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Biomedical subjects

F Ginsberg-Fellner

Publications and source records attributed to F Ginsberg-Fellner.

69 records · Page 4Linked to original sources

The growth of adipose tissue in children and adolescents. Cross-sectional and longitudinal studies of adipose cell number and size.

Adipocyte size and number were determined in 288 subjects ranging in age from 4 mo to 19 yr. The study was performed in 110 obese and 178 non-obese subjects. 4-yr, longitudinal, follow-up studies were also performed in 132 subjects. The results demonstrate that the contribution of cell number and size to the growth of the fat depot in nonobese children varies with age. Deviations from this normal development were observed in obese children shortly after 1 yr of age. By 11 yr of age obese children exceeded the mean cell number found in nonobese adults. Indeed, obese subjects displayed more rapid and earlier elevations in both cell number and size, which were maintained throughout the study. Thus obese children display both quantitative and qualitative differences in fat tissue development when compared to nonobese children. The data indicate that the rate and type of adipose tissue cellular development one encounters in children may play a role in the development of the enlarged fat depots found in obese subjects.

Adipose Tissue↗

Ischemia and sensory nerve conduction in diabetes mellitus.

Sensory conduction along the median nerve was evaluated during 30 minutes of ischemia in patients with diabetes mellitus. There was abnormal persistence of the sensory evoked potential in 19 of 22 diabetic patients, but not in normal controls, patients with nonmetabolic neuropathies, or 5 of 6 patients with motor neuron diseases. There was an excellent correlation between ischemic resistance and effective control of glucose metabolism, as manifested by Hb A1C levels. These data suggest that abnormal ischemic resistance in diabetes may be the most sensitive indicator of peripheral neural dysfunction even when there are no other electrophysiologic or clinical abnormalities.

Adolescent↗

Recurrent hyperosmolar nonketotic episodes in a young diabetic.

A 15-month-old girl was successfully treated for substantial hyperosmolarity in the absence of ketosis at the onset of permanent insulin-requiring diabetes mellitus. Hypotonic solutions containing small amounts of glucose and subcutaneous administration of low doses of insulin were empolyed. Potassium was added to the hydrating solutions during the second hour of treatment. In the next three months, two recurrences of this syndrome were verified and successfully treated in a similar manner.

Blood Glucose↗

Factitial panniculitis and necrotizing fasciitis in juvenile diabetes.

A fifteen-year-old diabetic girl developed multiple inflammatory areas on the extremities and abdominal wall at the site of insulin injection. The bizarre clinical manifestations led to great difficulties in determining both its etiology and its treatment. However, three months after her initial hospitalization, we found that the lesions were probably secondary to self-injection with a chemical agent rather than a result of insulin allergy. If idiopathic recurrent dermal infection is observed, then factitial origin should be suspected.

Abdomen↗

Peripheral nerve responses during ischemia in the evaluation of diabetic neuropathy.

The stability of sensory conduction and evoked potentials during ischemia has been used in the evaluation of diabetic neuropathy and diabetic control (Hgb A1C). Six newly diagnosed juvenile diabetics were studied at diagnosis and 3 to 12 months later. In three patients in good control, ischemic "resistance" became normal. In three patients in poor control, resistance remained increased; two of these three experienced a 10%-20% slowing in conduction velocity. Similar relationships between control and ischemic resistance are found in long-term diabetics. These data suggest that abnormal ischemic resistance may herald the onset of an electrical and clinical neuropathic state.

Adolescent↗

Diabetes mellitus and autoimmunity in patients with the congenital rubella syndrome.

An increased incidence of insulin-dependent diabetes mellitus (IDDM) has been reported in patients with congenital rubella syndrome (CRS). Thus, studies of children with CRS would be of great importance in following the development of IDDM in a susceptible population. A total of 242 children with CRS, 30 of whom already have diabetes (mean age, 17.4 +/- 0.3 years) have been evaluated. In this latter group, the frequency of HLA DR3 is significantly increased and that of HLA DR2 significantly decreased. While pancreatic islet cell cytotoxic or surface antibodies (ICSA) are found in 20.2% of the total population of patients with CRS, they are present in 50%-80% of patients with glucose abnormalities. In all but five of the ICSA-positive patients, glucose abnormalities are currently present. In addition, glucose intolerance is found in greater than 50% of the DR3-positive nondiabetic patients with CRS evaluated to date. The data demonstrate that patients with CRS at risk for IDDM have the same genetic and immunologic features seen in classic IDDM, namely the presence of HLA DR3 and the absence of HLA DR2 and the high prevalence of ICSA before decompensation.

Adolescent↗

Transient lipoprotein lipase deficiency with hyperchylomicronemia.

Type I hyperlipoproteinemia is a rare disorder characterized by the presence of chylomicrons in fasting plasma and dysfunction of the lipoprotein lipase system. The disease may result from primary genetic defects leading to the lack of the enzyme lipoprotein lipase or to a deficiency in the CII apoprotein activator of that enzyme. It may also appear secondary to underlying systemic diseases. We now describe a case of hyperchylomicronemia and pancreatitis with a lack of lipoprotein lipase activity as assessed by three different methods. The patient had no evidence of a plasma inactivator of lipoprotein lipase, and his plasma was able to activate the enzyme in control postheparin plasma. The postheparin plasma hepatic triglyceride lipase was normal. Tests for associated systemic diseases were negative. Six weeks after presentation, that patient's lipoprotein levels and postheparin plasma lipase activities were normal. This was a unique case of hyperchylomicronemia which for a limited time was indistinguishable from primary lipoprotein lipase deficiency by current biochemical techniques.

Child↗

Randomized, controlled trial of diabetic patient education: improved knowledge without improved metabolic status.

We randomized 749 insulin-treated patients on the rolls of the Mount Sinai Medical Center Diabetes Clinic in a controlled trial of diabetic patient education; 345 agreed to participate, of whom 165 were assigned to the education group and 180 to the control group. Cognitive scores increased from 5.3 +/- 1.6 to 5.8 +/- 1.6 in the education group, but there was no change in the control group, whose score was 5.3 +/- 1.7 before and after the intervention (P = .0073). HbA1c fell from 6.8 +/- 2.1 to 6.1 +/- 2.0% in the education group and from 6.6 +/- 2.0 to 6.3 +/- 2.0% in the control group, an insignificant difference (P = .1995). The fasting blood glucose decreased from 223 +/- 94 to 179 +/- 73 mg/dl in the education group and from 199 +/- 81 to 185 +/- 76 mg/dl in the controls (P = .1983). Triglycerides, high- and low-density lipoprotein cholesterol, and insulin dosage also failed to show significant variation among groups. The foot-lesion score showed similar progression in the education and control groups. Neither diastolic nor systolic blood pressure showed significantly greater change in the education or the control group, with falls noted, particularly in diastolic pressures, in both patient groups. Differences between the groups were not significant for sick days, hospitalizations, emergency room visits, or outpatient visits. The sample sizes of the study and control populations were sufficiently large to detect a difference in means between the education and control groups in the HbA1c, the primary outcome variable, of greater than 1.0%, with alpha = .05 and a power of .95. Thus, our study suggests that patient education may not be an efficacious therapeutic intervention in most adults with insulin-treated diabetes mellitus.

Aged↗