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Biomedical subjects

J T Ireland

Publications and source records attributed to J T Ireland.

At least 19 recordsLinked to original sources
PubMed1979

Sulphonylureas and cardiovascular disease: a problem for few diabetics.

Because of the doubts cast on the safety of the sulphonylureas we analysed 1000 consecutive referrals to a diabetic clinic to identify the number of new patients equally suitable for treatment with a sulphonylurea or insulin. After excluding previously diagnosed and treated diabetics and those with a non-diabetic glucose tolerance test there were 531 new diabetics. Youth and insulin dependency, old age or obesity accounted for 390. A further 40 required diet alone, 50 had concomitant disease or socio-domestic circumstances influencing treatment choice, and 10 had secondary diabetes. Thus, only 41 diabetics (7.7% of new patients or 4.1% of total clinic referrals) appeared suitable for optional sulphonylurea or insulin therapy. We conclude that there are relatively few diabetics for whom the questionable safety of the sulphonylureas poses a therapeutic problem, and equally few who would be available for any further long-term, random-allocation trials of their effects upon the cardiovascular system.

Adult↗
PubMed1979

Diagnostic imaging in diabetes mellitus.

Diagnostic imaging techniques have an important role in supplementing the clinical evaluation of the diabetic. These are discussed in relation to the pathophysiologic changes: vascular degeneration, neurologic and infective changes, and maternal-fetal influences during pregnancy.

Diabetes Complications↗
PubMed1977

Blood glucose control and glomerular capillary basement membrane thickening in experimental diabetes.

Glomerular capillary basement membrane thickness (BMT) was measured in 23 rats which had had streptozocin-induced diabetes for 14 months and in 12 age-matched controls. Diabetic rats were randomly allocated to different groups, either receiving no treatment or treated with a low carbohydrate diet or insulin, or both. Control rats were randomly allocated to a normal or low carbohydrate diet. Among the diabetic rats mean plasma glucose concentrations for the groups ranged from 27-4 mmol/l (494 mg/100 ml) in the untreated rats to 9-8 mmol/l (177 mg/100 ml) in those receiving both a low carbohydrate diet and insulin. A highly significant positive relation was found between BMT and plasma glucose concentration for individual rats. When BMT was corrected for body weight a similar relation was observed.

Animals↗
PubMed1977

Neonatal acidosis associated with transient methylmalonicaciduria and vitamin B12 deficiency.

Investigation of a neonate presenting with a metabolic acidosis, vomiting and an apnoeic attack revealed abnormal urinary excretion of methylmalonic acid (MMA) associated with a low serum vitamin B12. Restriction of dietary protein was followed by normalisation of acid-base balance. Reintroduction of normal daily protein intake did not precipitate flrther acidosis or increased excretion of MMA. The transient methylmalonicaciduria was probably due to deficiency of vitamin B12.

Acid-Base Equilibrium↗
PubMed1976

Hypoaldosteronism in three sibs due to 18-dehydrogenase deficiency.

Three sibs all presented in the early neonatal period with a salt-losing syndrome. The salt-losing form of congenital adrenal hyperplasia was diagnosed and appropriate treatment with glucocorticosteroids, mineralocorticosteroids, and additional dietary salt started. Although early life was maintained with difficulty, with age all 3 children required decreasing amounts of replacement steroids to maintain normal plasma electrolyte balance. They were reinvestigated at the ages of 15 years and 8 years (twins), when cortisol synthesis and metabolism proved normal, but aldosterone synthesis was blocked by deficiency of 18-dehydrogenase. Rational treatment of these cases of a salt-losing syndrome in which aldosterone synthesis alone is blocked due to lack of the enzyme 18-dehydrogenase requires the administration of a mineralocorticosteroid drug only. Since deoxycorticosterone (acetate or pivalate) requires intramuscular administration, as life-long therapy oral fludrocortisone is preferable. Although fludrocortisone has glucocorticoid activity, the "hydrocortisone equivalent" effect of the small dosage used was unlikely to inhibit either pituitary corticotrophin or growth hormone production.

Adolescent↗
PubMed1975

A case of hypopituitarism with diabetes insipidus and loss of thirst. Role of antidiuretic hormone and angiotensin II in the control of urine flow and osmolality.

A 20-yr-old male was found to have diabetes insipidus is association with panhypopituitarism but without any focal neurological lesion being identified. He was initially treated with steroid supplements, the features of diabetes insipidus being controlled with a thiazide diuretic. Eighteen months later the patient lost thirst sensation and stopped treatment, subsequently being re-admitted with severe dehydration, oliguria and focal neurological signs. Further investigation, including brain biopsy, confirmed the presence of an atypical pinealoma which was considered inoperable. Measurements of plasma antidiuretic hormone (ADH) and angiotensin II (AII) concentrations during the severe dehydration showed very high levels of AII, but inappropriately low plasma ADH levels for the severity of dehydration. We consider that the evidence obtained from this case supports the view that the oliguria with hypertonic urine present during severe dehydration was due to a direct renal action of the very high AII levels, possibly supplemented by the residual ADH secretion.

Adult↗
PubMed1975

Diabetic complications in a patient with coexisting anterior hypopituitarism.

We present a patient who developed insulin-requiring diabetes several years after the onset of symptoms of anterior hypopituitarism. It is likely that the hypopituitarism protected him against the development of diabetic retinopathy and glomerular basement membrane thickening but not against neuropathy and atheroma. The significance of this in relation to the growth-hormone-microangiopathy hypothesis is discussed.

Aged↗
PubMed1972

The role of fibrin deposition in diabetic glomerulosclerosis: a light, electron and immunofluorescence microscopy study.

The possible role of fibrin deposition in the development of diabetic glomerulosclerosis has been investigated by light, immunofluorescence, and electron microscopy examination of renal tissue obtained by percutaneous biopsy from seven diabetic patients having minimal clinical evidence of renal involvement and at necropsy on nine diabetic patients. Although the biopsy specimens showed only early to moderate diffuse glomerulosclerosis without either nodular or exudative lesions, approximately 70% of glomeruli examined showed specific fluorescence for fibrinogen in a discontinuous linear pattern along the capillary basement membrane and diffusely in the mesangium. Moreover the immunofluorescence findings correlated well with the distribution patterns of material thought to be fibrin both in the light microscopy studies, by virtue of its staining properties, and by electron microscopy, because of periodicity, texture, and electron density. It is suggested that electron-dense granular deposits seen on electron microscopy may represent intermediate compounds in the fibrinogen to fibrin conversion, and that endothelial and mesangial trapping of fibrinogen or other macromolecules may initiate or accelerate mesangial enlargement, nodule formation, and irregularity of the basement membrane.

Adult↗