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The idea that, in view of potent drugs, the dietary treatment of a metabolic disease must be reserved for a small group of particularly susceptible patients or even for a minority of neurotically structured patients who would alone be capable of bearing the hardship of a consequent change of accustomed feeding habits needs correction. Considerably greater importance must be attached to dietetics in disorders of uric acid metabolism than formerly, particularly with a view to the status already gained by the dietary treatment of diabetes mellitus a long time ago. Dietetic therapy of familial hyperuricemia and its later clinical manifestation, gout, is a basic therapy of a preventive character. Because today, superiority is increasingly conceded to prophylaxis rather than to the treatment of late sequelae.
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PMID:[Diet in hyperuricemia (author's transl)]. 17 May 14

The paper presents an analysis of clinical symptoms, signs and laboratory data of 330 diabetic patients who developed lactic acidosis after having been treated with biguanides (phenformin, buformin, metformin). From the review of the literature an attempt is made to find special features that predisposed patients to develop lactic acidosis such as accompanying illnesses and additional medications, to describe the course of illness and also the factors that influenced the prognosis. Of the patients that developed lactic acidosis 50.3% died. These patients were older, they suffered more frequently from cardiovascular shock, their acidosis was more severe, the whole blood lactate concentration was higher, and the degree of renal insufficiency was more advanced. From our observations we conclude the the treatment of diabetes mellitus with biguanides should be reserved for specially selected patients.
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PMID:Lactic acidosis in biguanide-treated diabetics: a review of 330 cases. 34 19

Fasting plasma glucose determination is the test of choice for diagnosis of diabetes. Glucose tolerance testing should be reserved for patients with borderline fasting values or possible diabetic complications and those suspected of having gestational diabetes. Strict attention to patient variables is essential if glucose tolerance testing is to be of value. The diagnosis of diabetes should be reserved for those patients with symptoms and unequivocal hyperglycemia, those with fasting plasma glucose values of 140 mg/dl or more repeatedly, and those with glucose tolerance test values of 200 mg/dl or more at two hours and at least one other time.
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PMID:Diabetes mellitus: test strategies for diagnosis and management. 49 89

Obese people, more than 45 kg above their ideal weight, can be treated by an intestinal by-pass. This operation must be reserved for patients where conservative treatment failed, where there is no organic origin, and given the operative risk be not increased by underlying serious disease. Good pre- and postoperative collaboration of the patient together with clinical and biological controls are essential. The operation consists of an end-to-side jejuno-ileostomy with proximal suture of the blind loops; or an end-to-end jejuno-ileostomy with implantation of the blind loops in the colon. Loss of weight to near ideal plus improvement of diabetes, hypertension, gout and hyperlipaemia can be expected. Diarhea will occur for a few months or one year. Biochemical values usually remain stable: values for lipids decrease to lower normal if elevated before the operation. During fast weight loss, there are changes in the liver structure and hepatic tests; these are transient and reversible.
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PMID:[Intestinal by-pass for obesity (author's transl)]. 98 31

The effectiveness of caloric restriction and weight reduction in lowering the blood sugar level in obese diabetics has been rediscovered. The twin goals of attaining and maintaining ideal body weight and normoglycemia can be achieved through diet therapy in about 80% of patients who are intensively educated and continuously monitored by a well informed, highly motivated team of physician, dietitian, and nurse. It appears that chronic insulin therapy should be reserved for hyperglycemic individuals who are pregnant or who are at or below ideal body weight, for persons with juvenile onset diabetes who are obviously insulin-dependent, and for acutely decompensated diabetics.
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PMID:Symposium: Controlling diabetes mellitus with diet therapy. 124 32

The recent development of ambulatory blood pressure (ABP) monitoring techniques has improved recording of blood pressure in therapeutic trials and in the clinical setting. The application of ABP differs according to which of these 2 applications is being considered. In therapeutic trials, a placebo control is required. The large quantity of precise data acquired with ABP monitoring allows the study of a limited number of patients; it also allows individual study of patients with a 'white coat' response (i.e. elevated blood pressure in response to examination by the clinician). Analysis of data from ABP monitoring may include the following: comparison of mean blood pressure values over 24 hours, daytime or night-time, or over any other selected time period; 24-hour blood pressure profiles, or analysis hour-by-hour, giving true chronotherapy, and providing data regarding the wearing-off of a drug effect or loss of therapeutic control; analysis of blood pressure at particular times, such as on waking; or specific examination of nonresponders. In individual patients, ABP monitoring should be reserved for specific indications. It can be used before initiation of treatment to confirm the necessity for treatment, especially in the context of hypertension at rest or the 'white coat' effect. With established treatment, ABP monitoring can be used in patients with resistant hypertension, in severe hypertension to examine loss of blood pressure control over time or inversion of the day/night cycle, and in patients with a specific illness, e.g. diabetes, in order to obtain the lowest blood pressure readings possible. Examination of these factors assists clinicians to accurately decide upon the timing and frequency of antihypertensive therapy.
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PMID:Use of ambulatory blood pressure monitoring in the management of antihypertensive therapy. 128 74

The main role of thrombosis in the acute coronary event is now well documented. Numerous hemostatic factors are involved in thrombosis. Among them, fibrinogen, factor VII, leucocytes and platelets have been shown by epidemiology, to be closely related to the acute coronary event. The key role seems to be reserved to platelets since the close relationship of their activity as evaluated by platelet aggregation tests, to both coronary episodes and the main risk factors such as smoking, diabetes and dietary habits, has been recently demonstrated. In addition, the role of platelets has been confirmed by the marked protective effect against coronary events, of drugs such as aspirin, inhibiting platelet aggregation.
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PMID:[Hemostatic anomalies and coronary risk]. 129 35

GH and FA are useful monitors in the care of diabetic patients. For most situations, GH is the preferred test and should be routinely monitored. FA should be reserved for exceptional situations in which blood glucose control over one to two weeks must be assessed or in patients with a hemoglobinopathy. Patients with diabetes should be advised of their present GH level and the preferred goal.
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PMID:The why and wherefore of fructosamine. 142 70

In an assessment of the contributions of autonomic neuropathy and vascular disease to the aetiology of male impotence in diabetes, evidence of autonomic neuropathy was identified in 23/39 (59%) individuals complaining of impotence. Thirteen of 26 men aged < 60 years tested with an intracorporeal injection of papaverine experienced little or no response and seven had tumescence but no rigidity. Radioisotope phallography demonstrated vascular disease in six of these seven, suggesting evidence of a vascular component in 19/26 (73%). Only one patient had non-organic impotence. Overall, evidence of vascular disease alone was demonstrated in 10/26 (38%), vascular disease plus autonomic neuropathy in 9/26 (35%), and autonomic neuropathy alone in 6/26 (23%). Many diabetic men complaining of impotence appear to have a significant vascular component which renders intracorporeal papaverine treatment ineffective. We compared the performance of a vacuum constriction-band (Erecaid) and condom-type (Synergist) device in 10 randomly selected men from this group. The devices, provided in random order for 5 months each, were assessed by questionnaire and interview of both the patient and partner. Two couples defaulted and another could use neither device. Although erectile capacity could be restored in the remainder, subsequent intercourse was only deemed satisfactory to both partners in five couples, who unanimously preferred the constriction-band device. In treatment with vacuum devices the constriction-band type seems to be the device of choice; the condom type should probably be reserved for those unable to use the constriction-band type.
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PMID:Impotence in diabetes: aetiology, implications for treatment and preferred vacuum device. 147 32

Primary infra-inguinal arterial reconstructions were reviewed for primary patency and outcome of thrombosis in 144 patients. Distal anastomoses in these patients were to the popliteal artery and were above the knee in 63, below the knee in 53 and at the tibial level in 28. The treatment used was: polytetrafluoroethylene (PTFE) in 33 cases, PTFE with an interposition vein cuff in 29 cases, autogenous saphenous vein (ASV) in situ in 47 cases, and reversed technique in 26 cases. Life table analysis showed a 59% overall primary patency at 3 years. Patency rates of above knee anastomoses (65%) and below knee (61%) were statistically different from the tibial anastomoses (42%, P = 0.005). In both above and below knee popliteal anastomoses there was a statistically significant difference in the patency of ASV and the PTFE/vein cuff technique (P = 0.0006) but there was no difference between ASV and PTFE. There was no difference in patency rates for the various types of grafts with tibial anastomoses. Data were analysed at 3 years, taking into account the variables of smoking, diabetes or indications for surgery respectively and no difference was found in patency. The number and calibre of the run-off vessels did not influence patency significantly, hence anastomosis to any good quality vessel regardless of run-off is recommended. The poor results with the interposition vein cuff technique are unexplained but this study suggests that the technique should be reserved for anastomoses below the popliteal artery.
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PMID:A retrospective analysis of infra-inguinal arterial reconstruction: three year patency rates. 155 May 13


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