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Biomedical subjects

M Small

Publications and source records attributed to M Small.

At least 109 records · Page 6Linked to original sources
PubMed1988

Comparison of conventional twice daily subcutaneous insulin administration and a multiple injection regimen (using the NovoPen) in insulin-dependent diabetes mellitus.

Thirty-seven stable insulin-dependent diabetic patients receiving twice daily premixed porcine soluble and isophane insulins (Mixtard or Initard, Nordisk Laboratories) were enrolled in a trial to compare the effects of this regimen and an intensified regimen on glycaemic control and flexibility of lifestyle. After a two month run-in period patients were randomized to continue taking premixed insulin (n = 18) or to change to Human Actrapid (three times daily pre-prandial doses using a NovoPen) plus Human Ultratard (n = 19: "pen" group, Novo Laboratories). Diabetic control was assessed at monthly intervals for six months by glycosylated haemoglobin assay (HbA1), 7-point blood glucose profiles and frequency of hypoglycaemic episodes. At randomization, glycaemic control had significantly improved in the group as a whole and patients were well matched with respect to body mass index (BMI) and glycaemic control. No significant changes in BMI, HbA1, mean 7-point glucose profiles or hypoglycaemic episodes were found after six months either within or between groups. Hypoglycaemic episodes were common during the study. There were no technical problems with the NovoPen. Patients using the NovoPen felt it added greater flexibility to their lifestyle. From our study results the main indication to start a multiple injection regimen is to improve the flexibility of the patient's lifestyle and not to improve glycaemic control.

Adult↗
PubMed1988

Fetal glycaemic control and neonatal complications in diabetic pregnancy.

To examine the relationship between fetal glycaemic control and macrosomia or neonatal hypoglycaemia, we measured umbilical cord glycosylated haemoglobin (GHb) by affinity chromatography in 44 diabetic and 40 normal pregnancies. Levels of GHb in cord blood were not significantly different between these two groups, suggesting good maternal glycaemic control was achieved in the diabetic patients. Moreover in the diabetic pregnancies, cord GHb levels did not differ in infants who were macrosomic or developed hypoglycaemia by comparison with those infants who showed neither phenomenon. We conclude that overall fetal glycaemic control in the 4-6 week period prior to delivery does not appear to influence these common neonatal complications of diabetic pregnancy.

Adult↗
PubMed1988

Thyrotrophin receptor antibodies in type 1 (insulin-dependent) diabetes mellitus.

Graves' disease and type 1 (insulin-dependent) diabetes are common autoimmune endocrine disorders which may co-exist. Since the class II HLA-DR3 antigen is associated with both these diseases, and since an association between DR3 and the thyrotrophin receptor antibody (TRAb) has been suggested, we wished to determine whether TRAb levels were increased and were HLA-D related in diabetes mellitus. In 115 clinically euthyroid subjects (33 type 1 diabetics, 82 healthy controls) there was a correlation between age and TRAb levels (r = -0.39, p less than 0.001). TRAb levels were elevated in DR3 subjects (n = 32) compared to an age matched group of non-DR3 (n = 61) subjects [median (range): 18.1 (-1.7 to 47.4) versus 6.7 (-9.8 to 19.1), p less than 0.001]. Diabetic DR3 and control DR3 subjects had similar TRAb levels which were elevated when compared to their respective non-DR3 control group (both p less than 0.001). All but two subjects (both diabetic) had TRAb levels in our normal range. Thus TRAb levels are elevated in the subjects who possess the HLA-DR3 antigen. Since DR3 is found so commonly in type 1 diabetes this phenomenon may partly explain the association with Graves' disease in this patient population.

Adult↗
PubMed1987

Missed Addisonian crisis in surgical wards.

Three women were admitted to the surgical wards with acute gastro-intestinal symptoms and despite good clinical (pigmentation, hypotension) and biochemical (hyponatraemia, acidosis) evidence of Addisonian crisis had unnecessary investigations with delay in the diagnosis and appropriate management of this medical emergency. Clinicians should take careful note of the typical electrolyte upset seen in Addisonian crisis.

Addison Disease↗
PubMed1987

Unusual causes of calf swelling--2. Rhabdomyolysis mimicking deep vein thrombosis.

