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Biomedical subjects

E Chantelau

Publications and source records attributed to E Chantelau.

At least 55 records · Page 3Linked to original sources
PubMed1995

Association of below-knee atherosclerosis to medial arterial calcification in diabetes mellitus.

In diabetes mellitus, peripheral arterial occlusive disease (PAOD) more often affects the lower rather than the upper leg. It is hypothesized that peripheral medial arterial calcification (MAC) may be related to this phenomenon. In 42 diabetic patients subjected to arteriography for PAOD, forefoot roentgenogrammes were also obtained for assessment of MAC, e.g. of the metatarsal arteries. The distribution of PAOD (number of partial and total arterial stenoses per leg) was assessed according to the coexistence of MAC. A total of 242 partial and complete stenoses was found in 35 MAC-positive legs and 28 MAC-negative legs. MAC-positive legs displayed 4 (3-6) stenoses per leg (median with 95% confidence interval), vs. 3 (2-5) stenoses per MAC-negative leg. MAC-positive legs had more than twice as many stenoses located in the lower (2.6 (2.3-2.8) stenoses below knee) as compared to the upper leg (1.3 (1.0-1.7) stenoses above knee; P < 0.05), whereas stenoses were equally distributed above and below the knee in MAC-negative legs. The prevalence of stenoses in the truncus tibiofibularis and in the foot arteries (e.g. arteria dorsalis pedis) was unaffected by MAC-status. In conclusion, the predominance of PAOD in the lower leg of diabetic patients appears to be related to the presence of forefoot medial arterial calcification. The underlying pathogenesis remains to be elucidated.

Aged↗
PubMed1994

Effect of insulin concentration, subcutaneous fat thickness and skin temperature on subcutaneous insulin absorption in healthy subjects.

Subcutaneous insulin absorption kinetics were assessed in 50 healthy study subjects (21 female, 29 male; age 26 +/- 3 years, BMI 22.5 +/- 1.8 kg/m2; mean +/- SD) during 45 min after periumbilical injection of soluble human U40- or U100-insulin (0.15 IU/kg). Subcutaneous fat thickness was measured by ultrasound, and skin temperature at the injection site was registered. Serum insulin concentrations increased within 30 min from basal values of 37 +/- 15 to 140 +/- 46 pmol/l after U40-insulin and from 36 +/- 10 to 116 +/- 37 pmol/l after U100-insulin (p < 0.001). After 45 min serum insulin concentrations were 164 +/- 43 pmol/l with U40-insulin and 128 +/- 35 pmol/l with U100-insulin (p < 0.001). Decline in blood glucose levels and suppression of C-peptide were comparable. The serum insulin levels reached 30 and 45 min after U40- and U100-insulin injection were positively correlated with skin temperature (p < 0.0008), and negatively correlated with subcutaneous fat thickness (p < 0.009). In conclusion, the lower insulin concentration of U40-insulin, higher skin temperature, and a thinner subcutaneous fat tissue at the injection site are associated with accelerated and enhanced subcutaneous insulin absorption.

Absorption↗
PubMed1994

[Quality control and quality assurance in therapeutic shoes for the diabetic foot].

More than 90% of diabetic patients with previous neuropathic foot ulcers will experience ulcer relapses within 48 months of follow-up. Custom-made cushioned footwear, according to observations in 217 patients at various centres, can prevent approximately 50% of ulcer relapses. However, the reports quoted lack some precision and clarity as to the etiology of the foot lesions taken into account, the time the footwear had been worn by the patients, the quality of the footwear, as well as the quality of simultaneous foot care, and the total observation period. Future long-term studies on the efficiency of footwear for diabetic patients are warranted, with better standardization. It is suggested that new technical equipment for computerized monitoring of in-shoe foot-pressures during gait should be used for quality control of the footwear of diabetic patients.

Diabetic Foot↗
PubMed1993

A case of lipoatrophy with human insulin-therapy.

A case of progressive insulin-induced lipoatrophy is reported in an insulin-dependent diabetic patient having been treated exclusively with human insulin. The lipoatrophy was stopped after insulin therapy was changed from subcutaneous injections to continuous subcutaneous infusion with human insulin.

Diabetes Mellitus, Lipoatrophic↗
PubMed1993

Outpatient treatment of unilateral diabetic foot ulcers with 'half shoes'.

The impact of 'half shoes' in the treatment of neuropathic forefoot ulcers was studied in two groups of diabetic patients, who were treated either by standard treatment alone (retrospective controls, n = 22), or by standard treatment plus 'half shoes' (cases, n = 26). The groups were matched for sex, age, type, and duration of diabetes and ulcer grading. The 'half-shoe' cases' vs controls' median overall healing time was 70 vs 118 days, the median difference being 48 (95% CI: -5 to 82) days (NS). In the case group, hospitalization was required in 1/26 (4%) of patients, vs 9/22 (41%) of the control patients (chi-square, p < 0.01). The home nursing service was required in 23% of the cases vs 18% of the controls (NS). It is concluded that the use of half-shoes, in conjunction with standard treatment provided by a specialized diabetic foot clinic, may reduce the overall healing time and does reduce the hospitalization rate. This has implications for a rational strategy of treating unilateral diabetic neuropathic foot ulcers.

