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Biomedical subjects

W Beischer

Publications and source records attributed to W Beischer.

At least 19 recordsLinked to original sources
PubMed2003

Endothelial nitric oxide synthase (ecNOS) 4 a/b gene polymorphism and carotid artery intima-media thickness in type-1 diabetic patients.

AIM: To study putative associations of the ecNOS 4 a/b polymorphism with carotid artery intima-media thickness (IMT) and diabetic complications in young type-1 diabetic patients. METHODS: Study participants were 147 type-1 diabetic patients (56 men and 91 women), mean age 30.1 +/- 6.6 years (range 14 - 44), with a diabetes duration of 13.1 +/- 8.1 years. HbA1c, albuminuria, and lipid status were assessed by standard laboratory techniques, the ecNOS 4 a/b genotype was determined by polymerase chain reaction with subsequent polyacrylamide gel electrophoresis. The patients were categorized according to the presence or absence of hypertension, nephropathy and retinopathy. The IMT, which can be used to estimate early stages of arteriosclerosis, was measured by high-resolution ultrasonography. RESULTS: The ecNOS genotypes were distributed as follows: 7.5 % a/a, 30.6 % a/b, and 61.9 % b/b. The IMT values did not differ between the patients with various ecNOS genotypes (a/a: 0.62 +/- 0.13; a/b: 0.63 +/- 0.21; b/b: 0.63 +/- 0.13; all: 0.63 +/- 0.15 mm). The prevalence of retinopathy was significantly higher in patients with the b/b genotype (odds ratio: 2.4 vs. a/a+a/b; 95 % CI, 1.1 - 5.3). CONCLUSIONS: Our results do not support the hypothesis that the ecNOS 4 a/b polymorphism interacts with the development of early carotid arteriosclerosis in young type-1 diabetic patients, but they give grounds to assume that in these patients it could influence the occurence of diabetic retinopathy.

Adolescent↗
PubMed2002

Determinants of early carotid atherosclerosis progression in young patients with type 1 diabetes mellitus.

The results of cross-sectional studies addressing early preintrusive atherosclerosis in type 1 diabetic patients are conflicting. In an observational longitudinal study we determined the course of carotid artery intima-media thickness (IMT) over a period of 2.5 years in mean. A total of 102 patients with type 1 diabetes mellitus (age < or = 40 years, diabetes duration > or = 2 years at baseline examination) who were participants of the baseline examination was studied again in a follow-up. HbA1c, albumin excretion rate (AER), lipids, systolic and diastolic blood pressure, retinopathy, and current smoking status were assessed at baseline and follow-up. The IMT of the common carotid artery was measured by high-resolution ultrasound, the maximum IMT was evaluated. The annual progression rate (APR) was calculated from the difference between baseline and follow-up IMT reading and the time between both examinations. The follow-up IMT was significantly higher, compared to the baseline measurement: 0.65 +/- 0.18 vs. 0.57 +/- 0.14 mm (p < 0.001), the mean APR was 0.033 mm/year. The APR was correlated with age (r = 0.337, p < 0.01), diabetes duration (r = 0.252, p < 0.05), hypertension (r = 0.225, p < 0.05), and systolic blood pressure (r = 0.281, p < 0.05) at the baseline examination. Comparing subgroups, defined according to APR tertiles, with no IMT progression (first tertile, mean APR - 0.012 mm/year), mild progression (second tertile, mean APR 0.037 mm/year), and advanced progression (third tertile, mean APR 0.088 mm/year), patients with advanced progression significantly (p < 0.05) more often had hypertension and nephropathy than subjects with mild progression. In a multiple linear regression analysis, the changes of plaque frequency and of the nephropathy status between baseline and follow-up examinations were independent predictors of the APR.

Adult↗
PubMed2001

Limited joint mobility in type 1 diabetic patients: associations with microangiopathy and subclinical macroangiopathy are different in men and women.

