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Biomedical subjects

I Enders

Publications and source records attributed to I Enders.

17 recordsLinked to original sources
PubMed1998

Does the long-term clinical course of type I diabetes mellitus differ in patients with prepubertal and pubertal onset? Results of the Berlin Retinopathy Study.

UNLABELLED: The objective of the present study was to investigate potential differences at presentation of type I diabetes and during its long-term clinical course in children and adolescents with prepubertal and pubertal manifestation. Clinical, immunological and biochemical characteristics at diabetes onset of 453 patients (320 prepubertal, 133 pubertal; median age at manifestation 7.1 years (0.7-13.9) and 13.1 years (9.2-17.6), respectively) were evaluated. Glycaemic control and exogenous insulin requirements were followed prospectively, with a median follow up of 9.4 years. At the onset of the disease no differences concerning the degree of metabolic decompensation, impairment of somatic health, and islet cell antibody status could be detected between the groups, except for a smaller body weight loss in pubertal patients (P=0.011). The duration of partial remission (insulin requirements <0.5 IU/kg body weight/day) was unrelated to age or pubertal status at onset. It was found to be longer in boys than in girls in the total cohort (median duration: 279 vs 215 days, P = 0.0071). Despite an absence of differences during the early course of the disease, glycaemic control was better, and daily insulin doses were significantly lower in patients with pubertal onset, after 6 years of diabetes. CONCLUSION: Adolescents with a pubertal onset of type I diabetes have a more benign long-term course of the disease demonstrating better glycaemic control and lower insulin requirements, although the presentation of the disease at onset and its course during the first 6 years are not different from those of children with a prepubertal manifestation of diabetes.

Adolescent↗
PubMed1998

Monitoring for retinopathy in children and adolescents with type 1 diabetes.

In children with an average diabetes onset at 11 y of age, the first retinal changes can be expected after a median diabetes duration of 9 y, while the median time until clinically relevant background retinopathy is 14 y. Periodic examinations of the retinal status become necessary with the onset of puberty or after 5 y of diabetes duration. Only sensitive methods should be used for retinopathy screening; the minimum recommended standard is a stereoscopic slit-lamp biomicroscopic examination in mydriasis. The degree of glycaemic control, both before and after puberty, appears to be of outstanding importance for the development of retinopathy, but the contribution of other factors (arterial blood pressure, lipid abnormalities, sex steroids, smoking and genetic factors) may be of varying relevance in the individual patient. Thus, to improve the long-term prognosis for children with diabetes appropriate screening for retinopathy and associated risk factors is mandatory.

Adolescent↗
PubMed1998

Factors modifying the effect of hyperglycemia on the development of retinopathy in adolescents with diabetes. Results of the Berlin Retinopathy Study.

The Berlin Retinopathy Study follows children from the onset of diabetes with serial retinal examinations by fluorescein angiography. It confirmed that long-term poor glycemic control, both before and after puberty, is the major risk factor for the development of retinal changes. The relationship between long-term HbAlc and background retinopathy follows an exponential, non-linear function. Apart from glycemia, several other factors (age at onset, puberty, lipids, blood pressure, genetic factors, smoking) may be of varying relevance in the individual patient. Nevertheless, best glycemic control from the onset of diabetes appears to be of outstanding importance as the HbAlc levels already during the first year of diabetes are related to the later development of background retinopathy.

Adolescent↗
PubMed1997

Factors influencing height and weight development in children with diabetes. Results of the Berlin Retinopathy Study.

