Diagnosis of venous thromboembolism.
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Humans↗
Biomedical subjects
G Berrut
Publications and source records attributed to G Berrut.
Renal changes on hyperglycemia and angiotensin-converting enzyme in type 1 diabetes.
Hyperglycemia causes capillary vasodilation and high glomerular capillary hydraulic pressure, which lead to glomerulosclerosis and hypertension in type 1 diabetic subjects. The insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene can modulate risk of nephropathy due to hyperglycemia, and the II genotype (producing low plasma ACE concentrations and probably reduced renal angiotensin II generation and kinin inactivation) may protect against diabetic nephropathy. We tested the possible interaction between ACE I/D polymorphism and uncontrolled type 1 diabetes by measuring glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) during normoglycemia ( approximately 5 mmol/L) and hyperglycemia ( approximately 15 mmol/L) in 9 normoalbuminuric, normotensive type 1 diabetic subjects with the II genotype and 18 matched controls with the ID or DD genotype. Baseline GFR (145+/-22 mL/min per 1.73 m2) and ERPF (636+/-69 mL/min per 1.73 m2) of II subjects declined by 8+/-10% and 10+/-9%, respectively, during hyperglycemia; whereas baseline GFR (138+/-16 mL/min per 1.73 m2) and ERPF (607+/-93 mL/min per 1.73 m2) increased by 4+/-7% and 6+/-11%, respectively, in ID and DD subjects (II versus ID or DD subjects: P=0.0007 and P=0.0005, for GFR and ERPF, respectively). The changes in renal hemodynamics of subjects carrying 1 or 2 D alleles were compatible, with a mainly preglomerular vasodilation induced by hyperglycemia, proportional to plasma ACE concentration (P=0.024); this was not observed in subjects with the II genotype. Thus, type 1 diabetic individuals with the II genotype are resistant to glomerular changes induced by hyperglycemia, providing a basis for their reduced risk of nephropathy.
Adult↗
[Type 2 diabetes: new therapeutic perspectives].
UKPDS: The results of the United Kingdom Prospective Diabetes Study (UKPDS) were reported in 1998. This multi-center, prospective, randomized, intervention trial of 5102 newly-diagnosed patients with type 2 diabetes mellitus was aimed at determining whether improved blood glucose control can prevent complications and reduce associated morbidity and mortality. THE RESULTS: Improved blood glucose control was shown to reduce the number of complications, mainly by reducing the effect of microangiopathy. There was however no reduction in the number of diabetes-related deaths nor in the risk of myocardial infarction or sudden death. CONTROVERSY OVER CALCIUM ANTAGONISTS: Calcium antagonists are suspected of increasing the risk of cardiovascular disease. On the basis of published reports, the JNC VI guidelines are recommended: calcium antagonists should not be used as first line treatment in diabetics. RECENT DRUGS: Acarbose, an alpha-glucosidase inhibitor, lowers post-prandial blood glucose level. It has marketing approval for single-drug regimens in France. Miglitol, another alpha-glucosidase inhibitor, would have the same therapeutic effect. Orliatort, an gastro-intestinal lipase inhibitor, is indicated in obese patients but long-term results are lacking to evaluate effects in diabetics.
Acarbose↗
Necrobiosis lipoidica: treatment by hyperbaric oxygen and local corticosteroids.
Necrobiosis lipoidica (NL) is closely associated with diabetes mellitus. Two-thirds to three-fourths of patients with NL have diabetes, although NL occurs in only 0.3% of diabetic patients. Typical lesions are found on pretibial skin, usually in young female diabetic patients whose disease is inadequately controlled. The cause of this dermopathy remains unknown. Multiple treatments have been described but have not led to consistent results. We report the case of a 28-year-old insulin-dependent diabetic woman with a disease duration of 23 years who spontaneously developed ulcerated NL on pretibial skin. NL progressively improved during 113 sessions of hyperbaric oxygen therapy and local corticosteroids.
Administration, Topical↗
Microalbuminuria as a predictor of a drop in glomerular filtration rate in subjects with non-insulin-dependent diabetes mellitus and hypertension.
