Sustained azathioprine-induced remission in Wegener's granulomatosis.

It is conceivable, therefore, that the " enhancement " postulated by Floyd et al. (1966) is provided by the action of these two hormones. Turner (1968) has already shown in vitro that the insulinotropic effect of the amino-acid leucine is augmented by pancreozymin, while Ohneda et al. (1968) have recently reported that pancreozymin augments the insulinotropic effect of amino-acids in the dog. Further support for this hypothesis is provided by the present study, in which an increased insulinotropic effect of secretin and pancreozymin occurred in the presence of raised levels of circulating amino-acids. Circumstantial evidence for a significant role of seoretin and pancreozymin in the insulin response to protein, but not in response to glucose, may be adduced from the work of Estrich et al. (1967). These workers observed the effects of several oral test loads and could find no difference between the mean plasma insulin and glucose response to carbohydrate alone or to carbohydrate plus fat, yet fat is also known to stimulate secretin and pancreozymin release (Wang and Grossman, 1951). Carbohydrate plus protein, however, was associated with a significantly greater insulin but a lesser glucose response than a carbohydrate load alone, suggesting that the augmenting effect of intestinal hormones on insulin release occurs only in the presence of raised levels of plasma amino-acids. This interpretation of the role of these hormones is consistent with the failure to observe any effects of endogenous secretin and pan-creozymin on glucose-induced insulin release, when intra-duodenal hydrochloric acid at physiological concentration was used as the secretory stimulus (Boyns et al., 1967; Mahler and Weisberg, 1968) and with the failure of intraduodenal infusions of glucose to affect external pancreatic secretion (Sum and Preshaw, 1967). Malignant granulomatous disease of the respiratory tract has a relentless progressive course which as yet has not been greatly influenced by treatment. In the case reported below azathioprine appears to have effected amelioration of this condition. Of particular significance is the continuance of this satisfactory state in the months following cessation of immunosuppressive therapy. CASE REPORT In 1962 the patient, a woman then aged 57, had been under investigation because of vitreous opacities. Special examinations showed negative x-ray films of the chest; sinuses, and jaws, and a normal blood urea. No significant features developed until the second half of 1967, when her general health and energy deteriorated. She had lost considerable weight and experienced severe headaches and pronounced nasal obstructive …