OBJECTIVE: To investigate the influence of glycemic control and insulin therapy on the longitudinal growth and weight development of children with diabetes. RESEARCH DESIGN AND METHODS: Prospective measurements of standing height and weight were recorded longitudinally in 634 children after IDDM onset (median age at onset, 9 years [range 1-15 years]; median diabetes duration at final examination, 11 years [range 1-19]; 3,236 patient-years on two or three injections daily; 399 patient-years on multiple injection therapy [MIT]). RESULTS: Normal development was found until puberty, with a tendency toward stunted growth and overweight (weight > 97th centile) thereafter. Female sex (P < 0.01) and MIT (P < 0.01) were associated with overweight. Final height was evaluated in a subgroup of 197 young adults followed until age 18 years. Relative growth was calculated as the difference between the standard deviation scores (SDSs) at manifestation (median 0.2 [range -3.5 to 2.9]) and at 18 years of age (reduction of -0.5 [-2.5 to 1.8]), equivalent to a median loss of 2.9 cm in boys and 2.3 cm in girls. Significant linear correlations with the change in height SDS after diabetes manifestation were found for age at manifestation (r = 0.21, P < 0.001) and prepubertal (r = -0.40, P < 0.001) and postpubertal HbA1c (r = -0.15, P < 0.001). While children with poorer relative growth also had a higher BMI (P < 0.05), no influences of sex, prevalence of limited joint mobility, or presence of retinopathy were found. CONCLUSIONS: Female sex and MIT are associated with diabetes-related obesity. Prepubertal and postpubertal glycemic control appear to be of importance for the diabetes-associated relative growth deficit.

Adolescent↗
PubMed1996

Lipid profiles and blood pressure: are they risk factors for the development of early background retinopathy and incipient nephropathy in children with insulin-dependent diabetes mellitus?

The objective of this study is to examine the influence of lipid profiles and blood pressure on the development of microvascular complications in adolescents with insulin-dependent diabetes mellitus (IDDM) in a matched pairs study. Patients with early background retinopathy (n = 21) or microalbuminuria (n = 15) and their respective statistical twins participated in the study. Serum total cholesterol, high-density lipoprotein (HDL) cholesterol, fasting triglycerides, glycosylated haemoglobin A1c (HbA1c), and systolic and diastolic blood pressure during 3 years prior to the development of early background retinopathy or incipient nephropathy were examined. The multivariate discriminant analysis demonstrated glycaemic control and HDL cholesterol to be the most important variables related to the development of retinal lesions (84% correctness), and diastolic blood pressure to be associated with microalbuminuria (57% correctness). In addition to poor glycaemic control, different factors seem to be important for the early retinal or renal lesions of juvenile IDDM.

Adolescent↗
PubMed1994

Long-term glycemic control has a nonlinear association to the frequency of background retinopathy in adolescents with diabetes. Follow-up of the Berlin Retinopathy Study.

OBJECTIVE: To assess the influence of long-term glycemic control on the development of background retinopathy in adolescents followed longitudinally from the onset of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: Repeated retinal fluorescein angiographies, in intervals of 1-2 years, were evaluated prospectively in 346 patients (190 males, 156 females; 19.8 [8.8-35.4] years of age; diabetes duration of 10.4 [1.1-27.4] years at their latest eye examination, median [range]). The influences of long-term HbA1c (mean of 18 [1-95] determinations per person) and microalbuminuria (> or = 2 of > or = 3 measurements > or = 15 micrograms/min x 1.73 m2) were studied by multiple linear regression, life-table analysis, and trend analyses. RESULTS: The rate of background retinopathy per 100 patient-years increased with poorer glycemic control from 0.7 (long-term HbA1c < 7% to 7.3 (HbA1c > 11%) following an exponential function. Life-table analysis after subdivision in HbA1c quartiles of equal sizes (HbA1c < 8, 8-9, 9-10, and > 10%) revealed an individual median expectation of background retinopathy after more than 25, 16.2, 12.7, or 12.0 years of diabetes, respectively. However, significant differences were found only between 8-9% and 9-10%, calculated either as prevalence, life-table analysis, or relative incidence, thus suggesting that a threshold model may also fit the data. After 12 years of diabetes, < 25% of those patients exhibiting microalbuminuria (n = 18) were expected to be free from retinopathy compared with 81% of those with normoalbuminuria (n = 86). CONCLUSIONS: Two statistical models are appropriate to explain the relationship between glycemic control and risk for background retinopathy: 1) a continuous exponential relationship as described by the DCCT or 2) the presence of a threshold HbA1c level at 9%. Thus, diabetes treatment in children should aim at long-term HbA1c levels < 9.0%, but every progress closer to normal may further reduce the risk.