UNLABELLED: Hypertension and non-insulin-dependent diabetes mellitus (NIDDM) are two major risk factors for end-stage renal failure. The value of microalbuminuria (urinary albumin excretion [UAE]: 30-300 mg/24 h) as an indicator of the glomerular filtration rate (GFR) is not known in these patients. METHODS: The relationships between microalbuminuria and GFR in subjects with NIDDM and hypertension were studied cross-sectionally (Study I) and longitudinally (Study II). RESULTS: In study I, 205 NIDDM subjects with hypertension (151 with normoalbuminuria [UAE < 30 mg/24 h] and 54 with microalbuminuria) were studied. The GFR of subjects with normoalbuminuria (97 +/- 30 ml/min) (mean +/- SD), and microalbuminuria (97 +/- 27 ml/min; NS) were similar. Study II examined 51 of the subjects with normoalbuminuria and 21 with microalbuminuria 22 months (range 13-57) later. The GFR of subjects with microalbuminuria (-10 +/- 19 ml/min) declined more than in those with normoalbuminuria (+4 +/- 17 ml/min; Student's t-test: p = 0.0022). The predictive value of microalbuminuria for a drop in GFR was independent of the antihypertensive treatment used, the follow-up time, or changes in UAE. The only variable linked to GFR loss in subjects with microalbuminuria was an increase in diastolic blood pressure (p = 0.0298). CONCLUSION: Microalbuminuria is a risk factor for a drop in GRF in NIDDM subjects with hypertension, and a reduction in blood pressure is the only effective way to prevent a loss of GFR in subjects with microalbuminuria.
Albuminuria↗
[Compressive dyspnea and dysphagia caused by sclerous cervical cutaneous metastasis disclosing breast carcinoma].
INTRODUCTION: Cutaneous metastases from breast carcinoma are infrequently the first sign of the disease. They usually appear as cutaneous thoracic nodules. We report the case of a cutaneous sclerous metastasis from breast carcinoma revealed by acute compressive dyspnea and dysphagia. CASE REPORT: A 65 years old woman was admitted for compressive acute dyspnea and dysphagia attributed to the growth of a sclerous cervical isolated metastasis. Investigations revealed rapidly growing low-differentiated primitive breast carcinoma. Chemotherapy induced good clinical response allowing a 27 months survival, in spite of a strong chemodependance. DISCUSSION: This case-report of a breast carcinoma's metastasis is notable because of its clinical revealing signs (acute compressive dyspnea and dysphagia), clinical aspect, cervical location preceding primitive cancer's clinical expression, and long term survival with treatment. The initial submaxillary location suggest the possibility of a metastasis to submaxillary salivary glands with secondary extension to the skin.
Aged↗
[Nephropathy in non-insulin-dependent diabetics].
In the USA, diabetic nephropathy is involved in 34% of cases of end stage renal failure. In Europe, five-year survival of diabetics with end renal failure is 31%, compared with 55% in the non diabetic population. Three phenomena are involved in the development of nephropathy in non-insulin-dependent diabetic patients: glomerular hyperfiltration, elevation of urinary albumin excretion and high blood pressure, the latter sometimes being present before the discovery of diabetes. Even if control of blood sugar is improved, various prospective studies have failed to demonstrate any benefic effect in terms of reducing renal failure in non-insulin-dependent diabetic patients. Some data indicate that angiotensin-converting enzyme inhibitors can reduce the amount of proteinuria and slow the progression of diabetic nephropathy in insulin-dependent diabetic patients, but data remain controversial in non-insulin-dependent diabetic patients. Specifically, in these patients, there is no evidence pointing to an advantage of lowering blood pressure with angiotensin converting enzyme-inhibitors to reduce morbidity or mortality.
Diabetes Mellitus, Type 2↗
Loss of the nocturnal decline in blood pressure in subjects with essential hypertension and microalbuminuria.
BACKGROUND: Microalbuminuria, a marker of early renal damage, predicts mortality in non-diabetic subjects. The loss of circadian blood pressure regulation is associated with the severity of essential hypertension and has been reported in hypertension due to renal disease. We therefore looked for a possible link between microalbuminuria and the smaller decrease in nocturnal blood pressure that occurs in essential hypertension.METHODS: The 24 h ambulatory blood pressure of 52 subjects with essential hypertension was measured and their urine tested for microalbuminuria (urinary albumin excretion of 30-300 mg/24 h). RESULTS: The subjects with (n = 10) and without (n = 42) microalbuminuria were comparable in clinical characteristics, antihypertensive treatments and serum creatinine. They had significantly different night-time systolic, diastolic and mean blood pressure decreases on ambulatory blood pressure monitoring. Two-factor analysis of variance showed that the day-night blood pressure decrease was linked to microalbuminuria status. The day-night blood pressure change of subjects with microalbuminuria differed from that of subjects without microalbuminuria independently from the daytime blood pressure level. CONCLUSION: Subjects with essential hypertension and microalbuminuria show a loss of nocturnal blood pressure decline. Whether microalbuminuria indicates a subtype of essential hypertension due to renal disease or severe hypertension with early renal damage remains to be clarified.
Journal Article↗
[Decrease of nocturnal blood pressure in type II diabetic subjects with microalbuminuria].
