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Biomedical subjects

D Daneman

Publications and source records attributed to D Daneman.

At least 109 records · Page 6Linked to original sources
PubMed1982

Hypoparathyroidism and pseudohypoparathyroidism in childhood.

Although relatively uncommon, the conditions of hypoparathyroidism and pseudohypoparathyroidism in childhood provide an exciting diagnostic and therapeutic challenge. Knowledge of calcium-phosphate homeostasis has progressed rapidly over the past few years so that our understanding of the basic pathophysiological mechanisms has increased tremendously. However, further clinical and basic scientific research will, no doubt, unravel further variations of the various disease entities described.

Child↗
PubMed1981

Factors affecting glycosylated hemoglobin values in children with insulin-dependent diabetes.

In 477 children with IDD treated by conventional methods, GHb (microcolumn chromatography) and a simultaneous random blood glucose concentration were measured over an 18-month period as indicators of metabolic control (once in 61 children, twice in 99, three or more times in 317). The data were analyzed to assess the effects of patient's age, sex, disease duration, and, in a random subgroup of 273, the number of daily insulin injections and insulin dose (U/kg). The mean +/- SEM percent GHb over this period was 11.8 +/- 0.2% and blood glucose concentration 237 +/- 9 mg/dl. Only seven children (1.4%) had a normal GHb value. There was a highly significant correlation between GHb and both age and blood glucose concentration but not with disease duration greater than one year. The correlation with age was present only in the girls. In 416 children evaluated more than once, with a mean duration between initial and most recent evaluations of 11.3 months, GHb remained within +/- 1% of the initial value in 40.5%, decreased in 32.3%, and increased in 24.2%. These data indicate a closer relationship between metabolic control in children with IDD and age of the child, particularly in females, than with disease duration. In our clinic, using conventional therapeutic methods, the ability to improve control over the short term as measured by changes in percent GHb has been quite limited. This study helps to target those IDD children, especially adolescent girls, requiring a more aggressive therapeutic approach.

Adolescent↗
PubMed1981

Electroencephalographic changes in diabetic ketosis in children with newly and previously diagnosed insulin-dependent diabetes mellitus.

Abnormal electroencephalograms in patients with long-standing diabetes mellitus have been attributed to hypoglycemia. EEG changes in newly diagnosed patients or in patients during episodes of diabetic ketoacidosis have not previously been reported. We performed serial EEGs at one, 12, 24 hours and five days after initiation of treatment for DKA on 39 patients aged 11 months to 16 years with newly or previously diagnosed insulin-dependent diabetes mellitus. Twenty-seven patients were in ketoacidosis and 12 patients ketotic only. Abnormal EEGs were found in 30 patients on admission. The EEG changes at one hour, classified in order of increasing severity, correlated with the serum glucose, osmolality, bicarbonate, beta-hydroxybutyrate, and acetoacetate values, but not with pH or glycosylated hemoglobin. The rate of improvement of the EEGs was unaffected by the addition of phosphate to the intravenous fluids during therapy. EEG changes persisted in five of the seven children who had follow-up studies at two to five months, and in two of the six children one year after admission. We conclude that EEG changes are common in children with DKA or ketosis, the severity of the abnormalities being most closely associated with the degree of hyperosmolality rather than acidosis. These changes may persist in some cases, possibly accounting for the increased frequency of EEG abnormalities in diabetic children.

Adolescent↗
PubMed1981

The effects of targeting improvements in urine glucose on metabolic control in children with insulin dependent diabetes.

A treatment program designed to increase the percentage of negative urine tests was implemented using a multiple-baseline across groups design in a sample of 19 families of children with insulin dependent diabetes. The treatment involved instruction in insulin adjustment, decrease in intake of simple sugars and saturated fats, and increase in exercise, along with teaching the parents to support improvements in children's self-regulatory behaviors using a point economy and praise. New procedures designed to measure and reinforce adherence to the urine testing regimen were developed. Results showed significant increases in percentage of negative urines consistent with implementation of treatment across the three treatment groups, which were maintained over the follow-up period. Metabolic measures of control, including glycosylated hemoglobin and serum glucose did not show improvements even though the relationship between the percentage of negative urine tests and glycosylated hemoglobin was very high during treatment.

Behavior Therapy↗
PubMed1981

Diabetic retinopathy in Mauriac's syndrome. Paradoxical deterioration with improved metabolic control.

We report four children with marked short stature, hepatomegaly, and delayed adolescence. Initial funduscopy demonstrated only occasional microaneurysms in two children and a single intraretinal hemorrhage in another. Improved control required large increases in insulin dosage. Growth rate improved significantly and hepatomegaly regressed. Puberty progressed rapidly in two older patients with poor final height. Paradoxically, with improved control, retinopathy progressed rapidly. One child with proliferative retinopathy in both eyes developed vitreous hemorrhage and blindness in one eye. Two required pan retinal photocoagulation with no further progression of their retinopathy. These rapidly progressive retinal changes remain unexplained. We advise caution when correcting metabolic derangements of diabetic patients who have been poorly controlled for a prolonged period.

