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K Van Acker

Publications and source records attributed to K Van Acker.

25 records · Page 2Linked to original sources
PubMed1989

Effect of a long term very low calorie diet on glucose/insulin metabolism in obesity. Influence of fat distribution on hepatic insulin extraction.

Hyperinsulinemia is a well-recognized entity of simple obesity. In upper body obesity a diminished hepatic extraction of insulin contributes to the hyperinsulinemia. SHBG levels correlate (r = 0.34, P less than 0.05) with the c-peptide/insulin molar ratio. After long term weight reduction by very low calorie dieting, not only fasting and total area insulin decreased significantly, also hepatic insulin extraction improved markedly. This observed change was related to an increase in SHBG both for men and women.

Adult↗
PubMed1975

Progressive intrahepatic cholestasis (Byler's disease): case report.

This paper reports the case of a child in which the clinical and laboratory data indicate a progressive intrahepatic cholestasis of the type described as Byler's disease. The histological and histochemical findings suggest an intrahepatic cholestasis. Electron microscopy reveals interruptions of the bile canalicular membrane, which have been described as characteristic of this disease. A striking feature in the present case is the remarkable increase of microfilamentous structures in the pericanalicular ectoplasm and in the hepatocytic cytoplasm. The findings suggest a primary disturbance in bile acid secretion as the casue of cholestasis, entailing a hypertrophy of pericanalicular microfilaments which supposedly play a role in the final step of biliary secretion.

Bile Acids and Salts↗
PubMedDate not supplied

Comparison of risk factors for foot problems in diabetic patients attending teaching hospital outpatient clinics in four different European states.

Although the St Vincent declaration calls for common European action in order to reduce major amputations, the differences in the incidence of foot problems and the prevalence of risk factors has not been fully investigated. We have examined the risk factors for foot ulceration and amputation in 278 consecutive patients (mean age 50.4 years, range 18-79 years) attending outpatient clinics of four teaching hospitals: Athens, Manchester, Rome, and Antwerp. There were no differences in age, weight or sex among the four groups but the percentage of patients with Type 1 diabetes was higher in Rome and Antwerp. Patients in Rome and Antwerp also had a longer duration of diabetes compared to Athens and Manchester. Mean vibration perception threshold was similar in all groups. No differences were found in the number of patients with moderate or severe clinical neuropathy (neuropathy disability score > 5), severe sensory loss (VPT > 25 V), and limited joint mobility. Symptomatic peripheral vascular disease was more frequent in Antwerp (p < 0.05) compared to the other three centres and foot ulceration in Rome compared to Manchester (p < 0.05). The number of smokers or ex-smokers and the average alcohol consumption were similar in all centres. We conclude that, despite a few differences mainly in Type 1 diabetic patients, there are no major differences in the risk factors for foot ulceration and that, therefore, similar strategies for the prevention of foot problems may be equally successful in different European countries.

Adult↗
PubMedDate not supplied

The Diabetic Foot Project of Flanders, the northern part of Belgium: implementation of the St Vincent consensus. Sensibilisation and registration in diabetes centres.

As a result of the St Vincent declaration, a Belgian "task force" was installed in 1992 and consequently 16 working groups were formed. They presented their objectives in 1995. The working group "prevention and treatment of diabetic foot lesions" started the implementation of a screening program to obtain an overview of the presentation of diabetic foot lesions, the amputation rate and the prevalence of patients with a foot at risk. This study reports the results from 43 out of 73 Flemish diabetes centres. 1653 patients were enrolled in this study (53% women, 47% men, median age 61). 34.6% were type 1 and, 65.4% type 2. One or more arterial pedal pulses were absent in 28%, 30.5% had an abnormal monofilament test, 35% skin lesions and 28% malformations. Still 19% smoked, 15.8% had visual problems and 11% had already developed an ulcer previously. Ulcers were reported in 8.7% of which almost 2/3 belonged to Wagner class I. 69 (3.87%) of the patients had had amputations. According to the four-risk categories-scale 46.3% of the patients belonged to the highest one; peripheral vascular disease, previous amputations, previous ulcers, and Charcot joints. In our region we didn't have previous data on the prevalence and morbidity of the amputation rate with diabetes patients. We observed 3.87% amputations, which is rather high in comparison with international data (0.44% - 2.4%). The general follow-up of diabetic foot problems can be organised in co-operation with other care providers. A national program therefore is going to start in the next months. We all have to be aware of the size of the problem to offer the best possible prevention. As we have seen, the use of inlay soles and podiatrist-made ortheses for example is very low. We hope that all care providers will participate in this important project, so that they will acquire a specific attitude towards these patients. In daily clinical practice there are some key-roles to be respected by all health care providers. In our opinion the next are of the utmost importance: take off your diabetic patient's shoes when they visit you; give specific education if your patient has a foot at risk; if an ulcer is present, carefully follow-up is mandatory and if no good evolution of the ulcer is seen, an early referral to a diabetic foot clinic is obvious. Together we can lower down the amputation rate of diabetic foot lesions. And that would be a marvelous implementation of the St Vincent declaration in Belgium.

Aged↗