OBJECTIVE: To study the relationship of limited joint mobility (LJM) in type 1 diabetic patients with microvascular complications, hypertension, and early atherosclerosis and to determine whether sex has an influence on possible associations. RESEARCH DESIGN AND METHODS: A total of 335 consecutive unselected patients (191 women and 144 men), aged 14-40 years, were studied for LJM, retinopathy, nephropathy (stages III and IV), and hypertension. Standard laboratory tests were performed; the intima-media thickness (IMT) of the carotid arteries, which reflects the extent of early atherosclerosis, was measured by high-resolution ultrasound, and plaques were identified. RESULTS: The frequency of LJM was 33.7% (29.8% in women and 38.9% in men). Subjects with LJM had a longer diabetes duration (P < 0.001) than those without (women 16.7 +/- 9.1 vs. 10.3 +/- 6.0 years; men 15.0 +/- 9.0 vs. 9.4 +/- 6.3 years). Age, HbA1c, lipids, and systolic/diastolic blood pressure were not different between men and women with or without LJM. Men with LJM had a higher albumin excretion rate (37.1 vs. 13.1 microg/min, P < 0.05) than those without LJM and showed a higher risk of proteinuria (odds ratio 1.8, 95% CI 1.2-2.7; P < 0.05), retinopathy (2.4, 1.7-3.5; P < 0.001), and hypertension (1.7, 1.2-2.6; P < 0.05). The occurrence of these complications was not different between women with and without LJM, but only women with LJM had a greater IMT (0.59 +/- 0.13 vs. 0.55 +/- 0.10 mm, P < 0.05) and a higher risk of plaques (odds ratio 2.1, 95% CI 1.3-3.4; P < 0.05) than women without LJM. In a multiple logistic regression analysis, adjusted for age and diabetes duration, male sex independently predicted the presence of LJM. Moreover, LJM proved to be an independent predictor of retinopathy in men only. CONCLUSIONS: LJM is an indicator of microvascular disease in men, and LJM is associated with early macrovascular disease in women.

Adolescent↗
PubMed2000

[The stiff-man syndrome with diabetes mellitus type 1 and autoimmune thyroiditis].

HISTORY AND ADMISSION FINDINGS: A 54-year-old woman with type 1 diabetes of about 2 years' duration developed painful cramps in the muscles of the abdominal wall, the back and the thighs. On admission physical examination confirmed markedly increased tone of the muscles of the trunk and those proximal to it. INVESTIGATIONS: Markedly increased amounts of anti-GAD (glutamic acid decarboxylase) antibodies were present in both serum and cerebrospinal fluid (CSF). Electroneurography and -myography revealed mild polyneuropathy but no other neurological abnormality. DIAGNOSIS, TREATMENT AND COURSE: Suspected stiff-man syndrome (SMS) was confirmed by the increased anti-GAD antibodies and the marked improvement on gradually increasing doses of clonazepam. The autoimmune syndrome affected several organ systems: central nervous system (SMS), pancreas (diabetes), thyroid (immuno-thyroiditis). Immunosuppressive treatment with azathioprine was begun. The patient remains in good general condition 22 months after the initial diagnosis, and there have been no new organ involvement. CONCLUSION: It is important to include SMS in the differential diagnosis, even though the symptoms are not those of the full-blown picture of this rare disease. Absence of muscle cramps and myoclonus but presence of depressive symptoms can easily result in misdiagnosis, preventing early initiation of effective symptomatic treatment.

Azathioprine↗
PubMed2000

[Subclinical arteriosclerosis in patients with newly diagnosed type 2 diabetes mellitus. Demonstration by high-resolution ultrasound measurements of intima-media thickness of the common carotid and femoral arteries].

BACKGROUND AND OBJECTIVE: Type 2 diabetes mellitus is an important risk factor for the development of atherosclerosis. Early subclinical manifestation of atherosclerosis can be reliably recognized by measuring the thickness of the intima and media (IMT). The aim of this study was to examine vessel changes and the extent of possible risk factors in patients with newly diagnosed type 2 diabetes (interval since diagnosis < or = 1 year) and control persons without DM. PATIENTS AND METHODS: Maximal IMT was measured by high resolution ultrasound of the common carotid (CCA) and femoral arteries (FA) in 51 type 2 diabetics and 18 controls. Various clinical and laboratory data (urinary excretion of albumin and protein, blood lipids) as well as amount of smoking, frequency of eating fruit and amount of sport activity were obtained in a standardized manner. RESULTS: The patients' body-weight was markedly greater and blood pressure significantly higher than that of the controls. Hypertension was present in 43% of patients (control group 11%) microalbuminuria in 26%. Mean IMT of the CCA was 0.76 +/- 0.20 mm in the patients and 0.64 +/- 0.16 mm in the controls (p < 0.01). The IMT of the FA, however, was not significantly different in the two groups (patients: 0.80 + 0.30 mm, controls: 0.75 +/- 0.31 mm). The IMT of the CCA was correlated with the patients' age (r = 0.55; p < 0.001), with the level of total cholesterol (r = 0.39; p < 0.01), and with the presence of hypertension (r = 0.38; p < 0.01). Patients who daily eat fruit had a significantly lower IMT of the FA than those who did not eat fruit regularly (no such difference was found regarding the CCA). Linear multiple regression analysis indicated that these variables were factors that independently affected the IMD of the CAA and the FA. CONCLUSIONS: An increase in subclinical atherosclerosis was demonstrated in type 2 diabetics already during the first year after diagnosis. The risk factors for the development of atherosclerosis in newly diagnosed diabetics exert a greater effect on the CCA than the FA. Regular eating of fruit seems to have a favourable effect on the progression of atherosclerosis of the FA.

