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Hyaline membrane disease or respiratory distress syndrome of prematurely born infants is more common in males, in Caucasians, has a familial predisposition, and is associated with maternal diabetes and delivery by cesarean section before the onset of labor. Now known to be the sequel of surfactant deficiency, it can be predicted prenatally by assay of amniotic liquid for surface active materials produced by the fetal lung. Deficiency of adequate surfactant synthesis or secretion can result in low levels of lecithins and other phospholipids in amniotic liquid. Lung maturation can result in low levels of lecithins and other phospholipids in amniotic liquid. Lung maturation can be accelerated if labor or elective delivery can be deferred at least 24 hours. Glucocorticoids given to the mother cross the placenta and enter fetal lung tissues; specific receptors exist in the lung which permit glucocorticoids to promote cell differentiation and surfactant synthesis precociously. Clinical trials support the efficacy and lack of short-term toxicity of glucocorticoids in human pregnancy after 28 weeks gestation in the event of premature onset of labor. Maternal toxemia, infection or illness which may be aggravated by glucocorticoids may contraindicate prenatal treatment. Postnatally endogenous glucocorticoids accelerate lung maturation, and further administration confers no additional benefit.
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PMID:Chevalier Jackson Lecture: In quest of the prevention of hyaline membrane disease. 57 67

Martha, an elderly patient, presented a real challenge to our nursing staff. As a new diabetic, she needed a great deal of education in addition to extensive nursing care for her multiple bleeding leg ulcers, dehydration and malnutrition due to uncontrolled diabetes, and reactive depression. Despite these problems, in approximately one month's time Martha was able to return to her home in control of her diabetes and her emotions and ambulating without pain. Her successful return to normal life was enhanced by holistic nursing management. The nursing staff found that the use of a problem list and a diabetes educational plan assisted them in individualizing their patient care.
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PMID:A new diabetic with complications: primary nursing care. 58 27

Nutrient requirements do not change markedly with advancing age, but life style, socioeconomic status, psychologic changes, and the presence of chronic disease alter nutrient intake in the elderly. It is important to recognize and deal with these factors in attempting to correct malnutrition and in prescribing dietary treatment. Malnutrition includes a variety of disorders: undernutrition, nutrient deficiencies and imbalances, and obesity. Frequent small feedings, with nutritional supplements for patients with profound weight loss, are the initial treatment for undernutrition. Iron supplements and a diet of foods rich in iron and in promoting iron absorption are required in treating iron deficiency anemia. Management of macrocytic anemia should include specific nutrient therapy plus improvement of diet to include leafy vegetables and animal foodstuffs. Diet is an important adjunct in treating chronic diseases. Maturity-onset diabetes mellitus often can be managed by diet alone, with attention to correct proportions of fat, carbohydrate, and protein and to the decreased caloric requirements of elderly patients. The importance of continuing dietary modifications in hyperlipidemia and hypertension is well known. Although dietary manipulation in osteoporosis is not curative, a diet high in calcium and containing adequate floride and vitamin D affords maximum dietary protection against progress of the disease.
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PMID:Guidelines for maintaining adequate nutrition in old age. 64 78

The plasma proteins are constantly shuttling between intravascular and extravascular mass of a specific plasma protein is determined by its individual rate of synthesis and the mean total time it spends in plasma. The ratio of intravascular to total mass (distribution ratio) is determined by the relative rate, at which it passes from plasma to interstitial spaces (transcapillary escape rate: TER) and the relative return rate via lymph. TER in a specific organ depends on the local leakiness of the microvasculature. The overall value in normal man varies with the molecular weight of the protein being about 5%/h of the intravascular albumin mass, 3%/h for IgG and less than 1%/h for IgM. The higher the TER, the lower is the intravascular fraction. Hypertension, diabetes mellitus, burns, myxedema and certain types of liver cirrhosis will increase TER. In hypertension and diabetes this may be compensated for by an increased lymphatic return rate. Hypoproteinemia due to malnutrition or urinary or gastrointestinal loss is accompanied by a shift from the extravascular to the intravascular space.
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PMID:Intra- and extravascular distribution of albumin and immunoglobulin in man. 73 85

