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Biomedical subjects

D R Hadden

Publications and source records attributed to D R Hadden.

At least 145 records · Page 8Linked to original sources
PubMed1982

The effect of intensive dietary therapy on serum high density lipoprotein cholesterol in patients with Type 2 (non-insulin-dependent) diabetes mellitus: a prospective study.

Intensive dietary therapy in 57 newly diagnosed Type 2 (non-insulin-dependent) diabetic patients led to an increase, compared with pre-treatment levels, in serum high density lipoprotein (HDL) cholesterol and the HDL/total cholesterol ratio after 3 and 6 months (0.05 less than p less than 0.1). The increase in HDL cholesterol was related to the degree of weight loss achieved. In 28 patients whose weight decreased by greater than or equal to 10% average body weight during the 6 months, HDL cholesterol rose from 1.22 +/- 0.06 to 1.36 +/- 0.06 mmol/l (p less than 0.001), whereas patients who lost less weight showed no significant increase in HDL cholesterol. The increase in mean serum HDL-cholesterol levels in female patients was associated with a mean weight reduction of 12.1% average body weight. Patients who were obese at diagnosis lost more weight during the study than non-obese patients (mean 13.2 versus 5.6% average body weight), and showed a significant increase in serum HDL-cholesterol levels. We conclude that intensive dietary therapy may lead to a less atherogenic lipid profile in Type 2 diabetes, particularly in patients who achieve a major weight reduction.

Adult↗
PubMed1982

Cushing's syndrome in pregnancy--treatment with metyrapone.

A 23-year-old female presented with severe Cushing's syndrome in the 23rd week of pregnancy. Investigations showed plasma cortisol 770 nmol/l (08.00 h) and 850 nmol/l (23.00 h); plasma ACTH was 10 ng/l (08.00 h) and 27 ng/l (23.00 h); urinary free cortisol excretion was 2460 nmol/24 h. Dexamethasone 2 mg 6-hourly for 48 h suppressed the 08.00 h plasma cortisol only to 680 nmol/l. Abdominal C.T. scan showed a right adrenal adenoma. The patient was treated with metyrapone and a good clinical improvement ensued. Plasma cortisol was reduced to 300-500 nmol/l. Depsite ultrasonographic evidence of normal fetal growth, urinary oestriol excretion was markedly deficient. Prior to the spontaneous onset of labour, there was a marked rise in plasma cortisol despite continuous metyrapone treatment. A normal female infant was born at 37 weeks' gestation. The maternal adrenal adenoma was subsequently removed. The deficiency of oestriol synthesis during the pregnancy may be explained by metyrapone-induced inhibition of C19-hydroxylation.

Adenoma↗
PubMed1981

H.L.A. antigens in proliferative diabetic retinopathy.

One hundred and four patients with diabetes mellitus present for at least 15 years were tissue typed for HLA antigens AI and B8. Fifty six patients had severe proliferative retinopathy and 48 patients no retinopathy. The results were compared with a group of 200 normal blood donors. There was no significant difference in frequency of AI and B8 between the two groups od diabetic patients. The HLA pattern A-I B+8 was more frequently present among the group of patients with proliferative retinopathy.

Adolescent↗
PubMed1980

Dietary management of maturity-onset diabetes.

Dietary management of maturity-onset diabetes is a basic medical concept. It is difficult to study scientifically because of variable eating habits and the impossibility of rigorous measurement. The non-insulin-requiring diabetic patient is often managed by the family doctor, who may not have access to dietetic assistance, and assessment of the success of simple but careful dietary measures is infrequent. We have taken a special interest in this group of patients, and find that most maturity-onset diabetic patients can be satisfactorily managed on diet only. In a group of 58 such patients there was a significant fall in mean weight and fasting plasma glucose and triglyceride concentrations after six months, which persisted for up to three years. This achievement was chiefly due to those patients who were graded as "good" in their dietary adherence, but less good dieting still achieved weight loss, though plasma glucose and triglyceride concentrations did not fall so low. The clinical dietitian has played a central part in this study.

Adult↗
PubMed1980

Antithrombin III activity and other coagulation changes in proliferative diabetic retinopathy.

Antithrombin III, factor VIII, fibrinogen and fibrinolytic activity were measured in two groups of long-standing insulin-dependent diabetic subjects (24 with proliferative retinopathy, 24 without detectable retinopathy) and 24 non-diabetic controls. Mean antithrombin III (+/- 1 SD) was 115.9 (+/- 15.1), 109.8 (+/- 18.1) and 101.4% (+/- 12.5), respectively, in the retinopathy, non-retinopathy and control groups. Statistical significance was obtained when comparing the retinopathy and control groups (p < 0.001) and when comparing all 48 diabetics collectively with controls (p < 0.01). Mean factor VIII coagulant activity was 137.5 (+/- 37.0), 126.2 (+/- 58.2) and 97.0% (+/- 38.7), respectively, in the three groups. Again the differences between all diabetics and controls (p < 0.01) were statistically significant. Similar increases were observed for other modalities of factor VIII activity. Fibrinolytic activity was significantly increased in both diabetic groups but fibrinogen levels, although increased, were not statistically different from levels in controls. It is suggested that the observed changes are more likely to be secondary to the development of retinopathy and that the increase in antithrombin III activity is due to an increase in alpha 2-macroglobulin.

Adult↗
PubMed1980

Plasma glucagon and insulin concentrations in acromegaly.

Sixteen patients with clinically active acromegaly were investigated; four of these had insulin-independent diabetes mellitus. Those acromegalic subjects who were not diabetic exhibited excessive insulin responses to glucose and arginine stimulation. By contrast, plasma glucagon concentrations in these patients did not differ significantly from those in control subjects. Acromegalic patients who also had insulin-independent diabetes had a markedly reduced insulin response to glucose stimulation, while arginine-induced insulin secretion was relatively well preserved. Although there was a tendency for plasma glucagon concentrations to be higher in the diabetic than in the nondiabetic group of acromegalic subjects, this difference did not achieve statistical significance either in the basal state or during the glucose amd arginine infusion tests.

Acromegaly↗
PubMed1980

Pseudohypoparathyroidism presenting with rickets.

Pseudohypoparathyroidism (PHP) is a condition characterized by hypocalcemia, hyperphosphatemia, and an impaired phosphaturic response to exogenous parathormone (PTH). A minority of patients with PHP have associated bone disease, and in some the radiological appearances have been suggestive of rickets. We report a patient with PHP who had epiphyseal enlargement and bowing of the long bones similar to that seen in rickets. Radiology showed generalized osteomalacia with failure of epiphyseal calcification and several pseudofractures. Bone biopsy showed increased osteoid seams. The phalanges of both hands showed subperiosteal erosions consistent with hyperparathyroidism. Biochemically, he had persistent hypocalcemia, hyperphosphatemia, and an elevated alkaline phosphatase. Plasma calcitonin, magnesium, and 25-hydroxycholecalciferol levels were normal. The 1,25-dihydroxycholecalciferol level was within the normal adult range but was probably inappropriately low for an adolescent. Plasma parathormone was elevated (1.3--1.7 microgram/liter; normal, < 0.73). His diet was not deficient in vitamin D. Gastrointestinal function was normal. Renal function was normal, apart from an increase in the maximum tubular reabsorption of phosphate (46--52.6 mg/liter glomerular filtration rate; normal, 38 +/- 5). Intravenous PTH infusion tests were performed on the patient and a control subject before and 6 months after serum calcium levels had returned to normal. The maximum increases in cAMP excretion in the patient were 0.03 and 0.05 mmol/g creatinine before and after treatment, respectively (control, 0.53 and 0.24); the maximum increases in phosphate excretion in the patient were 0.14 and 0.04 mmol/g creatinine before and after treatment, respectively (control, 0.32 and 0.07). He responded to initial treatment with a high dose of calciferol and later to 1,25-dihydroxycholecalciferol in a dose of 1 microgram/day. It is considered that renal resistance to PTH is his primary abnormality, with the bone disease representing a secondary phenomenon.

Adult↗
PubMed1980

Morbidity and mortality in patients with diabetic retinopathy.

Most studies indicate that diabetics have both a higher mortality rate and a higher morbidity rate secondary to generalized vascular occlusive disease than non-diabetic patients of corresponding age and sex. There is also some evidence that diabetics with proliferative retinopathy are more at risk than diabetics without retinopathy. This study was undertaken to determine and compare the morbidity and mortality rates in diabetics with: (a) No retinopathy, (b) Background retinopathy, (c) Proliferative retinopathy. The records and fundus photographs of 800 diabetics were reviewed and the data statistically analysed according to age, sex, presence and type of retinopathy, morbidity, and mortality. The mortality rates were also compared with the normal population life study data.

Adolescent↗