Arteriosclerosis↗
PubMed1999

[Diabetes therapy in the elderly for better prognosis and well-being. Which strategies are suitable?].

A specific and important aim of treatment in elderly diabetics is neither to induce nor aggravate geriatric syndromes. Clinical observations indicate that this goal can be achieved in the elderly diabetic only when the control of blood glucose, blood pressure and blood lipids meet the recommendations of the European NIDDM Policy Group for type 2 diabetics. In principle, the same possibilities for the treatment of diabetes apply to the elderly as to younger diabetics, with differences merely of priority. As a result of the manifold afflictions of geriatric patients, problems arise with the implementation of treatment. However, intensive individual training of the elderly diabetic is capable of preserving his/her independence.

Aged↗
PubMed1998

Determinants of carotid artery wall thickening in young patients with Type 1 diabetes mellitus.

To investigate associations between early atherosclerosis and possible risk factors for it in young patients with established Type 1 diabetes mellitus (DM), we measured the combined intima-media thickness (IMT) of the common carotid arteries with high resolution ultrasound in 310 young patients (age < or = 40 years, mean 27.9 +/- 6.5) with a diabetes duration > or = 2 years, and in two control groups of similar age (control 1:40 healthy subjects, control 2: 40 Type 1 DM recently diagnosed patients). Albumin excretion rate and lipids (total cholesterol and triglycerides) were measured and retinopathy and hypertension (systolic blood pressure > 140 or diastolic blood pressure > 90 mmHg) sought in the patients. Mean maximum IMT was 0.52 +/- 0.06 mm in control group 1 and 0.50 +/- 0.05 mm in control group 2 with a mean difference of 0.02 mm (95% CI: -0.01, 0.04). The more established Type 1 DM patients had a significantly greater IMT (0.57 +/- 0.13 mm, p < 0.001) than both control groups. In a subgroup analysis, patients with microvascular diabetic complications (n = 99) had a significantly greater IMT (0.63 +/- 0.17 vs 0.55 +/- 0.10 mm, p < 0.001) than those without (n = 211). In a multiple linear regression analysis with a significance level of < or = 0.10, the carotid artery IMT of our established diabetic patients was related to age, male gender, triglycerides and nephropathy, suggesting the latter as the main diabetes-specific risk for intima-media thickening in young Type 1 DM patients.

Adult↗
PubMed1998

[Determination of intima-media thickness of the carotid artery: influences of methods, proband and examination variables].

AIM: Comparison of two different methods for the measurement of the common carotid artery intima-media thickness (IMT) regarding results and reproducibility, and investigation of the influence of the subjects' characteristics on the results. METHOD: 20 healthy subjects were studied (6 men, 14 women, mean age 27.4 +/- 4.4 years). B-Mode pictures were taken of the carotid arteries on both sides (longitudinal sections from ventral and lateral) and stored for measurement either in systole or in diastole. Maximum IMT was measured conventionally by manual setting of calipers (method 1), the mean IMT over a length of 1 cm was calculated from the area of the intima plus media by means of a computer (method 2). 10 subjects were studied twice for the evaluation of intra- and interobserver variability. RESULTS: Mean IMT was between 0.48 +/- 0.07 mm (method 1/observer 1) and 0.55 +/- 0.07 mm (method 2/observer 2). IMT values resulting from method 2 had a better correlation in repeated measurements (coefficient 0.84/0.93 for inter-/intraobserver comparison) than those resulting from method 1 (0.79/0.67). Age and height were significantly correlated with IMT (coefficients 0.53 and 0.52 for method 2), no correlation was found for body weight, BMI, sex or years of smoking. There was a significant inverse correlation between blood pressure and IMT (-0.21 to -0.32). CONCLUSION: In younger healthy subjects, the results of IMT measurement are influenced by age, height and actual blood pressure. The values resulting from both methods are comparable, whereas method 2 has a better reproducibility.