Adolescent↗
PubMed1980

Glycosylated haemoglobin in children with insulin-dependent diabetes mellitus.

Glycosylated haemoglobin (HbA1) was measured serially by microcolumn chromatography in 38 children with newly diagnosed insulin-dependent diabetes. Initial HbA1 levels of 13.6 +/- 0.5% fell signficiantly from day 0 (prior to therapy) both to day 1 (1.6 +/- 0.2% decrease) and to day 3-5 (2.6 +/- 0.4% decrease) (P < 0.001). This drop correlated closely with changes in blood glucose (P < 0.001), less closely and inversely with plasma bicarbonate levels (P < 0.01), but not with prior duration of symptoms or changes in serum cholesterol and triglyceride concentrations. HbA1 levels reached a nadir of 8.2 +/- 0.3% 3 weeks to 6 months after diagnosis, and correlated with decreasing insulin dosage (P < 0.001). HbA1 levels rose again to 11.4 +/- 0.5% in 21 patients followed for more than 3-6 months. Our results indicate that (1) HbA1 level change rapidly during initial stabilization of insulin-dependent diabetes suggesting that glycosylation may not be entirely irreversible, and (2) HbA1 levels are consistent with clinical assessment of control during remission and postremission phases.

Adolescent↗
PubMed1980

Pheochromocytoma in children--an update.

Eight cases of pheochromocytoma in children were managed between 1958 and 1978. Headache, visual blurring, sweating, and hypertension were the most common findings. One patient presented with a hypertensive crisis during appendectomy. Three other children had a family history of pheochromocytoma and Hippel-Landau disease, thyroid carcinoma, and renal stones. The diagnostic approach was based on a high suspicion of the disease from the clinical picture. The most reliable laboratory investigations were urinary VMA, metanephrine, and catecholamines. I.V.P. and angiography were successful in localizing the tumor. In 4 cases, CT scan localized the tumor, although a second tumor was not seen in 1 case. Preoperative control of hypertension was achieved with phenoxybenzamine, propanolol, apresoline and reserpine in seven cases. The main anesthetic drugs used were pentothal, methoxyflurane, nitrous oxide, Innovar, and pancuronium. Tumors were located in the right adrenal in four, the left adrenal in two, both adrenals in one, and bilateral para-aortic sites in one. In two cases, hypertensive episodes during manipulation of the tumor were controlled with phentolamine. Ligation of the venous drainage from a tumor was associated with a sudden sustained fall in systemic blood pressure in six cases. In two, blood pressure remained elevated until a second tumor was found and removed. Hypotension was then corrected by the rapid infusion of fluid and blood, and vasopressors were not used. There were no postoperative complications and all children remained normotensive during the follow-up. The tumors of seven of the patients were benign. One tumor showed a low grade malignancy.

Adolescent↗
PubMed1978

The initial management of simple febrile seizures.

One hundred consecutive cases of simple febrile seizures in childhood were studied. Seventeen of these children had had more than one seizure during the febrile episode, but none of the patients had a further seizure after treatment with simple antipyretic measures. Thus it appears unnecessary to give anticonvulsants to prevent early recurrence of simple febrile seizures.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Eating disturbances, diabetes and the family: an empirical study.

This study of 113 adolescent females with IDDM and their mothers investigated whether: (1) interaction patterns are more dysfunctional in families of girls with eating disturbances than in those without; and (2) the relationship between family functioning and metabolic control is mediated by an eating disturbance. Based on self-reported eating attitudes and behaviors, subjects were categorized as Nondisturbed (N = 56), Mildly Disturbed (N = 37), and Highly Disturbed (N = 20). Mothers and daughters rated overall family functioning (FES), and daughters rated parental relationships (IPPA, MFP). Metabolic control was assessed using HbA1c levels. MANCOVA illustrated that eating disturbances are associated with the perception of poor communication with mothers and fathers, a lack of trust in their accessibility and responsiveness, and overall family environments perceived to be conflictual and inadequate in support and structure. Regression analyses revealed that the presence and severity of an eating disturbance mediates the influence of family functioning on metabolic control.

Adaptation, Psychological↗
PubMedDate not supplied

Intensive diabetes management decreases Na-Li countertransport in young subjects with type 1 diabetes and enlarged kidneys.

