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Biomedical subjects

G Rayman

Publications and source records attributed to G Rayman.

35 records · Page 2Linked to original sources
PubMed1989

Dependent oedema and attenuation of postural vasoconstriction associated with nifedipine therapy for hypertension in diabetic patients.

We studied the incidence of oedema 2 weeks following initiation of nifedipine therapy for hypertension in a group of 10 diabetic subjects, and also measured skin blood flow (SBF) with a laser Doppler flowmeter, before and after lowering the foot. SBF with the foot horizontal increased after nifedipine from 0.31 V (arbitrary units of flow) to 0.51 V (NS). The postural fall in blood flow in dependency was significantly attenuated by nifedipine from 64.4 to 24.0%. Five patients developed ankle oedema. Results were similar in a small group of non-diabetic subjects starting nifedipine. The attenuation of reflex postural vasoconstriction is therefore likely to contribute to development of the oedema associated with starting nifedipine therapy, which should be monitored carefully in diabetic patients.

Adult↗
PubMed1989

Patient experience with a jet injector.

The acceptability of a jet injector compared with disposable syringes for insulin injections was assessed in 10 people with Type 1 diabetes. The majority considered disposable syringes easier to use and either less painful or no more painful than jet injections. Given the choice only 1 of the 8 people completing the study would continue using the jet injector.

Adult↗
PubMed1989

Lead encephalopathy from an imported Toby mug.

Encephalopathy is an unusual manifestation of lead poisoning in an adult, the more common presentation being abdominal colic, anaemia and limb palsy. We report a case of adult lead encephalopathy and describe the use of a simple screening test for lead poisoning together with the increasing number of cases associated with imported ceramics.

Adult↗
PubMed1988

New device to improve the accuracy of bedside blood glucose tests.

A new device to improve the accuracy of blood glucose measurements with glucose-oxidase reagent strips is described. The device ensures that an adequate amount of blood is applied onto the reagent pad when the strip is fully inserted. When the strip is withdrawn, the pad is automatically wiped, and so the reaction can be accurately timed. The device also reduces the risk of blood contamination of other surfaces. Use of a prototype of this device enabled more accurate measurement of blood glucose on general wards.

Blood Chemical Analysis↗
PubMed1988

The feasibility of a potentially 'ideal' system of integrated diabetes care and education based on a day centre.

A new system of clinical and educational care designed to replace traditional diabetic clinics is described. The overall aims were to provide adequate consultation time, patient access according to diabetic and social needs, minimal waiting time, continuity with experienced staff and objective based learning programmes in an environment suited to learning. This was achieved by changing the role of the diabetes nurse specialist from undertaking delegated tasks to providing primary consultative care, reorganization of existing staff and provision of a purpose designed unit. This gave sufficient flexibility to arrange daily early morning and weekly evening clinic sessions for routine diabetes counselling and medical audit with primary education scheduled at other times. A year's experience showed that our major targets had been met, with the provision of adequate consultation time, halving of waiting time, ease of patient access and continuity with either the doctor or nurse in consulting role. Default rates have fallen and patient and staff morale has improved substantially. Apart from an underestimate of receptionist and a small increase in technician hours, these changes have been achieved within the predicted small revenue cost.

Appointments and Schedules↗
PubMed1988

An indwelling subcutaneous FEP cannula for intermittent insulin injection: patient experience and effect on diabetic control.

The acceptability and efficacy of injecting insulin through a subcutaneous FEP cannula (to reduce the frequency of needle pricks) compared with conventional multiple injection therapy was examined in a cross-over study. Thirty-two insulin-dependent diabetic patients injected through the cannula for 10 weeks using a pen injector, followed by 10 weeks using the injector alone, or vice versa. Rapid-acting insulin was given before meals and intermediate-acting insulin at bedtime. Blood glucose control was not affected by cannula use (glycosylated haemoglobin: cannula, 8.6 +/- 0.3%; no cannula, 8.6 +/- 0.3%). Twenty-two of the 30 patients completing the study preferred to use the cannula and 21 requested to continue using it. There were no complications associated with its use.

