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Results of the initial clinical evaluation in 20 human subjects of a subcutaneously implanted microsensor-based amperometrically glycemia-monitoring system, carried out between April 1994 and June 1995, are reported. The system was based on the electrical connection ("wiring") of the reaction centers of glucose oxidase to a gold electrode and on elimination of the chemicals that interfere with glucose monitoring through their horseradish peroxidase-catalyzed oxidation by internally generated hydrogen peroxide. The sensor was finer than a 29-gauge needle and had no leachable components. Because of its high selectivity for glucose, the sensor output was virtually nil at zero glucose level. This enables prompt "one-point" in vivo calibration of the sensor with a single blood glucose sample. Microsensors were subcutaneously implanted in ten nondiabetic and ten insulin-dependent diabetes mellitus (IDDM) volunteers. All subjects underwent standard meal tests and intravenous glucose-tolerance tests (IVGTT) in addition to hourly plasma glucose measurements. The sensor signals were continuously recorded, and the glucose concentration estimates were derived by calibrating the sensor using a single blood sample (one-point calibration). Regression analysis revealed that the sensor-estimated glucose concentrations were linearly related to the plasma glucose concentrations (r2 = 0.75) over a wide glucose concentration range (2-28 mmol/L) (sensor estimate = plasma 0.96 + 0.26 mmol/L). The difference between the estimated and actual glucose concentration was -0.13+/-0.23 mmol/L [mean +/-95% confidence interval (CI), n = 546], and 95% of the estimates fell in clinically acceptable zones of the Clarke error grid. The sensing delay time was 10.4+/-2.3 min as measured by the IVGTT. The subjects reported no discomfort associated with wearing the sensors.
J Diabetes Complications
PMID:Initial evaluation of a 290-microm diameter subcutaneous glucose sensor: glucose monitoring with a biocompatible, flexible-wire, enzyme-based amperometric microsensor in diabetic and nondiabetic humans. 987 61

This paper considers the risks related to each of the complications of diabetic autonomic neuropathy. Gastroparesia induces its own functional disorders in the digestive tract but is also probably involved in an undetermined proportion of unstable diabetes. Neural bladder, in its aspect of hypoactive, hypocontractile and hypoaesthesic bladder, makes patients prone to urinary chronic retention and repeated urinary infections or even kidney disease. In patients with hypoglycaemia unawareness, the responsibility of autonomic neuropathy may be suspected in those with severe cardiac autonomic neuropathy (CAN) or selective autonomic neuropathy characterised only by a defect in adrenergic contraregulation of hypoglycaemia. CAN is the best-known and most frequent complication of dysautonomia. Several longitudinal studies have clearly shown that CAN is associated with excessive mortality. Various functional disorders may account for the increased frequency of cardiovascular events. In particular, a reduction of left ventricle ejection fraction, inadaptability of haemodynamic response to exercise, alterations of the nycthemeral pattern of blood pressure variations, ventricle repolarisation and ventilatory function have been associated with CAN. Though the relationship between CAN and silent myocardial ischaemia is not clearly established, CAN seems to increase the frequency of major cardiac events, particularly in patients with silent myocardial ischaemia. Vascular neuropathy, by altering peripheral vasomotricity, may contribute to foot ulcer. The statistical association between CAN and retinopathy and kidney disease suggests that CAN might contribute to worsening microangiopathic complications or at least be considered as a marker of these complications. Finally, several arguments suggest an association between CAN and insulin resistance. Thus CAN might be involved in the poor prognosis of kidney disease or insulin resistance. From a practical point of view, the risks related to diabetic dysautonomia, which range from simple discomfort to severe complications, should lead to systematic detection of dysautonomia. In any event, detection by standardised tests analysing heart rate variations should be widely performed, and the presence of CAN should lead to a specific cardiovascular assessment.
Diabetes Metab 1998 Nov
PMID:[Diabetic autonomic neuropathy: what are the risks?]. 988 Dec 35

Little information is available as to the exact financial cost of the clinical features of diabetic neuropathy. At least 20% of diabetic patients have a neuropathic problem consisting of either sensory pain and discomfort, foot ulceration or impotence. This represents a large load of clinical work in any diabetes service. Such patients should be offered thorough and sympathetic clinical facilities, from careful diagnosis and assessment through to treatment and counselling, to allow them to accept, and hopefully obtain improvement in, what is essentially an incurable clinical situation. Similarly, the emotional and financial costs to the patients of such a chronic condition have not been adequately assessed. It seems reasonable to suggest that such costs are high, and it is a general impression that patients with this problem do not receive adequate time and attention in many busy diabetes services.
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PMID:The cost of diabetic neuropathy. 1015 4

