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Biomedical subjects

L Sandvik

Publications and source records attributed to L Sandvik.

At least 37 records · Page 2Linked to original sources
PubMed1988

The response of diabetic retinopathy to 41 months of multiple insulin injections, insulin pumps, and conventional insulin therapy.

Forty-five diabetic patients were randomized and treated with continuous subcutaneous insulin infusion (CSII), multiple insulin injections (MI), or conventional insulin treatment (CIT) for 41 months. Near-normoglycemia was obtained with CSII and MI but not with CIT. A transient increase in microaneurysms and hemorrhages was seen at three months in CSII-treated patients. After 41 months, a moderate progression in microaneurysms and hemorrhages was registered, as assessed from fundus photographs, in all treatment groups. Fluorescein angiograms indicated a tendency (not statistically significant) to retarded progression of retinopathy in MI- and CSII-treated patients compared with CIT-treated patients. Soft exudates developed after three to six months of rapid tightening of metabolic control in 50% of patients on CSII and MI regimens. Those patients who had soft exudates had a slower progression of retinopathy three years later than those who did not develop soft exudates. Transient progression of retinopathy may be related to fluctuations in blood glucose levels, although a favorable effect of long-term improved metabolic control was not documented.

Adult↗
PubMed1988

Oscillatory potentials, macular recovery time, and diabetic retinopathy through 3 years of intensified insulin treatment.

Forty-five diabetic patients, 18 to 45 years of age, with mild or no retinopathy, were randomly assigned to continuous subcutaneous insulin infusion (CSII), multiple injections (Mls), and conventional insulin treatment (CIT). The effects of near-normoglycemia (CSII and MI) on oscillatory potentials (electroretinography [ERG]) and macular recovery time (nyctometry) were studied prospectively for 41 months. Before randomization, the amplitudes of oscillatory potentials were negatively correlated to age (P = 0.002) and positively correlated to the diameter of retinal veins (P less than 0.05). Men had shorter macular recovery time than women (P = 0.03). Nyctometry and oscillatory potentials were not related to mean blood glucose values, glycosylated hemoglobin (HbA1), retinopathy, blood pressure levels, or duration of diabetes. Changes in metabolic control (MI and CSII; P less than 0.01) and in microaneurysms and hemorrhages (CSII and CIT) during the study did not affect oscillatory potentials or nyctometry. Soft exudates (15 patients) and proliferative retinopathy (1 patient) transiently developed with MI and CSII regimens. No changes in oscillatory potentials or nyctometry were observed and no pretreatment characteristics of these parameters predicted the occurrence of these ischemic lesions. At the stage of proliferation, however, lowered amplitudes of oscillatory potentials and lengthened macular recovery time were observed.

Adult↗
PubMed1988

Do data from a previous exercise test influence the prognostic information given by a second routine exercise ECG test? A 13 1/2-year follow-up study in apparently healthy middle aged men.

A positive exercise ECG test in a middle-aged man without confounding disease is a strong indicator of occult coronary heart disease. In the years following a positive test mortality, but CHD events vary considerably compared with subjects having normal exercise tests. If a second exercise test is positive in the same subjects years later, this signifies a disease which is prone to progress in a very severe way in the ensuing years. A first normal test followed by a second pathologic test has an intermediate prognostic significance compared with two normal tests years apart. The clinical course indicates that preventive measures should be taken after observing a positive exercise test, and even more importantly if two positive tests are observed years apart.

Adult↗
PubMed1988

Transdermal scopolamine in drooling.