Adult↗
PubMed1986

Impaired microvascular hyperaemic response to minor skin trauma in type I diabetes.

The microvascular response of foot skin to minor thermal injury and the skin of the anterior abdominal wall to injury from a needle was assessed by laser Doppler flowmetry in 23 patients with type I diabetes and 21 healthy control subjects. After minor thermal injury mean (SD) maximum skin blood flow was significantly lower in the diabetic group than the control group (0.53 (0.11) v 0.72 (0.10) V, in arbitrary units of flow, respectively, p less than 0.001) and was negatively correlated with the duration of diabetes (r = -0.60; p less than 0.01). After needle injury a similar pattern of impairment was seen, the peak flow value recorded being significantly lower in the diabetic group than the control group (0.28 (0.10) v 0.41 (0.09) V, respectively; p less than 0.001) and also negatively correlated with the duration of diabetes (r = -0.61; p less than 0.01). There was a significant relation between the response obtained at the two sites of injury in the diabetic group (r = +0.72, p less than 0.001) but not in the control group. The impairment in response was not related to diabetic control and was not explicable in terms of a reduction in superficial skin capillary density. The inability of the diabetic skin microvasculature to respond normally to injury may be an important factor in the development of foot ulceration that often follows minor trauma.

Adolescent↗
PubMed1986

Blood flow in the skin of the foot related to posture in diabetes mellitus.

Normal healthy subjects show a reflex rise in precapillary resistance in the skin of the foot when they rise from lying to standing. To investigate the integrity of this reflex in patients with diabetes mellitus blood flow in the plantar region of the big toe was measured, using a laser Doppler flowmeter. The responses of diabetic patients with and without peripheral sensory neuropathy and healthy control subjects matched for age and sex were studied, with the foot at heart level and the foot passively lowered to 50 cm below the heart. In normal subjects mean blood flow recorded during the third to fourth minute of dependency fell to 18.1 (SD 11.9)% of the preceding resting flow determined with the foot at heart level. In the diabetic patients without neuropathy blood flow fell to 28.9 (18.6)% of the preceding resting flow. In the diabetic patients with neuropathy blood flow fell to 53.5 (23.7)% of the preceding resting flow, which was significantly different from the value achieved by the diabetics without neuropathy (p less than 0.02) and the healthy controls (p less than 0.002). Six normal subjects were indirectly heated to release sympathetic tone and achieve the same mean skin temperature of the foot as the diabetic patients with neuropathy, and blood flow fell to 38.7 (24.3)% of the preceding resting flow, a value not significantly different from the response seen in the patients with neuropathy. These findings suggest that the postural control of blood flow in the foot is disturbed in patients with diabetic neuropathy, and this disturbance is compatible with a loss of sympathetic vascular tone. The resultant hyperperfusion on dependency may account for the oedema seen in some patients with neuropathy and may also act as a stimulus for the thickening of capillary basement membranes.

Adolescent↗
PubMed1986

Effect of indirect heating on the postural control of skin blood flow in the human foot.

It has been shown in previous studies that skin blood flow in the human foot falls when the extremity is placed below heart level, owing to an increase in precapillary resistance that is probably mediated by a local sympathetic axon reflex or a myogenic response. In order to clarify the influence of the central thermoregulatory mechanisms on this local postural vasoconstrictor response, 12 normal male subjects were studied under standardized conditions, at rest and during heating of the trunk with an electric blanket. Skin blood flow was measured before and during body heating using laser Doppler flowmetry with the foot maintained at heart level and placed passively 50 cm below the heart. Skin blood flow and skin temperature were determined at two sites: the plantar surface of the big toe, an area with a relatively large number of arteriovenous anastomoses, and the dorsum of the same foot, where these anastomoses are few or absent. When the foot was placed in the dependent position, skin blood flow recorded in the dorsum of the foot during indirect heating fell to a level similar to that achieved before heating. In contrast, indirect heating greatly diminished the postural fall in skin blood flow recorded in the plantar surface of the big toe. In conclusion, the partial release of sympathetic vasoconstrictor tone associated with indirect heating appears to over-ride the local postural control of cutaneous vascular tone in areas where arteriovenous anastomoses are relatively numerous.

