RESUMEN
Thirty patients with insulin-dependent diabetes mellitus (IDDM) who had advanced background retinopathy were randomized to unchanged conventional treatment (UCT) or to continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 2 yr. The mean blood glucose and hemoglobin A1C (HbA1C) were significantly lower in the CSII group than in the UCT group. The mean blood glucose and HbA1C did not change from the first to the second year in either of the treatment groups in spite of less frequent home-monitoring of blood glucose and less frequent outpatient visits during the second year. Four patients in the CSII group and five in the UCT group developed proliferative retinopathy. However, a marginally significant trend was found toward more frequent improvement of retinal morphology in the CSII group (47%) than in the UCT group (13%). Beat-to-beat variation was found to deteriorate significantly with UCT compared with a nonsignificant improvement with CSII therapy. Vibration sense was unchanged in both treatment groups. It is concluded that near-normal blood glucose levels can be maintained with CSII therapy in spite of less frequent home-monitoring of blood glucose and outpatient visits. Furthermore, established background retinopathy may progress to proliferative retinopathy in spite of 2 yr of near-normal blood glucose levels. However, a marginally significant trend toward more frequent improvement of retinal morphology was found among CSII-treated patients compared with conventionally treated patients. Large-scale, prospective, randomized studies are needed to confirm these results.
Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Neuropatías Diabéticas/sangre , Retinopatía Diabética/sangre , Sistemas de Infusión de Insulina , Glucemia/análisis , Estudios de Seguimiento , Humanos , Retina/patología , Retina/fisiopatologíaRESUMEN
A 5-year study on the predictive value of the macular recovery time, as recorded by nyctometry, in the development of proliferative diabetic retinopathy in insulin-dependent diabetes mellitus has been completed. Seventy-seven patients with a median age of 30,8 years and a median duration of the disease of 15,8 years participated. In the follow-up period, 16 out of 20 patients initially showing abnormally prolonged macular recovery time had developed proliferative diabetic retinopathy the median duration from the initial investigation to the diagnosis of retinal neovascularization being 34 months. Contrary to this finding, only 4 out of 57 patients initially showing normal macular recovery had advanced into proliferative retinopathy, and the median duration until diagnosis of this condition was 45 months. It is concluded that nyctometry can serve as an easily performed screening method in selecting those at risk of developing proliferative retinopathy within a few years.
Asunto(s)
Adaptación a la Oscuridad , Retinopatía Diabética/diagnóstico , Mácula Lútea/fisiopatología , Tamizaje Masivo/métodos , Adolescente , Adulto , Diabetes Mellitus Tipo 1/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Factores de TiempoRESUMEN
A preliminary report on laser treatment of senile macular degeneration is presented. Over a one year period 234 patients with symptoms and signs of macular degeneration were examined with fluorescein angiography. 32 patients (14%) showed neovascular membranes accessible to treatment with blue/green argon laser. At the end of the observation period (mean 8.7 months) one half of the treated group had unchanged or better visual acuity, whereas the other half showed deterioration of the visual acuity. It is not known whether this result differs from the average spontaneous course. A controlled trial is necessary in order to evaluate the possible beneficial effect of laser treatment of senile macular degeneration in our population.
Asunto(s)
Terapia por Láser , Degeneración Macular/cirugía , Adulto , Anciano , Humanos , Degeneración Macular/fisiopatología , Persona de Mediana Edad , Agudeza VisualRESUMEN
Pharmacokinetics of ketoprofen were studied in five patients with more or less severe renal failure. Results were compared to those recorded in seven healthy volunteers. The degree of renal failure was evaluated by determining creatinine clearance. Ketoprofen was assayed by mass fragmentometry. As expected, results clearly show that the half-life of ketoprofen is prolonged in patients with renal failure. Duration of half-life is positively correlated with severity of renal failure.
Asunto(s)
Cetoprofeno/metabolismo , Fallo Renal Crónico/metabolismo , Fenilpropionatos/metabolismo , Creatinina/sangre , Humanos , CinéticaRESUMEN
A prospective long-term study on the predictive value of nyctometry in the development of proliferative diabetic retinopathy in insulin-dependent diabetes mellitus is in progress. Sixty-one patients participated. At a follow-up 3 years after the initial investigation, none of the patients initially showing results above the lower normal limit had developed proliferative retinopathy, whereas 6 out of 16 eyes initially displaying reduced values of nyctometry had advanced into proliferative retinopathy. It is concluded that nyctometry is valuable as an easily performed screening method in selecting those at risk of developing proliferative retinopathy within a few years.
Asunto(s)
Retinopatía Diabética/prevención & control , Tamizaje Masivo/métodos , Adolescente , Adulto , Adaptación a la Oscuridad , Diabetes Mellitus/tratamiento farmacológico , Retinopatía Diabética/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , RiesgoRESUMEN
30 insulin-dependent diabetic patients with background retinopathy were randomised to conventional treatment (UCT) or treatment with continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 1 year with fortnightly seven-sample home blood glucose measurements and retinal examinations every 6 months. Mean blood glucose and stable haemoglobin A1c during months 3-12 were significantly lower in the CSII than the UCT group. Retinal morphology deteriorated during the year with no significant differences between UCT and CSII groups. The frequency of deterioration was highest in the CSII group, especially among the 10 patients with best glycaemic control. Proliferative retinopathy developed in 3 patients--2 of these were CSII treated. Retinal function (oscillatory potential, macular recovery time, and posterior vitreous fluorophotometry) improved significantly with CSII treatment and deteriorated significantly with UCT. Changes in retinal function were most pronounced in patients with the best and the poorest regulated glycaemic control.
