Fluorescein leakage: First sign of juvenile diabetic retinopathy.
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Biomedical subjects
Publications and source records attributed to H Dorchy.
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In order to ascertain the first vascular lesions responsible for infantile diabetic retinopathy, 300 angiofluorographies were performed in 87 children and adolescents whose diabetes became clinically apparent before the age of 14. Compared with normal ophtalmoscopy, the angiofluorography enabled to double the frequency of the diagnosis of incipient retinopathy. In addition to the classical diabetic lesions, the authors describe modifications of vascular permeability noted by leakage of fluorescein and observed in 75% of initial retinopathies. These leakages must be considered to be the first lesions of infantile diabetic retinopathy. They appear before microaneurysms: they seem to be reversible. Highly significant correlation between degree of control, duration of diabetes and frequency of retinopathy were demonstrated.
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In six insulin deprived adolescent diabetics, the influence of muscular effort equal to 50% of the VO2 max on the coefficient of glucose assimilation was evaluated. During an IVTT the coefficient of glucose assimilation at rest was (0.59). 10(-2) +/- 0.14 and it did not increase during physical activity. A minimal concentration of insulin is apparently indispensable to increase glucose utilisation during muscular effort. At higher concentrations other factors probably intervene to enhance glucose assimilation.
Urinary total protein, albumin and beta2-microglobulin excretion during exercise on a bicycle ergometer was determined in a group of 7 adolescent male diabetics and in a comparable control group. There was no difference, neither in the diabetic group nor in the control group, in the excretion of these proteins under the provocative effect of physical exercise. These results suggest exercise may not always give a positive response and is not a discriminative function in reliable studies of renal function.
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The 11th case of permanent neonatal diabetes mellitus appearing during the first month of life is reported. A critical review of the literature is also presented. The permanence of diabetes is demonstrated by the duration of insulin therapy still necessary after 30 months. Insulin-stimulation tests have been performed some for the first time in such a young diabetic. They have shown a nearly total failure in beta-cell response, only very high doses of glucagon provoking a moderate insulin secretion. The absence of acetonuria is discussed. It can perhaps be explained by the hyperglycemia which, by a mass effect, brings about cellular glucose penetration and this stops liberation of Nefa's from adipose tissue.
Estimations of urinary glucose in 178 diabetics using 4 tests, Ketodiastix, Tes-Tape, Clinitest 5/10 and Clinitest 2/10 were compared with polarimetric determinitation. Clinitest is more accurate and specific, and as reliable as enzymatic methods. The widened scale of Clinitest 2/10 permits the detection and satisfactory estimation of glycosuria ranging from 0,25% to 5%; it is specially suitable for monitoring the labile insulin dependent diabetes of children or adolescents. Enzymatic methods are suitable for the qualitative detection of glycosuria, for the control of stable, maturity-onset diabetes or to meet the need for rapidly available diagnostic information.
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