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Biomedical subjects

A C MacCuish

Publications and source records attributed to A C MacCuish.

At least 19 recordsLinked to original sources
PubMed1992

Benefits of training junior physicians to detect diabetic retinopathy--the Glasgow experience.

The accuracy and appropriateness of 115 consecutive referrals by non-consultant physicians to a specialist Diabetic Retinopathy Clinic were assessed in a retrospective study. The source of the referrals was masked throughout the study. Referrals were classed as 'appropriate' or 'inappropriate' for patient management, and the referral diagnosis (where specified) was compared with the ophthalmologist's initial assessment. It was graded as 'correct', 'partly correct' and 'incorrect'. Referrals from physicians who had received 40-50 hours of outpatient training in the Diabetic Retinopathy Clinic (group A, n = 49) were compared with referrals from doctors without this special instruction (group B, n = 66). Referral was deemed 'appropriate' in 32 (65%) of group A referrals, but in only 22 (33%) of group B (chi 2 = 11.54, df = 1, P less than 0.001). Referral diagnosis (when expressed) was graded as 'correct' in 28 (67%) of group A referrals compared with only 12 (30%) of group B, being 'incorrect' in 10 (25%) of group B referrals and just two (4.5%) of group A (chi 2 = 12.9, df = 2, P less than 0.005). Regular fundoscopy with accurate assessment and appropriate action is vital to prevent loss of vision in diabetic patients. Short-term outpatient training in a Diabetic Eye Clinic leads junior physicians to more appropriate referral and more accurate referral diagnosis.

Diabetic Retinopathy↗
PubMed1991

Effects of acute insulin-induced hypoglycaemia on haemostasis, fibrinolysis and haemorheology in insulin-dependent diabetic patients and control subjects.

1. The effects of acute hypoglycaemia on haemostasis, fibrinolysis, blood viscosity and erythrocyte aggregation were examined after acute insulin-induced hypoglycaemia in six normal male subjects and in six male patients with poorly controlled insulin-dependent diabetes. In the control subjects hypoglycaemia caused a significant increase in the concentration of von Willebrand factor, with no change in the concentrations of fibrinogen and cross-linked fibrin degradation products. Fibrinolysis was enhanced, as indicated by significant increases in tissue plasminogen activator concentration and the fibrin plate lysis area, with a fall in plasminogen-activator inhibitor activity, suggesting complex formation. Whole-blood and plasma viscosity increased significantly after hypoglycaemia, but there was no significant change in erythrocyte aggregation tendency. 2. In diabetic patients the increase in the concentration of von Willebrand factor was significantly greater than in the control group (analysis of variance, P less than 0.02). The basal concentration of tissue plasminogen activator was reduced at 3.7 +/- 0.7 mg/l (mean +/- SEM) in the diabetic group compared with 8.5 +/- 1.3 mg/l in the control group (Student's t-test, P less than 0.01), but thereafter the increase in response to hypoglycaemia was similar. The changes in the other variables were not significantly different from the changes in the control group. 3. During acute hypoglycaemia in poorly controlled diabetic patients there is promotion of haemostasis with a greater increase in the concentration of von Willebrand factor, which, in association with the increase in viscosity, might reduce perfusion in diabetic microangiopathy, leading to aggravation of the microvascular complications of diabetes.

Acute Disease↗
PubMed1991

Impaired anal sensation and early diabetic faecal incontinence.

Faecal incontinence develops in up to 20% of diabetic patients. To try to determine the relative contributions of sensory and motor neuropathy in this troublesome complication, anorectal function was examined in 10 male diabetic patients with early faecal incontinence (mucus leakage or faecal staining without the need to wear a pad), 10 asymptomatic male diabetic patients, and 10 normal control subjects. Motor function was tested using anal manometry to determine the resting and maximum squeeze pressure, and the functional anal canal length. No significant differences were found between the groups. Sensory function was tested by measuring the mucosal sensitivity to electrical stimulation, and the response to inflation of a balloon in the rectum. In the mid-anal canal position the symptomatic patients had a significantly higher sensory threshold at 6.6 +/- 2.8 mA compared with 3.0 +/- 1.2 mA in the normal control subjects (p less than 0.002), and in the high anal zone symptomatic patients had a significantly elevated sensory threshold at 9.1 +/- 2.0 mA compared with 4.6 +/- 1.6 mA in asymptomatic patients and 3.6 +/- 1.3 mA in the normal control subjects (both p less than 0.001). There were no significant differences in the first sensation of fullness, maximum tolerated volume or percentage fall from resting pressure between the groups on inflation of the balloon. Elevation of the sensory threshold in the upper anal canal is an early abnormality in the development of diabetic faecal incontinence.

Anal Canal↗
PubMed1991

Do rheological variables play a role in diabetic peripheral neuropathy?

