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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Sur 258 patients opérés pour hyperparathyroïdie secondaire (HPT II) entre 1971 et 1988, 33 ont eu une ou plusieurs réinterventions pour HPT II persistante ou récidivante. Ces réinterventions n'ont été suivie ni d'une mortalité ni d'une morbidité significative. Après parathyroïdectomie incomplète (25 cas), 15 patients ont été réopérés. Douze d'entre eux avaient déjà été opérés dans un autre établissement. Trois patients sont morts pour des causes sans rapport avec leur HPT II. Les 12 autres patients sont guéris. Après parathyroïdectomie subtotale réussie (79 cas), 2 patients (2.5%) ont eu une récidive, respectivement 5 et 6 ans plus tard. Actuellement les 2 patients sont guéris. Après parathyroïdectomie totale avec autotransplantation (152 cas), 16 patients (10.5%) ont dû être réopérés á cause des greffons. Le délai moyen avant la réintervention fut de 2 1/2 ans. Une hypertrophie des fragments greffés fut observés dans 4 cas (2.6%) mais 2 seulement de ces 4 patients ont été guéris après ablation des greffons. Chez 5 patients du tissu parathyroïdien résiduel ou une glande surnuméraire au cou ou dans le médiastin ont été suspectés, mais ceci n'a pas été confirmé: un patient a été à nouveau cervicotomisé sans succès, un autre refuse toujours la réopération, et 3 sont morts. Chez 6 autres patients la récidive était discutable et l'HPT II n'a pas été confirmée. Quant aux 3 derniers patients, le diagnostic était incorrect et une intoxication à l'aluminium fut démontre utérieurement. Les résultats d'une réintervention pour HPT II persistante ou récidivante dépendent avant tout d'un bon diagnostic. Après parathyroïdectomie subtotale réussie, les réinterventions sont rares et simples. Après parathyroïdectomie totale et transplantation, on ne doit pas oublier que les récidives peuvent survenir sur les greffons et/ou sur le tissu résiduel au cou ou au médiastin.
    Abstract: Resumen Entre 258 pacientes operados por hiperparatiroidismo secundario (HPT II) entre 1971 y 1988, un total de 33 tenían historia de una o más reoperaciones por HPT II persistente o recurrente. Estas operaciones no produjeron mortalidad ni morbilidad significativa. De 25 pacientes con paratiroidectomía inadecuada, 15 pacientes fueron reoperados. Doce habían sido operados inicialmente en otra institución. Tres murieron por causas no relacionadas con su HIPT II; los otros 12 pacientes se encuentran libres de enfermedad. De 79 pacientes sometidos a paratiroidectomía subtotal exitosa, 2 (2.5%) tuvieron recurrencia a los 5 y 6 años, respectivamente. Actualmente los 2 están libres de enfermedad. De 152 pacientes sometidos a paratiroidectomía con autotrasplante, 16 (10.5%) requirieron reoperaciones sobre los injertos. El promedio del intervalo a la reoperación fue de 2 1/2 años. Se observó hipertrofia de los fragmentos injertados en 4 casos (2.6%), pero sólo 2 fueron curados con la remoción de los injertos. Se sospechó la presencia de tejido paratiroideo residual o de una glándula supernumeraria ubicada en el cuello o en el mediastino en 5 casos, pero ésto no pudo ser confirmado puesto que uno ya había sido reoperado sobre el cuello sin éxito, otro aún rehusa operación, y 3 han muerto. En otros 6 pacientes, la recurrencia apareció dudosa y el HPT II no pudo ser confirmado. El diagnóstico fue incorrecto en los últimos 3 pacientes, y en ellos se comprobó, más tarde, intoxicación por aluminio. Los resultados de la reoperación por HPT II dependen, en primer lugar, de un diagnóstico correcto. Después de paratiroidectomia total y trasplante, debe tenerse en cuenta que las recurrencias pueden presentarse en el trasplante y/o el tejido residual en el cuello o el mediastino.