Adult↗
PubMed1998

Lack of association between the insertion/deletion polymorphism of the angiotensin-converting-enzyme gene and diabetic nephropathy in IDDM patients.

The insertion/deletion (I/D) polymorphism of the angiotensin-converting-enzyme (ACE) gene has been reported to be associated with diabetic nephropathy in IDDM. We studied the relationship between this polymorphism and diabetic nephropathy in 210 IDDM patients. Their DNA was analyzed by polymerase chain reaction to type for the presence (I) or absence (D) of the 287 bp fragment in intron 16 of the ACE gene. The relative frequency of the different genotypes was 33.8% (DD), 43.8% (ID), and 22.4% (II). There were no significant differences between the genotypes in age, body-mass-index, blood pressure, plasma total cholesterol and triglycerides. The prevalence of microalbuminuria or nephropathy was 23.9% in the DD, 16.3% in the ID, and 17% in the II genotypes. The higher percentage of microalbuminuria or nephropathy in the DD genotypes was due to an increasing frequency of DD genotypes in the IDDM patients with long diabetes duration. After matching for diabetic retinopathy, gender, and diabetes duration, there was no association between the ACEI/D polymorphism and diabetic nephropathy. In conclusion, these results suggest that the ACE DD genotype cannot be regarded as a risk factor for diabetic nephropathy, but may even be associated with diabetes duration and thus longevity in IDDM patients.

Adult↗
PubMed1998

Evaluation of the insertion/deletion ACE gene polymorphism as a risk factor for carotid artery intima-media thickening and hypertension in young type 1 diabetic patients.

OBJECTIVE: To study the distribution of the insertion/deletion polymorphism of the ACE gene in young type 1 diabetic patients and to evaluate possible associations between the ACE genotype, arterial hypertension, and intima-media thickness (IMT) of the common carotid artery. RESEARCH DESIGN AND METHODS: Study participants were 148 type 1 diabetic patients (56 men and 92 women), aged 14-44 years, with a diabetes duration of > or = 2 years. HbA1c, albuminuria, and lipid status were assessed by standard laboratory techniques; the ACE genotypes were assessed by polymerase chain reaction. The patients were categorized according to the presence or absence of hypertension, nephropathy, and retinopathy. The IMT, which can be used to estimate early stages of atherosclerosis, was measured by high-resolution ultrasonography. RESULTS: The ACE genotypes were distributed as follows: 21% II, 37% ID, 42% DD. The IMT values did not differ among patients with various ACE genotypes (0.63 +/- 0.15 mm), but the prevalence of hypertension was significantly higher in patients with DD (odds ratio, 4.26 versus II + ID; 95% CI, 1.64-11.06). Multiple linear regression analysis showed that only age, hypertension, and sex were determinants for the IMT. CONCLUSIONS: Our results suggest a relationship between the prevalence of hypertension and the deletion polymorphism of the ACE gene in young type 1 diabetic patients, but we could not find an association between carotid artery IMT and ACE genotype in this population.

Adolescent↗
PubMed1998

Low-dose iloprost infusions compared to the standard dose in patients with peripheral arterial occlusive disease Fontaine stage IV. DAWID Study Group.

BACKGROUND: Intravenous iloprost, titrated from 0.5 up to 2.0 ng/kg/min has been shown in patients with PAOD III/IV to significantly improve healing of trophic lesions, relief of rest pain, and reduce the rate of major amputation or death at 6 months as compared to placebo. The effect is considered related to improvement of the microcirculation. The aim of the present trial was to identify an optimum dose regarding treatment response and tolerability, by studying 4 doses of 25, 50, 75 and 100 micrograms iloprost daily. PATIENTS AND METHODS: 302 patients with PAOD IV were randomised via a double-blind fashion to one of the 4 doses. The primary endpoint was the responder rate at end of treatment. Responders were defined as patients with very good or good global efficacy, as judged by lesion healing and pain relief. Side effects were documented and a pre-defined benefit/risk index was calculated. RESULTS: No dose-dependency of iloprost regarding primary or secondary endpoints was observed. The rate of responders ranged between 48.7-53.5%. Side effects, mainly related to vasodilation, increased dose-dependently (p < 0.001, chi 2-test), with a significant decrease of the benefit/risk index from 2.19 +/- 1.19 to 1.64 +/- 0.97 (p = 0.012, ANOVA). Responders had a better outcome at 6 months than non-responders (2.6 fold higher rate of major amputation or death; life table analysis). CONCLUSIONS: It is concluded that iloprost should be titrated to the optimum rather than maximum tolerated dose, since a higher incidence of side effects not associated with an increased treatment response was observed at higher doses.