Whole blood viscosity and its determinants were measured in diabetic patients with and without peripheral neuropathy to assess whether these variables could have a role in the microvascular aetiology of diabetic peripheral neuropathy. Although corrected whole blood viscosity at high and low shear rates (5.29 +/- 0.51 and 21.10 +/- 3.03 mPa s), plasma viscosity (1.41 +/- 0.13 mPa s), and red cell filtration ratio (0.49 +/- 0.04) in diabetic patients were significantly different from non-diabetic control subjects (high shear rate 4.83 +/- 0.54, low shear rate 17.36 +/- 2.78, plasma 1.29 +/- 0.09 mPa s, all p less than 0.001, and red cell filtration ratio 0.55 +/- 0.03, p less than 0.001) there were no significant differences between diabetic patients with neuropathy and those without. Blood rheology is altered to a similar extent in diabetic patients with and without neuropathy.

Blood Viscosity↗
PubMed1990

The relationship between colonisation, secretor status and in-vitro adhesion of Candida albicans to buccal epithelial cells from diabetics.

This study investigated whether oral candida infection in diabetics and adhesion of Candida albicans to buccal epithelial cells in vitro were related. Buccal cells from 50 patients with diabetes mellitus showed a significant increase in adhesion of C. albicans strain CDS 88 compared with those collected from 50 non-diabetic controls matched for age, sex and denture status. Oral candida carriage, candida infection and secretor status were also investigated in both groups. The frequency of carriage was increased, but not significantly, and there was a significantly higher incidence of candida infection in diabetic patients compared with controls. Diabetic patients who were non-secretors had a significantly increased frequency of oral candida carriage.

Candida albicans↗
PubMed1990

Evaluation of red cell deformability by a filtration method in type 1 and type 2 diabetes mellitus with and without vascular complications.

Previous studies of red cell deformability (RCD) in diabetic patients have produced conflicting results. We have therefore reassessed this problem with the Carri-Med Filtrometer, which measures RCD independently of the rate of clogging of the filter. The initial red cell filtration ratio relative to buffer (mean +/- SD) of 69 diabetic patients (28 type 1 and 41 type 2) was significantly impaired in both type 1 (0.470 +/- 0.047) and type 2 diabetic patients (0.488 +/- 0.065), when compared to 66 non diabetic control subjects (0.540 +/- 0.032; both p less than 0.001). A significant difference in RCD was noted between type 1 and type 2 diabetics (p less than 0.03), but no association with vascular complications was found. No significant correlations were noted between RCD and the duration of diabetes, age, HbA1, leucocyte count, or mean red cell volume. However RCD was inversely related to mean red cell haemoglobin concentration (r = -0.43, p less than 0.01). Diabetics had significantly lower mean red cell volume and significantly higher mean cell haemoglobin concentration than non-diabetics, but these changes could not explain the difference in RCD, which may be related to alterations in the red cell membrane.

Adult↗
PubMed1989

Changes in phagocytic function with glycaemic control in diabetic patients.

Phagocytic function was assessed by serial whole blood chemiluminescence in poorly controlled type 2 (non-insulin dependent) diabetic patients during efforts to improve glycaemic control and compared with a group of well controlled type 1 (insulin dependent) diabetic patients. Chemiluminescence (corrected to a standard polymorphonuclear count) remained below normal (0.15-0.30 photons/second/cell) for most of the type 2 patients until 12 weeks when the value was significantly increased in patients showing improved glycaemic control (mean (range) 0.25 (0.01-0.43) photons/second/cell) compared with those showing no improvement (0.12(0.01-0.31) photons/second/cell). There was a significant inverse correlation of delta HbA1 with delta chemiluminescence. Although mean chemiluminescence for the type 1 diabetic patients was within the normal range, there was a wide scatter of values (0.19 (0.04-0.43) photons/second/cell) and there was no significant difference compared with the final value of type 2 patients with improved control. Glycaemic control is therefore a major determinant of phagocytic function in diabetic patients, but other factors must contribute, particularly in type 1 (insulin dependent) patients.

Adult↗
PubMed1989

Tissue plasminogen activator inhibition in diabetes mellitus.

Depression of fibrinolysis may be relevant to the vascular complications of diabetes mellitus. Plasminogen activator inhibitor (PAI) is an important inhibitor of fibrinolysis in humans, and we have found basal activities of PA inhibition to be elevated in patients with diabetes compared with a reference group of healthy subjects (mean +/- SD 268 +/- 268 vs. 105 +/- 48%; P less than .0001). With a monoclonal antibody, it was shown that high inhibition values were due to PAI-1. No differences in PA inhibition were noted in relation to type of diabetes, diabetic treatment, or presence or absence of vascular complications. Basal PA inhibition did not correlate with in vivo (B beta 15-42 antigen) or ex vivo (fibrin plate) fibrinolytic activity or HbA1. In patients with non-insulin-dependent diabetes mellitus, treatment with the anabolic steroid stanozolol significantly reduced PA inhibition. These findings suggest a further abnormality of fibrinolysis in diabetes, but the lack of a relationship among other measures of fibrinolysis renders its biologic significance uncertain.