Adolescent↗
PubMed1992

Quantitative assessment of urinary protein and enzyme excretion--a diagnostic programme for the detection of renal involvement in type I diabetes mellitus.

In an effort to establish a reliable programme for the clinical monitoring of renal involvement in patients with type-I diabetes mellitus, we quantified the urinary excretion of immunoglobulin G (IgG), transferrin (Tf), albumin (Alb), alpha 1-microglobulin (alpha 1MG), N-acetyl-beta-D-glucosaminidase (NAG), and total protein in 130 dipstick negative children and young adults with type-I diabetes. Eighty-five sex- and age-matched healthy persons served as a control group for the definition of the upper reference limits (95th centiles; micrograms min-1 1.73 m2): transferrin 1.4; albumin 16.6; total protein 27.1; NAG: 2.0 mU min-1 1.73 m2. Sex-related differences were detected for IgG (men: 3.8; women: 1.7) and alpha 1 MG (men: 6.0; women: 4.0 micrograms min-1 1.73 m2). The urinary excretion of IgG, Tf, alpha 1MG, NAG, and total protein was significantly higher in subjects with diabetes when compared to healthy controls (p < 0.01). Furthermore, 20 patients (15%) showed an elevated excretion of tubular markers (alpha 1MG and NAG), and 3 patients (2%) of at least two glomerular markers (Alb and/or Tf and/or IgG). Additionally, 18 individuals (14%) presented a mixed excretion pattern of both tubular and glomerular markers. These data suggest that the quantitation of both glomerular and tubular proteinuria provides a sensitive and cost-effective instrument for the non-invasive screening for renal involvement in patients with diabetes mellitus.

Adolescent↗
PubMed1991

[Therapy of diabetes mellitus in childhood and adolescence. Goals, evaluation criteria and results].

We report on the results of longterm treatment of 466 children and adolescents with Type I diabetes (IDDM) between 1980 to 1989. Of these, in, 1989, 240 patients, aged 1 to 20 years, were under continuous treatment, 168 (70%) with CT and 72 (30%) with ICT. For 112 of 466 patients (24%) the medians of all measured HBA1c values were calculated to be less than or equal to 7.7%, for 53% between 7.8 and 9.6%, and for 24% greater than or equal to 9.7%. The respective percentages for the ICT patients were found to be 32, 48, and 20%. Medical treatment was accompanied by the continuous offer of education and psychosocial support. In order to reduce the risks for secondary vascular complications, good glycemic control is important in particular during postpubertal years. Therefore children and adolescents need support to obtain both, the acceptance of their disease and the individual responsibility necessary to endure any intensified treatment regimen. Furthermore, the effects of any therapeutic approach should not be measured by glycated haemoglobin only, but in particular by the young subject's individual development and his gain in courage to go on.

Adolescent↗
PubMed1990

[Thoracic impedance in the determination of hydration following heart surgery under extracorporeal circulation].

Changes in thoracic water content are measurable by determining basic impedance (Zo). In 57 cardiac surgical patients Zo decreased postoperatively by an average 24% corresponding to water retention of about 1.51. On the second postoperative day the difference to the initial preoperative value was still 8.5% corresponding to a water amount of over 500 ml. A close mathematic correlation exists between changes in the basic impedance (delta Zo) and fluid balance with a correlation coefficient of 0.94. The simple, non-invasive method is suitable for therapeutic control of fluid balance and quantitative diagnosis of pulmonary hyperhydration forms of various causes.

Adult↗
PubMed1989

[Impedance cardiography following cardiac surgery].