    Notes: Abstract Among 258 patients operated on for secondary hyperparathyroidism (HPT II) from 1971 to 1988, a total of 33 had one or more reoperations for persistent or recurrent HPT II. These reoperations did not induce any mortality or significant morbidity. After inadequate parathyroidectomy (25 cases), 15 patients were reoperated. Twelve of these had undergone initial surgery at another institution. Three patients died of causes unrelated to their HPT II. The other 12 patients are disease-free. After successful subtotal parathyroidectomy (79 cases), 2 patients (2.5%) had a recurrence 5 and 6 years later, respectively. Currently, the 2 patients remain disease-free. After total parathyroidectomy with autotransplantation (152 cases), 16 patients (10.5%) had reoperations on the grafts. The mean time before reoperation was 2 1/2 years. Hypertrophy of grafted fragments was observed in 4 cases (2.6%), but only 2 of these 4 patients were cured by removal of the grafts. Residual parathyroid tissue or a supernumerary gland in the neck or the mediastinum was suspected in 5 patients, but this could not be confirmed because one had already been reoperated on in the neck without success, another still refuses reoperation, and 3 died. In 6 other patients, the recurrence was debatable and HPT II was not confirmed. In the last 3 patients, the diagnosis was incorrect and aluminium intoxication was proved later. Results of reoperations for persistent or recurrent HPT II depend, first, on a correct diagnosis. After Successful subtotal parathyroidectomy, reoperations are rare and simple. After total parathyroidectomy and transplantation, it must be kept in mind that recurrences can occur on the grafts and/or on residual tissue in the neck or mediastinum.
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  • 2
    ISSN: 1432-5233
    Keywords: Insulin-dependent diabetes ; Islet cell antibodies ; Complement-fixing ICA ; C-peptide ; Geographical variation ; Seasonal variation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Finland and Sweden have the highest incidence of insulin-dependent diabetes in children in the world, about 3–4 times that of countries in the Mediterranean area, with the exception of Sardinia. We have collected information from several European clinics and from Pittsburgh, USA, in order to find out whether this difference in incidence is associated with corresponding differences of the disease pattern. Patients in Finland or Sweden (‘North’) and Pittsburgh were younger (〈10 years old) at diagnosis compared with those in the other clinics in Europe (P〈0.05 versusP〈0.02). In the North, boys were in excess (58%) in contrast to France (40%) and Pittsburgh (46%). Patients in the North had a shorter duration of symptoms (〈8 days;P〈0.001) and higher blood glucose (〉20 mmol/l;P〈0.05) than those attending the other European clinics. Irrespective of age, there were more ICA-positive patients in the North (94%) than in Berlin-Vienna (67%;P〈0.01) or in France (70%;P〈0.01). There was a tendency for non-diabetic parents and siblings in the North to have lower C-peptide values (〈0.26 pmol/ml) at the time of diagnosis of the proband and to be ICA-positive more often than relatives in the other European clinics. The seasonal variation of diagnosis, showed no obvious geographical differences, with recorded diagnosis always lowest during the summer. We conclude that certain factors seem to cause not only a high incidence of diabetes in children in Finland and Sweden but perhaps also a more aggressive early disease process.
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  • 3
    ISSN: 1432-0428
    Keywords: Islet cell autoantibodies ; Type 1 (insulin-dependent) diabetes mellitus ; first degree relatives ; prediction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Factors associated with diabetes onset were analysed for their predictive value in 708 first-degree relatives of Type 1 (insulin-dependent) diabetic patients including 374 parents and 308 siblings of Type 1 diabetic patients. Relatives were prospectively followed for 2 304 subject years with blood samples for specific autoantibody evaluation. Islet cell cytoplasmic autoantibody titres were quantified in Juvenile Diabetes Foundation units with a threshold of positivity of 5 units. Insulin autoantibodies were determined using Tyr-A14 iodinated human insulin. HLA typing was performed in 92% of the relatives. During the time of study, 17 of 646 (2.6%) relatives showed islet cell antibodies. During follow-up, eight relatives developed diabetes, including six with high islet cell antibody titre. Taking titres above 20 units increased the positive predictive value from 35% to 75% whereas the presence of insulin autoantibodies did not increase the positive predictive value for the disease. Analysis of metabolic profiles months before the onset of diabetes by either oral or intravenous glucose loads, indicated a considerable level of heterogeneity with relatives with a high islet cell antibody titre who rapidly developed insulin-dependent diabetes, whereas others remained insulin-independent during the same observation period despite comparable titres. This study clearly indicates that initial islet cell antibody titre is not sufficient to predict individual outcome. Follow-up samples are clearly needed to monitor progression of the disease. Few relatives with persistent immunologic positivity progress to clinical Type 1 diabetes, suggesting that non-progressive and sub-clinical Beta-cell dysfunction is common. Despite current knowledge and available genetic and immune markers, early identification of the relatives progressing to clinical diabetes is still difficult and does not allow at the present time aggressive immunointervention at the prediabetic stage.
