Biomedical subjects
Publications and source records attributed to K R Huddle.
A case of diabetic keto-acidosis complicated by rhinocerebral mucormycosis is described. Early diagnosis, control of the diabetes, aggressive surgical debridement, and systemic antifungal therapy resulted in a successful outcome.
A combined clinic for pregnant diabetic women was established at Baragwanath Hospital to assess the effects of intensive monitoring of mother and fetus and of good glycaemic control on perinatal outcome. Home blood glucose monitoring was introduced as a method for assessing glycaemic control. Standard methods of maternal and fetal monitoring were used. Sixty-two diabetic pregnancies were evaluated prospectively. Twenty women had diabetes diagnosed for the first time in the current pregnancy and the remaining 42 had established diabetes. All patients followed a diabetic diet, and 95% were treated with insulin. The technique and accurate recording of blood glucose were managed by all patients, and a mean capillary blood glucose of 6.5 mmol/l for the group was achieved. Caesarean section was performed in 52% of cases with a mean period of gestation at the time of delivery for the total study population of 37 weeks. The mean neonatal weight was 3,130 g. The perinatal mortality rate of 64/1,000 was accounted for by 3 stillbirths and 1 early neonatal death. No major congenital anomalies occurred.
Hypo-aldosteronism has been considered an important pathophysiological mechanism in the development of hyperkalaemia. This may occur as a consequence of defective regulatory mechanisms in the plasma renin-angiotensin-aldosterone system. Two case reports of hyperkalaemia are described which illustrate the differentiation of hyperreninaemic from hyporeninaemic hypo-aldosteronism. Laboratory investigations, together with measurements of plasma renin activity and aldosterone concentrations during adrenocorticotrophic hormone stimulation and sodium depletion, demonstrated this difference. Appropriate therapy with fludrocortisone (Florinef; Squibb) and furosemide (Lasix; Hoechst) respectively returned the situation to normal.
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A patient presenting with hypokalaemic muscle weakness is described. An associated hyperchloraemic metabolic acidosis was noted, which gave the clue to the final diagnosis of type I ('classic' or 'distal') renal tubular acidosis. Treatment resulted in clinical and biochemical recovery.
A case of Takayasu's arteritis complicated by renovascular hypertension is described. The hypertension was refractory to conventional medical treatment but responsive to captopril therapy. Deterioration in renal function occurred on initiation of captopril therapy; this resolved on reduction of dosage. A captopril-induced disturbance of renal autoregulation was probably responsible for this phenomenon.
In order to explore the feasibility of home blood glucose monitoring (HBGM) in Type 1 diabetics in developing countries, we introduced the technique to Type 1 patients below the age of 30 yr attending the Diabetic Clinic serving Soweto in South Africa. Despite initial problems, HBGM with visually-read strips was applied to 45 of the 64 young Type 1 diabetics identified ("HBGM group"). The remaining 19 were continued on urine glucose monitoring only ("HUGM group"), usually because of attendance and compliance problems. After 4 months' follow-up, glycosylated haemoglobin (HbA1) fell from 10.5 +/- 2.6% (mean +/- SD) to 9.0 +/- 1.7 (p less than 0.001) in the HBGM group, but was unchanged (10.1 +/- 2.1 vs 9.9 +/- 1.9, pn.s.) in HUGM patients. HBGM can thus be introduced in adverse social conditions, and may be associated with improved diabetic control. Costs, in terms of finance and medical time, were not excessive. Unfortunately, a significant minority were excluded by attendance and other problems, and analysis of diabetic complication rates (before the programme began) showed that these patients had significantly more complications than those deemed suitable for HBGM (42.1% vs 15.5%, p less than 0.05).
Black-insulin-dependent diabetics under the age of 30 years attending a busy South African diabetic clinic were intensively screened for a 4-month period. In the 66 patients studied, the following previously undiagnosed conditions were discovered: cataract (1), peripheral neuropathy (16), retinopathy (8), tuberculosis (4) and anaemia (3). In addition, 29 (43,9%) were on insulin regimens that were not ideal. Attempts were made to improve glycaemic control, especially in those patients with complications, and defective insulin regimens were corrected. The screening programme was carried out with normal manpower and investigative facilities, and the extra time involved was not excessive. This programme could be used (in either an expanded or a limited form) in any diabetic clinic, and would probably considerably improve the health of young insulin-dependent diabetic patients.
An unusual case of factitious hypoglycaemia is described. The distinction between exogenous and endogenous hyperinsulinism is illustrated.
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Sixty people with hyperglycaemia were admitted to Baragwanath Hospital as emergency patients during an 8-week study period in 1981, and one-quarter of them died in hospital. Many of these hyperglycaemic emergencies could have been prevented; 88% of the patients were known diabetics, one-third of whom required only oral hypoglycaemic agents for diabetic control. Sixty-one per cent of the patients had concomitant diseases, primarily infections. Earlier treatment might well have prevented deterioration of diabetic control, yet only 6% of the patients had attended the health services in the previous week in spite of recognizing that they were becoming progressively more ill. These patients were at high risk of subsequent admission, one-third of those discharged being readmitted within 3 months. Attendance compliance during a 3-month follow-up period was poor, and the discharged patients lacked the skills and knowledge necessary to maintain adequate diabetic control. One-quarter of those on insulin could not measure their dose correctly, most could not adequately test their urine and did not know what action to take if they had worsening symptoms of hyperglycaemia or developed intercurrent illness. Hyperglycaemic emergency admissions could be reduced by improving ambulatory diabetic services, thus saving costs of hospital care. Recommendations for improving the hospital service include maintaining a register of patients who have had hyperglycaemic emergencies and special care to ensure that they acquire the necessary knowledge and skills. Other methods of improving compliance regarding attendance and medication should be applied. These recommendations need to be implemented and their efficacy evaluated.
Eighteen of 66 Black patients with type I (insulin-dependent) diabetes mellitus had limited joint mobility (LJM). The presence of LJM was related to the duration of diabetes but not to the total daily insulin dose or to the glycosylated haemoglobin percentage. The incidence of diabetic retinopathy was not increased in those patients with LJM, but this was probably because of the relatively small study population and the relatively short duration of diabetes in this group. Short stature was a feature of this group of patients.
A patient with hypogonadotrophic hypogonadism and anosmia (Kallmann's syndrome) presenting as delayed puberty is described. The clinical, hormonal and testicular histological features are noted. The basic principles of treatment are discussed.
A case of hypocalcaemic cardiomyopathy associated with primary hypoparathyroidism is described. The cardiac failure, which initially proved resistant to conventional therapy, resolved with correction of the serum calcium and magnesium levels.
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Three cases of phaeochromocytoma are described. Several clinical manifestations are highlighted. The biochemical diagnosis, tumour localization and management are discussed. Surgical removal of these tumours has resulted in the cure of symptoms and hypertension in these 3 cases.
Two cases of primary aldosteronism are described. Both patients presented with neuromuscular symptoms related to the metabolic manifestations of this syndrome; both had diastolic hypertension. The cause of the syndrome in the first case was probably bilateral adrenal hyperplasia and in the second either adrenal hyperplasia or adrenal adenoma. Pharmacological treatment has resulted in control of the symptoms, metabolic manifestations and blood pressure in both cases.