A 55 year old woman with pain and swelling of the leg was heparinized on the basis of a clinically diagnosed ilio-femoral deep vein thrombosis (DVT). Subsequent investigation showed her to have extensive rhabdomyolysis of the leg. Rhabdomyolysis can mimic the appearance of deep vein thrombosis and this case further illustrates the importance of venography in the assessment of the swollen leg.

Diagnosis, Differential↗
PubMed1987

Severity of coronary artery disease and basal fibrinolysis.

Basal venous blood levels of several components of the fibrinolytic enzyme system (plasminogen activator, plasminogen, fibrin degradation products, alpha 2-antiplasmin, and alpha 2-macroglobulin) were measured in 100 white men with angiographically defined coronary artery disease. The tests of fibrinolysis were not related to the severity of coronary artery disease, as indicated either by the number of vessels involved or by a coronary score system. Fibrinogen levels, however, did show a modest association with the extent of coronary atheroma (r = 0.21, p less than 0.05). Triglyceride levels were associated with the inhibitors of fibrinolysis: positively with alpha 2-antiplasmin (r = 0.31, p less than 0.005) and negatively with alpha 2-macroglobulin (r = -0.25, p less than 0.05). The alpha 2-antiplasmin levels were significantly elevated in patients with hypertriglyceridaemia. Neither smoking nor beta-blockade had any effect on the tests of fibrinolysis. This study adds support to the association of plasma fibrinogen with ischaemic heart disease.

Adult↗
PubMed1987

The effect of exercise on thrombin and plasmin generation in middle-aged men.

Plasma levels of B beta 15-42 peptide and fibrinopeptide A (FPA) were measured as indicators of plasmin-mediated fibrin(ogen)olysis and thrombin activity of fibrinogen in 34 middle-aged men, at rest and following a standard exercise test. In the group as a whole no significant changes in B beta 15-42 or FPA were noted after exercise. When the group was subdivided into men with (n = 20) and without (controls n = 14) coronary heart disease, exercise-stimulated thrombin and plasmin generation was found only in the control group who exercised for a significantly longer duration. The rise in B beta 15-42 was related to both the intensity and duration of exercise. Similar increases in plasma fibrinolytic activity (fibrin plate) occurred in both groups and no other differences in the components of the fibrinolytic system (plasminogen, alpha 2-antiplasmin, fibrin degradation product) were noted either after exercise or between the groups. Exercise in normal middle-aged men is associated with modest thrombin and plasmin activation.

Adult↗
PubMed1987

The hyperglycaemic, hyperosmolar non-ketotic syndrome: some aspects of management.

Hyperosmolar non-ketotic coma is a relatively uncommon but important medical emergency. It is associated with a high mortality, which has changed little over the past twenty years. Approximately half of all patients give no prior history of diabetes and since patients often present with neurological abnormalities, resembling a cerebrovascular accident, the diagnosis can sometimes be delayed or missed. Therefore every patient presenting to hospital with a state of clouded consciousness or objective signs of neurological abnormality, should have a blood glucose estimation performed at an early stage. It has been suggested that a regimen of less aggressive early fluid replacement, with more attention being directed to the associated or underlying problems, may be beneficial to the patient. Claims that the continuing high mortality in non-ketotic coma can be improved by such measures await confirmation.

Anti-Bacterial Agents↗
PubMed1987

Thrombin and plasmin activity in diabetes mellitus and their association with glycaemic control.

Abnormalities of haemostasis are common in diabetes mellitus. As indicators of fibrinolysis and coagulation, plasmin and thrombin activity were assessed by assay of the fibrinogen peptide derivatives B beta 15-42 and fibrinopeptide A respectively in 60 diabetic patients and 50 control subjects in a cross-sectional study. Glycosylated haemoglobin (HbA1) correlated with B beta 15-42 (r = -0.26, p less than 0.05) and fibrinopeptide A (r = 0.30, p less than 0.05) in the diabetic patients suggesting that poor glycaemic control (i.e. high HbA1 levels) was associated with depressed plasmin and enhanced thrombin activity. Compared to controls, fibrinopeptide A levels were increased in diabetics (p less than 0.001) irrespective of sex or type of diabetes. B beta 15-42 levels were normal in diabetic females but increased in diabetic men (p less than 0.001) possibly secondary to the activation of coagulation. These results suggest that in diabetes mellitus activation of coagulation is the dominant haemostatic abnormality and that better glycaemic control could influence in-vivo plasmin and thrombin activity favourably.

