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Biomedical subjects

B Morell

Publications and source records attributed to B Morell.

9 recordsLinked to original sources
PubMed1990

[Control of diabetes and late complications].

When insulin was introduced in medical therapy in 1922, it permitted to save diabetics from premature death; however, it has allowed, after a certain period of time, for the appearance of a cohort of chronic complications connected more or less specifically to the degree of hyperglycemia. After a short review of the pathophysiology of the microangiopathy, the authors have tried to demonstrate, on the basis of numerous prospective and retrospective studies in the human as well as in the animal, that an important relationship exists between the degree of glycemic control and the severity of the classical complications, retinopathy, neuropathy and nephropathy. However, the most recent studies have stressed the role of some other factors, not well established in the past, as for example the potential negative impact on retinopathy of rapid normalization of glycemia, following a long period of poor metabolic control. Likewise, high blood pressure, smoking, genetic background, as well as probably also excess of protein intake, do play an important etiopathogenic role. Thus, the simplistic equation hyperglycemia = complications is not completely valid. Microangiopathic risk in insulin-dependent diabetics seems to be low as long as their HbAlc is below 7.5%, and they do not have hypertension and do not abuse tobacco. Finally, the general approach to therapy is redefined: Try to get as close as possible to near-normoglycemia by multiple insulin injections, without causing, however, major hypoglycemia; this should be done very early after the onset of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[The diabetic foot].

Neuropathy, arterial obstruction and infection are involved to varying degrees in the development of the 'diabetic foot'. A careful diagnosis is necessary in order to comprehend the various noxa and to introduce the adequate therapy. In case of the predominantly neuropathic foot with malum perforans, one must essentially proceed in a conservative way; only cornea callosities and osteomyelitic parts must be removed. In case of the predominantly angiopathic foot, revascularizing measures are most important. After improving the blood flow, the necrotic parts of the foot are sparingly resected. As prevention of a possible relapse, two things are necessary: accurately fitted shoes in order to prevent pressure points, and extremely careful foot care in order to prevent infections.

Diabetic Angiopathies↗
PubMed1985

Disabilities and handicaps in Aquitaine.

An extension of the national survey on health and medical consumption in Aquitaine used a questionnaire on presence of disability and handicap. Communication, personal cares, mobility and occupations were restricted in respectively 1.5, 3.3, 3.2, and 10.6%. People aged 60 and over were mainly concerned. Personal and domestic care disabilities were noted for 1 out of 8, communication disabilities were present among 1 out of 20. One out of 7 was restricted for mobility and physical independence; 1 out of 4 was restricted for customary occupations and 1 out of 10 for social relationships. Those physically dependent living alone were 5%.

Adolescent↗
PubMed1979

[Progress and developments in insulin therapy].

BANTING and BEST revolutionized diabetes therapy with the discovery of insulin 57 years ago. Since then, progress in this area has been slow despite tremendous reseach efforts. The subcutaneous injection of a depot insulin does not provide optimal control of blood sugar. True progress has been brought about by intravenous insulin administration for the management of diabetic coma. The authors do not recommend ultra low dose therapy. The prognosis of diabetic coma is much better than 20 years ago, in particular because of much improved and continuous supervision of the circulation (CVP, ECG, K+ etc.). Pancreas and islet transplantation fail in man due to immunological rejection. The "artificial pancreas" with a glucose sensor is useful for research purposes, and for controlling blood sugar for a few days at most. The implantable glucose sensor is not yet in sight. The authors have treated diabetics successfully with a programmable flexible open loop infusion program. The basal insulin infusion rate can be varied from 0.25 to 2 U/h, and rectangular one hour extra insulin infusions between 2 and 10 U/h are superimposed by pushing a button on the steering unit. The pump automatically switches back to the basal rate after one hour. No hypoglycemic reactions have been observed in patients on ths program on the ward or at home. At present, technical problems with the catheter remain to be solved before this simple therapeutic approach can be applied routinely.

Adolescent↗
PubMed1979

[New insulins in diabetes therapy].

The new MC or RI insulins are critically reviewed and the indications for switching to MC or RI pork insulin are discussed. A new means of determining the insulin requirement of brittle diabetics is short-time use of an insulin infusion apparatus.

Animals↗
PubMed1979

Optimal blood sugar control in labile diabetics using a portable open-loop insulin infusion system with a flexible program.

11 labile diabetics were well controlled after 2 days of an i.v., open-loop insulin infusion program consisting of constant, empirically determined, basal infusion rates (mean: 1.1 U/h) and superimposed rectangular one-hour insulin infusions between 2 and 8 U/h during the main meals. The steering unit switches automatically back to the basal infusion rate after one hour. An almost optimal blood sugar profile was already obtained on the third day of the infusion program. We believe that such a flexible, open-loop insulin infusion program would render long-term optimal blood sugar control in "labile" diabetics possible if the technological development ever allows implantation of the infusion pumps.

Adolescent↗
PubMed1978

[Adjustment of unstable diabetics with a simple insulin infusion program].

In view of the importance of knowing exactly how much insulin is required by diabetics who are difficult to control with subcutaneous insulin, an insulin infusion program has been tried in such patients. The apparatus, which was produced by Siemens as a prototype, works according to the following simple and flexible principle: During the day a basal rate of insulin is continuously infused. During the three main meals an additional rectangular insulin infusion is initiated by turning a knob. After an hour the apparatus switches automatically back to the basal ratio. We have used this machine in 13 patients who are fully mobile. 11 of them showed an almost ideal blood sugar profile after 4 days. After switching back to subcutaneous insulin 8 of these 11 patients did better than before but not as well as on the insulin infusion program.

Blood Glucose↗