Aged↗
PubMed1994

[Carotid artery wall changes in young type-1 diabetics. The ultrasonic diagnosis of early arteriosclerosis].

In a prospective study high-resolution ultrasonography was used to document any early carotid-artery wall changes (intima-media thickening; plaques), in 165 type I diabetics up to the age of 40 years (66 males, 99 females; mean age 27.5 +/- 6 years; duration of diabetes > 1 year). In two control groups (group 1: 40 with type I diabetes of up to one year's duration; group 2: 20 healthy subjects) the mean intima-media thickness was 0.50 +/- 0.05 and 0.51 +/- 0.06 mm, respectively (maximal value 0.6 mm). In the patients with a longer duration of diabetes it was significantly higher at 0.56 +/- 0.11 mm (P < 0.001). Of the 165 patients with a diabetes duration of more than 1 year, 134 had normal intima-media wall thickness (< 0.6 mm, mean 0.52 +/- 0.07 [group A]), in 15 (group B) it was 0.75 +/- 0.06 mm, and in 16 (group C) there were plaques with a wall thickness of 0.67 +/- 0.15 mm. The incidence of nephropathy and hypertension or hypercholesterolaemia (only in group C) was significantly higher in groups B and C than A (P < 0.01). It is thus clear that these consequential or associated diseases go together, in young type I diabetics, with an increased risk of early arteriosclerosis.

Adult↗
PubMed1991

[Administration of prostaglandin E1 in diabetics and non-diabetic patients with severe Fontaine stage IIb arterial occlusive disease].

The success in therapy of prostaglandin E1 intra-arterially and intravenously applied to diabetics and non-diabetics with PAOD, stages IIb-IV according to Fontaine, was scrutinized in a city hospital primarily concerned with geriatrics, metabolism, and angiology. All the patients included were examined in retrospective studies with regard to the improvement of their situations during their stays in hospital and--in addition to that--a part of them prospectively some time after their stays in hospital. In all, 99 patients were included in the retrospective examination of which there were 60 diabetics and 39 non-diabetics. Of the 60 diabetics 53 were in stage IV, 5 in stage III, and 2 in stage IIb while in case of non-diabetics 26 were in stage IV, 10 in stage III, and 3 in stage IIb. 50 of the diabetics and 27 of the non-diabetics were treated intra-arterially. The prospectively orientated post-observation included 38 diabetics and 24 non-diabetics. The results of the retrospective examination revealed a significantly superior efficiency of intra-arterially applied PGE1 compared with the intravenous application, both, with regard to the reduction of needed analgesics and the improvement of the clinical situation. A comparison between intra-arterially treated diabetics and non-diabetics showed a significantly higher rate of success of the diabetics regarding to the improvement of the clinical situation. Concerning the prospective post-examination: due to their PAOD the diabetics took significantly more often analgesics at the time of their post-examination than the non-diabetics. Also concerning the development of their clinical situations the diabetics turned out to have worse results than the non-diabetics, however, the differences were not significant in this case.

Aged↗
PubMed1988

Substitution of basal delivery of insulin by proinsulin in type I diabetic patients under CSII.

In seven C-peptide negative type I diabetic patients conventional insulin therapy was replaced by CSII using biosynthetic human insulin. After a pretest period of 1-3 days duration, the patients received in randomized order basal subcutaneous infusion of either biosynthetic human proinsulin (assumed potency 4 U/mg) or insulin for two days each. For meals, insulin was given throughout the study. Insulin doses were adjusted to the patients requirements during the prephase. Afterwards changes of basal rates were allowed only in case of nocturnal hypoglycemia; bolus doses were modified when premeal glucose concentrations were outside the range from 80 to 120 mg/dl. During the test period with basal proinsulin infusion, plasma glucose control (MBG, MAGE, M-value) was significantly better (P less than 0.05) when compared to periods with basal insulin infusion. Basal rates of insulin and proinsulin as well as bolus doses of insulin were similar at all study periods. It is concluded that subcutaneous basal proinsulin infusion, supplemented by subcutaneous premeal insulin administration, can be used for glucose control of patients with type I diabetes. As basal proinsulin delivery gives significantly better results than basal insulin delivery, the question arises whether the present formulation of proinsulin is equipotent to insulin formulations.

Adult↗