In type 1 diabetes, increases in sodium-lithium countertransport (Na-Li CT), kidney volume (KV), and albumin excretion rate (AER) may precede the development of persistent microalbuminuria. Limited data exist on reversibility of these factors early in the evolution of diabetic nephropathy. A crossover design was used to study the separate effects of enalapril and intensive diabetes management (IDM) on Na-Li CT, KV and AER in 17 children and adolescents with type 1 diabetes (5-10 years duration) with large kidneys (>275 ml/1. 73 m(2)) and predominantly normoalbuminuria. Subjects were randomized to receive 3 months of either enalapril (0.25 mg/kg/day) or IDM, a 3-month washout, followed by the alternate treatment for 3 months. During IDM, HbA1c decreased 2.5% (pre 9.5+/-0.3% (mean+/-SE), post 7.0+/-0.1%, p<0.0001), but was unchanged while on enalapril (pre 8.8+/-0.3%, post 8.5+/-0.3%, p=0.1). A significant decrease in Na-Li CT was seen with IDM (pre 0.43+/-0.05, post 0.36+/-0.04 mmol/l RBC/h, p=0.006) but not angiotensin converting enzyme inhibition (ACE-i) (pre 0.39+/-0.04, post 0.38+/-0.04 mmol/RBC/h, p=0.4). Neither ACE-i nor IDM affected KV or AER. It is concerning that kidney enlargement does not appear reversible at this early stage in the pathogenesis of diabetic nephropathy, although our conclusions are limited by the short duration of intervention and small sample size. The reduction in Na-Li CT with IDM suggests this may be a potentially modifiable risk factor for diabetic nephropathy.

Adolescent↗
PubMedDate not supplied

Ambulatory blood pressure monitoring in insulin-dependent diabetes mellitus adolescents with and without microalbuminuria.

The aim of our study was to compare ambulatory blood pressure monitoring (ABPM) measures (mean systolic/diastolic blood pressure, diurnal rhythm, and pressure burden) in matched normo- and microalbuminuric (IDDM) adolescents and healthy controls. Twenty-four hour monitoring was undertaken in 39 normotensive (normal clinic blood pressure measurements) IDDM adolescents (22 normo- and 17 microalbuminuric subjects) and 23 controls. Subjects were matched for age, bodymass index, gender, and IDDM duration. Microalbuminuria was diagnosed on the basis of a urinary albumin excretion rate greater than 15 but less than 200 micrograms/min in two of the three 24-h urine collections. The microalbuminuric patients differed from the normoalbuminuric subjects and controls in having higher mean 24-h and overnight systolic pressure, loss of systolic diurnal rhythm and increased systolic and diastolic pressure burden. There were no differences between the three groups in diastolic blood pressure. The normoalbuminuric group differed from the controls only with respect to an increased systolic pressure burden. Microalbuminuric IDDM adolescents show similar, albeit milder changes in ABPM, to those reported in adults with microalbuminuria. We postulate that these milder changes represent an earlier phase to that observed in the adult population and that taken together, the adolescent and adult data suggests a specific order in the development of ABPM changes in diabetic subjects.

Adolescent↗
PubMedDate not supplied

Nodular hyperplasia in treated congenital goitrous hypothyroidism.

Two patients with congenital goitrous hypothyroidism, treated since birth, are described. Each developed progressive nodular thyroid enlargement in adolescence, possibly related to ongoing thyroid stimulation due to slight and transient elevations of thyroid stimulating hormone (TSH) levels. The incidence and degree of persistent thyroid enlargement in these patients has not been well documented. If present in a significant number of patients despite appropriate L-thyroxine replacement, our therapeutic aims in congenital goitrous hypothyroidism may need to be modified to achieve TSH suppression, rather than normalization.

Adolescent↗
PubMedDate not supplied

Frequency and characteristics of lingual thyroid not detected by screening.

Four patients with lingual thyroid glands presenting beyond the neonatal period have been evaluated at the Hospital for Sick Children, Toronto since the advent of neonatal TSH screening. All were female, clinically euthyroid at diagnosis and presented with symptoms of a lingual mass. We estimate that 1.6% of lingual thyroids are missed by this TSH based thyroid screening program and approximately 1/600,000 live births present in childhood or adolescence with a lingual thyroid. Physicians should still include lingual thyroid in the differential diagnosis of a mass at the base of the tongue.

Child↗
PubMedDate not supplied

Eating disorders in female adolescents with insulin dependent diabetes mellitus.

Recent case reports have suggested an association between anorexia nervosa and/or bulimia with insulin-dependent diabetes mellitus (IDDM). Fifty-eight females aged fifteen to twenty-two with IDDM for more than one year were assessed for the presence of eating disorders. Patients were screened for eating and weight pathology using the Eating Disorder Inventory (EDI) and Eating Attitudes Test-26 (EAT-26). Glycosylated hemoglobin (HbA1) was measured to assess metabolic control. Subjects who scored above the cut-off points associated with eating and weight pathology were interviewed. Clinically significant eating and weight pathology was found in 20.7 percent of the population. Of these subjects, anorexia nervosa was found in 6.9 percent and the syndrome of bulimia, based on DSM-III criteria, was found in 6.9 percent. In patients with bulimia, there was a strong inverse correlation between bulimic symptoms and metabolic control. These findings suggest that anorexia nervosa may be more common in female adolescents with IDDM than in nondiabetic populations and that bulimic symptoms may be a risk factor for poor metabolic control.

Adolescent↗