Diabetic gastropathy is a term that encompasses a number of neuromuscular dysfunctions of the stomach, including abnormalities of gastric contractility, tone, and myoelectrical activity in patients with diabetes. These abnormalities range from tachygastrias to antral hypomotility and frank gastroparesis. Diabetic gastropathies may be acutely produced during hyperglycemia. Symptoms of chronic diabetic gastropathy include chronic nausea, vague epigastric discomfort, postprandial fullness, early satiety, and vomiting. Because these symptoms are nonspecific, other disorders such as mechanical obstruction of the gastrointestinal tract, gastroesophageal reflux disease, cholecystitis, pancreatitis, mesenteric ischemia, and drug effects should be considered. Neuromuscular abnormalities of the stomach may be assessed noninvasively with gastric emptying tests, electrogastrography, and ultrasound. Gastrokinetic agents such as metoclopramide, cisapride, domperidone, and erythromycin increase fundic or antral contractions and/or eradicate gastric dysrhythmias. Diet and glucose control also are important in the management of diabetic gastropathy. As the pathophysiology of diabetic gastropathy is better understood, more specific and improved treatments will evolve.
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PMID:Diabetic gastropathy: gastric neuromuscular dysfunction in diabetes mellitus: a review of symptoms, pathophysiology, and treatment. 1038 75

We conducted an observational study to evaluate the effectiveness of an endoscopic technique for harvesting the greater saphenous vein for aortocoronary bypass grafting. We hypothesized that the endoscopic technique would minimize the risk of postoperative wound complications. From May 1997 to July 1998, we used an endoscopic technique to harvest the greater saphenous vein in 50 patients who underwent aortocoronary artery bypass grafting. Twenty-five of the patients had an increased risk for wound complications due to preexisting diabetes, obesity, peripheral vascular disease, or lymphedema. The average duration of the procedure was 39 minutes (range, 11 to 70 minutes). The average length of the harvested vein was 58 cm (range, 25 to 85 cm). We made an average of 2.5 incisions per patient (range, 1 to 5 incisions), and the average incision length was 7 cm (range, 3 to 10 cm). Two patients (4%) required conversion to an open technique using 5 small incisions. Postoperative complications included 1 wound infection (2%) and 1 small hematoma (2%). Two patients (4%) had minor erythema at the incision site, and 5 patients (10%) had postoperative lymphedema. The most common problem, ecchymosis, was seen in 6 patients (12%). None required repeat hospitalization or reoperation for wound complications. In our study, the endoscopic approach yielded superior cosmetic results, and reduced wound complications and discomfort, compared with traditional methods of vein harvesting. After gaining expertise with this minimally invasive method of vein harvesting, a surgeon can safely remove the saphenous vein in 20 to 30 minutes.
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PMID:Endoscopic harvesting of the greater saphenous vein for aortocoronary bypass grafting. 1039 34

A case of scleredema diabeticorum of Buschke associated with nuchal fibroma and organic solvent exposure is reported. The patient presented with a neck mass causing discomfort and restriction of movement. Histological examination showed this to be a nuchal fibroma. Additionally, there was widespread induration of the skin of his trunk which was asymptomatic. A biopsy showed features of scleredema. This is the first reported association of these two conditions, both of which show increased and thickened collagen bundles without significant fibroblast proliferation. They differ by the occurrence of mucin in scleredema, although this is not always demonstrable, particularly in late lesions. The possibility that nuchal fibroma is an end stage, localized form of scleredema is canvassed. The patient's medical history included insulin-dependent diabetes mellitus with complications of retinal vessel thrombosis and peripheral neuropathy. The patient also had significant past exposure to a wide variety of chemicals, including organic solvents.
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PMID:Nuchal fibroma associated with scleredema, diabetes mellitus and organic solvent exposure. 1071 99

Peripheral arterial disease affects at least 10% of adults older than 70 years. Risk factors such as diabetes, hypertension, hyperlipidemia, history of smoking, and genetics increase the incidence of the disease. Intermittent claudication, experienced as calf pain or cramping, is the primary symptom in patients with lower-extremity peripheral arterial disease. Patients with claudication are unable to walk even moderate distances. As a result, they often lead lives that are profoundly restricted. Medical therapeutic options available for patients with intermittent claudication are limited to a small number of medications and walking exercise rehabilitation. Walking exercise training can significantly increase ability and decrease calf discomfort for many patients. Nurses can have a major impact on improving the quality of life of patients with claudication, not only by seeking referrals to established institutional walking exercise programs, but also by helping patients in the community develop a personalized walking program. In this article, a nursing plan of care including short-term and long-term goals is addressed. A case study will illustrate the effectiveness and improved quality of life that an individualized program of walking exercise had for one community-based client.
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PMID:Relieving intermittent claudication: a nursing approach. 1081 85