Adult↗
PubMed1993

[Obliterating diabetic microangiopathy of the diabetic foot--reality or false conclusion?].

Occlusive diabetic microangiopathy like diabetic retinopathy and diabetic nephropathy has not been confirmed unequivocally in the diabetic foot. Non-occlusive disturbances, such as impaired vasomotion due to diabetic neuropathy, have been documented in the diabetic foot. Their clinical relevance, however, remains to be established. Recent reports have shown that the histopathological picture of diabetic gangrene is associated with septic vasculitis rather than diabetic microangiopathy. The assumption that diabetic gangrene in the presence of palpable foot pulses is due to occlusive microangiopathy and thus can be treated only by major amputation, appears to be unfounded.

Amputation, Surgical↗
PubMed1993

[In former East Germany were diabetic patients not only "well managed", but also well treated?].

The quality of diabetes care in the former GDR 1989/90 and in former West Germany 1990/91 was compared in a case control study. The study group consisted of 83% of the diabetic patients registered in the local diabetes care unit in Jena who were on insulin. The patients (86 women, 104 men; 131 Type-I and 59 Type-II, aged 16-60 years) were in the care of the local diabetes care unit. The control group consisted of randomly selected diabetic patients of the outpatient department of the university of Düsseldorf (matched pairs). Despite a different strategy of therapy the HbA1c (Jena/Düsseldorf) was the same: 154%/153% of the mean normal value in type-I and 178%/175% in type-II. The prevalence of retinopathy in type-I and type-II and proteinuria in type-I was not different, whereas the prevalence of proteinuria in type II- and of hypertension in both types of diabetes was higher in Jena.

Adolescent↗
PubMed1992

Pathological proteinuria in patients with insulin-dependent diabetes mellitus: relation to intensive insulin therapy.

A matched case-control study was performed to assess the prevalence of pathological proteinuria (greater than 50 mg/l) 18-34 years after onset of insulin-dependent diabetes mellitus (IDDM), in relation to intensive insulin therapy. Three groups of patients were studied greater than or equal to 18 years after onset of IDDM. In patients of group A and group B, intervention took place greater than or equal to 8 years after onset of IDDM: group A changed from traditional insulin therapy to continuous subcutaneous insulin infusion (CSII), and patients of group B changed from traditional insulin treatment (less than 3 injections/day) to multiple daily insulin injection therapy. Patients of group C continued traditional insulin therapy without intervention. The prevalence of pathological proteinuria was 3/21, 5/21, and 15/21 in group A, B, and C, respectively; 22.0 (95% confidence interval: 19.5 to 24.5) years, 22.1 (19.9 to 24.3) years, and 22.6 (20.2 to 25.0) years after onset of IDDM in group A, B, and C. The prevalence of pathological proteinuria differed significantly between group A and B vs. group C (x2 = 16.2, p less than 0.001; odds ratio 15 (3.2 to 70.3)). Glycosylated haemoglobin was 7.5 (6.9 to 8.1)% in group A, 7.6 (6.3 to 8.3)% in group B, and 8.9 (8.2 to 9.6)% in group C. In group A and B, 4/21 patients had hypertension, compared to 11/21 patients in group C. In group B, 1/21 patients had serum-creatinine greater than 130 mumol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Habitual physical activity in adult IDDM patients. A study with portable motion meters.

The objective of this study was to assess the habitual physical activity of insulin-dependent diabetes mellitus (IDDM) patients on intensive insulin therapy. This case-control study consisted of 34 IDDM patients (14 on multiple injection therapy, 20 on continuous subcutaneous insulin infusion [CSII], and control subjects matched for sex, age, weight, height, body mass index, smoking behavior, and occupational status). Seven IDDM patients were studied before and after changing from multiple injection to CSII therapy. All patients were well controlled according to HbA1c. Portable motion meters were used to assess habitual physical activity during 7 consecutive days with appreciable reproducibility (coefficient of variation 1.24%) and agreement to standardized activity protocols (r = 0.96, P < 0.001). Habitual physical activity was similar in IDDM patients on injection treatment and in controls, respectively. CSII-treated patients exhibited on the average 17% less habitual physical activity than control subjects (P < 0.05). Changing from multiple injection therapy to CSII lowered habitual physical activity insignificantly in seven patients. There was no indication of decreasing physical exercise (e.g., sports) by CSII in this patient group. No correlations were found between habitual physical activity and HbA1c or body mass index, respectively. Habitual physical activity is similar in IDDM patients on multiple injection therapy and control subjects, but may decrease by CSII therapy.

Adult↗