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  • 1
    ISSN: 1432-0428
    Keywords: IDDM ; nerve conduction velocity ; neuropathy ; intensified insulin treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have investigated the effect of long-term strict glycaemic control on peripheral and autonomic nerve function in 45 IDDM patients (age 18–42 years, diabetes duration 7–23 years) without clinical signs of neuropathy or other neurological disease. They were randomly assigned to treatment either with continuous insulin infusion, multiple injections (4–6 times daily), or conventional treatment (twice daily) for 4 years and followed prospectively for 8 years. Motor and sensory nerve conduction velocities were measured at the start and after 8 years. Autonomic nerve function tests were performed only once, after 8 years. A significant reduction of nerve conduction velocity was observed during 8 years in patients with mean HbA1 more than 10% (n=12, group mean 10.9%, range 10.1–13.2%) compared to patients with HbA1 less than 10% (n=33, group mean 9.0%, range 7.5–9.9%). Change of motor nerve conduction velocity in the peroneal nerve was: −4.8±4.9 (SD) vs −2.2±5.3 m/s (p〈0.01). Change of motor nerve conduction velocity in the posterior tibial nerve was: −6.8±5.7 vs −3.9±5.1 m/s (p〈0.05). No significant changes were observed in the ulnar nerve. Change of sensoric nerve conduction velocity in the sural nerve was: −8.9±8.0 vs −4.6±5.3 m/s (p〈0.05). Multiple regression analysis showed that a change in HbA1 of 1% resulted in a 1.3 m/s change in nerve conduction velocity during 8 years. A significantly lowered heart-rate variation during deep breathing (p〈0.05) and heart-rate response to standing (p〈0.01) was found in patients with HbA1 more than 10% compared to patients with HbA1 less than 10%. This study confirms that the long-term lowering of blood glucose retards the deterioration in nerve conduction velocity observed in the diabetic nerve.
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  • 2
    ISSN: 1432-0428
    Keywords: Key words IDDM, nerve conduction velocity, neuropathy, intensified insulin treatment.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have investigated the effect of long-term strict glycaemic control on peripheral and autonomic nerve function in 45 IDDM patients (age 18–42 years, diabetes duration 7–23 years) without clinical signs of neuropathy or other neurological disease. They were randomly assigned to treatment either with continuous insulin infusion, multiple injections (4–6 times daily), or conventional treatment (twice daily) for 4 years and followed prospectively for 8 years. Motor and sensory nerve conduction velocities were measured at the start and after 8 years. Autonomic nerve function tests were performed only once, after 8 years. A significant reduction of nerve conduction velocity was observed during 8 years in patients with mean HbA1 more than 10 % (n =12, group mean 10.9 %, range 10.1–13.2 %) compared to patients with HbA1 less than 10 % (n =33, group mean 9.0 %, range 7.5–9.9 %). Change of motor nerve conduction velocity in the peroneal nerve was: –4.8±4.9 (SD) vs –2.2±5.3 m/s (p〈0.01). Change of motor nerve conduction velocity in the posterior tibial nerve was: –6.8±5.7 vs –3.9±5.1 m/s (p〈0.05). No significant changes were observed in the ulnar nerve. Change of sensoric nerve conduction velocity in the sural nerve was: –8.9±8.0 vs –4.6±5.3 m/s (p〈0.05). Multiple regression analysis showed that a change in HbA1 of 1 % resulted in a 1.3 m/s change in nerve conduction velocity during 8 years. A significantly lowered heart-rate variation during deep breathing (p〈0.05) and heart-rate response to standing (p〈0.01) was found in patients with HbA1 more than 10 % compared to patients with HbA1 less than 10 %. This study confirms that the long-term lowering of blood glucose retards the deterioration in nerve conduction velocity observed in the diabetic nerve. [Diabetologia (1994) 37: 579–584]
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  • 3
    ISSN: 1619-1560
    Keywords: sweat gland ; substance P ; vasoactive intestinal polypeptide ; diabetic neuropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Vasoactive intestinal polypeptide (VIP) and substance P (SP) immunoreactivity are reduced in the cutaneous nerves of diabetic patients with peripheral neuropathy. The functional significance of this finding was studied by measuring the forearm sweat response to intradermal methacholine and the effect of coadministration of VIP and SP in six normal subjects, and in six diabetic patients with neuropathy and eight without. Flare responses to the two peptides were also measured. Methacholine-induced sweat output was significantly greater in neuropathic patients compared with the other groups (p 〈 0.05), suggesting upper limb denervation supersensitivity. VIP and SP alone did not evoke sweating in any subject. Injection of VIP or SP reduced methacholine-induced sweating to a similar degree in all groups, except that the reduction was smaller in the nonneuropathic group than in the others (p = 0.028 versus normal subjects, p = 0.014 versus neuropathic diabetic patients). Flare responses to the peptides were markedly reduced in the neuropathic patients compared with the other groups (p 〈 0.01). In neuropathic patients, increased sweat responses and decreased flare coexist with diminished neurophysiological measurements; cutaneous sweating and flare responses provide valuable additional information to conventional methods of neurological assessment in diabetic neuropathy.