Compounds of the trace element vanadium have been shown to mimic insulin in in vitro and in vivo systems. These compounds have been found to exert anti-diabetic effects in rodent models of type 1 and type 2 diabetes mellitus as well as in a limited number of studies in human diabetic subjects. Thus, vanadium compounds have emerged as agents for potential use in diabetes therapy. However, treatment of diabetic animals with inorganic vanadium salts has also been associated with some toxic side-effects such as gastrointestinal discomfort and decreased body weight gain. In addition, vanadium salts have been reported to exert toxic effects on the liver and kidney. More recently, it was shown that organic vanadium compounds were much safer than inorganic vanadium salts and did not cause any gastrointestinal discomfort, hepatic or renal toxicity. This review briefly summarizes the anti-diabetic and toxic effects of vanadium compounds.
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PMID:Anti-diabetic and toxic effects of vanadium compounds. 1083 8

Background: Genital herpes is a common sexually transmitted disease in adolescents. It may be associated with significant morbidity if not diagnosed on time or not properly treated. The objective of this study was to determine the incidence of labial adhesion secondary to primary herpes in young women and the possible predisposing factors for this complication.Methods: Analysis of the clinical data regarding primary genital herpes in young women in the adolescent clinic at a university hospital in outpatient clinic setting. Cases of primary genital herpes seen between December 1(st) 1998 and November 30(th) 1999 were included.Results: A total of 34 female adolescents with age range 12-19 years were diagnosed with primary genital herpes during this time period. 7 patients (20.6%) were found to have severe labial adhesion at time of diagnosis. All 7 patients were seen by other providers prior to their visit to the adolescent clinic and 4 were correctly diagnosed. All 7 patients were given antiviral therapy, but none was given local treatment. At time of diagnosis all 7 patients had anuria for more than 24 hours and severe pain and discomfort. 3 patients had Diabetes Mellitus (one of these was also pregnant) and one patient had asthma. The age range for these 7 patients was 13-17. Treatment with local anesthetics helped resolve the adhesion in 5 patients and surgical treatment was needed in the remaining two patients.Conclusion: Labial adhesion is a common, severe complication of primary genital herpes in young women. Very young age, chronic medical conditions, incorrect diagnosis and lack of topical treatment may predispose to the development of this complication. Use of topical therapy should be an integral part of the comprehensive treatment for primary genital herpes in female adolescents to alleviate discomfort and prevent urinary retention and labial adhesion.
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PMID:Labial adhesion as a complication of primary genital herpes in young women 1086 85

Agitation and aggressiveness are frequent in the elderly and often related to dementia. As a result of the ageing of the general population this is becoming a major public health concern. No or little epidemiological data, during primary health care, about symptoms, co-morbidity, nor medical and social consequences of elderlys' disruptive behavior have been gathered or published in the French literature. Thus, in order to describe these disorders, a survey in cooperation with general practitioners (GP) was conducted. A representative sample of 212 French GP's, all with preferential geriatric activity were asked to conduct a study by including retrospectively their two most recent patients older than 65, who had exhibited agitation and/or aggressiveness. From this cross sectional study, 410 patients (female: 61%, male: 39%) were included. The mean age was 81 years (sd: 7.65). The patients suffered from change in verbal behavior (80%), verbal aggressiveness (71%), physical agitation (60%), wandering (48%), and/or physical aggressiveness (31%). The average of disruptive behavior symptoms per patient was 2.9. The symptoms appeared progressively in 81% of patients, the mean duration was two years and it was the first episode in 40% of patients. Disruptive behaviors may be explained in view of organic illness in 62% of patients (cardiovascular disease: 37%, neurologic: 12%, diabetes: 7%, dehydratation: 5%), dementia (Alzheimer disease: 20%, vascular dementia: 18%, mixed dementia: 14%). In 54% of patients disruptive behavior may be explained in view of depression: 34%, and anxiety disorder: 31%. A triggering factor was observed in 57% of cases (psychosocial stress: 39%). Somatic consequences of the symptoms were frequently identified: decrease of alimentary intake: 39%, weight loss: 27%, dehydratation: 11%, falls: 32%, and irregular medication intake: 31%. Limitation of daily life activities: 85%, and family life: 97% were also noted. Acceptability of patient's symptoms by the family was good (no discomfort or transitory and mild irritability) in 61% of cases, and very bad (reactions of exhaustion, hospitalization requirement) in 13%. This study carried out during primary care, showed that the elderly's disruptive behaviors cause severe medical consequences and familial and social distress.
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PMID:[Causes and consequences of elderly's agitated and aggressive behavior]. 1087 60


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