Antibodies, Monoclonal↗
PubMed1989

Adrenal androgens in insulin-dependent diabetes mellitus.

The adrenal androgens dehydroepiandrosterone sulphate (DHAS) and androstenedione (A2) are major secretory products of the adrenal gland, although their precise function is unclear. There is limited evidence to suggest adrenal androgen levels may be altered in diabetes, and that insulin secretion may influence these hormones. Therefore we have measured fasting levels of serum DHAS, A2, testosterone, oestradiol (in males only), sex hormone binding globulin (SHBG), HbA1 and C-peptide (basal and glucose stimulated), in 17 post-pubertal, uncomplicated patients with insulin-dependent diabetes mellitus (IDDM), and made comparisons to 17 of their sex and age-matched (to within 5 yr) non-diabetic siblings. Concentrations of the adrenal androgens were within the laboratory normal range in all the subjects and no differences were noted between the diabetics and their siblings or between males and females. No correlations were noted between the hormones and either HbA1 or C-peptide. In contrast to previous reports we have found that C-peptide status does not influence adrenal androgen levels, and that normal concentrations of these androgens are found in non-ketotic patients with IDDM.

Adrenal Cortex Hormones↗
PubMed1988

Association of hypertension with blood viscosity in diabetes.

Plasma and whole blood viscosity and its determinants were measured in 86 diabetic patients (29 hypertensive and 57 normotensive) and compared with 52 non-diabetic control subjects to assess whether hypertension has an additive and adverse effect on blood viscosity. Whole blood viscosity (corrected for haematocrit), at high and low shear rates (95 and 0.95 s-1), was significantly higher in both Type 1 (5.1 +/- 0.5 (+/- SD), 19.8 +/- 2.9) and Type 2 (5.2 +/- 0.3, 21.1 +/- 2.0) diabetic patients compared with control subjects (4.9 +/- 0.6, 17.4 +/- 2.6 mPa s, p less than 0.01). Corrected whole blood viscosity at high shear rate was significantly higher in hypertensive than in normotensive Type 2 diabetic patients (5.5 +/- 0.4 vs 5.2 +/- 0.3 mPa s, p less than 0.01). Plasma viscosity was significantly higher in diabetic patients compared with control subjects (1.4 +/- 0.1 vs 1.3 +/- 0.1 mPa s, p less than 0.01), but there was no difference between hypertensive and normotensive diabetic patients (1.4 +/- 0.1 vs 1.4 +/- 0.2 mPa s). Fibrinogen levels were similar in all the groups.

Adult↗
PubMed1988

Cerebral oedema in diabetic ketoacidosis.

Modern management of diabetic ketoacidosis has reduced mortality of this condition from inevitable death in the pre-insulin era to less than 5% in specialised centres. Most fatalities now reflect the underlying disease which has caused metabolic decompensation, such as acute myocardial infarction, cerebrovascular accident or septicaemia. However patients may still die as a direct result of the metabolic disturbances per se and the rare complication of cerebral oedema in diabetic ketoacidosis is almost invariably associated with fatal outcome.

Adult↗
PubMed1988

Management of diabetes resistant to subcutaneous insulin with intravenous insulin via an implanted infusion pump.

Diabetes resistant to conventional subcutaneous insulin injection is a rare complication of insulin-dependent diabetes which poses a major management problem. We report three cases treated for a total of over seven patient years with fully implanted insulin infusion devices. Technical difficulties with the devices and their operation have been substantial but the patients are much improved and hospitalisation has been dramatically reduced. We suggest that implanted insulin pumps are a real treatment option for patients with this unusual syndrome.

Adolescent↗
PubMed1988

Diabetic hyperosmolar non-ketotic decompensation.

To assess whether the outcome of hyperosmolar non-ketotic decompensation has changed in the past 20 years with modern medical management, a retrospective study analysis was performed of all patients presenting with the syndrome to a large teaching hospital during the period 1982 to 1986. Twenty-two patients were identified of whom 68 per cent had no previous history of diabetes mellitus. The immediate mortality rate (within 72 h of presentation) was 36 per cent (eight of 22), the overall mortality rate was 41 per cent (nine of 22) and vascular thromboembolism was common. A comparison was made of the early deaths (n = 8) and survivors (n = 14) in an attempt to identify favourable prognostic factors. The two groups could not be distinguished either by clinical or laboratory variables at presentation nor by treatment regimen; however there was a significant delay in establishing the diagnosis in some of the patients who died. Our results indicate there has been no improvement in the outcome of the hyperosmolar non-ketotic decompensation syndrome in the last two decades and that a high index of suspicion is required to identify patients presenting with this condition.

Aged↗