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  • 1
    ISSN: 1433-0350
    Keywords: Craniofacial surgery ; Cephalometric radiography ; Computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A program for preoperative workup and postoperative follow-up in children with craniofacial anomalies is described. Objective measurements were made with cephalometry and computed axial tomography. Improvement in length of the anterior cranial base and shape of the calvaria after surgery and growth was demonstrated in this manner in serial follow-ups. It was concluded that both cephalometry and computed tomography were essential for the diagnosis, surgical planning and follow-up for this group of patients.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Acta neuropathologica 55 (1981), S. 97-103 
    ISSN: 1432-0533
    Keywords: Infantile striatal necrosis ; Computed tomography (CT) ; Morphology ; Excitotoxic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A case of infantile bilateral striatal necrosis (IBSN) is reported, the first one found in Scandinavia. Extensive clinical and laboratory investigations did not reveal any evidence of a neurometabolic disease. By computed tomography (CT) degeneration of putamen of either side was detected. The neuropathologic findings included extensive bilateral destruction of the striatum and pallidum and degeneration of the substantia nigra and tegmental nuclei. In the damaged regions, accumulations of cells containing sudanophilic lipids were found and Alzheimer type II glial cells, which were also seen in the cortex. On the basis of the clinical picture and the destruction of nerve cells in particular areas of the brain, in the present case and previously published cases of IBSN, the possible role of glutamatc and other excitotoxic transmitters in the pathogenesis of the disease is discussed.
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  • 3
    ISSN: 1432-0428
    Keywords: Diabetic microangiopathy ; early diabetes ; influence of metabolic regulation ; microvascular permeability of small and large molecules
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The microvascular permeability to small and large molecules was studied during good and poor metabolic regulation in ten short duration juvenile diabetics. The following variables were measured; daily urinary albumin and β2-microglobulin-excretion rates, whole body transcapillary escape rate of albumin (TER), glomerular filtration rate (GFR), capillary filtration coefficient (CFC), and capillary diffusion capacity (CDC). The urinary albumin and β2-microglobulin concentration were measured by sensitive radioimmunoassays; TER was determined from the initial disappearance of intravenously injected 125I-labelled human serum albumin; GFR was measured by single shot 51Cr-EDTA clearance; CFC was measured on the forearm by straingauge plethysmography and CDC for 51Cr-EDTA was determined in the hyperaemic anterior tibial muscle by the local clearance technique. All the above mentioned variables, except CDC, were significantly increased during poor metabolic regulation, indicating a functional microangiopathy. The mechanisms of these alterations appear to be increased filtration pressure in the microcirculation and/or increased porosity of the microvasculature. The findings of increased microvascular albumin passage are compatible with the hypothesis that the organic — histologically demonstrated — diabetic microangiopathy is a long-term effect of periods of increased extravasation of plasma proteins, with subsequent protein deposition in the microvascular wall, i. e. the concept of plasmatic vasculosis.
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  • 4
    ISSN: 1432-0428
    Keywords: Diabetes ; functional diabetic microan-giopathy ; glucagon ; kidney function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Kidney function was studied in six normal males before and during a 2 h glucagon (10 ng/kg/min) infusion. The following variables were determined during each 20 min clearance period; glomerular filtration rate (GFR), renal plasma-flow (RPF), filtration fraction (FF), urinary albumin andβ 2-microglobulin-excretion rates. Glucagon infusion resulted in a fourfold increase in plasma glucagon concentration. The infusion induced a significant increase in GFR (+9%), FF (+ 9%) and urinaryβ 2-microglobulin excretion rate (+ 32%), (p〈0.01). RPF and urinary albumin excretion rates were not significantly changed. We suggest that glucagon may contribute to the reversible kidney function alterations typically found in poorly regulated juvenile diabetes, a state with relative or absolute hyperglucagonaemia.