For checking the possibility of using impedance cardiography in intensive care, 10 patients were examined before and up to 2 days after cardiac surgery with extracorporeal circulation. The comparison of stroke volumes examined by thermodilution with those calculated from impedance cardiography showed a good correlation (r = 0.933). The cardiac output measured by impedance cardiography was reduced to 77% of the initial preoperative value. It increased again to 94% on the second postoperative day. HEATHER-index and dZ/dt are well suited for supervision and quantitative treatment control in the postoperative period. The thoracic impedance was diminished more than 20% after extracorporeal circulation and did not yet reach the preoperative value on the second day. The continuous measurement of the thoracic impedance proved to be particularly helpful for assessing the pulmonary hydration and for controlling the fluid balance.

Cardiac Surgical Procedures↗
PubMed1988

Long-term monitoring of treatment with recombinant human growth hormone by serial determinations of type III procollagen-related antigens in serum.

Inasmuch as recombinant human growth hormone is now more generally available for the treatment of different types of short stature, there is a need for better short-term indicators of treatment success. In healthy children, serum concentrations of antigens related to the aminoterminal propeptide of type III procollagen (P-III-NP) closely follow the growth velocity curve. P-III-NP was measured longitudinally in 20 children with growth hormone deficiency during 6 months of human growth hormone substitution therapy. Two different radioimmunoassay systems were used; one recognizes predominantly the intact propeptide showing a lesser affinity to a smaller monomeric peptide (RIAgnost assay), while the other assay detects both forms equally (FAB assay). These results were compared to the growth response [median 5.6 (0.4 to 13.9) cm in 6 months] and to other established growth correlated parameters (somatomedin C, alkaline phosphatase). A relatively better growth response correlated significantly with high pretreatment P-III-NP (RIAgnost assay) values (r = 0.56) and delayed bone age (r = -0.70). A combination of these parameters in multiple regression analysis increased the cumulative prediction value to above 60% (r2 = 0.61). On the other hand, P-III-NP (FAB assay) values proved to be best in monitoring treatment, correlating with the individual growth rate during the first 3 months (r = 0.40; p less than 0.05), during the consecutive 3 months (r = 0.66; p less than 0.001), and during the total 6-month period (r = 0.46; p less than 0.05). All other parameters showed associations to growth only during some treatment periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1980

[Socio-psychological factors of "family-oriented obstetrics", including "rooming in" (author's transl)].

The introduction of the "rooming in" system to maternity wards of many hospitals has been accompanied by additional demands on the hospital made by parents together with their desire tor "natural birth". Therefore, additional factors have to be taken into due consideration in the context of "family-oriented obstetrics". Interviews were made with 1,000 mothers, just after delivery to find out what they thought about certain marginal conditions in maternity advisory centres, delivery rooms, and on maternity wards. Their replies were statistically evaluated.

Attitude↗
PubMed1979

[The relevance of "family-oriented obstetrics" and its consequences for the maternity hospital (author's transl)].

By inventing the "rooming in", the organisational prerequisites for the undisyurbed early mother--child relationship, which is of fateful relevance for the newborn, are provided. Since part of the responsibility for the child is transferred to the mother already in the hospital, an adequate instruction is necessary. Thus, a change is taking place pertaining to the tasks of the nursing personnel. In an inquiry made on 950 female patients, the social-psychological aspects of the "romming in" were examined and evaluated. The joint accommodation of mother and child ought to be available on request for approximately 50% of the delivered women. During the night the newborns should be taken to the nursery. This meets with the needs of many women for undisturbed rest during the night despite "rooming in" and also with the necessity for control of the newborns by the nursing staff. The general judgment of the patients on a clinic cannot be changed essentially by the invention of "rooming in". This is depending to a great extent on various other factors.

Berlin↗
PubMedDate not supplied

Can retinopathy be prevented?

Clinical retinopathy eventually develops in the majority of insulin dependent diabetics during several decades of metabolic abnormality. Early structural lesions short of clinical significance may occasionally be detected in children much more frequently, however, after puberty. Major factors modulating the development of retinopathy are duration of diabetes, glycemic control and blood pressure.

Adolescent↗