Body Temperature Regulation↗
PubMed1984

Hyperinsulinaemic hypoglycaemia due to chlorpropamide-induced nesidioblastosis.

A 25 year old woman suffering from recurrent attacks of hypoglycaemia underwent a laparotomy for suspected insulinoma. No tumour was found, but histology showed islet cell hyperplasia and nesidioblastosis. Although these changes have been reported as a cause of hypoglycaemia in infants, they are only rarely the cause of hypoglycaemia in adults; in the present case they were found to be the result of covert sulphonylurea administration. The fact that sulphonylureas can cause nesidioblastosis is not well recognised by either physicians or pathologists and it should be considered before "cryptogenic nesidioblastosis" is deemed the cause of hypoglycaemia in adults.

Adult↗
PubMed1983

Finger sepsis.

Explore the source record for details and available documents.

Female↗
PubMed1983

Investigation of hirsutism: testosterone is not enough.

In a consecutive series of 41 hirsute women clinically classified as benign androgen excess, only 34% were found to have elevated plasma 'total' testosterone (T), 22% having subnormal sex hormone binding globulin (SHBG). When expressed as the ratio T/SHBG ('free androgen index'), 85% of the patients had values above the normal range. It is concluded that this index is more reliable than total testosterone in assessing androgen status in female patients.

Adult↗
PubMedDate not supplied

Sustained silver-releasing dressing in the treatment of diabetic foot ulcers.

This study investigated the clinical performance and safety of a sustained silver-releasing foam dressing, Contreet Foam, in the treatment of diabetic foot ulcers. Twenty-seven patients with diabetic foot ulcers of grade I or II (Wagner's classification) were followed for six weeks: one week run-in using Biatain dressings, four weeks' treatment with Contreet dressings. Four ulcers healed during the four-week treatment with Contreet 56% in average. Contreet Foam showed good exudate management properties and was considered easy to use. Only two infections occurred showed that all six of the non-study ulcers developed an infection during the study. All ulcers (study ulcers as well as non-study ulcers) were treated according to good practice of diabetic wound care. There were no directions for the treatment of secondary wounds. No device-related adverse events were observed. This study demonstrated that Contreet Foam is safe and easy to use and effectively supports healing and good wound progress of diabetic foot ulcers.

Adult↗
PubMedDate not supplied

Evaluation of a self-calibrating blood glucose monitor.

A new reflectance blood glucose meter designed for hospital use, the Reflocheck (Boehringer-Mannheim, West Germany), was evaluated. The instrument showed excellent correlation with a routine laboratory method (r = 0.996), and the coefficients of variation at high, medium, and low glucose levels were less than 4%.

Blood Glucose↗
PubMedDate not supplied

'Learning Diabetes'--a multi-media learning package for patients, carers and professionals to improve chronic disease management.

A multi-media program for those with insulin and non-insulin dependent diabetes, and for their carers, has been produced. It is delivered on CDROM and contains an extensive amount of very high quality generated video of patients using short clips (maximum 2 min) totalling 2.5 h in 240 files using MPEG compression. The video is combined with a wide range of graphic based activities engaging the user in fully interactive processes and allowing them to obtain extensive understanding of the disease and to relate to attitudes and perceptions about it from those with the same condition. The program is robust and appears to meet the educational needs for its extent of interactivity, degree of choice for the user and provision of information based on real patient experience. It is easily used and modified to meet users of different socio-cultural needs and can be translated into different languages. It offers the opportunity not only for increased learning and improved self-management of those with diabetes, but also greater understanding by those who care for them, both professional and non-professional. Using the same framework, programs are being developed for other chronic diseases including asthma and hypertension.

CD-ROM↗