The New England journal of medicine
-
Letter Case Reports
Treatment of painful diabetic neuropathy with topical capsaicin.
-
Polyunsaturated fatty acids are thought to lower the serum cholesterol level more effectively than monounsaturated fatty acids. It is unclear whether the difference--if any--is due to a lowering of the level of high-density lipoprotein (HDL) or low-density lipoprotein (LDL) cholesterol. We therefore placed 31 women and 27 men on a mixed natural diet rich in saturated fat (19.3 percent of their daily energy intake from saturated fat, 11.5 percent from monounsaturated fat, and 4.6 percent from polyunsaturated fat) for 17 days. ⋯ In women, the HDL cholesterol level did not change with either. We conclude that a mixed diet rich in monounsaturated fat was as effective as a diet rich in (n-6)polyunsaturated fat in lowering LDL cholesterol. Both diets lowered the level of HDL cholesterol slightly in men but not in women.
-
To identify early metabolic abnormalities in non-insulin-dependent diabetes mellitus (NIDDM), we measured sensitivity to insulin and insulin secretion in 26 first-degree relatives of patients with NIDDM and compared these subjects both with 14 healthy control subjects with no family history of NIDDM and with 19 patients with NIDDM. The euglycemic insulin-clamp technique, indirect calorimetry, and infusion of [3-3H]glucose were used to assess insulin sensitivity. Total-body glucose metabolism was impaired in the first-degree relatives as compared with the controls (P less than 0.01). ⋯ During hyperglycemic clamping, first-phase insulin secretion was lacking in patients with NIDDM (P less than 0.01) and severely impaired in their relatives with impaired glucose tolerance (P less than 0.05) as compared with control subjects; insulin secretion was normal in the relatives with normal glucose tolerance. We conclude that impaired glucose metabolism is common in the first-degree relatives of patients with NIDDM, despite their normal results on oral glucose-tolerance tests. Both insulin resistance and impaired insulin secretion are necessary for the development of impaired glucose tolerance in these subjects.
-
Randomized Controlled Trial Clinical Trial
Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction.
The occurrence of ventricular premature depolarizations in survivors of myocardial infarction is a risk factor for subsequent sudden death, but whether antiarrhythmic therapy reduces the risk is not known. The Cardiac Arrhythmia Suppression Trial (CAST) is evaluating the effect of antiarrhythmic therapy (encainide, flecainide, or moricizine) in patients with asymptomatic or mildly symptomatic ventricular arrhythmia (six or more ventricular premature beats per hour) after myocardial infarction. As of March 30, 1989, 2309 patients had been recruited for the initial drug-titration phase of the study: 1727 (75 percent) had initial suppression of their arrhythmia (as assessed by Holter recording) through the use of one of the three study drugs and had been randomly assigned to receive active drug or placebo. ⋯ Because of these results, the part of the trial involving encainide and flecainide has been discontinued. We conclude that neither encainide nor flecainide should be used in the treatment of patients with asymptomatic or minimally symptomatic ventricular arrhythmia after myocardial infarction, even though these drugs may be effective initially in suppressing ventricular arrhythmia. Whether these results apply to other patients who might be candidates for antiarrhythmic therapy is unknown.