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Biomedical subjects

I A MacFarlane

Publications and source records attributed to I A MacFarlane.

At least 73 records · Page 4Linked to original sources
PubMed1991

Spontaneous hypoglycaemia due to a pleural fibroma: role of insulin like growth factors.

A 64 year old woman with a long history of "drop attacks" and dizzy spells was found to have spontaneous hypoglycaemia. A slowly enlarging pleural mass had been present for at least five years. At thoracotomy the mass (weight 1.7 kg) was excised and the hypoglycaemia ceased. Histologically the tumour was a pleural fibroma, with no features of malignancy. Endocrine tests before surgery showed a subnormal growth hormone response to spontaneous hypoglycaemia, a reduced concentration of serum insulin like growth factor I (IGF-I), and an inappropriately high concentration of serum insulin like growth factor II (IGF-II). After resection of the tumour the growth hormone response to insulin induced hypoglycaemia and the IGF-I and IGF-II concentrations were normal. These data suggest that the hypoglycaemia was due to production of IGF-II by the tumour, causing increased glucose utilisation and an impaired growth hormone counterregulatory response to hypoglycaemia.

Female↗
PubMed1991

Contact thermography of painful diabetic neuropathic foot.

OBJECTIVE: To investigate regional differences in skin blood flow (measured by contact thermography) in the diabetic neuropathic foot and to examine the effect of foot temperature on the severity of neuropathic pain. RESEARCH DESIGN AND METHODS: Thirty-five diabetic patients with painful polyneuropathy (PPN) and 33 healthy age- and sex-matched control subjects comprised the study. Mean foot temperature (MFT) in PPN (mean +/- SE 28.3 +/- 0.3 degrees C) was significantly higher (P less than 0.001) than in the control subjects (25.9 +/- 0.5 degrees C), with the highest temperatures over the metatarsal areas and heel. Visual analogue scale pain score (mean +/- SD 5.3 +/- 1.9 cm) did not correlate with MFT (r = -0.14, P = 0.52). In 10 patients with PPN followed for 2-8 mo (mean 4.6), MFT fell by 1.6 degrees C (P = 0.05), but pain scores did not alter. CONCLUSIONS: Neuropathic pain is unaffected by alterations in skin temperature. Elevated skin temperatures at recognized sites of weight bearing (metatarsal heads and heels) are common in the diabetic neuropathic foot and may indicate tissue injury or inflammation induced by pressure trauma or increased arteriovenous shunting. Follow-up studies will determine whether thermographic hot spots are more susceptible to ulceration.

Diabetic Neuropathies↗
PubMed1991

Unrecognised Cushing's syndrome and adrenal suppression due to topical clobetasol propionate.

A 53-year-old man with cushingoid appearance--obesity, osteoporosis causing lumbar and thoracic vertebral collapse and a past history of hypertension and depression presented with symptoms and signs of adrenocortical insufficiency. He denied the use of corticosteroid medication. However, it was eventually discovered that he had used clobetasol propionate (Dermovate), a potent topical steroid cream, for five years. The development of adrenal insufficiency symptoms coincided with the withdrawal of the cream.

Adrenal Insufficiency↗
PubMed1990

Longitudinal changes in serum fructosamine do not parallel those in glycated haemoglobin in young adults with insulin-dependent diabetes.

In 93 adolescent and young adult patients with type 1 diabetes (163 paired comparisons) changes in fructosamine concentration correlated poorly with changes in HbA1 (r = 0.53); this correlation was no better if fructosamine values were adjusted for serum albumin by calculating a fructosamine/albumin index, F.A.I. (155 pairs, r = 0.50). These correlation coefficients were lower than those for cross-sectional comparisons (HbA1 vs. fructosamine, r = 0.74; HbA1 vs. F.A.I., r = 0.80). One-way analysis of variance showed that values of HbA1, fructosamine and F.A.I. all tended to increase as glycaemic control, judged by the clinician, worsened (P less than 0.001). HbA1 correlated better with clinical assessment than did either uncorrected fructosamine or F.A.I. We conclude that changes in fructosamine from one clinic visit to the next do not provide a basis for changing therapy. Clinical assessments tend to agree with values for HbA1, which may be more reliable than fructosamine because of its longer biological half life.

Adolescent↗
PubMed1990

Clinical hyperthyroidism due to non-neoplastic inappropriate thyrotrophin secretion.

We report a case of hyperthyroidism due to inappropriate thyrotrophin (TSH) secretion in a patient with selective pituitary resistance to thyroid hormone action. Symptoms of hyperthyroidism in patients with this disorder are usually mild, implying some peripheral tissue resistance to the metabolic effects of thyroid hormone. Our patient had unusually severe symptoms, including marked weight loss and cardiac arrythmias which required carbimazole and beta-blocker therapy for control. Somatostatin was ineffective in suppressing TSH secretion. The introduction of sensitive thyrotrophin assays should facilitate the accurate diagnosis of TSH-induced hyperthyroidism and avoid inappropriate treatment.

Adult↗
PubMed1990

Pituitary enlargement and hyperprolactinaemia due to primary hypothyroidism: errors and delays in diagnosis.

Two young women with pituitary gland enlargement and hyperprolactinaemia were referred for pituitary surgery. Both had received bromocriptine (one patient for 13 years) for presumed prolactinoma. Mild clinical signs of hypothyroidism were present and endocrine tests revealed primary autoimmune thyroid failure. Following thyroxine replacement treatment, the pituitary enlargement and hyperprolactinaemia completely resolved. In both patients the hyperprolactinaemia was relatively mild and menorrhagia had been present for many years. A third patient, a 61-year-old man presenting with bitemporal hemianopia due to pituitary enlargement underwent transphenoidal pituitary surgery. The results of thyroid function tests on admission were not available until after surgery. Although the patient was clinically euthyroid, these revealed primary hypothyroidism and his considerable pituitary enlargement may also have been secondary to thyroid failure. Urgent thyroid function tests should be performed in all patients with pituitary enlargement prior to surgery to exclude hypothyroid induced pituitary swelling.

Adult↗
PubMed1990

Thecal cell reaction associated with an ovarian leiomyoma and presenting with virilization.

A 56-year-old woman presented with marked hirsutism and virilization of gradual onset. Menstruation had ceased at 43 years. The serum testosterone was grossly elevated (49 nmol/l) with levels of estradiol well above the postmenopausal range (200 pmol/l). Both serum testosterone and estradiol levels showed a marked but transient increase during the administration of the GnRH analog, buserelin. This indicated that the release of these steroids was under gonadotropin control. Bilateral oophorectomy revealed a greatly enlarged left ovary, and histology demonstrated a leiomyoma of the ovary with marked thecal reaction, which was probably responsible for the elevated serum testosterone and virilization. Testosterone levels returned to normal after bilateral oophorectomy. Excessive thecal androgen production associated with non-epithelial ovarian tumors is extremely uncommon and the response to buserelin has not previously been reported.

Buserelin↗
PubMed1990

Short term fluctuations in blood glucose concentrations do not alter pain perception in diabetic-patients with and without painful peripheral neuropathy.

Previous studies have suggested that acute hyperglycaemia may affect pain thresholds in non-diabetic subjects. We investigated the effects of acute fluctuations in blood glucose on the perception of pain in diabetic patients with and without painful diabetic neuropathy. Rapid swings in blood glucose concentration produced by IV glucose injection did not alter heat pain thresholds in diabetic patients without symptomatic neuropathy. Also, marked changes in neuropathic pain were not accompanied by significant alterations in blood glucose concentration in diabetic patients with painful neuropathy. Therefore, the alleged effects of acute hyperglycaemia on pain perception described in non-diabetic subjects are not reproduced in diabetic patients.

Adult↗
PubMed1989

Problems of diabetics in prison.

