Insulin-treated diabetic patients with poor glycaemic control are frequently referred to diabetes specialist nurses, but little data exist as to the effectiveness of this practice. We therefore analysed the progress of 43 prospectively referred insulin-treated patients with glycosylated haemoglobin (HbA1c) levels > 7.5%. Diabetes nurse intervention involved re-education, dietary advice and insulin dose adjustment. Improvement in control was defined as a final HbA1c < 7.0% or a fall of ...

The case is presented of a 31-year-old woman who developed florid clinical and biochemical Cushing's syndrome due to metastatic hepatic carcinoid tumour from a probable pancreatic primary. Hypercortisolaemia was controlled with metyrapone and ketoconazole, but high doses of octreotide failed to affect plasma cortisol and urinary 5-hydroxyindole acetic acid (5HIAA) levels, or prevent rapid tumour growth. Hepatic polystyrene embolisation failed, and she was treated by liver transplantation ...

A39-year-old man was admitted urgently with abdominal pain and vomiting to a surgical ward. He had a history of excessive alcohol intake and previous attacks of acute alcoholrelated pancreatitis. Examination was unremarkable apart from a tachycardia of 120/minute in sinus rhythm and generalized abdominal tenderness. Investigations revealed normal haemoglobin, urea and electrolyte levels. White cell count (WCC) was 11.5/mm3 and plasma glucose 13.1 mmol/litre (there was no past or family ...