The effect of oral anticholinergic drugs has been limited in the treatment of drooling. Transdermal scopolamine (1.5 mg/2.5 cm2) offers advantages. One single application is considered to render a stable serum concentration for 3 days. A distinct reduction of basal salivation was demonstrated in an open trial of six healthy volunteers. Eighteen mentally retarded patients with a drooling problem were studied in a double-blind, placebo-controlled cross-over trial. The therapeutic effect of transdermal scopolamine was assessed by a visual analogue scale. Three patients dropped out due to loss of the system. In the remaining 15 patients, the active drug caused a reduction of drooling which was significant in the period from 24 to 72 h. There were few and slight objective signs of unwanted effects. Scopoderm may cause drowsiness and affect tooth health. The management of drooling should primarily be focused on the cause. Sensomotor training is often valuable in cerebral palsy. Factors such as nasal obstruction, mucosal irritation, and drug-induced parkinsonism should be given attention. Sometimes, however, a temporary symptomatic treatment is indicated, for example on special occasions or in order to cure peri-oral skin lesions. Transdermal scopolamine may offer this possibility.

Administration, Cutaneous↗
PubMed1988

Effects of intensified insulin treatment on retinal vessels in diabetic patients.

Forty-five diabetic patients were randomly assigned to treatment with continuous subcutaneous insulin infusion (CSII), multiple injections (MI), and conventional insulin treatment (CIT). They were prospectively followed up for one year. A computerised scanning microdensitometer was applied on fundus photographs of retinal vessels, and we studied changes in calibres of the blood column (W0) and in width (Wr/W0) and intensity (Ir) of the central 'light reflex'. After six months of improved metabolic control the Ir was reduced in both MI and CSII cases compared with CIT cases (p less than 0.01), indicating haemorrheological changes in the retinas. Within these six months cotton-wool spots appeared in half the patients (n = 15) on CSII and MI, but not in CIT patients. Subjects who developed cotton-wool spots, compared with those who did not, had greater intensities of reflection and larger calibres of vessels at the start of the study (p less than 0.01). On intensifying the treatment they were characterised by a larger fall in hemoglobin A1 (p less than 0.01) and by a larger decrease in Ir on arteries (p less than 0.05) and veins (p less than 0.01). The behaviour of the retinal circulation is different in patients developing transient ischaemic lesions on intensified insulin treatment from its behaviour in those who do not.

Adolescent↗
PubMed1988

Ovarian morphology in patients with polycystic ovaries and in an age-matched reference material. A statistical evaluation of 149 cases.

The ovarian morphology in 149 patients with the clinical syndrome of polycystic ovaries (group I) is described. The ovaries from 10 age-matched women (group II) with no signs of ovarian disorder were investigated as a reference material. The number of cysts documented for group I was twice that of the reference group and the ovarian volume three times that of the normals. No significant difference in follicle number was seen between the two groups. The tunica albuginea was thicker in group I with more pronounced atretic changes. The duration of symptoms for group I correlated significantly with body mass index, thickening of tunica, degree of stromal hyperplasia and the calculated means of ovarian volume. A correlation was also seen between ovarian volume, degree of follicular atresia and stromal hyperplasia, as well as between the thickness of the tunica albuginea, number of follicles and degree of follicular atresia.

Adolescent↗
PubMed1988

Reduction of urinary albumin excretion after 4 years of continuous subcutaneous insulin infusion in insulin-dependent diabetes mellitus. The Oslo Study.

Urinary albumin was studied in 45 patients with insulin-dependent diabetes in a 4-year prospective randomized trial, comparing continuous sc insulin infusion (CSII), multiple insulin injections, and conventional treatment with twice daily injections. Strict blood glucose control was obtained with CSII and multiple injections, better than with conventional treatment (2P less than 0.01): mean glycosylated haemoglobin (% HbA1 +/- SEM) after 4 years: CSII 9.0 +/- 0.4%; multiple injections 9.4 +/- 0.4%; conventional treatment 10.5 +/- 0.5. A total of 696 24-h urine specimens were collected. After 4 years of CSII from the time of randomization, urinary albumin excretion was reduced (26 +/- 5 to 16 +/- 4 mg/24 h, mean +/- SEM, 2P less than 0.01), when compared with conventional treatment (2P = 0.01), when compared with conventional treatment (2P = 0.01) where no change was observed (21 +/- 4 to 22 +/- 6 mg/24 h, n.s.). The reduction observed during multiple injection treatment was not significant (17 +/- 3 to 14 +/- 3 mg/24 h). Long-term near-normoglycaemia may influence the mechanisms leading to albuminuria in diabetes, if introduced at an early stage of the disease.