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  • 5
    ISSN: 1432-0428
    Keywords: Haemoglobin A1c ; rapid glycosylation ; chromatography ; glucose ; 2-ketohexose derivatives ; artificial pancreas
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Chromatographically determined haemoglobin A1c concentration was measured during short-term (1–24 h) changes in glucose concentration in vitro and in vivo. In vitro at 37 °C the HbA1c concentration increased with glucose concentration and time both in normal and diabetic erythrocytes. In normal erythrocytes incubated in 20–100 mmol/l glucose, the increases in the HbA1c concentration were maximal after 4–6 h and then stable for the next 18–20 h. During the first hour, increases in the HbA1c concentration were linear with time and on average 0.034% HbA1c × h−1 × mmol/l glucose−1. In erythrocytes, after a rapidly produced increase (2h), HbA1c decreased to preincubation concentrations during a further incubation of the erythrocytes in a glucose-free medium at 37 °C for 4–6 h. The mean rate of linear decrease was 0.017% × h−1 × mmol/l glucose−1. After incubation of erythrocytes in 100 mmol/l glucose for 24 h, 1.3% HbA1c remained stable for 6 h in saline. The rapid increase in HbA1c concentration, as determined by chromatography, was not due to stable HbA1c (ketoamine linked glucose) as no increase was found in the HbA1c concentrations determined by the thiobarbiturate method. In juvenile diabetics controlled by an artificial beta-cell, rapid changes of blood glucose concentration (up to 20 mmol/l) resulted in increases in HbA1c concentration of as much as 1.9% within 12 h (mean 1.1%). Rapid in vivo increases in HbA1c concentration were reversible by normalization of the blood glucose concentration. That rapid changes in HbA1c may occur in daily diabetic life was evidenced by differences in HbA1c concentration between blood samples from out-patient diabetics incubated in saline for 16 hours at 4 °C and 37 °C (range of differences 0.2–1.4% HbA1c). The differences correlated to the blood glucose concentration at the time of sampling blood for HbA1c determination. Thus, incubation of blood at a low glucose concentration prior to determination of the glycosylated haemoglobin concentration may overcome interference from rapidly produced HbA1c.
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  • 6
    ISSN: 1432-0428
    Keywords: Haemoglobin A1c ; synthesis ; glucose ; hyperglycaemia ; artificial pancreas ; density separated erythrocytes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The synthesis of glycosylated haemoglobins in vivo was measured during 24 h of controlled hyperglycaemia in seven insulin dependent diabetics. The mean blood glucose concentration was 22 mmol/l, while electrolytes and other metabolites were kept normal by infusion of 4–23 IU of insulin during hyperglycaemia. The study confirmed the velocity and magnitude of unstable HbA1c formation previously found in vitro. The stable HbA1c formed in 24 h was on average 0.006% of total haemoglobin/ mmol glucose. This compares well with the rate of HbA1c synthesis reported in normal subjects using 59Fe-kinetic measurements, and is in accordance with the concept of slow changes in stable HbA1c with time and glucose concentration. To investigate the possibility that the rate of HbA1c synthesis varies with erythrocyte age, glycosylated haemoglobins were measured in erythrocyte fractions after density separation on Percoll-Albumin gradients. We found both in normal subjects and in insulin treated diabetics that the 5% least dense cells contained 70%–80% of whole blood HbA1c. Assuming the least dense cells to be the youngest erythrocytes, this observation is inconsistent with a slow linear increase in HbA1c. Similar results were obtained in six newly diagnosed insulin dependent diabetic patients both before and after the first 30 days of insulin treatment, even though a marked decrease in young cell HbA1c would be expected with the improved glucose control observed. We therefore conclude that density separation of erythrocytes is an inadequate technique to study age related HbA1c synthesis.
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  • 7
    ISSN: 1432-0428
    Keywords: Long-term mean blood glucose concentration ; glycaemic control ; haemoglobin A1c ; Type 1 diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Since glucose control and glycosylated haemoglobin varies asyncroneously, we have studied the steady-state relationship between these two factors. In Type 1 (insulin-dependent) diabetic patients with a constant haemoglobin A1c during the preceding 2 years, 15 ambulatory blood glucose profiles during a 5-week period showed a constant glucose level and provided a precise estimate of the mean blood glucose concentration. In addition, we studied 15 non-diabetic subjects who provided three glucose profiles and had one haemoglobin A1c determination performed. A good correlation was found for a curvilinear relationship (haemoglobin A1c=2.07 x mean blood glucose0.596, r=0.98). This close relationship indicates that glycosylated haemoglobin is a valuable, but not very sensitive, index of glucose control.
