Search PubMed⌕ Search

Biomedical subjects

B M Frier

Publications and source records attributed to B M Frier.

At least 181 records · Page 10Linked to original sources
PubMed1986

Cardiac function and coronary arteriography in asymptomatic type 1 (insulin-dependent) diabetic patients: evidence for a specific diabetic heart disease.

Cardiac function was examined in 63 asymptomatic Type 1 (insulin-dependent) diabetic patients, aged 30-50 years, using radionuclide ventriculography and exercise electrocardiography to investigate the possible existence of a specific diabetic heart disease. Comparisons were made with 45 age- and sex-matched non-diabetic controls. Radionuclide ventriculography was performed at rest and during the physiological stresses of isometric exercise, cold-pressor testing and dynamic exercise. Scans were technically satisfactory in 56 of the diabetic patients and 38 of the control subjects. The resting left ventricular ejection fractions and the responses to isometric exercise and cold-pressor testing were similar in the diabetic patients and controls. A smaller rise in the left ventricular ejection fraction during dynamic exercise was observed in male diabetic patients compared with male control subjects (9 +/- 1% (mean +/- SEM) vs 14 +/- 1% (p less than 0.005)). A similar trend was observed in female diabetic patients, with a rise of 5 +/- 1% on dynamic exercise compared with a rise of 8 +/- 1% in the control group. Sixteen diabetic patients (29%) demonstrated an abnormal response to dynamic exercise, and 5 of these had an abnormal exercise electrocardiogram. Cardiac catheterisation and coronary arteriography were performed in eight of these 16 patients, and all 8 had normal coronary arteries. Endomyocardial biopsy revealed arteriolar thickening and interstitial fibrosis in 5 patients, and in 2 patients basement membrane thickening was conspicuous. Thus, in diabetic patients cardiac function may be abnormal without evidence of coronary heart disease, and some patients appear to have the histological changes consistent with a diabetic microangiopathy involving the heart.

Adult↗
PubMed1986

Reduced number of angiotensin II receptors on platelets in insulin-dependent diabetes.

Angiotensin II receptors on platelets were studied in 13 patients with uncomplicated type I diabetes mellitus and in 15 age-matched normal subjects. Receptor density on cells from the diabetic patients was 15% lower than the normal subjects (5.2 +/- 0.8 SD sites/platelet in diabetic patients and 6.4 +/- 0.8 in normals, P less than 0.001), but there were no differences in receptor affinity as measured by Kd (4.9 +/- 1.5 X 10(-10) mol/l in diabetic patients and 5.4 +/- 1.4 X 10(-10) mol/l in normals). Plasma concentrations of renin and angiotensin II were similar in both groups. The reduced density of angiotensin II receptors on platelets from patients with insulin-dependent diabetes may reflect a generalized abnormality of angiotensin II receptor regulation.

Adult↗
PubMed1986

Fatal rhinocerebral mucormycosis in newly diagnosed diabetic.

A 48-year-old male developed fever and sore throat while in Spain and was admitted to hospital, dehydrated, ketotic, pyrexial, and with a blood glucose of 35 mmol/l. Despite treatment with intravenous fluids, insulin, cephalosporin, potassium and bicarbonate he returned to Britain 7 days later, underhydrated and acidotic, though euglycaemic. His face was discoloured, there was painless nasal and maxillary swelling, oral candidiasis, and he went on to develop ophthalmoplegia and sudden blindness. Staphylococcus albus and mycelial fungus were isolated, the latter was identified as Mucor hiemalis, but despite treatment with amphotericin B co-ordinated with radical maxillary-facial surgery he died 31 days after the initial symptoms. Rhinocerebral mucormycosis is a recognized complication of ketoacidosis which is rarely reported in the UK. The organism invades arteries aggressively, therefore radical therapy must be started early to prevent the high mortality.

Brain Diseases↗
PubMed1986

Hypoglycaemic coma associated with gastric carcinoma.

Gastric carcinoma may rarely be the cause of tumour-associated hypoglycaemia. We report the case of an elderly woman who presented in hypoglycaemic coma, and who was found subsequently to have an adenocarcinoma of the stomach. Hypoglycaemia persisted despite prednisolone, diazoxide, and a high concentration dextrose infusion. The few published cases are reviewed in which an association was established between gastric carcinoma and hypoglycaemia, and the possible aetiology of the hypoglycaemia is discussed.

Adenocarcinoma↗
PubMed1985

Diabetes, driving, and the general practitioner.

