Rituximab is a genetically engineered chimeric monoclonal immunoglobulin (Ig)G1 antibody. It binds the CD20 trans-membrane surface antigen expressed by mature B cells but not by antibody secreting plasma cells, and removes the cells by activating complement, inducing cell-mediated lysis, and by apoptosis. Mainly used for the treatment of non-Hodgkin's lymphomas, rituximab has recently been tried with favourable responses in rheumatoid arthritis, systemic lupus erythematosus, and other chronic immunological diseases. Wegener's granulomatosis (WG) is a granulomatous vasculitis with high morbidity and mortality. It is thought that anti-neutrophil cytoplasmatic antibodies (ANCA) with specificity for proteinase 3 (PR3) are possibly involved in the pathogenesis of the disease. Conventional therapy with cyclophosphamide and corticosteroids generally succeeds in inducing remission, but relapses frequently follow. Among the biological agents, tumour necrosis factor-alpha (TNF-alpha) inhibitors have been tried with some success. Based on a case report we recently treated three refractory WG patients with rituximab and achieved almost complete but temporary remission. CD20+ cells disappeared rapidly in peripheral blood, only to rise prior to subsequent disease flares occurring at 34, 63, and 54 weeks, respectively (Figure 1). A new flare occurred in one patient at 86 weeks. At the end of the observation periods (54, 102, and 120 weeks), only one patient had proteinuria. Chest radiographs became normal in two patients, while infiltrates remained unchanged in the third. Granulomatous retro-orbital or sinus masses in two patients seemed unresponsive to therapy.

Adult↗

PubMedDate not supplied

Lack of pharmacokinetic interaction between glibenclamide and trimethoprim-sulphamethoxazole.

Eight patients aged 57-86 years with non-insulin-dependent diabetes mellitus (NIDDM) taking long-term glibenclamide treatment (5-15 mg/day) were given oral trimethoprim-sulphamethoxazole due to an acute bacterial infection. After 4-6 days of combined treatment, the total plasma glibenclamide concentrations were determined every second hour for 12 h, and the area under the curve (AUC) was computed. A second plasma glibenclamide profile was obtained 2-4 weeks after withdrawal of trimethoprim-sulphamethoxazole. The levels of plasma glibenclamide did not differ between the two occasions, nor did the simultaneously determined levels of blood glucose and plasma insulin. It is concluded that there is no consistent pharmacokinetic interaction between glibenclamide and trimethoprim-sulphamethoxazole in NIDDM patients.

Acute Disease↗

PubMedDate not supplied

The effects of physical training in people with insulin-dependent diabetes.

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Adolescent↗

PubMedDate not supplied

Insulin-induced hypoglycaemia and absorption of injected insulin in diabetic patients.

The effect of insulin-induced hypoglycaemia (soluble insulin 1 mU kg-1 min-1 IV) on the absorption of 125I-labelled soluble insulin (10 U SC) from thigh was studied in 10 insulin-treated Type 1 diabetic patients on a test and a control day. Disappearance of 125I was followed by external gamma counting. Adipose tissue blood flow was measured concomitantly using the 133Xe-clearance technique. Arterial plasma levels of glucose, insulin, adrenaline and noradrenaline were determined intermittently. Hypoglycaemia occurred at a glucose level of 2.2 +/- 0.1 (+/- SE) mmol l-1 after 58 +/- 6 min. Peak levels of adrenaline (6.44 +/- 1.62 nmol l-1) and noradrenaline (2.29 +/- 0.39 nmol l-1) were found 10 min later. During the 30-min period after onset of hypoglycaemia, adipose tissue blood flow increased 132 +/- 45% (p less than 0.05) but the disappearance rate of 125I-insulin was unchanged. Thus, insulin absorption was unaltered in connection with hypoglycaemia in Type 1 diabetic patients, in contrast to the depression previously reported in healthy subjects, despite similar increases in adipose tissue blood flow.

Adult↗

PubMedDate not supplied

Glucose and insulin responses in relation to insulin dose and caloric intake 12 h after acute physical exercise in men with IDDM.

Acute exercise in insulin-dependent diabetic patients may perturb glycemic control, and adjustments of insulin and diet might be required to avoid postexercise hypoglycemia. The aim of this study was to assess the role of alterations in insulin dose or caloric intake on blood glucose and free-insulin levels during 12 h after an evening bout of exercise. Nine insulin-dependent diabetic men (28-42 yr of age) receiving two daily injections with a combination of intermediate-acting and soluble insulin participated in the study. Patients were randomly assigned to four treatment protocols: A, 50% reduction in intermediate-acting insulin dose; B, 50% reduction in soluble insulin dose; C, extra caloric intake (1700 kJ) 1 h after exercise; and D, no change. Exercise consisted of 45 min of cycling at 60% of maximal oxygen uptake at each occasion. Glucose and insulin responses were similar for the four protocols. There was a significant (P less than .001) time effect found regardless of treatment, with lowest blood glucose values 75 min after exercise. Hypoglycemia occurred in six of the nine patients at some time during the study, with half of the occurrences on the control night (protocol D). Consistent individual plasma insulin and glucose patterns were observed independent of protocol used. In some patients, hypoglycemia was evident after reductions in insulin dose, and in others it was evident on the night increases in caloric intake were to occur; thus, none of the interventions were totally adequate in preventing exercise-induced hypoglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Some characteristics of steroid diabetes: a study in renal-transplant recipients receiving high-dose corticosteroid therapy.

Risk factors and course of steroid diabetes were investigated in 145 renal-transplant recipients who were given a high-dose steroid regimen. Persistent steroid diabetes developed in 25% of the patients and transient diabetes in another 22%. When antidiabetic therapy was required, insulin had to be given in 50%. The incidence of steroid diabetes correlated with steroid dose, age, body weight, and diabetes heredity but not with abnormal glucose tolerance or with another complication of steroid therapy, posterior-pole lenticular cataract. There was no association with HLA-A and B antigens. Thus, steroid diabetes is a frequent complication of high-dose corticosteroid therapy and is similar to type II diabetes. However, it often requires insulin therapy.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Serum lipid and lipoprotein levels in female type I diabetics: relationships to aerobic capacity and glycaemic control.

The aims of this study were to examine the relationships between serum lipoprotein levels, glycaemic control and physical fitness in female Type I diabetic patients. Twenty-one patients were investigated. Those with the best glycemic control, as assessed by measurements of haemoglobin A1 levels, were found to have lower total triglyceride and VLDL triglyceride concentrations. They also had higher HDL and HDL2 cholesterol level than patients with less good control. Patients with high maximal oxygen uptake had higher HDL2 and lower LDL cholesterol levels as well as lower total triglyceride levels. It is concluded that both high aerobic capacity and good glycaemic control may be favourable for lipid status in Type I diabetic patients.

Adult↗