The aim of this study was to evaluate the circadian blood pressure variations in subjects with or without microalbuminuria (Urinary Albumin Excretion (UAE) between 30 and 300 mg/24 h. Forty-nine non-insulin dependent diabetic subjects with essential arterial hypertension and without proteinuria (UAE < 300 mg/24 h) were consecutively recruited. Systolic (SBP) and Diastolic Blood Pressure (DBP) have been measured using a SpaceLabs 90207 ambulatory blood pressure monitor, every 15 minutes during daytime (7:00 a.m. to 22:00 p.m.) and every 30 minutes during nighttime (22:00 p.m. 7:00 a.m.). UAE has been measured by nephelometry on three 24 h urine collections. The group with microalbuminuria (n = 16) was not different from the group with normoalbuminuria (n = 33) for age, sex ratio, body mass index, known diabetes duration, proportion of anti-hypertensive treatment, serum creatinine and HbA1c. Daytime blood pressures (SBP/DBP: 144 +/- 15/83 +/- 8 vs 137 +/- 13/84 +/- 9 mmHg) and nighttime DBP (75 +/- 7 vs 74 +/- 9 mmHg) were comparable between both groups. In contrast, the nighttime SBP was higher in subjects with microalbuminuria than in those without (139 +/- 17 vs 129 +/- 17 mmHg; p = 0.016). If dippers are the subjects with a nocturnal blood pressure reduction (SBP and/or DBP) below 4%, there is a relationship between "non dippler" subjects and those with microalbuminuria (Chi-squared test = 5.67; p = 0.017). In conclusion, hypertensive non-insulin dependent diabetic subjects with microalbuminuria have a loss of nocturnal blood pressure decrease.
Aged↗
[What decisions to make in view of microalbuminuria in a diabetic?].
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Albuminuria↗
Relationship between fat intake and glomerular filtration rate in normotensive insulin-dependent diabetic patients.
Glomerular hyperfiltration is a candidate marker for diabetic nephropathy in insulin-dependent diabetic patients since it can reflect elevated glomerular capillary pressure, a cause of glomerulosclerosis. We studied the potential contribution of several dietary components to glomerular hyperfiltration during a cross-sectional study of 110 consecutive normotensive, non-proteinuric insulin-dependent patients with respect to glomerular filtration rate (GFR) and food intake. GFR was measured using the 51Cr-EDTA plasma disappearance technique. Glomerular hyperfiltration was defined as GFR > 137 ml.min-1 1.73 m-2 (mean +2 SD of age-matched healthy controls). Food intake was recorded with a computer-assisted programme. Thirteen patients displaying glomerular hyperfiltration ingested more protein (1.60 +/- 37 vs 1.38 +/- 0.34 g.kg-1 body weight.day-1; p = 0.032) and more fat (1.70 +/- 0.54 vs 1.39 +/- 0.44 g.kg-1 body weight.day-1; p = 0.022) than other subjects, although their total energy intakes were similar. Univariate regression analysis showed that GFR was positively related to both protein (r = 0.28; p = 0.003) and fat (r = 0.25; p = 0.007) intakes and negatively related to age (r = -0.29; p = 0.002). Stepwise multivariate regression analysis indicated 2 independent determinants for GFR: age (F = 15.26) and fat intake (F = 13.15). Excess fat intake may contribute to glomerular hyperfiltration in insulin-dependent diabetes.
Adolescent↗
[Microalbuminuria and non-insulin-dependent diabetes: practical interpretation and therapeutic consequences].
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Albuminuria↗
Comparison of the analytical and clinical performances of three thyrotropin immunoassay kits.
We first compared the analytical performances in terms of precision of two different generation thyrotropin (TSH) assays: Amerlite TSH-60 Assay (K2-TSH) versus Berilux hTSH (B3-TSH) and Kodak Amerlite TSH-30 Ultrasensitive Assay (K3-TSH). Then, we compared the clinical performances in 69 thyrotropin-suppressed patients with thyroid cancer and in 17 other patients referred for newly diagnosed hyperthyroidism. All the patients were given 200 micrograms of Protirelin IV for TRH testing. At the analytical level, the functional detection limit (FDL) was 0.006, 0.017, and 0.04 mU/l for B3-, K3-, and K2-TSH, respectively. At the clinical level of the 17 hyperthyroid patients, 52.9% displayed a positive TRH test with B3, 5.9% with K3, and 11.8% with K2; besides, 29.4% had a basal TSH detectable value with B3, 5.9% with K3, and 11.8% with K2. Among the patients receiving suppressive therapy: 1) 95.6%, 49.3%, and 50.7% showed a detectable TSH response to TRH, with B3-TSH, K2-TSH, and K3-TSH, respectively, and 2) only 5.8% had undetectable basal TSH values with Berilux hTSH, versus 84% with K2 and 89.8% with K3. Considering our findings, we first conclude that third generation TSH assays (having a functional sensitivity limit between 0.01 and 0.02 mU/l) can be useful for monitoring patients on thyroxine suppressive therapy, so as to distinguish partial from more complete thyrotropin suppression. Secondly, even though K3 has a FDL consistent with a third generation TSH assay, it appears less clinically sensitive than B3. Yet, no current assay can thoroughly ascertain a state of overtreatment. Finally, it is important to routinely determine the FDL, which can vary from one kit to the other, within one generation of TSH assays. Indeed, B3 with a FDL at 0.006 mU/l is more useful for monitoring LT4-suppressed patients for thyroid cancer than K3 whose FDL is 0.017 mU/l.
Adult↗
Value of ambulatory blood pressure monitoring in type I (insulin-dependent) diabetic patients with incipient diabetic nephropathy.
Ambulatory blood pressure monitoring (ABPM) is currently proposed for measuring blood pressure in type I, insulin-dependent diabetic subjects with incipient diabetic nephropathy. However, the value of this method, in comparison with conventional ones in detecting blood pressure differences between normotensive type I, insulin-dependent diabetic subjects with or without microalbuminuria, is questionable. We obtained systolic, diastolic, and mean blood pressures (SBP/DBP/MBP) in 10 hospitalized normotensive type I, insulin-dependent diabetic subjects with microalbuminuria, and in 29 others without, using a mercury sphygmomanometer (method 1) and an automatic device (Dinamap; method 2) to obtain morning (9 to 11 AM) measurements, and ABPM (SpaceLabs 90207; method 3) to obtain daytime (7 AM to 10 PM) and nighttime (10 PM to 7 AM) measurements. During the daytime, SBP/DBP/MBP values were higher in microalbuminuric than in normoalbuminuric patients, whatever the blood pressure measurement method used (P = .034/.061/.033, two-factor ANOVA). Analysis of 24-h ABPM also showed higher SBP/DBP/MBP in microalbuminuric than in normoalbuminuric patients (P = .022/.040/.016), and demonstrated a defect in nocturnal SBP decrease in microalbuminuric compared with normoalbuminuric patients (P = .028). Stepwise multiple regression analysis indicated nocturnal SBP as the only independent factor determining for microalbuminuria (F = 6.72). Thus ABPM, in relation to other methods, indicates above all that the most relevant blood pressure change in type I insulin-dependent diabetic subjects with microalbuminuria is a defect in nocturnal SBP decrease.
Adult↗
Responses of autoimmune factor VIII inhibitors to a combination of cyclophosphamide and prednisone.
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Autoantibodies↗
Microalbuminuria.
Microalbuminuria indicates slightly elevated urinary albumin excretion. In most cases, microalbuminuria is of glomerular origin and indicates initial glomerulosclerosis. Microalbuminuria has a high predictive value for nephropathy in insulin-dependent diabetes subjects and for premature mortality due to cardiovascular disease in non-insulin-dependent diabetes subjects and in the general population. All cardiovascular risk factors can be determinants for microalbuminuria constitution, especially the genetic determinants of these risk factors. Thus, microalbuminuria can be an indicator to summarize renal or cardiovascular risk, or both, in various populations. Treatment interventions were performed using microalbuminuria as the endpoint. So far, the most convincing results were obtained with angiotensin I-converting enzyme inhibitors to prevent nephropathy in insulin-dependent diabetes subjects.
Albuminuria↗
Antihypertensive efficacy and acceptability of perindopril in elderly hypertensive patients.
The antihypertensive efficacy and acceptability of perindopril, an angiotensin-converting enzyme (ACE) inhibitor, was evaluated in 2,927 elderly (> or = 70 years) hypertensive patients in general practice, as part of an open 6-month trial conducted on a total of 23,460 patients with mild-to-moderate hypertension. Patients were ambulatory and selected if diastolic blood pressure (DBP) was between 94 and 115 mm Hg and no serious illness or ACE inhibitor intolerance was known. Perindopril was started at 2 or 4 mg once daily and, if supine DBP remained > 90 mm Hg, the daily dose could be doubled after 1 or 3 months (or a diuretic added if perindopril titration reached 8 mg). At entry, the 2,927 patients (65% females) were on average 74 years old, body weight was 68.2 kg, duration of hypertension was 9.4 years, and prior antihypertensive treatment was present in 78%. Percentage of normal DBP (< or = 90 mm Hg) was 69% at 1 month, 86% at 3 months (in patients on perindopril alone), and 94% at 6 months. At 6 months the reduction of systolic blood pressure and DBP was 28 and 16.6 mm Hg, respectively. Of the 2,927 patients at entry, 8.6% dropped out during the trial, including 6.1% due to side effects. Cough was the most common symptom (8.9%) leading to withdrawal in 3.4% of cases. In one patient, serum creatinine increased (3-fold at 1 month), but overall no significant variation of renal function occurred, as shown by stable plasma creatinine and potassium levels.
Aged↗