The prevalence of diabetes due to chronic pancreatitis would appear to be increasing. In western countries this is associated with the known increase in alcohol consumption and AIP. Malnutrition may be etiologic in tropical areas. The incidence of diabetes in chronic pancreatitis is dependent on a number of factors. It is more common in alcohol-induced pancreatitis, rarely occurs after the first attack but tends to increase with time and rises markedly in calcific pancreatitis. Abnormal glucose tolerance occurred in 91% of patients with calcific pancreatitis and 70% of patients with noncalific AIP in our follow up of five to 12 years. This stresses the importance of serial regular glucose tolerance tests in these patients (Table I). The insulin-reserve is severely depleted in most patients who do not yet demonstrate abnormal glucose tolerance, indicating that pancreatitis regularly affects the islets and that nearly all patients are potential diabetics. The beta cells appear to respond better to oral glucose, glucagon or secretin than to i.v. glucose suggesting a selective glucose receptor loss or block to hyperglycemia in chronic pancreatitis. The alpha cells seem to be more resistant to the effects of chronic pancreatitis but true hypoglucagonemia was found in 16% of patients. In addition, stimulated growth hormone secretion may be deficient in pancreatic diabetes. These last two factors, among others, may be responsible for the protracted and even fatal hypoglycemia to which some patients with AIP on insulin therapy are liable. The danger of drug-induced hypoglycemia, coupled with the infrequency of vasculopathy, retinopathy and nephropathy in pancreatic diabetes has induced us to keep these patients hyperglycemic and glycosuric rather than in a sugar-free state, as long as symptoms are contained. Recurrent abdominal pain, marked weight loss and associated steatorrhea often raise special problems in the management of the pancreatic diabetic.
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PMID:Clinical and hormonal aspects of pancreatic diabetes. 80 21

In 15 mongrel dogs, a mixture of exocrine and endocrine pancreatic tissue obtained by a simple procedure was implanted into the liver of the same animal through a branch of the portal vein. Five animals with partial pancreatectomy were used for a morphological study. In a second group of ten dogs, 5 delayed and 5 immediate pancreatectomies were performed. No diabetes appeared after the pancreatectomy. The subsequent blood glucose and insulin levels remained within or close to the normal range for several weeks in 9 animals and up to 10 months in a last one, still alive. In 9 out of 10 animals, the long term study was limited between 6 and 17 weeks by the development of a malnutrition syndrome with hepatic steatosis due to the lack of exocrine secretory function because of the pancreatectomy. The last animal still alive developed the malnutrition syndrome after a second complementary resection of a small pancreatic fragment left along the duodenum. This last animal without diabetes at the 45th week suggests that the endocrine function of the autotransplanted pancreatic tissue could be maintained over a long period of time.
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PMID:[Prevention of diabetes in pancreatectomised dogs by autotransplantation of pancreatic tissue in the liver]. 81 64

Among the secretory disturbances ("Dyschylien") of salivary glands the sialadenosis of the parotid gland is a clinic and a morphologic definited entity. The typical clinical symptom is a bilateral, often recurrent, and painless swelling of the parotid gland. The characteristic pathological findings consist in an acinar cell hypertrophy without any inflammatory signs. According to this definition, sialadenosis has to be separated from those diseases of salivary glands, which are primarily altered by inflammation of the salivary tissue with secondary secretory disturbances. From flinical point of view it is possible to distinguish the following kinds of sialadenosis according to the syntropy with various diseases: Endocrine sialadenosis (in diabetes mellitus, dysfunction of gonads, pituitary gland, thyroid gland etc.); dystrophic-metabolic sialadenosis (malnutrition, avitaminosis, alcohilsm, chronic liver diseases etc.), and neurogenic sialadenosis (dysfunction of the vegetative nervous system, drug damages e.g. antihypertensive agents). The question arises, whether all forms of sialadenosis have a common etiology and a coincidental pathogenic factor. The following studies were carried out with the aim to find further details concerning the etiology and pathogenesis of sialadenosis. The study is based on the following material: a) 126 Biopsies of parotid glands from patients with sialadenosis (Register of salivary gland diseases at the Institute of Pathology, University of Hamburg, supported by Deutsche Forschungsgemeinschaft). This material was collected from 1965 to 1973. b) 80 Biopsies of parotid glands from patients with other diseases (parotitis [4]; acinic cell carcinoma [4]; other parotid and oral tumors [72]; for comparison. c) Experimental studies on the parotid salivary glands of Wistar-rats. The biopsies of the parotid glands were studied histologically, morphometrically, and ultrastructurally. The investigations centered on the ultrastruct of sialadenosis. Before interpreting the ultrastructural findings in view of etiology and pathogenesis of sialadenosis, it was primarily necessary to study the normal ultrastructure of the human parotid gland including the vegetative nervous system. Furthermore it was necessary to elucidate details of a functional morphology of the secretory cycle and to integrade the findings into a concept of general pathology of secretory disturbances. The following results were achieved by our investigations: 1. Normal ultrastructure of human parotid gland: The architecture of the acinar cells is identical with these of other animal species (cytoplasm with a basal standing nucleus, rough endoplasmatic reticulum, Golgi-apparatus, secretory granules etc.). Further identical elements are intercalated and striated ducts, myoepithelial cells, and the vegetative nervous system (postganglionic sympathetic and parasympathetic neurites, however no ganglionic cells in the parotid gland)...
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PMID:[Sialadenosis of the parotid gland. Ultrastructural, clinical and experimental findings in disturbances of secretion (author's transl)]. 100 13

