Prognostic significance of the changes in the carbohydrate metabolism in severe head injury.
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Biomedical subjects
Publications and source records attributed to M Stützel.
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Serial fasting blood glucose and basal serum insulin were measured in brain-injured patients. The endocrine changes were compared with the level of consciousness. Evaluating the serial examinations of 92 brain-injured and 31 control patients we came to the following conclusions. There is a quantitative correlation between the alterations in the level of consciousness and the fasting blood-glucose and serum-insulin levels in brain-injured patients. Deep coma is connected with a high blood-sugar level, clear consciousness with a normal glucose level. The insulin level is, however, decreased in the comatose state and normal in the state of clear consciousness. According to the alterations in blood-glucose and insulin levels, brain-injured patients can be divided into four groups. The alterations in the insulin level cannot give a proper explanation of the blood-sugar changes. Some changes in the levels of both blood glucose and serum insulin may have prognostic significance. According to our results it can be supposed that certain cerebral structures take part in the regulation of the basal insulin secretion.
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Insulin secretion has been studied after an oral glucose load in 81 patients with primary hyperlipoproteinaemia and 15 control sugjects. Glucose tolerance was reduced mainly in Type IV, and to a lesser extent in Type IIB hyperlipoproteinaemia. Insulin secretory response to glucose was reduced in Type V and heterogeneous in Type IV hyperlipoproteinaemia. No correlation was found between the triglyceride level and the rate of insulin secretion.
One of the most important questions arising in experiment on surviving segments of vessels is the question of flow of material into the vessel wall through the intima or adventitia. To make a distinction is important for the interpretation of results of in vitro experiments. By using a "tissuephil" tested already in practical surgery wound-adhesive free of any noxious effect, authors could form segments of vessels, having an only intimal or adventitial surface. Using this technique the flow of blood into the wall through intima or adventitia could be investigated separtely. At in vitro experiments most part of the labelled material flows into the vessel wall through the adventitia. This fact can be explained by the presence of microinjuries of the adventitia caused by the removing of the surrounding fat tissue. It is believed that only the flow through the intima gives an information about the condition of the vessels. Flow through the adventitia is mostly artificial.
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