Adolescent↗
PubMed1988

Single case studies from a statistician's point of view.

In a clinical single case study the object is to decide whether a certain treatment has an intended effect on a certain patient. It is pointed out that the design should only be used in clinical situations where several rather strong assumptions are fulfilled. However, in these situations the design may be of significant value.

Clinical Trials as Topic↗
PubMed1988

Coronary heart disease without angina pectoris: silent ischemia.

Myocardial ischemia without symptoms (= silent ischemia = Sl) has become a well known clinical entity in subjects with heart disease and in apparently healthy subjects. Detection of Sl is easiest and least expensively done with exercise ECG-testing (X-ECG). Data on the significance of Sl in the present report is derived from long-term follow-up of 2014 men aged 40-59 yrs, studied 1972-75, restudied in 1979-81 and 1986-88. The sources of information are: 1) 50 men with Sl detected with X-ECG/coronary angiography in 1972-75; 2) subjects with positive X-ECG in 1979-81 (but not in 1972-75); 3) preliminary data from the last follow-up study; and 4) complete data on cardiovascular mortality by Aug. 1987. The survey data indicate: a) Sl detected with X-ECG, confirmed with angiography is an indicator of later severe CHD-complications over 12-15 yrs; b) positive X-ECGs (not validated invasively) increase the risk of future CHD events and death from CHD 2-4 fold compared with subjects with normal X-ECG of similar age; c) limited isotope studies from the 1986-88 study indicate a very high specificity of a positive X-ECG in CHD, and d) cardiovascular mortality is very accurately predicted by factors known to be associated with the development of CHD. In accordance with the world literature, Sl is frequently observed in apparently healthy middle-aged and old men, and increases the risk of future CHD considerably when encountered.

Adult↗
PubMed1987

The light reflex in retinal vessels and its relation to age and systemic blood pressure.

The light streak characteristics on retinal vessels were studied by microdensitometry on fundus photographs. We compared the width and the intensity of the reflex in a young group (mean: 19.7-year-old; n = 40) and in an older group (mean: 45.3-years-old; n = 22) of normal subjects. By subgrouping according to age and blood pressure levels, we studied possible effects of these parameters on the light streak. We found higher intensity of reflection from both arteries and veins in the older group (P less than 0.01). This effect seemed mostly related to the age of the subjects. We also registered a relation between systolic blood pressure and intensity of reflection from veins in the young group (P less than 0.03). Optical changes in the vessel walls in the ageing process and intravascular pressure effects on the indices of refraction in the erythrocytes/plasma may account for these findings. The width of the reflex was not found to be related to either the age or the blood pressure level of the subjects.

Adolescent↗
PubMed1987

The central light reflex of retinal arteries and veins in insulin-dependent diabetic subjects.

The width (Wr/Wo) and the intensity (Ir) of the central light reflex were studied on retinal arteries and veins in insulin-dependent diabetic patients. A diabetic group (n = 45) was compared to normal subjects (n = 57), and the groups were matched according to age and blood pressure levels. A computerized scanning microdensitometer was applied across various sites on vessels in fundus photographs. The Ir of the reflected light was significantly reduced in diabetic arteries and veins compared to the vessels in the control group (P less than 0.001). This may implicate abnormalities in blood rheology of the retinal circulation in diabetes. The Wr/Wo was found narrower in veins in diabetic patients (P less than 0.001). This probably indicates differences in haemodynamics of venous flow in diabetic and normal subjects. The intensity was correlated to the duration of diabetes (P less than 0.05), while neither the width nor the intensity were found related to sex, metabolic control, intraocular pressure or retinopathy.

