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Biomedical subjects

B Morell

Publications and source records attributed to B Morell.

At least 19 recordsLinked to original sources
PubMed1996

[The diabetic foot].

Neuropathy, arterial obstruction and infection are involved to varying degrees in the development of the "diabetic foot". A careful diagnosis is necessary in order to comprehend the various noxa and to introduce the adequate therapy. In case of the predominantly neuropathic foot with malum perforans, one must essentially proceed in a conservative way; only callosities and osteomyelitic parts must be removed. In case of the predominantly angiopathic foot, revascularizing measures are most important. After improving the blood flow, the necrotic parts of the foot are sparingly resected. As prevention of a possible relapse, two things are necessary: accurately fitted shoes in order to prevent pressure points, and extremely careful foot care in order to prevent infections.

Callosities↗
PubMed1994

[Lupus erythematosus in old age].

Over a period of 2 months an 88-year-old man developed progressively more severe breathing-related pain under the right shoulder blade, loss of appetite, general weakness, depressive mood, sub-febrile temperature and nocturnal sweating. Various inflammation parameters were raised (sedimentation rate 43 mm in the first hour; C-reactive protein 26 mg/dl; white cell count 12,500/microliters). There also were pleural effusion and signs of mild nonspecific hepatitis. Antibiotics were administered because bacterial pneumonia was suspected. But the patient's condition deteriorated and he developed nightly periods of disorientation. There was no evidence for any advanced malignancy. Immunological tests pointed towards older-onset systemic lupus erythematosus: titre for antinuclear antibodies markedly raised to 1:20 480; anti-DNA titre moderately raised to 1:125 IU/ml. The patient's general condition and the pleuritic pain improved within 2 days under treatment with prednisone (50 mg daily); the depression, disorientation and fever receded within a week. The anti-DNA titre fell to 47 IU/ml after 8 weeks. He was able to resume his usual social activities and was kept on a maintenance prednisone dose of 5.0 mg daily.

Aged↗
PubMed1994

Hypersensitivity to molybdenum as a possible trigger of ANA-negative systemic lupus erythematosus.

After implantation of two metal plates a 24 year old woman developed fever of unknown origin and successively more symptoms of an ANA-negative systemic lupus erythematosus (SLE). These symptoms resolved after removal of the plates and recurred during patch testing of the metal components, which showed a reaction to molybdenum. A lymphocyte transformation test indicated a delayed-type hypersensitivity to molybdenum. Subsequent progressive flare ups of SLE appeared without molybdenum reexposure. This is the first report suggesting the existence of a hypersensitivity to molybdenum, which may act as another environmental trigger for SLE.

Adult↗
PubMed1990

[Control of diabetes and late complications].

When insulin was introduced in medical therapy in 1922, it permitted to save diabetics from premature death; however, it has allowed, after a certain period of time, for the appearance of a cohort of chronic complications connected more or less specifically to the degree of hyperglycemia. After a short review of the pathophysiology of the microangiopathy, the authors have tried to demonstrate, on the basis of numerous prospective and retrospective studies in the human as well as in the animal, that an important relationship exists between the degree of glycemic control and the severity of the classical complications, retinopathy, neuropathy and nephropathy. However, the most recent studies have stressed the role of some other factors, not well established in the past, as for example the potential negative impact on retinopathy of rapid normalization of glycemia, following a long period of poor metabolic control. Likewise, high blood pressure, smoking, genetic background, as well as probably also excess of protein intake, do play an important etiopathogenic role. Thus, the simplistic equation hyperglycemia = complications is not completely valid. Microangiopathic risk in insulin-dependent diabetics seems to be low as long as their HbAlc is below 7.5%, and they do not have hypertension and do not abuse tobacco. Finally, the general approach to therapy is redefined: Try to get as close as possible to near-normoglycemia by multiple insulin injections, without causing, however, major hypoglycemia; this should be done very early after the onset of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[The diabetic foot].

Neuropathy, arterial obstruction and infection are involved to varying degrees in the development of the 'diabetic foot'. A careful diagnosis is necessary in order to comprehend the various noxa and to introduce the adequate therapy. In case of the predominantly neuropathic foot with malum perforans, one must essentially proceed in a conservative way; only cornea callosities and osteomyelitic parts must be removed. In case of the predominantly angiopathic foot, revascularizing measures are most important. After improving the blood flow, the necrotic parts of the foot are sparingly resected. As prevention of a possible relapse, two things are necessary: accurately fitted shoes in order to prevent pressure points, and extremely careful foot care in order to prevent infections.

