The American journal of medicine
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Randomized Controlled Trial Clinical Trial
Combination insulin/glyburide therapy in type II diabetes mellitus. Effects on lipoprotein metabolism and glucoregulation.
A randomized double-blind, placebo-controlled trial of insulin plus glyburide was carried out in 22 insulin-treated patients with poorly controlled type II diabetes mellitus. Glycemic control and lipoprotein responses were assessed for 16 weeks. Oral glucose tolerance testing was performed at weeks 0, 4, and 16. ⋯ Mean fasting and stimulated serum C-peptide levels after oral glucose, however, were significantly higher in the patients with response at week 4 compared with the patients without response. The mean maximal incremental C-peptide level was 1.50 +/- 0.19 ng/ml at week 0 in the patients with response compared with 0.67 +/- 0.28 ng/ml in the patients without response (p less than 0.01). Lipoproteins were not different in the two groups.(ABSTRACT TRUNCATED AT 400 WORDS)
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To determine the clinical significance of a high anion gap (more than 16 meq/liter), consecutive patients in whom electrolyte determinations were made in an emergency room and who had either a normal (8 to 16 meq/liter) (n = 571) or a high (n = 100) anion gap were contrasted. No differences were noted between the groups with regard to age or length of stay in the hospital, but in the group with a high anion gap, there was an increased severity and frequency of multiple electrolyte disorders, and higher general admission rates (66 percent with high anion gap versus 51 percent with normal anion gap, p less than 0.02), rates of admission to an intensive care unit (25 percent with high anion gap versus 14 percent with normal anion gap, p less than 0.03), and mortality within one week of admission (12 percent with high anion gap versus 0.5 percent with normal anion gap, p less than 0.001) as compared with the group with a normal anion gap. ⋯ Thus, an elevated anion gap is associated with an increased severity of illness that is independent of concomitant severe electrolyte abnormalities. Patients with a normal or high anion gap that survived the first week of hospitalization were shown to have an extremely low risk for mortality.
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The duration of therapy and outcome were examined in 76 patients with polymyalgia rheumatica without evidence of temporal arteritis at presentation. Seventy-five patients received corticosteroids, with a mean prednisone dosage of 22.8 mg per day initially. Duration of therapy was assessed using life-table methods. ⋯ Evolution of arteritis during the course of therapy was infrequent, occurring in only one patient. Steroid-related adverse effects occurred in 22.7 percent of patients and were more common in females. The data suggest that, although corticosteroids may be discontinued in some patients with polymyalgia rheumatica, prolonged therapy is required in a significant number.
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Nasopharyngeal carcinoma has a well-defined geographic distribution, primarily affecting persons from southern China and Southeast Asia. Environmental factors are numerous and appear to have a secondary role, mainly in the promotion of the neoplastic process. ⋯ The tumor expands locally to contiguous structures, spreads through the cervical lymphatics following the jugular chain, and eventually metastasizes to the skeleton and liver. Primary management consists of radiation therapy to cervicofacial fields and usually offers adequate palliation, with a five-year median survival of 67 percent for stage I and 17 percent for stage IV disease.