PubMed Health⌕ Search

Biomedical subjects

J G Klebe

Publications and source records attributed to J G Klebe.

At least 37 records · Page 2Linked to original sources
PubMed1989

Changes in renal volume during normal pregnancy.

Twenty-four healthy pregnant women with a normal pregnancy demonstrated a significant uniform enlargement of both kidneys. The renal volumes increased by a maximum of 30% during pregnancy. However, this could not be attributed to hydronephrosis, as the patients were selected in such a way that none with pelvectasia participated in the study. All regained normal renal volume within the first week after delivery. It is well known that a glomerular hyperfiltration takes place during normal pregnancy. Possible pathogenetic mechanisms are discussed.

Adult↗
PubMed1988

Intravascular "mulberry-like" bodies: morphological, immunohistochemical, and ultrastructural observations of an incidental finding caused by autolysis?

Intravascular "mulberry-like" bodies in a stillborn female infant with moderate maceration are reported. The histogenesis of these structures is discussed based on light-microscopic, immunohistochemical and ultrastructural findings. No demonstrable causal relation between the intravascular lesions and fetal death was found, the cause of death being attributed to intrauterine asphyxia. It is concluded, that intravascular "mulberry-bodies" most likely represent artifacts due to red blood cell autolysis.

Adult↗
PubMed1986

Impaired insulin receptor binding and postbinding defects of adipocytes from normal and diabetic pregnant women.

To evaluate the relative contribution of insulin binding and postbinding defects of glucose utilization in peripheral tissue during normal and diabetic pregnancy, we have studied the in vitro insulin action of isolated adipocytes from eight nondiabetic pregnant women and nine pregnant women with insulin-dependent diabetes mellitus who were undergoing cesarian section. The pregnant women were compared with a matched group of normal nonpregnant women undergoing gynecologic surgery. Insulin binding to adipocytes measured at tracer insulin concentration was reduced by 45% (P less than 0.01) in normal pregnant women and by 30% (P less than 0.02) in pregnant women with diabetes. In contrast, no changes were found between the three groups in insulin binding to pure monocytes and erythrocytes. The glucose transport system in fat cells from both groups of pregnant women was characterized by impaired maximal (P less than 0.05) and half-maximal (P less than 0.05) response to insulin. When fat cell glucose metabolism was studied, pregnant diabetic women exhibited decreased basal lipogenesis (P less than 0.05) and decreased maximal responses of lipogenesis and glucose oxidation to insulin stimulation (P less than 0.05). Similar but less pronounced abnormalities were seen in glucose metabolism of adipocytes from nondiabetic pregnant women. In conclusion, both in late normal and diabetic pregnancy, insulin binding to adipocytes is significantly reduced and accompanied by decreased insulin sensitivity and reduced maximal insulin responsiveness of glucose transport and by impaired basal and maximally insulin-stimulated glucose metabolism.

Adipose Tissue↗
PubMed1986

Diabetes mellitus and pregnancy. A seven-year material of pregnant diabetics, where control during pregnancy was based on a centralized ambulant regime.

A 7-year survey of the outcome of pregnancy complicated by diabetes mellitus, carried out at the Aarhus center, is presented. The material comprised 344 diabetic pregnant women where the control was based mainly on a centralized ambulant regime. The latter half-period was moreover based on self-monitoring of the blood glucose level. This achieved a significantly better blood glucose regulation, with a reduction of the mean blood glucose level from 7.9 to 6.4 mmol/l. Furthermore, the introduction of self-monitoring halved the number of hospitalizations necessary for blood glucose regulation. Pregnancy was complicated in about 35%. The importance of screening for urinary tract infection is emphasized, since this, which was present in 20% of cases, might be a possible factor in ketoacidosis and/or intra-uterine growth retardation. In 19% of the vaginal births it was deemed necessary to give instrumental assistance; 5% had shoulder dystocia. The cesarean section frequency was 31%. The antenatal mortality rate was 1.2% and the uncorrected perinatal mortality was 3.5%, half of the neonatal mortality was due to fatal congenital malformations. About half of the newborn babies required immediate intensive neonatal treatment. Because of the high frequency of complications in pregnant diabetics, during childbirth and in the neonatal period, centralized monitoring by a highly specialized team is necessary in order to maintain the present relatively low perinatal mortality and morbidity rates and the low number of cesarean sections, together with the most convenient control regimen for this highly pathological group. Furthermore, centralization will facilitate research which, together with prepregnancy consultation, may reduce the frequency of major fetal malformations.