Diabetic Angiopathies↗
PubMed1985

[Candida endophthalmitis: diagnosis, course and therapy in 8 patients].

Over a two-year period 8 patients were hospitalized with a presumptive diagnosis of Candida endophthalmitis. 6 patients were heroin addicts, while in the 2 other patients no risk factor could be identified. The presumptive diagnosis was based on the typical findings of retinohyalitic exudate and exclusion of other factors causing endophthalmitis. Intravenous therapy with amphotericin-B and flucytosin resulted in definitive scar healing. In 1 patient vitrectomy was necessitated by recurrence of endophthalmitis resistant to antifungal therapy.

Adolescent↗
PubMed1985

Disabilities and handicaps in Aquitaine.

An extension of the national survey on health and medical consumption in Aquitaine used a questionnaire on presence of disability and handicap. Communication, personal cares, mobility and occupations were restricted in respectively 1.5, 3.3, 3.2, and 10.6%. People aged 60 and over were mainly concerned. Personal and domestic care disabilities were noted for 1 out of 8, communication disabilities were present among 1 out of 20. One out of 7 was restricted for mobility and physical independence; 1 out of 4 was restricted for customary occupations and 1 out of 10 for social relationships. Those physically dependent living alone were 5%.

Adolescent↗
PubMed1982

[Idiopathic thrombocytopenic purpura in pregnancy. Interdisciplinary care, demonstrated on a case report with a review of the literature].

The case is reported of a 30-year-old primigravida presenting with idiopathic thrombocytopenic purpura (ITP) at 31 weeks gestation. Because the thrombocytopenia became progressively resistant to steroids, pregnancy was terminated at 36 weeks gestation by primary caesarean section after platelet transfusion. Subsequent therapy with high-dose intravenous gammaglobulin transiently reversed the thrombocytopenia. However, 3 weeks after delivery splenectomy was performed because of relapse of ITP. The baby showed only very mild, transient thrombocytopenia without clinical symptoms. Based on a literature survey covering 159 deliveries of women with ITP described in 18 publications in the period 1973-1982, the following points are discussed: 1. risk of ITP in pregnancy for mother and child (maternal mortality 0.6% per delivery, perinatal mortality 2.4%, risk of neonatal intracranial hemorrhage 2.4%), 2. therapy of ITP in pregnancy and its effects on the fetus; 3. mode of delivery; 4. perinatal management of the mother; 5. management of the newborn.

Delivery, Obstetric↗
PubMed1982

Insulin absorption from the abdomen and the thigh in healthy subjects during rest and exercise: blood glucose, plasma insulin, growth hormone, adrenaline and noradrenaline levels.

Insulin was absorbed faster from the abdomen than from the thigh under resting conditions and during exercise. Exercise enhanced the rate of insulin absorption marginally. The fall of blood glucose during rest and exercise was not significantly different after insulin injection into either site. The faster absorption of insulin from the abdomen during rest and exercise was reflected in a sharper rise of serum growth hormone levels and urinary adrenaline excretion. Therefore exercise should not be taken immediately after injection of a large dose of soluble insulin, particularly into the abdomen.

Abdomen↗
PubMed1981

[Control of the juvenile diabetic with the insulin dosage device: indications and uses].

The Clinitest was used to assess the effect of inpatient treatment in 24 labile insulin-dependent diabetics with a portable open loop insulin infusion device. The Clinitest results one month prior to hospitalization were compared with those during 3 months following inpatient treatment. During the first month after the hospital stay 21 patients (88%) were better controlled. Only 15 (63%) maintained better control for the whole period of 3 months. After the hospital stay the patients experienced an average of 4 more slight hypoglycemic episodes than before hospitalization. In patients who were better controlled for the whole period of 3 months the insulin dose had been adjusted considerably. Besides inadequate daily adjustment of the insulin dose, half the patients were not sufficiently motivated and did not cooperate with their diabetologists. One third of the patients did not follow a diet and one fifth practiced inadequate insulin injection techniques. These were the major causes of poor control prior to hospitalization. The results show that short term treatment with an open loop insulin infusion device is worth while for all diabetics in whom less than one third of all Clinitests are sugarfree, and also for all those in whom there are doubts about the actual insulin requirement.

