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Biomedical subjects

C Holler

Publications and source records attributed to C Holler.

18 recordsLinked to original sources

[First case of human toxocariasis (?) with adult worms in the circulatory system, detected by the presence of embryonated eggs in hemolysis concentration].

Ascarids's eggs were found by blood concentration in a Cameroonese patient with hypereosinophilia. Eggs, similar to those of Toxocara canis or cati, were present in 6 blood concentrations carried out during 7 weeks. These eggs (70-75 x 100-112 microns) contained embryos and hatching of 437-504 microns long larvae was sometimes observed. The presence of adult worms in a well oxygenated localization (e.g.; the left ventricle) was supposed. A pleural effusion was also observed but the low number of eosinophils in the pleural fluid (3%) eliminated the responsibility of the parasite. The treatment by thiabendazole for an associated strongyloidosis was well tolerated but inefficient. On the contrary, the treatment by diethylcarbamazine, well tolerated, induced the disparition of the circulating eggs. This result was confirmed by 6 blood concentrations carried out during 6 months.

Adult

[Recrudescence of imported malaria (author's transl)].

In the light of two recent cases of severe central nervous system malaria due to neglect in chemoprophylaxis, the authors report the very marked recrudescence in imported malaria and draw attention to the frequency of cases due to P. falciparum, the agent of malignant tertian fever and of malignant episodes. The necessity of early diagnosis in such cases is mentioned, together with the treatment of simple malaria and, in particular, of malignant varieties. In order to be effective, chemoprophylaxis must be begun immediately following arrival in an endemic area, continued regularly throughout the stay there and continued for 2 months after leaving. The blood of former malaria suffers, in order to avoid the risks of transfusion malaria, should be used only after seroimmunological studies have demonstrated the absence of anti-malaria antibodies.

Africa

[Malaria].

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Humans

Failure and efficacy of insulin therapy in insulin dependent (type I) diabetic patients.

In order to determine the degree of metabolic control (HbA1c [normal less than 5.8%], mean blood glucose [MBG], glucosuria and lipids) and the prevalence of late diabetic complications in insulin-dependent diabetic patients treated by conventional insulin therapy both patients of a diabetes center (DC: n = 130; age 37.1 +/- 1.4 years) and a rural area (RA: n = 73; age 38.4 +/- 2.4 years) were examined within their local setting. Eighty such insulin-dependent diabetic patients were also taught a technique of near normal glycemic insulin substitution (NIS), which separates basal from prandial insulin replacement and instructs the patients to immediately correct self-controlled (3.8 +/- 0.1/day) aberrant blood glucose values. None of the groups on conventional insulin therapy was able to achieve satisfactory metabolic control or to avoid late diabetic complications, but rural patients were even worse off (BG 240 +/- 10 mg/dl; HbA1c 8.7 +/- 0.2% [normal: 3/73 = 4%]) than those of the DC (MBG 191 +/- 5 mg/dl; HbA1c 7.1 +/- 0.2% [normal: 27/130 = 21%]), while the prevalence of late diabetic complications was almost identical (RA/DC: neuropathy 22%/25%; retinopathy 41%/38%; macroangiopathy 15%/13%; but proteinuria 14%/5.4%). Metabolic control was improved by NIS with twice daily injections of basal (long acting) and separately of prandial (regular) insulin (total: 4.8 +/- 0.1 injections/day; MBG 130 +/- 2 mg/dl; HbA1c 5.8 +/- 0.1% [normal: 41/80 = 51%]. We conclude (1) that conventional insulin therapy just prevents metabolic catastrophe but in more than 79% of insulin-dependent diabetic patients lacks the ability to provide good metabolic control, while (2) NIS, a more physiological form of insulin therapy, improves this deplorable situation 5- to 12.4-fold.

Adult

Diabetes care in rural area: clinical and metabolic evaluation.

To evaluate the efficacy of conventional diabetes care in a rural area, metabolic control and the presence of late complications were studied in 622 diabetic patients treated by general practitioners beyond the reach of diabetic centers. Seventy-three (12%) of the patients were classified as type I diabetics (age, 38.0 +/- 16.1 yr; duration of diabetes, 12.8 +/- 9.3 yr) and 549 as type II diabetics (age, 67.0 +/- 10.8 yr; duration of diabetes, 7.3 +/- 5.8 yr). Fifty-eight percent of type I diabetic patients administered insulin once daily and 42% twice daily, whereas most (83%) type II diabetics on insulin received only one insulin injection per day. Treatment of type II diabetic patients consisted of sulfonylureas (58%), diet alone (22%), insulin (18%), and biguanides or a combination of sulfonylurea with biguanides (2%). Poor therapeutic efficacy was observed in all patients, and postprandial hyperglycemia (blood glucose greater than 160 mg/dl) was predominant both in type I diabetics (86%) and in type II diabetics on insulin (80%) as well as off insulin (55%). HbA1c above normal (greater than 5.8%) was seen in 96% of type I and in 90 and 73% of type II diabetics with or without insulin therapy, respectively. Accompanying glucosuria was present in type I (73%) and in type II diabetics (on insulin, 71%; off insulin, 33%). Mean prevalence of late diabetic complications was greatest for insulin-treated patients (type I, type II with, and type II without insulin treatment: retinopathy, 41, 56, 22%; proteinuria, 13, 14, 3%; peripheral neuropathy, 21, 51, 12%), whereas macroangiopathy (16, 53, 31%) predominated in type II diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia