ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00676.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00677.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00678.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The Diabetes Education Study Group of the European Diabetes Association was founded in 1979 with its major goal to make effective patient training an integral part of any diabetes therapy. However, even today, in many places diabetes education is not an obligatory part of treatment, but is regarded as an optional service to the patient which is frequently fragmentary and haphazard. On the other hand, many physicians still subject their patients to rigid dietary instructions and obedience training, an approach which is mistaken for diabetes education. Several misconceptions about diabetes education keep counteracting the spread and hence the availability of effective treatment and teaching programmes for all Type 1 diabetic patients. One such misconception is that diabetes education could compensate for deficiences of inappropriate insulin treatment regimens. Studies failing to demonstrate the impact of diabetes education on metabolic control, typically used an insulin treatment regimen with only one or two insulin injections per day, the predominant use of intermediate acting insulin preparations, and without (day‐to‐day) adjustment of insulin dosages by the patients themselves. A further reason for a lack of success of diabetes education is an unstructured approach which is frequently mistaken for individualized care. The deleterious effects of putting patients on intensified insulin therapy without offering them sufficient and systematic training have manifested themselves at various places by an excessive increase in the risk of severe hypoglycaemia, and of ketoacidosis during therapy with continuous subcutaneous insulin infusion. The effective and safe performance of insulin therapy requires both a rational system of insulin substitution and intensive training of the patients to carry it out. The injection of regular insulin before main meals and the use of intermediate or long‐acting insulin preparations for the substitution of basal insulin requirements combined with daily metabolic self‐monitoring and (day‐to‐day) adaptation of insulin dosages by the patients themselves allow a substantial improvement of glycaemic control without an increase in the risk of severe hypoglycaemia and the adoption of a more flexible life style largely freed from forcing and directive dietary and other impositions. Each diabetes centre should continuously evaluate the quality of care offered to their patients as a basis for a specific and systematic improvement of its treatment and education programmes. Such quality control measures must include a recording of the patients' degree of metabolic control and the frequencies of severe hypoglycemia and ketoacidosis. The results of such quality control systems need to be made available to the public, i.e. the diabet

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00679.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. The acute effect of smoking and snuffing on insulin sensitivity was studied in a group of healthy habitual smokers.DesignThe euglycaemic clamp technique was combined with the subcutaneous injection of a bolus (0.1 U kg−1) of fast‐acting insulin (Actrapid®). Randomized subjects smoked either one cigarette per hour for 6 h, took one bag‐packed snuff per hour for 6 h or refrained from nicotine for 48 h before as well as during the clamp.Subjects. Seven healthy smokers, four females and three males, of normal weight (BMI, mean ± SKM. 21 ± 0.7 kg m−2with a range of 18.6–23.9), aged 31 ± 2 years (range 24–35 years), who had consumed at least 20 cigarettes per day for at least 5 years were studied. They were recruited through an advertisement in a newspaper.Results. The steady‐state plasma nicotine levels were similar during smoking and snuffing. The insulin and glucose levels were also similar during all three clamps. Smoking, but not snuffing, impaired insulin action (P<0.05) mainly due to a lower peripheral glucose uptake. The mean growth hormone levels during the 6‐h study were more than doubled during smoking (P<0.01) while no significant differences were seen in the other counter‐regulatory hormones.Conclusion. Smoking (also in habitual smokers) acutely impairs insulin action and leads to insulin resistance. Thus, smoking can be of importance for the development of the insulin resistance syndrome associated with risk for c

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00680.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.In 1991 171 teams in 21 European countries performed 4976 bone marrow transplants. There were 1829 transplants from an HLA‐identical sibling donor. 101 from a non‐identical family member. 30 from a twin. 217 from an unrelated volunteer donor and 2799 autologous transplants. Indications for transplants were leukaemias in 2569 (52%), lymphoproliferative disorders in 1472 (30%), solid tumours in 549 (11%), aplastic anaemia and thalassaemia in 261 (5%), inborn errors in 97 and miscellaneous disorders in 28 patients. There are marked differences between the participating European countries. They relate to absolute numbers, indications and techniques. Less than 10 transplants per 10‐million inhabitants are performed in Eastern European countries. Ten to fifty transplants per 10‐million inhabitants are done in two, 50–100 transplants per 10‐million inhabitants in five, 100–200 transplants per 10‐million inhabitants in eight countries and more than 200 per 10‐million inhabitants in one country (P<0.01). The number of transplant teams ranges from less than one to twelve per 10‐million inhabitants (P<0.01). For the continent it becomes 3.3 per 10‐million inhabitants.The reasons for these differences are not explained by this survey. The most likely explanation for the differences in transplant activity is availability of transplant beds, trained staff and resources. Bone marrow transplants are expensive. However, the demand is increasing and will increase further with the routine availability of unrelated volunteer donors. Clearly, criteria are required in Europe to define the indications and solutions to meet the legitimate requirements for transplantation in the vari

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00681.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The present study is a prospective examination of the relationship between platelet aggregation and the occurrence of graft failure in a single cohort of heart transplantation (HT) recipients. One‐hundred‐and‐twenty‐four patients underwent platelet function study and were then followed for 1 to 24 months (mean 6.7 months). There were nine re‐transplantations and 13 deaths (11 related to ischaemic events, and two others). In 15 patients, pathologic examination confirmed or revealed that recent acute myocardial infarction was the obvious cause of the graft failure. In five patients, myocardial fibrosis related to severe and diffuse coronary disease was the only microscopic finding. In the last two patients, the cause of the heart failure was not clearly identified. In recent myocardial infarction there was a high incidence (14/15) of coronary thrombi. Thrombi were multiple, disseminated in the coronary tree end of different age. Their presence at autopsy or after explantation was associated with an enhancedex vivoplatelet aggregability as compared with patients without coronary thrombi (n= 8): 43.3 ± 1.7% of maximal aggregation vs. 34.4 ± 2.4 (P= 0.006) and 48.4 ± 5.2 vs. 22.6 ± 4.9 (P= 0.003) for the primary and secondary waves of ADP‐induced aggregation. These results suggest that thrombosis and platelets may play a major role in the process of accelerated coronary artery d

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00682.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Effects of caffeine on ambulatory blood pressure, heart rate, renin‐angiotensin system, and ANP were studied in patients treated for mild to moderate hypertension in a randomized, double‐blind, placebo‐controlled, cross‐over trial comparing 2 weeks of caffeine‐free diet with 2 weeks of regular coffee use. Twenty‐three patients (13 men; aged 28–74 years) with treated, mild to moderate essential hypertension and a regular intake of 3–4 cups of coffee daily completed the study.Mean 24‐h, day‐ or night‐time ambulatory blood pressure and heart rate were not different between regimens. Nor were there any effects on the renin‐angiotensin system while ANP was significantly increased during caffeine intake. Compliance of the dietary regimen was excellent as assessed by serum caffeine concentration measurements. We conclude that habitual coffee drinking did not influence the 24‐h blood pressure profiles or cardiovascular hormones

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00683.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objective. To test possible differences between patients with Alzheimer's disease (AD) and patients with other forms of dementia and the healthy population concerning body composition, blood pressure, metabolic data and leukoaraiosis (LA).Design. Retrospective study on data collected according to a predefined protocol.Setting. A geriatric, neuropsychiatric diagnostic unit.Subjects. Seventy‐one consecutive patients with dementia.Main outcome measures. Body mass index, blood pressure, metabolism and LA in AD compared to other dementia forms.Results. Mean blood pressure and fasting blood glucose levels were lower in patients with AD, 94 ± 12 mmHg and 4.3 ± 0.5 mmol l−1, compared to patients with unspecified dementia (NUD), 100 ± 10 mmHg and 5.5 ± 2.5 mmol l−1(P<0.05) and vascular dementia (VAD), 114 ± 12 mmHg and 5.6 ± 1.6 mmol l−1(P<0.001) and the age‐matched healthy population. Body mass index, serum cholesterol and Cortisol were similar in all groups of dementia patients whereas triglycerides were highest in the VAD group. No cases of diabetes or treatment for hypertension were found in the AD group while the prevalence was 21% and 36% for diabetes in the NUD and VAD groups and 8% in the population from the same region. There were 16% with antihypertensive treatment in dementia NUD, 50% in VAD, and 30% in the general population. Treated or newly detected hypothyreosis was present in 11 % of the AD patients, none in the other dementia groups and 2% in the general population. Smoking was least common in AD. Degree of LA correlated with blood pressure and blood glucose levels.Conclusions. AD was clearly different to other dementia patients. They had lower blood pressure, blood glucose and higher prevalence of hypothyreosis than the healthy, age‐matched population. These findings may indicate that AD could be a hypom

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00684.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Cerebral toxoplasmosis is optimally treated with the combination of high doses of sulphadiazine and pyrimethamine. We described two patients with AIDS treated for cerebral toxoplasmosis who developed renal failure due to sulphadiazine‐induced crystalluria. Symptoms and renal failure were rapidly reversed with urine alkalinization and hydration. A careful monitoring and adequate hydration of patients with AIDS treated with high doses of sulphadiazine appears mandatory to avoid this complicatio

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00685.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY