Partial mastectomy for breast cancer.
Partial mastectomy for breast cancer.
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部分乳房切除术治疗乳腺癌。
DOI：
10.1136/bmj.2.6147.1268
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发表时间：
1978
影响因子：
--
通讯作者：
R. Tagart
中科院分区：
文献类型：
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作者：
R. Tagart
我们观察到ac细胞对精氨酸刺激的反应与特发性糖尿病中观察到的反应相当，这与Passa等的观察结果一致，并与输血性含铁血黄素沉着症患者中发现的受损反应形成对比，表明铁沉积以外的因素在IH相关糖尿病的发生中起作用。然而，在IH中，可能存在5-细胞的选择性破坏，高血浆胰高血糖素值因此仅反映胰岛素缺乏，并且有趣的是McGavran等人5在尸检研究中观察到n-细胞中的铁多于ax-细胞中的铁。然而，在输血性含铁血黄素沉着症中也观察到这种p细胞或铁沉积的倾向。显然，进一步的组织学研究，使用现代技术的指示。肝硬化（在我们的9例病例中得到证实）可能与IH相关的糖尿病有关，但不太可能是高胰高血糖素浓度的原因，因为我们的病例中只有2例肝功能值异常，并且没有门腔静脉分流的证据。这些发现增加了越来越多的证据，表明IH患者的糖尿病不仅仅是由于铁对胰岛细胞的损伤。有几个因素，包括肝硬化、遗传影响或铁沉积，可能起作用。在个别情况下，每一种方法都可能在不同程度上发挥作用。
Our observation of an ac-cell response to arginine stimulation comparable with that seen in idiopathic diabetes agrees with the observations of Passa et a14 and contrasts with the impaired responses found in patients with transfusional haemosiderosis, suggesting that factors other than iron deposition play a part in the genesis of diabetes associated with IH. In IH, however, there may possibly be a selective destruction of the 5-cell, the high plasma glucagon values thus merely reflecting insulin lack, and it is of interest that McGavran et al,5 in necropsy studies, observed more iron in the n-cells than in the ax-cells. This predisposition of the p-cell .or iron deposition was, however, also noted in transfusional haemosiderosis. Clearly further histological studies using modern techniques are indicated. Hepatic cirrhosis (proved in nine of our cases) may contribute to the diabetes associated with IH, but is unlikely to be the cause of the high glucagon concentrations, since liver function values were abnormal in only two of our cases and there was no evidence of portocaval shunting. These findings add to the accumulating evidence that diabetes in patients with IH is not due solely to islet cell damage by iron.' 2 4 Several factors, including hepatic cirrhosis, genetic influences, or iron deposition, might play a part. Each of these may operate to varying degrees in individual cases.