The medical fitness of drivers who have diabetes is assessed primarily by general practitioners. A survey was made of the knowledge of driving and diabetes of 105 general practitioners in Glasgow. Ninety four (90%) knew that people who were insulin dependent were required by law to declare their condition to the Driver and Vehicle Licensing Centre in Swansea, but most were unaware that people with diabetes should not hold a "till 70" driving licence. Seventy one doctors (69%) claimed that patients were recalled individually for fitness to drive. The minimum visual acuity for driving was stated correctly by 37 (35%). Only eight respondents knew that a hypoglycaemic diabetic driver can be charged with driving under the influence of a drug (Road Traffic Act 1972), and the practical advice that was given to patients about hypoglycaemia and driving was unsatisfactory. As a group the general practitioners showed deficiencies in knowledge regarding diabetes and driving, suggesting a need for further postgraduate education.

Automobile Driving↗
PubMed1985

Hypoglycemia during adrenergic beta-blockade: evidence against mediation via a deficiency of lactate for gluconeogenesis.

Acute hypoglycemia was induced using intravenous inulin in three groups of normal volunteers: (1) seventeen control subjects, (2) six subjects under beta-adrenergic blockade with propranolol, and (3) eight subjects given propranolol plus sodium lactate as an exogenous substrate for gluconeogenesis. Under propranolol blockade the recovery from hypoglycemia was significantly impaired. This impairment was not prevented by the infusion of sodium lactate despite the production of an adequate elevation of blood lactate concentrations. These findings suggest that the impaired recovery from hypoglycemia during beta-adrenergic blockade is not mediated via a deficiency of lactate as substrate for hepatic gluconeogenesis.

Adult↗
PubMed1985

Abnormal insulin secretion in carcinoma of the pancreas: response to glucagon stimulation.

In 34 patients suspected of having pancreatic cancer glucose homeostasis and insulin secretion in response to intravenous glucagon (1 mg) were studied prospectively. Twelve patients had pancreatic cancer at laparotomy and the remainder were designated a control group. Responses were also measured in 12 healthy volunteers. There was no significant difference in the rise of blood glucose between the groups after glucagon. The mean plasma insulin concentrations rose rapidly in both groups after glucagon but were significantly lower in the pancreatic cancer group. In patients with obstructive jaundice the plasma insulin response was a better discriminator of pancreatic cancer. Abnormal pancreatic beta-cell function is detectable in patients with pancreatic carcinoma before any change in glucose homeostasis, particularly in patients with obstructive jaundice. The glucagon stimulation test may be useful in the earlier diagnosis of pancreatic carcinoma before the development of clinically overt diabetes mellitus.

Aged↗
PubMed1985

Factitious diabetic instability.

Factitious diabetic instability is described in four patients. In three the predominant problem was recurrent hypoglycaemia. The fourth presented with apparent insulin resistance and episodes of ketoacidosis. The methods used to make the diagnosis are described, and the factors which contribute to this type of diabetic instability are discussed.

Adult↗
PubMed1985

Cardiac function and insulin-dependent diabetes: radionuclide ventriculography in young diabetics.

We have compared left ventricular function in 40 insulin-dependent diabetic patients (30 male, 10 female) aged 16-30 years (mean 23 years) with duration of diabetes 3 months to 25 years (mean 10 years) with 19 healthy age and sex-matched controls using radionuclide ventriculography at rest, during cold-pressor stimulation, isometric exercise, and dynamic exercise. There were no differences in exercise or smoking habits in the two groups. All subjects had a normal resting electrocardiogram and a normal electrocardiographic response to dynamic exercise using the Bruce protocol on the Marquette Computer Assisted System of Exercise. Left ventricular ejection fraction was similar at rest and fell in diabetics and controls, respectively, by 2.3 +/- 1.0% and 3.0 +/- 0.08% (NS) and by 2.4 +/- 0.8% and 2.2 +/- 0.8% (NS) during isometric exercise, and cold pressor testing. During supine dynamic exercise on a bicycle ergometer ejection fraction rose in both groups by 13.9 +/- 1.7% and 13.7 +/- 1.6%, respectively (NS). No statistically significant differences were found in peak ventricular filling and emptying rates and abnormalities of regional wall motion did not develop. Two female patients with diabetes for more than 10 years had an abnormal response to dynamic exercise manifested by a fall in ejection fraction. In comparison to the higher frequency of abnormalities reported in diabetics using echocardiography and the measurement of systolic time intervals, abnormal left ventricular function assessed by radionuclide ventriculography is uncommon in young patients.

Adolescent↗