Adolescent↗
PubMed1987

Increase in insulin antibodies during continuous subcutaneous insulin infusion and multiple-injection therapy in contrast to conventional treatment.

Forty-five insulin-dependent diabetics were randomized to 1 yr treatment with either continuous subcutaneous insulin infusion (CSII), multiple insulin injections (MI), or continued conventional treatment. The CSII group used regular insulin only, the MI group used 4-6 premeal injections of regular insulin and intermediate insulin at night, and the conventional group used two daily injections of combined regular and intermediate insulin. Only highly purified porcine insulin was used. Near normoglycemia was obtained during CSII and MI but not during conventional treatment. Antibodies against insulin were measured in serum samples by measuring the binding of iodinated porcine insulin to serum after removal of free and antibody-bound insulin from the samples by acid charcoal. The percent binding of 125I-labeled insulin increased significantly during MI and CSII, in contrast to conventional treatment. Nineteen patients had sufficient binding capacity for Scatchard analysis. In the CSII and MI groups, high- or low-affinity antibodies or both were induced. When insulin was administered subcutaneously during MI or CSII for 1 yr, the insulin antibody production increased, in contrast with conventional treatment.

Adolescent↗
PubMed1986

Effect of near normoglycaemia for two years on progression of early diabetic retinopathy, nephropathy, and neuropathy: the Oslo study.

Forty five insulin dependent diabetics were randomised to treatment with continuous subcutaneous insulin infusion (CSII), multiple insulin injections (five or six daily), or conventional twice daily insulin injections. Near normoglycaemia was obtained with CSII and multiple injections but not with conventional treatment (p less than 0.01). Hypoglycaemic coma was observed less frequently with CSII than with multiple injections and conventional treatment (p less than 0.001), but blood glucose concentrations below 2.5 mmol/l (45 mg/100 ml) were more common. After two years fewer retinal microaneurysms and haemorrhages had developed in the patients given CSII and multiple injections compared with those given conventional treatment, in whom the number had increased significantly (p less than 0.01). Motor nerve conduction velocity deteriorated in the patients given conventional treatment; in those given CSII it was unchanged during the first year but had improved after two years (p less than 0.01). Glomerular hyperfiltration was reduced with CSII, but no change occurred in urine albumin excretion rates. Long term near normoglycaemia may prevent the progression of early stages of late diabetic complications.

Blood Glucose↗
PubMed1986

The width of the light reflex on retinal arteries and veins.

A computerized microdensitometric technique was applied to fundus photographs of 40 young male subjects. The width of the blood column and the width of the central light reflex were measured on 240 arteries and 240 veins of various sizes. No light streaks were registered on vessels of caliber less than 50 micron. The ratio of the widths: light streak/blood column showed wider reflexes on small (less than 100 micron) compared to larger (greater than or equal to 100 micron) vessels in both arteries and veins (P less than 0.01). Small retinal veins had wider light streaks than small arteries (P less than 0.01). The results of these objective measurements are partly in conflict with previous ophthalmoscopic observations, and we challenge accepted views on clinical interpretation on reflectivity differences in normal retinal vessels. Our results are discussed on a background of hemodynamics of microcirculatory flow.

Adult↗
PubMed1986

The intensity of the light reflex on retinal arteries and veins.

The intensity profiles of the central light streak on various sized retinal vessels were measured by a computerized high quality scanning microphotometer. From the fundus photographs in 40 young men 240 arteries and 240 veins were analysed, and light streaks were found on 171 arterial and 170 venous sites. Differences in reflected intensities between arteries and veins and between small and large vessels were studied. In the whole range of vessels measured (50-200 microns) significantly higher intensities were found on arteries compared to veins (P less than 0.01). Large vessels (100-200 microns) reflected the light more intensely than small vessels (50-99 microns) (P less than 0.001). Variations in haemodynamics of flow and in physical properties of the streaming erythrocytes might account for the reflectivity differences between arteries and veins.

Adult↗