Asunto(s)
Glucemia/análisis , Diabetes Mellitus/tratamiento farmacológico , Retinopatía Diabética/sangre , Insulina/administración & dosificación , Adulto , Retinopatía Diabética/patología , Retinopatía Diabética/prevención & control , Hemoglobina A/análisis , Humanos , Sistemas de Infusión de Insulina , Persona de Mediana Edad , Estudios Prospectivos , Distribución Aleatoria , Retina/patologíaAsunto(s)
Adaptación a la Oscuridad , Retinopatía Diabética/diagnóstico , Electrorretinografía , Adolescente , Adulto , Diabetes Mellitus Tipo 1/complicaciones , Retinopatía Diabética/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , RiesgoRESUMEN
The pharmacokinetics of ketoprofen were studied in 7 volunteers and in 5 patients suffering from varying degrees of renal insufficiency. All the subjects received a single oral dose (50 mg) of ketoprofen. Plasma concentrations were measured up to 24 hours after administration and urinary excretion for 2 days. Ketoprofen concentrations were determined by mass-fragmentography with a minimum level of detection of 0.02 mg/l. As expected, a reduction of the [51Cr]EDTA clearance was correlated with an increase in the elimination half-life of ketoprofen. The urinary excretion corresponded to results reported by other groups.
Asunto(s)
Cetoprofeno/metabolismo , Fallo Renal Crónico/metabolismo , Fenilpropionatos/metabolismo , Adulto , Creatinina/metabolismo , Femenino , Cromatografía de Gases y Espectrometría de Masas , Semivida , Humanos , Cinética , Masculino , Persona de Mediana EdadRESUMEN
The study draws a comparison between the oscillatory potential of the electroretinogram and the initial dark-adaptation measured by nyctometry, with the aim of assessing the predictive value of nyctometry in juvenile diabetics. The study included 61 insulin-dependent juvenile diabetics, aged 18-49 years, with a disease duration of more than five years. A statistically highly significant correlation could be demonstrated between alterations in the oscillatory potential and in the initial dark-adaptation. The results justify the assumption that nyctometry can be used as an easily handled clinical tool in selecting those at risk of developing proliferative retinopathy in their subsequent 6-8 years.
Asunto(s)
Adaptación a la Oscuridad , Diabetes Mellitus Tipo 1/fisiopatología , Retinopatía Diabética/etiología , Electrorretinografía/métodos , Adolescente , Adulto , Diabetes Mellitus Tipo 1/diagnóstico , Retinopatía Diabética/diagnóstico , Femenino , Humanos , Insulina/uso terapéutico , Masculino , Oscilometría , Pronóstico , RiesgoRESUMEN
In 63 diabetic children, aged 10--14 years, with normal ophthalmoscopy, fluorescein angiography revealed slight diabetic retinopathy in maximally three, aged 12--14 years. These findings are discussed in relation to the controversial results published in a few other fluorescein angiographic studies on diabetic children. It is concluded that normal ophthalmoscopy does not exclude the presence of diabetic retinopathy and that fluorescein antiography is a valuable method in the early diagnosis of diabetic retinopathy.
Asunto(s)
Retinopatía Diabética/diagnóstico , Angiografía con Fluoresceína , Adolescente , Aneurisma/diagnóstico , Niño , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/patología , Femenino , Humanos , Masculino , Vasos RetinianosRESUMEN
The effect of topical ampicillin sodium and polyglycolic acid and silk sutures on the recurrence of an existing hernia or an incisional hernia and on infection rates in clean abdominal wounds (herniotomies and simple cholecystectomies) was studied in a triple-blind, randomized trial with 398 consecutive patients. One infection, three suture sinuses, and two incisional hernias occurred among 113 patients with cholecystectomies, while the corresponding rates in 285 patients with hernia repairs were 11 infections, no suture sinuses, and three recurrent hernias. No effect of ampicillin could be demonstrated, nor was any difference between polyglycolic acid and silk sutures shown. No interaction between the antibiotic and suture material was found, and no side effects were observed. Wound infection was significantly more frequent in patients with postoperative seromas or hematomas.
Asunto(s)
Ampicilina/uso terapéutico , Colecistectomía , Hernia Inguinal/cirugía , Suturas , Adulto , Anciano , Animales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ácido Poliglicólico , Complicaciones Posoperatorias/prevención & control , Conejos , Distribución Aleatoria , Recurrencia , Infección de la Herida Quirúrgica/prevención & control , Cicatrización de HeridasAsunto(s)
Atención de Enfermería , Defensa del Paciente , Médicos , Investigación , Dinamarca , Relaciones InterprofesionalesRESUMEN
Blow-bottles were compared with conventional postoperative pulmonary physiotherapy in a randomized trial of 98 patients undergoing gastric or biliary tract surgery. Radiological evidence of postoperative pulmonary lesions found by "blind" evaluation of the films occurred with the same frequency in the two groups (30.6%). Blow-bottles were found preferable to physiotherapy because they are less time-consuming.