Providing care for diabetics is difficult in prison. Six diabetic prisoners or former prisoners were seen whose care was difficult or unsatisfactory. Three had multiple admissions to hospital during their sentences with diabetic ketoacidosis that they induced themselves by not taking insulin. The motive seemed to be removal from prison to the fairly pleasant surroundings of the local hospital. A fourth prisoner required admission in a hyperglycaemic, hyperosmolar state that had gone unnoticed as he was thought to be "acting up." The two others had imperfect long term management of diabetes during their sentences. There is clearly room for improvement in diabetic services in British prisons, but manipulative behaviour on the part of some diabetic prisoners may remain a problem.

Adult↗
PubMed1988

Anti-smoking advice for young diabetic smokers: is it a waste of breath?

The effect of health counselling on the smoking habits of 60 diabetic patients (aged less than 40 years) was assessed. Measurement of breath carbon monoxide (CO) and urinary cotinine, a metabolite of nicotine, were used as objective markers of smoking. All patients wished to cease smoking and the impact of health counselling was reviewed in a 'Stop Smoking' clinic. In addition to routine advice on the health hazards of smoking, half the patients and their families also received further counselling during a home visit by a health visitor. After 6 months many of the 60 patients claimed to have reduced their cigarette consumption. However, the urinary cotinine concentrations did not confirm this. Only one patient actually stopped smoking and he had sustained a myocardial infarction during the study. There was a small but significant reduction of breath CO in the patients seen at home by the health visitor but the urinary cotinine concentrations were unchanged. This suggests that these patients abstained from smoking for only a few hours before attending the 'Stop Smoking' clinic.

Adult↗
PubMed1988

Does acute hyperglycaemia influence heat pain thresholds?

The influence of acute hyperglycaemia on pain sensation was assessed in eight young adult non-diabetic subjects. Acute hyperglycaemia was induced with IV glucose in a double blind fashion, with IV saline as a control. Pain thresholds were assessed by a painful heat stimulus delivered by a Marstock thermode on the thenar eminence. Heat pain thresholds did not significantly alter during either acute hyperglycaemia or the control saline infusion. Previous work demonstrating a lowering of electrical pain thresholds by hyperglycaemia has therefore not been confirmed using a natural painful stimulus.

Adolescent↗
PubMed1988

Virilization due to ovarian hyperthecosis in a postmenopausal woman.

A 51-year-old woman presented with hirsutism and virilization of gradual onset. The serum gonadotropin concentrations were in the postmenopausal range, the serum testosterone concentration was markedly elevated (9.8 nmol/l) and the serum estradiol concentration (220 pmol/l) was elevated above the postmenopausal range. A selective venous catheterization study demonstrated raised serum testosterone and androstenedione levels in ovarian veins and suggested the presence of a left ovarian tumor. The raised peripheral estradiol level was shown to be due to ovarian hypersecretion. After bilateral oophorectomy the serum testosterone became normal. Ovarian histology revealed bilateral stromal hyperthecosis. Ovarian hyperthecosis is a rare but important cause of serum testosterone levels in the neoplastic range. This is the third case reported of postmenopausal virilization due to ovarian hyperthecosis and the first report of a selective venous catheterization study in such a patient.

Androstenedione↗
PubMed1986

Bacteraemia in diabetics.

During a period of 22 months one or more episodes of bacteraemia were detected in 168 patients in hospital. Of these, 29% also had diabetes compared with 10% of the total number of patients admitted to hospital during this time (P less than 0.001). The diabetics with bacteraemia were elderly and diabetes had usually been present for many years. Most of them were not receiving insulin at the time bacteraemia was diagnosed. Escherichia coli was the commonest pathogen (33%) in the diabetics, the main source of infection being the urinary tract. This finding may be due to diabetic autonomic neuropathy, which leads to a poorly emptying, chronically infected bladder. Urinary tract infections with bacteraemia in elderly diabetics are often accompanied by vague non-specific symptoms and poor diabetic control. Fever is infrequent. Prompt antibiotic therapy and insulin injections to control the diabetes usually cure these serious infections.

Aged↗