THE DISAPPEARANCE OF SUGAR AFTER THE REMOVAL OF TUMORS IN DIABETICS

MORRIS MANGES
1913 Journal of the American Medical Association (JAMA)  
The ¿method of administering serum was practically the same in all cases, modified of course by the age and general condition of the patient. An initial dose°f from 30 to 45 c.c. was usually given to adult patients as soon as-they reached the hospital; a second injection of from 20 to 30 c.c. was given from twelve to eighteen hours later; and subsequently one or two doses of from 20 to 30 c.c. and a dose or two of from 10 to 15 c.c. at intervals of twenty-four hours. The continuance of the
more » ... treatment depended, of course, on whether or not meningococci Were still present in the spinal fluid. In favorable cases there was a marked diminution in the number of organ-ls|ns after the first injection of serum and usually an absence of organisms after the second or third injection; '»ut we noticed that we were much less apt to have a recurrence of infection if one or two injections of serum Were made after the spinal fluid showed no organisms present. When symptoms reappeared and organisms ".-a in were found in tbe spinal fluid, the serum was "dministered again as when the patient first came in. Some patients received serum from time to time over periods of weeks before the infection finally subsided. Epidemics differ so in their severity that it is not Possible to state to what extent the serum treatment mlluenced the mortality in this epidemic. Nevertheless I am convinced, first, that the course of the disease was 'nnlerially. shortened in those eases that, showed any response to treatment; second, that complications and sequelae were much less frequent, and third, that the remarkable results obtained in many cases seen early in Hie eourse of the disease were due to the specific action of the serum on the infection. 'lie statistics here recorded were gathered under the direc¬ tion of Dis. In the discussion of Joslin's paper,1 Miller called attention to a fact which is of great importance in the prognosis of diabetic patients who may require operations for the removal of tumors, and which may also have some value in the solution of the much-debated problems of the etiology of diabetes. I refer to the disappear anc e of sugar after the removal of tumors. Miller's case is as follows: A woman passed 50 gm. of sugar in spite of being on a rigid diet. She bad very severe uterine hemorrhages, and as a result was markedly anemic. A hysterectomy was performed. It was found that a carcinoma had developed on an old fibroid tumor. Several months later the patient returned, and it was found that she was entirely free from sugar. She is still well, in spite of taking an unlimited diet. In closing the discussion Joslin reported a similar case. The patient had a severe attack of diabetes; the glycosuria occurred in connection with a fibroid tumor of tlie uterus. When the fibroid was removed the sugar disappeared. I wish to report two similar cases from my own practice, in both of which the patients were severe diabetics vvilh advanced prostatic disease. In the first case, which occurred ten years ago, tlie patient was a man of (i'2 years with a long-standing diabetes with prostatic bladder symptoms of several years' duration. On account of his severe diabetes-the daily amount of sugar rang¬ ing from 50 to 150 gm., and a marked acidosis being presentlie was considered a bad surgical risk, the more so as lie had a very vulnerable skill. Finally the condition of urinary Kcpsis became so urgent that the drainage of tlie bladder and tlie removal of the prostate gland could no longer lie delayed., Tlie operation was performed in two stages by Dr. Lilienthal, and to every one's surprise was very well borne. Great relief was afforded to the patient, but what was especially gratifying was (lie marked improvement in tlie diabetes. For a long time the sugar excretion remained below 20 gin. ami tlie acidosis disap¬ peared. This was all the more reinarkalile as the patient had a bad family history of diabetes, und all attempts to render his sugar less had not been successful to any marked extent. About a year and ¡i half after the prostatectomy tlie diabetes again took on a severe form and he finally succumbed to it. The second ease first came under observation five years ago. The patient was a man, who was then 70 years old and who had been under tlie care of Dr. Chetwood for a long-stand i ng prostatic disease and diabetes. For a long time the sugar ranged between .'I and 5 per cent, in spite of dieting, and there was a marked acidosis. This patient too was considered a bad surgical risk on account of his ¡ikc and the diabetes. In his case also the development ofka bad urinary sepsis left no choice. The removal of the prostate and several large stones was a difficult opera¬ tion, and in spite of all precautions tlie convalescence was pro¬ tracted. Nevertheless the patient made a complete recovery, and he never had any further trou lite from his bladder. After tlie operation the sugar disappeared completely, and it never returned in spite of the most liberal diet. The sugar did not reappear even when he developed a pus kidney from which he died a few weeks ago after a short illness, as he refused to be operated on. The results in these two cases offer a striking corrobo¬ raron of the experience of Miller and Joslin; they seem to represent more than a coincidence, since in all the cases, four in number, the diabetes was a severe one with marked acidosis. In three of them the removal of a tumor was followed by a complete disappearance of the glycosuria, while in the fourth case there Avas a marked improvement for a year and a half, a result which was all the more remarkable since all efforts on my part to reduce the sugar had been unsuccessful for a long time, as the patient was an exceedingly neurotic man with a bad diabetic family history, and the suffering from bis bladder and prostate had been most intense. That diabetes can be cured even without dietetic treatment is a well-known fact even though such cases are quite uncommon. Naunyn, in bis masterly treatise,discusses this possibility, and shows its infrequency. It is most likely to occur when the diabetes has followed a cerebral trauma or in syphilitic diabetes. He also refers to eases of cured diabetes in which a curable organic disease cannot be diagnosticated, these cases being usually acute diabetes. He also notes the curious fact that a large proportion of the latter cases occur among children, who as a rule run such a severe and fatal course. He also warns against considering as cures the not infrequent cases of diabetes in old persons in whom the process simply becomes latent for a longer or shorter period. His conclusion is that "taken all in 1. Joslin,
doi:10.1001/jama.1913.04340090023010 fatcat:qbjl3y4lgbek5b4t5qwum5ogwe