Adolescent↗
PubMed1980

[Improvement in the treatment of diabetes by means of a portable insulin-infusion apparatus. Preliminary results in 4 unstable juvenile diabetics].

Four type 1 diabetics, 10 to 21 years after onset of diabetes and with no detectable levels of plasma C-peptide, were kept on intravenous insulin for 4 months by a portable open-loop insulin infusion system (Siemens, Germany). Using this system, a constant basal rate of insulin was continuously infused into the superior vena cava. During meals additional insulin was delivered for one hour. The patients went home after a few days on the ward, during which time the doses of insulin (basal and extra rates) were established. All four patients maintained the same diet, went to work and continued their personal habits as before. Blood sugar (Glucoquant) and glucosuria (Clinitest) were regularly controlled before, during and after this period. During long-term ambulatory treatment with the insulin pump improved metabolic control was achieved, as shown by lower mean blood glucose values, decreased urinary glucose excretion and by lowering of hemoglobin AIc. All four patients felt well and the number of complications, all technical, was relatively small.

Adult↗
PubMed1979

[Progress and developments in insulin therapy].

BANTING and BEST revolutionized diabetes therapy with the discovery of insulin 57 years ago. Since then, progress in this area has been slow despite tremendous reseach efforts. The subcutaneous injection of a depot insulin does not provide optimal control of blood sugar. True progress has been brought about by intravenous insulin administration for the management of diabetic coma. The authors do not recommend ultra low dose therapy. The prognosis of diabetic coma is much better than 20 years ago, in particular because of much improved and continuous supervision of the circulation (CVP, ECG, K+ etc.). Pancreas and islet transplantation fail in man due to immunological rejection. The "artificial pancreas" with a glucose sensor is useful for research purposes, and for controlling blood sugar for a few days at most. The implantable glucose sensor is not yet in sight. The authors have treated diabetics successfully with a programmable flexible open loop infusion program. The basal insulin infusion rate can be varied from 0.25 to 2 U/h, and rectangular one hour extra insulin infusions between 2 and 10 U/h are superimposed by pushing a button on the steering unit. The pump automatically switches back to the basal rate after one hour. No hypoglycemic reactions have been observed in patients on ths program on the ward or at home. At present, technical problems with the catheter remain to be solved before this simple therapeutic approach can be applied routinely.

Adolescent↗
PubMed1979

[New insulins in diabetes therapy].

The new MC or RI insulins are critically reviewed and the indications for switching to MC or RI pork insulin are discussed. A new means of determining the insulin requirement of brittle diabetics is short-time use of an insulin infusion apparatus.

Animals↗
PubMed1979

Optimal blood sugar control in labile diabetics using a portable open-loop insulin infusion system with a flexible program.

11 labile diabetics were well controlled after 2 days of an i.v., open-loop insulin infusion program consisting of constant, empirically determined, basal infusion rates (mean: 1.1 U/h) and superimposed rectangular one-hour insulin infusions between 2 and 8 U/h during the main meals. The steering unit switches automatically back to the basal infusion rate after one hour. An almost optimal blood sugar profile was already obtained on the third day of the infusion program. We believe that such a flexible, open-loop insulin infusion program would render long-term optimal blood sugar control in "labile" diabetics possible if the technological development ever allows implantation of the infusion pumps.

Adolescent↗
PubMed1978

[Adjustment of unstable diabetics with a simple insulin infusion program].

In view of the importance of knowing exactly how much insulin is required by diabetics who are difficult to control with subcutaneous insulin, an insulin infusion program has been tried in such patients. The apparatus, which was produced by Siemens as a prototype, works according to the following simple and flexible principle: During the day a basal rate of insulin is continuously infused. During the three main meals an additional rectangular insulin infusion is initiated by turning a knob. After an hour the apparatus switches automatically back to the basal ratio. We have used this machine in 13 patients who are fully mobile. 11 of them showed an almost ideal blood sugar profile after 4 days. After switching back to subcutaneous insulin 8 of these 11 patients did better than before but not as well as on the insulin infusion program.

Blood Glucose↗