Ambulatory Care↗
PubMed1986

Heart frequency of the fetus at birth.

Heart frequency was recorded in 10 infants during the delivery and the following day. It was found that during vaginal birth, in cephalic presentation, heart frequency decreased during the last 3 minutes before delivery of the head. In breech presentation the initial deceleration was shorter, while with cesarean section there was no initial deceleration. Shortly after delivery of the head and in close connection with the first cry, a tachycardia lasting approx. 10 minutes was observed in all infants. On the day after birth, all infants had a normal heart frequency. It is concluded that the heart frequency changes correspond to the alterations expected on the basis of the caput compression and the relative fetal hypovolemia arising during the final stage of the vaginal delivery. These observations also indicate that the variable deceleration is caused partly by fetal hypovolemia. The neonatal tachycardia is presumably a response to the ordinary placental transfusion and neonatal adaptation to extra-uterine life.

Blood Pressure↗
PubMed1985

Self-monitoring of blood glucose in pregnant diabetics. A comparative study of the blood glucose level and course of pregnancy in pregnant diabetics on an out-patient regime before and after the introduction of methods for home analysis of blood glucose.

Sixty-one pregnant patients with insulin-dependent diabetes mellitus completed a self-monitoring program consisting of five daily blood glucose tests at least twice weekly during the ambulatory periods of their pregnancies. Either a reflectometer method, Eyetone, glucometer--reflectometer, or Haemoglucotest 1-44 test strips were used. Of 1 834 glucose profiles, 45% were optimal, with all blood glucose values between 3.9 and 8.3 mmol/l. The 61 pregnancies were compared with 62 pregnancies where the diabetic control and therapy principles were identical, but where self-monitoring blood glucose methods were not employed. The self-monitoring regime resulted in a significant drop in mean blood glucose levels, from 7.8 +/- 1.3 to 6.4 +/- 1.0 mmol/l, compared with the period before the self-monitoring program was introduced. Furthermore, a decline in the number of diabetes-conditioned extra hospitalizations during pregnancy in the self-test group could be registered.

Ambulatory Care↗
PubMed1982

Transcutaneous PO2 monitoring in routine observation of newborns.

TcPO2 was monitored in 209 of 814 infants admitted to the premature ward connected to our obstetric department. The majority of the infants were monitored less than 14 h. Approximately 77% of the infants were treated with up to 40% O2, while for a period the remaining infants were treated with more than 40% O2. TcPO2 values were generally controlled to the desirable range of 7-12 kPa (50-90 mm Hg). The daily handling of the equipment was performed by the nursing staff, who found good correlation between the TcPO2 measurement and clinical observations. The importance of application of the electrode in the preductal area is stressed to avoid hyperoxemia in the retinal vessels.

Carbon Dioxide↗
PubMed1981

Insulin receptors in the pregnant diabetic and her newborn.

To ascertain if changes in the diabetic state during pregnancy were mediated by alterations in insulin receptors, we studied insulin receptors on monocytes and erythrocytes from 18 pregnant women with insulin-dependent diabetes (IDD) during the first and third trimesters. In the first trimester, insulin binding to both cell types was similar to that in normal nonpregnant women. Moreover, insulin receptor binding remained unchanged during the third trimester even in the face of the significantly increased insulin requirement and concomitant hyperinsulinemia. Our findings suggest that changes in insulin receptors are not primarily involved in alterations of diabetic control during pregnancy. Newborns of mothers with IDD have the appearance of fetal gigantism and often suffer from neonatal hypoglycemia. To determine whether altered insulin receptor binding might contribute to these phenomena, we studied insulin receptors on monocytes and erythrocytes in infants of normal mothers (n = 21) and mothers with IDD (n = 14). Compared to adults, insulin binding to both cell types from both categories of infants was significantly increased and to the same extent. The combination of fetal hyperinsulinemia and increased receptor binding in the presence of hyperglycemia may account, at least in part, for the accelerated growth of fetuses born of diabetic mothers. Finally, the enhanced neonatal glucose tolerance of these babies may be related not only to the hyperinsulinemia but also to increased insulin sensitivity mediated, in part, by the increased insulin receptor binding.

Erythrocytes↗
PubMed1979

Decreased insulin binding to monocytes from normal pregnant women.