In form of a survey report the author enters the modern knowledge and opinions concerning the etiopathogenesis of diabetes. Endogenic (hereditary) and exogenic (above all hyperalimentation and malnutrition, deficient muscular conditioning) factors act together. To the functional capacity and functional reserve of the B-cell a central importance is ascribed. The author particularly deals with the possibility of a bihormonal disturbance and with the metabolic syndrome as well as a differentiation into the two most important types of diabetes is performed. As to several problems the results of the Karlsburg team are cited.
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PMID:[Etiopathogenesis of diabetes mellitus today (continuation)]. 122 44

Glucose absorption rates in 14 Arabs in Saudi Arabia were determined by a jejunal perfusion technique and compared with those in 18 Africans in Zambia. None of the subjects had clinical evidence of systemic infection, gastrointestinal disease, malnutrition, or diabetes mellitus. The mean absorption rate was significantly higher in the Arabs. This was associated with a higher incidence of subclinical chronic systemic infection in the Africans. Other factors possibly responsible for the difference, including genetic difference, have, however, not been excluded.
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PMID:Rapid glucose absorption in Arabs in Saudi Arbia compared with that in Africans in Zambia. 125 84

A hospital-based study was designed to find out the frequency of use of oral pills to reassess the relative incidence of adverse drug reactions (ADRS) and the possibility of drug interactions and also to review the role of physicians or hospital clinics in monitoring their use. A group of women of reproductive age attending the postpartum unit of North Bengal Medical College and Hospital and the immunization clinic for coverage of their children were interviewed during July-September, 1987. Out of 500 women studied 66 (13.2%) were using oral contraceptives (OCs). Females of younger age group used OCs more frequently (86.3%) and none above 35 years used them. The acceptance of OCs was based on doctor's recommendation in 47 users (71.21%), while for 19 (28.79%) it was based on the advice of either husband or friends or relatives. 44 (66.67%) of the users received their monthly quota of OCs free from government hospitals. OC use was not halted in spite of malnutrition (24.24%), obesity (27.27%), breathlessness on exertion (28.79%), lump in the breast (9.09%), or diabetes (9.09%). Visual disturbances were present in 12.12% of users. 17 (15.76%) of users smoked. Less than 6 months after childbirth 17 (25.76%) nursing mothers resumed OC use. 58 (87.88%) of 66 users used OCs continuously for less than 3 years, 8 (12.12%) used them continuously for 2-5 years, and none used them continuously for over 5 years. 30 OC users (45.45%) were also taking one or more drugs concurrently along with the OCs. The most frequent were oral anticoagulants, phenytoin, antitubercular drugs, chloroquine, antileprosy drugs, salbutamol, corticosteroids and some antibiotics. In all such cases the prescribing physicians never seemed to be concerned about taking the drug use history.
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PMID:Profile of oral contraceptive usage by females of the northern part of West Bengal. 130 87


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