labeled insulin by another method of precipitation, PEG, an attempt was made to compete with the labeled insulin for its serum binding sites by adding a large amount of unlabeled insulin. This binding was not displaceable, however, and was therefore considered nonspecific. When the same procedures were repeated using normal serum to which increasing amounts of gamma globulin were added, the nonspecific binding of insulin increased in a linear fashion. Furthermore, a similar degree of high nonspecific insulin binding occurred in six patients with multiple myeloma and raised serum IgG concentrations. We therefore conclude that in the many clinical situations where hypergammaglobulinemia exists, false positive tests for the detection of antibodies against insulin (and probably other peptide hormones) will emerge unless appropriate methods are used to check for nonspecific peptide binding.

Black People↗
PubMed1981

Serum lipid, uric acid and glucose levels in urban black males doing manual or clerical work.

Serum lipid, uric acid and glucose levels were measured in four groups of Black male factory workers 1 hour after an oral glucose load. These groups comprised non-obese manual, obese manual, non-obese clerical and obese clerical workers. Obese men had significantly higher serum uric acid, total cholesterol and triglyceride levels and lower high=density lipoprotein (HDL) cholesterol levels than non-obese men. Serum glucose and low-density lipoprotein (LDL) cholesterol values were also higher in obese than in non-obese men, but the differences were not significant. Clerical workers had higher levels than manual workers for most of the biochemical variables measured, but only in the case of uric acid was the difference significant. Possible reasons for the fact that the effect of occupation on the variables was slight are briefly discussed.

Adult↗
PubMed1981

Failure to induce reactive hypoglycaemia by drinking a starch-based alcohol beverage (sorghum beer).

Alcohol is a well-recognised cause of fasting hypoglycaemia but may also provoked reactive hypoglycaemia when drunk together with a carbohydratee mixer. In this study the ability of sorghum beer (an 'in-built' alcohol-starch beverage widely enjoyed in Southern Africa) to induce reactive hypoglycaemia was compared with "gin and tonic' in eight non-obese health African men. After an overnight fast, each subject drank, in random sequence on their different occasions, 2 litres of sorghum beer (carbohydrat content approximately 5% and alcohol concentration 2.24 g/dl-2.8% v/v), the same volume of a control solution providing a similar carbohydrate load, or a gin and standard tonic water mixture. No evidence of reactive hypoglycaemia was apparent during the 5 hours after the beginning of the sorghum beer tolerance tests, despite a mean peak blood alcohol level reaching 80 mg/dl. both the peak and total plasma insulin responses were significantly reduced (p less than or equal to 0.05) when compared to the brisk responses elicited by the carbohydrate solution alone and the gin and tonic drinks, with consequent hypoglycaemia. These data suggest that African home-brews are not potent causes of reactive hypoglycaemia, although they may be implicated in the development of ethanol-induced hypoglycaemia in the fasting state.

Adult↗
PubMed1981

The role of diet in the pathogenesis and control of hyperlipidemia after renal transplantation.

Twenty-one Caucasian renal transplant recipients with hyperlipidemia and normal renal function were assessed with regard to their diet. Their average daily intake of energy and cholesterol was lower and the ratio of polyunsaturated to saturated fat higher in their diet than in that of a comparable urban Caucasian South African population. Nevertheless modification of their diets in one year produced a significant lowering of their body weight and a statistically significant drop in the mean plasma cholesterol (9.2 +/- 0.5 mmoles/l to 7.6 +/- 0.5 mmoles/l, P less than 0.05). Although the fall in plasma triglyceride in the group as a whole was not statistically significant (3.8 +/- 0.6 mmoles/l to 3.2 +/- 0.5 mmoles/l) the level did decrease substantially in 13 of the 21 patients (4.2 +/- 0.9 mmoles/l to 2.5 +/- 0.5 mmoles/l, P less than 0.01). It is suggested that diet has a definite role in the control of post-transplant hyperlipidemia but should probably be introduced immediately after immunosuppression is started and be coupled with a suitable exercise program for optimal effect.

Adult↗
PubMed1980

A host of hypercholesterolaemic homozygotes in South Africa.

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.

Adolescent↗
PubMed1979

Recurrent hypoglycemia associated with glutaric aciduria type II in an adult.

Repeated episodes of hypoglycemia accompanied by elevated serum concentrations of free fatty acid without ketosis, fatty infiltration of the liver, hepatic dysfunction, and proximal myopathy in a 19-year-old woman, prompted us to analyze her urine for organic acids. Greatly increased quantities of glutaric acid, ethylmalonic acid, dicarboxylic acids with six to 10 carbons, and isovalerylglycine were consistently found in her urine. The ability of cultured skin fibroblasts from the patient to oxidize [1(-14)C]butyrate and [2(-14)C]lysine was reduced. These urinary and in vitro findings indicated defective activity of several acyl coenzyme A dehydrogenases, including glutaryl, isovaleryl, and butyryl coenzyme A dehydrogenases -- establishing a diagnosis of glutaric aciduria Type II. Carnitine concentrations in the skeletal muscle and liver were moderately reduced, but carnitine deficiency was considered a secondary biochemical abnormality. Although glutaric aciduria Type II has previously been described only in a neonate, the disease must be considered in the differential diagnosis of hypoglycemia in adults.

Adult↗