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  • 4
    ISSN: 1573-5001
    Keywords: One-bond carbon-proton coupling constants ; β-Linked oligosaccharides ; Angular dependence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology
    Notes: Summary The angular dependence of1JC,H in model compounds related to β-linked oligosaccharides has been established by FPT INDO quantum chemical calculations. Values calculated for models of (1 → 1)-, (1 → 2)-, (1 → 3)- and (1 → 4)-linked disaccharides were compared, and the effect of the orientation of HO-2 elucidated. The angular dependence of1JC,H on the torsional angles ΦH and ΨH and the solvent dielectric constant (s) was characterized in the form:1JC,H = A cos2ϖ+B cosϖ + C sin2ϖ + D since + E + Fe. The1JC,H values, measured by DEPT methods for C-1-H-1 and C-X′-H-X′ in cellobiose, cyclic trisaccharide and hexopyranoses were used to adjust the calculated angular dependences. Based on the occurrence of the conformers for agarobiose, neoagarobiose, mannobiose and methyl β-xylobioside, the thermodynamically averaged 〈1JC,H 〉 values were calculated. The results obtained (〈1JC-1,H-1 〉 162.4, 〈1JC-4′, H-4′ 〉 147.6 Hz for methyl β-xylobioside; 〈1JC-1,H-1 〉 162.4 and 〈1JC-4′,H-4′] 〉 147.6 Hz for mannobiose; 〈1JC-1,H-1 〉 162.8 Hz for neo agarobiose and 〈1JC-1,H-1 〉 163.2 Hz for agarobiose) agree well with the experimental values of 162.7, 147.5, 160.4, 147.2, 160.9 and 165.7 Hz, respectively.
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  • 5
    ISSN: 0952-3499
    Keywords: Molecular modelling ; Polysaccharide-polysaccharide interactions ; Kappa carrageenan Mannan ; Galactomannan ; Chemistry ; Biochemistry and Biotechnology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine
    Notes: Molecular modelling has been used as a theoretical approach to investigate the kappa carrageenan structure and its interaction with mannan chains. Calculations revealed the existence of six minima for the kappa carrageenan structure in solution. Two of them were very close to the structure found in the solid state. The methodology allowed the calculation of the theoretical counterpart of the structures based on x-ray fibre diffractions studies. In the second step of this study, we have shown that there is the possibility of interactions between kappa carrageenan double helices and mannan chains. This interacting process is allowed by the flexibility of the mannan chains and structural changes of the kappa carrageenan double helices. The calculations suggest that the disaccaride mannan fragment might be required for recognition. The result of our investigation are in good agreement with a model of gel structure based on experimental data. This approach could be applied to simulate and predict other associations in molecular assemblies.
    Additional Material: 5 Ill.
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  • 6
    ISSN: 0006-3525
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: A computer program SAINT has been developed for the investigation of the structure and for the prediction of minimum-energy structure of polysaccharide-polysaccharide complexes. The energy minimization is carried out on internal geometrical parameters - namely bond angles, torsional angles, and five parameters describing the mutual orientations of polysaccharide chains. For this purpose, the nonderivative method of conjugated directions is used. This procedure was applied to computer modeling of an idealized model of the binary gelling κ-carrageenan and galactomannan system. It is shown that the interaction between two chains influences the structure of the individual polysaccharide molecule and that in the minimum-energy structures of the complex, the conformation of the chains does not correspond to the lowest energy.
    Additional Material: 3 Ill.
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  • 7
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 8
    ISSN: 0025-116X
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology , Physics
    Notes: 13C NMR measurements were taken on cooling of aqueous solutions of N-octyl-D-gluconamide to follow the process of gelation. On cooling from 90°C gelation sharply occurs at 60-62°C. In the pre-stage of gelation at 64°C an aggregated species, probably a dimeric form of octylgluconamide, is detected. Additional signals for sugar carbons C-1, C-4 and C-6 indicate hydrogen bonding. As a side reaction conversion of the octylgluconamide to the ammonium salt takes place. Assignments of the new signals were made with the ammonium salt formed from D-gluconamide and the corresponding octylammonium salt of gluconic acid. When the solution of octylgluconamide is kept at 64°C for a longer period, octylgluconamide, free and aggregated, and its ammonium salt coexist. At 64°C relaxation times t1 of the sugar carbons corresponding to the octylgluconamide species are much shorter than those of the salt, indicating a decrease of the mobility of the sugar carbons of the former in the pre-stage of gelation.
    Additional Material: 3 Ill.
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