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  • 4
    ISSN: 1573-2622
    Keywords: luminance electroretinogram ; pattern electroretinogram ; point-spread function ; straylight
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It is generally accepted that the pattern electroretinogram for very large spatial elements is the result of local luminance stimulation. Responses due to the luminance differences between elements may be assumed to be relatively unimportant because in the case of large elements only few retinal units are stimulated by gradients. With decreasing pattern element size one wonders to what extent the electroretinogram continues to be based on the local luminance stimulation. We investigated this question using 8 Hz checkerboard reversal and compared the pattern recordings with the recordings resulting from the same stimulus field modulated homogeneously (focal electroretinogram). A 100% modulated checkerboard at retinal level may be considerably less modulated because of imperfect optics of the eye. So the pattern electroretinogram should be compared with homogeneous field stimulation of correspondingly lower modulation depth. On the basis of the optical transfer properties of the eye we compared by subtracting the proper focal electroretinogram from the pattern electroretinogram. The difference response was virtually zero for check sizes larger than 120′. For checks from 60′ down the difference response was of the same order of magnitude as the adjusted focal recording. This difference response for eyes with normal optics is largest around 30′; its wave form was found to be rather invariant with check size.
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  • 5
    ISSN: 1573-2622
    Keywords: Competer ; automatic perimetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We evaluated the perimetric concept and the technical construction of the Competer. The testprocedures of the Competer are well conceived. The screening-strategy may fail in cases of central islands or large central defects. The interpretation of the visual field results is not easy, due to the use of a numerical print-out which, in addition, is different for screening and threshold examinations. The mechanical and electrical construction of the instrument could be improved. In the accompanying paper (Graniewski et al., 1982) results are presented of a comparative clinical evaluation.
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  • 6
    ISSN: 1573-2622
    Keywords: Fieldmaster 101 PR ; automatic perimetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The perimetric concept and the technical construction of the Fieldmaster 101 PR were evaluated. 64 eyes of patients and 10 normal subjects were examined. We conclude that the Fieldmaster is a well-engineered instrument, using an inefficient test strategy. The presentation of visual field results could be impoved. Clinical results of the patient examinations are presented.
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  • 7
    ISSN: 1573-2622
    Keywords: Ocuplot ; automatic perimetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The perimetric concept and the technical construction of the Ocuplot were evaluated. The mechanical and electrical construction of the instrument we tested was poor. The manufacturer claims improvements in newer specimens. We examined 87 eyes of patients and normal subjects with the Ocuplot and learned that the test-strategy is not efficient and yields a high proportion of false positive results. Clinical results of the patient-examinations are presented.
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  • 8
    ISSN: 1573-2622
    Keywords: Friedmann Visual Field Analyser Mark II ; perimetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The perimetric concept and the technical construction of the Friedmann Visual Field Analyser Mark II (VFA Mk II) were evaluated. This instrument for multiple stimulus static campimetry of the central 25° is the successor of the Friedmann VFA Mk I. The number of stimuli is increased (99 vs. 47) and the console is improved. The positions of the presented stimuli are indicated on a LED-monitor. The mechanical and electrical construction of the VFA Mk II appeared to be good. 106 eyes of patients and normal subjects were tested and we conclude that the larger number of stimuli, though improving the chance of detecting small defects, complicates the manual registration and the interpretation of clinical results and prolongs the test, especially in the case of visual fields with substantial defects.
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  • 9
    ISSN: 1573-2622
    Keywords: Filtering surgery ; cataract extraction ; central visual island ; visual field defect
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fifty advanced glaucoma patients with central visual field islands were evaluated before and after intra-ocular surgery with respect to visual acuity and visual field behavior. Thirteen patients underwent a cataract extraction, and 37 a filtering procedure. Visual acuity generally improved to a certain extent after lens extraction, and deteriorated after filtering surgery. For both groups the visual field island became somewhat larger with respect to the surface area, but the foveal value was usually lower after the operation. There was no clear relationship between visual acuity and foveal values or the surface area of the central island. One patient suffered unexplained loss of central vision.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Documenta ophthalmologica 73 (1989), S. 255-274 
    ISSN: 1573-2622
    Keywords: red glasses ; retinitis pigmentosa ; visual function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract As a consequence of animal studies reduction of the light regimes have been tried on patients with retinitis pigmentosa. The trials have been very limited and have not given reason for hope that such reduced light therapy may be beneficial. However, RP patients trying red glasses have reported acute subjective improvement of their visual function. It was the purpose of this study to try to document the reports more objectively. Five visual functions were tested with and without red glasses with the following results: 1. Visual acuity and contrast sensitivity. For one volunteer a small reproducible improvement was found. 2. Color vision. In most cases deterioration was found of already deficient color vision. 3. Visual fields. For volunteers with relatively preserved vision no difference or slight deterioration was found. For the other volunteers slight improvements were found. 4. Intraocular light scatter. No differences were found. 5. Dark adaptation. Improvements were found when the glasses were used as adaptation aid according to the method of Trendelenburg (rod function). For cone function no difference was found upon continuous wearing of red glasses. In conclusion: use of red glasses does not seem to be of great benefit as a rule. On the other hand, apart from the reduction in color discrimination no serious disadvantages seem to be inherent in their wear by RP patients.
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