Biomedical subjects
Publications and source records attributed to U Felsing.
With the changing structure of pediatrics the emphasis of medical care (also of specialized care) has more and more shifted to the outpatient departments. For complicated diagnostic procedures of intermediate treatment in acute illness day-care on a special ward is a useful compromise with increasing importance. Own experiences in this way of medical care are exemplarily discussed.
UNLABELLED: In extremely unstable (brittle) IDDM patients (n = 11) the metabolic effect of long-term (36 months) CSII proved to be superior to conventional insulin treatment (CIT) (statistical twins, n = 11): HbA1 = 8.6 +/- 0.3 versus 10.4 +/- 0.4, MBG = 5.6 +/- 0.3 versus 8.5 +/- 0.8, M (80)- value = 23.6 +/- 0.6 versus 56.7 +/- 10.2, GCI) = 37.3 +/- 15.6 versus 132 +/- 24.2. In addition, in CSII patients the metabolic control was significantly better than intensified conventional insulin treatment (ICT) before. Retinal morphology improved under CSII in 1 eye, did not change in 10 eyes and deteriorated in 11 eyes. Under CIT retinal findings improved in none, did not change in 16 and deteriorated in 16 eyes. Deteriorations under CSII appeared more frequently during the first than during the second and third year of treatment and seemed to be a consequence of too strict metabolic control and/or too fast decrease of the glycemia at the beginning of CSII. During 36 months of CSII no deterioration but in one case normalization of microproteinuria was observed. Under CIT three cases changed from normal into microproteinuria. Reduced motor nerve conduction velocity (MCV) and/or sensory nerve conduction velocity (SCV) could be normalized in most cases under CSII, but respiratory heart arrhythmia (RHA) at rest could not. Most patients--if highly motivated before starting CSII--remained positively motivated for long-term pump therapy. IN CONCLUSION: Our experiences over three years demonstrate a positive effect of CSII on the metabolism as well as on the course of early stages of microangiopathy and neuropathy. A longer period of observations will be necessary to evaluate this, conclusively.
The distal latencies, motor and sensory nerve conduction velocities, and respiratory heart arrhythmia (RHA) were measured in 14 patients with type I diabetes but without clinical signs of polyneuropathy. The electroneurographic parameters tended to improve as the HbA1 value decreased. The RHA was not affected.
10 labile insulin-dependent diabetic patients treated with CSII were followed up for 6 to 16 months under conditions of everyday life. The mean blood glucose (MBG), glycosylated haemoglobin (HbA1), motor nerve conduction velocity (MCV), and respiratory heart arrhythmia at rest (RHA) were investigated. A significant improvement of metabolic control was observed (MBG 8.03 +/- 1.40 vs 5.18 +/- 0.87 mmol/l, p less than 0.01; HbA1 10.7 +/- 1.3 vs 8.7 +/- 1.6%, p less than 0.05) in comparison with the control values under intensified conventional therapy. MCV increased gradually but the average RHA remained unchanged. The psychological examination employing a questionnaire reflects that all patients selected were highly motivated and that their positive attitudes were further stabilized during pump treatment. An average of three mild hypoglycaemic episodes occurred per month per patient; these were no more than under intensified conventional treatment. Other minor clinical and technical complications occurred at a total frequency of one per month per patient and did not achieve therapeutical relevance.