To ascertain whether the decrease of glucose tolerance in pregnancy might be mediated by changes in insulin receptors, we have studied insulin binding to monocytes in 12 normal women during late pregnancy and 14 healthy, young, normal weight, nonpregnant female controls. The pregnant women had significantly higher fasting insulin concentrations in plasma than the controsl (18 +/- 3.5 vs. 8 +/- 1.1 microU/ml; P less than 0.01). Fasting concentrations of glucose and ketone bodies in plasma were not significantly different in the two groups. Insulin binding to monocytes from pregnant women was about 35% lower at each insulin concentration tested compared to the nonpregnant controls (P less than 0.01 at tracer insulin concentrations). Changes in cellular insulin binding were due to changes of the receptor number per cell, whereas the receptor affinity was unaffected. Insulin binding was not significantly correlated with the fasting plasma insulin in either of the two groups (P less than 0.1). Our results suggest that the deterioration of glucose tolerance in normal late pregnancy might be explained by a decrease of insulin sensitivity caused by a reduction of the number of insulin receptors.

Adult↗
PubMed1978

Diminished gastrointestinal potentiation of insulin secretion in human pregnancy.

In order to investigate whether an increased gastrointestinal potentiation of glucose-induced insulin release might be involved in the enhanced insulin response to oral glucose in pregnancy, seven normal women were subjected to an oral glucose tolerance test (OGTT) and an IV glucose infusion test (IVGI) in the last trimester of pregnancy and again four to ten weeks post-partum. The amount of glucose administered intravenously was adjusted to obtain plasma glucose concentrations similar to those of the preceding OGTT. By this technique it was possible to quantitate the amount of insulin release attributable to gastrointestinal factors. Contrary to expectations, the results revealed that the gastrointestinal potentiation of insulin secretion was reduced by more than 75% in late pregnancy (p less than 0.05). The hyperinsulinaemia of pregnancy is therefore not explained by an increased activity of the entero-insular axis. Moreover the results confirm a substantially increased beta cell sensitivity to a glycaemic stimulus in pregnancy.

Administration, Oral↗
PubMed1978

Rupture of the spleen during delivery.

A case of traumatic rupture of a normal spleen in a complicated delivery is presented. The etiology of splenic rupture and therapeutic aspects of this unusual occurrence are discussed. It is pointed out that a violent expression of the fetus might be dangerous for the mother.

Adult↗
PubMed1977

Effect of pregnancy on the glucagon response to protein ingestion.

Plasma glucose, insulin and glucagon concentrations were measured before and after the ingestion of a protein-rich meal in 11 healthy pregnant women in the last trimester of pregnancy, and again in the same subjects postpartum. Compared to postpartum, basal levels of plasma glucose were lower in late pregnancy whereas basal insulin and glucagon concentrations were both enhanced. After the meal, insulin and glucagon concentrations in plasma increased in gestation as well as postpartum. Plasma glucose increased slightly in pregnancy but remained unchanged postpartum. The mean insulin response to the meal was unaffected by pregnancy whereas that of glucagon was reduced. Thus following protein ingestion, plasma glucose rose in pregnancy in spite of unchanged levels of insulin and depressed levels of glucagon. Favouring analbolism, the reduced glucagon response to protein ingestion in pregnancy fits in the concept of 'facilitated anabolism' in late pregnancy and, moreover, it lend further support to the idea that changes in glucagon secretion per se are not involved in the pathogenesis of the diabetogenicity of pregnancy.

Blood Glucose↗
PubMed1975

Human placental lactogen concentration during physiological fluctuations of serum glucose in normal pregnant and gestational diabetic women.

Oral glucose tolerance tests (OGTT) were carried out in 9 normal pregnant women and 11 non-obese gestational diabetics in late pregnancy. All samples were analysed for the content of glucose, insulin and placental lactogen hormone (HPL). Furthermore, spontaneous changes in the serum HPL concentration during a 3 h period were studied in 6 normal women in the 2nd half of pregnancy. During OGTT only small and insignificant changes in the level of HPL were observed in both the normal subjects and the gestational diabetics. Furthermore, the mean HPL concentration curves of the normal subjects and the gestational diabetics were superimposed although the mean glucose concentration curves were significantly different. The study of spontaneous changes in HPL revealed only small and insignificant fluctuations in the serum HPL level, and the mean concentration curve resembled those obtained from the OGTT-study. It is concluded that neither the absolute serum glucose level, nor physiological fluctuations in the serum glucose concentration seemed to influence the serum concentration of HPL in this type of patients.

Adult↗