Adult↗
PubMed1987

Hyperkalaemia, ketoacidosis and subcutaneous or intravenous insulin infusions.

We report a case of a previously stable Type 1 insulin-dependent diabetic who developed diabetic ketoacidosis with marked hyperkalaemia after starting continuous subcutaneous insulin infusion for neuropathy. On two occasions during his hospital admissions he had a rapid onset of hyperkalaemia after short interruptions to this intravenous insulin infusion. Hyperkalaemia can occur rapidly in patients who are treated with short acting insulin only.

Adult↗
PubMed1987

Amniotic fluid volume assessment with the four-quadrant technique at 36-42 weeks' gestation.

An ultrasound approach was developed to identify normal amniotic fluid volume. The uterine cavity was divided into four quadrants. With the use of linear-array, real-time B-scanning, the vertical diameter of the largest pocket in each quadrant was measured. The sum of these four quadrants was used to provide a single number for the amniotic fluid volume and termed the amniotic fluid index. This approach is simple, requires little time and gives a semiquantitative estimate of amniotic fluid volume. Based on our observations, the normal amniotic fluid index in term gestation is 12.9 +/- 4.6 cm. Evaluation of the relationship between amniotic fluid volume and fetal outcome is under investigation.

Amniotic Fluid↗
PubMed1987

Oestradiol levels in diabetic men with and without a previous myocardial infarction.

Elevated oestradiol levels have been found in men with a previous myocardial infarction and it has been suggested that hyperoestrogenaemia may explain partly the increased risk of coronary heart disease in diabetes mellitus. Therefore we have measured concentrations of oestradiol and testosterone (the main substrate for oestradiol) in a group of diabetic men with a previous myocardial infarction (n = 15), a matched group of diabetic men without overt cardiovascular disease (n = 13) and a group of healthy, non-diabetic men (n = 15). The diabetics had elevated oestradiol levels (p less than 0.03) despite lower testosterone levels (p less than 0.02) compared with control subjects. In the diabetic patients, a correlation between oestradiol and testosterone was found (r = 0.55, p less than 0.02) which suggested that the elevated oestradiol levels were only partly derived from the aromatization of testosterone. There were no differences in oestradiol or testosterone levels between the two diabetic groups. This study has shown that endogenous hyperoestrogenaemia is a consistent finding in diabetic men, irrespective of whether they have or have not sustained a previous myocardial infarction. The source of the raised oestradiol levels is uncertain. It is unclear whether hyperoestrogenaemia can be regarded as a risk for myocardial infarction in diabetic men.

Diabetes Complications↗
PubMed1987

Nasal changes following immersion in chlorinated water.

Ten swimmers had rhinomanometry, mucociliary clearance time and lung function tests performed pre and post swimming in a chlorinated swimming pool. No evidence of nasal irritation or adverse effects on nasal function were obtained.

Adolescent↗
PubMed1986

Computerizing the medical staff office.

To assist its medical staff in making appointments and reappointments to the medical staff, delineating clinical privileges, and maintaining quality assurance information, as well as to streamline clerical duties in the medical staff office, El Camino Hospital (a 460-bed acute care facility in Mountain View, California) developed a comprehensive, computerized medical staff quality assurance database (MESQUAD). This article describes MESQUAD as a program developed by one hospital to meet its unique needs.

California↗
PubMed1986

Impaired thyrotrophin secretion following the administration of thyrotrophin-releasing hormone in type II diabetes mellitus.

Serum thyrotrophin has been measured before and after the intravenous administration of 200 micrograms of thyrotrophin-releasing hormone in 91 white subjects (33 stable diabetic patients and 58 healthy controls), none of whom had any clinical evidence of thyroid or pituitary dysfunction. Seven of the diabetic subjects failed to achieve a rise of serum thyrotrophin of greater than 2 mU/l above basal concentrations, as compared with only one of the control subjects (P = 0.006). The difference in response between diabetics and controls was confined to patients with Type II (non-insulin-dependent) diabetes: thus 5 of 13 Type II patients and 2 of 20 Type I (insulin-dependent) patients failed to show a normal response to thyrotrophin releasing hormone injection. No significant effect of glycaemic control on thyrotrophin responses was noted. These results suggest that Type II diabetes mellitus may be a cause of impaired thyrotrophin secretion in patients with no clinical evidence of pituitary disease. The mechanism for this impaired pituitary hormone release remains to be clarified.

Adolescent↗