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  • 8
    ISSN: 1432-0428
    Keywords: Renal threshold ; splay ; creatinine clearance ; maximal rate of renal tubule glucose absorption ; glycosuria ; nephropathy ; Type 1 diabetes ; diabetic control
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The blood glucose/urinary glucose relationship was studied in 23 patients with Type 1 (insulin-dependent) diabetes. Glucose was infused intravenously in order to increase blood glucose concentration slowly and gradually. The renal threshold was recorded at the slightest trace of glycosuria and varied by a factor of 2 (from 6.0 to 14.3 mmol/l). The rise in blood glucose required to change the urinary output (0–1.1 mmol glucose/20 min) varied by a factor of 7 (1.1–7.6 mmol/l). The maximal rate of tubular glucose reabsorption varied by a factor of 2 (0.93–1.98 mmol/min). The renal threshold was negatively correlated with the creatinine clearance (r=-0.52, p〈0.05), but was not correlated with diabetic control, age or duration of diabetes. The maximal rate of glucose reabsorption was negatively correlated with age (r=-0.47, p〈0.05) and duration of diabetes (r=-0.54, p〈 0.05). In conclusion, urinary glucose excretion is dependent on both renal threshold and the splay and the slope of the blood glucose/urinary glucose excretion curve. Thus, the degree of glycosuria is of value as an index of diabetic control only when the blood glucose/urinary glucose relationship is known. The inverse correlation between renal threshold and creatinine clearance limits the usefulness of measuring glycosuria in patients with nephropathy.
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  • 9
    ISSN: 1432-0428
    Keywords: Diabetic nephropathy ; incipient nephropathy ; proteinuria ; urinary albumin excretion rate ; glomerular filtration rate ; blood pressure ; Type 1 diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Patients with Type 1 (insulin-dependent) diabetes without proteinuria were studied to define those patients who will later develop persistent proteinuria (more than 0.5 g protein/24 h). Two investigations were performed; 71 patients were studied longitudinally for 6 years and another 227 patients were studied cross-sectionally. All were less than 50 years of age and had developed diabetes before the age of 40 years. At entry into the study they had no proteinuria (Albustix method), had normal blood pressure and urinary albumin excretion rates 〈 200 μg/min (normal ⩽ 20 μg/min). The best predictor of persistent proteinuria or an albumin excretion rate 〉 200 μg/min was the initial urinary albumin excretion rate. During the longitudinal study, seven patients with an urinary albumin excretion rate of more than 70 μg/min at the start of the study developed persistent proteinuria or an albumin excretion rate 〉 200 μg/min. In contrast, only three out of the remaining 64 patients with urinary albumin excretion rate ⩽ 70 μg/min developed urinary albumin excretion rate 〉 200 μg/min. Patients with an urinary albumin excretion rate 〉 70 μg/min are thus at risk of developing diabetic nephropathy. We designate this stage of renal involvement incipient nephropathy. Patients with incipient nephropathy were further characterized in the cross-sectional study. Compared with normoalbuminuric patients, patients with incipient nephropathy had increased systolic and diastolic blood pressure, but normal serum creatinine. The glomerular filtration rate was higher than normal in patients with incipient nephropathy though not different from that of normoalbuminuric patients.
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  • 10
    ISSN: 1432-0711
    Keywords: Corticosteroid binding globulin ; Pregnancy associated hypertension ; Immunospecific affinity chromatography ; Electroimmunoassay ; Pregnancy zone protein ; Estriol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Corticosteroid binding globulin (CBG) was purified by one step positive immunospecific affinity chromatography and antibody to human CBG produced in goats. The goat anti-human CBG was used in the development of a precise rocket immunoelectrophoresis for CBG quantification. CBG levels measured by this assay were found to increase from 30 AU/ml to 100 AU/ml during pregnancy. There was no statistically significant association observed between levels of CBG, or circulating estriol, or pregnancy zone protein. Circulating CBG was estimated in 32 women with pregnancy associated hypertension, the levels were all within the normal range, and not significantly different from those seen in matched controls.
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