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Biomedical subjects

F I Martin

Publications and source records attributed to F I Martin.

At least 37 records · Page 2Linked to original sources
PubMed1987

Pregnancy in women with diabetes mellitus. Fifteen years' experience: 1970-1985.

The perinatal mortality of 613 children who were born to women with diabetes mellitus who attended the Diabetic Clinic of The Royal Women's Hospital between 1970 and 1985 was 4.5%. In 399 children who were born to mothers with pre-existing diabetes (95% of whom were insulin-dependent) the over-all perinatal mortality was 7.5%. In successive five-year periods, perinatal mortality in this group declined from 12.2% to 3.9% (1981-1985). In 214 children who were born to mothers with gestational diabetes, the perinatal loss was 1.4%. Between 1970 and 1985, the fetal loss that was attributed to poor control of diabetes declined; however, the prevalence of congenital abnormalities remained unchanged and these were the major cause of fetal loss in 1981-1985. Other high-risk categories that were identified included obstetric complications, particularly that of pre-eclampsia. Neonatal complications had little effect on the eventual outcome, but respiratory distress, macrosomia, hypoglycaemia, jaundice, polycythaemia, hypocalcaemia and hypomagnesaemia were documented frequently and required specialized assessment. The causes of the improvement in the outcome of pregnancy in women with pre-existing diabetes appear to be multifactorial and due to team management in a specialized unit. A reduction in the increased prevalence of major congenital abnormalities is the major challenge for the future.

Congenital Abnormalities↗
PubMed1987

The relationship of acute insulin sensitivity to the progression of vascular disease in long-term type 1 (insulin-dependent) diabetes mellitus.

In 51 individuals with Type 1 (insulin-dependent) diabetes mellitus initially of more than 15 years' duration, the acute hypoglycaemic effect of intravenous insulin (0.11 IU/kg) was related to outcome over 18 years. This acute insulin sensitivity, or glucose assimilation index, was reproducible over the period of study. At 18-year follow-up, initial low glucose assimilation index (less than 0.082 mmol X l-1 X min-1 was significantly (p less than 0.01) associated with death from vascular disease. Low glucose assimilation index was similarly significantly (p less than 0.01) associated with progression of atherosclerotic disease, but not with microangiopathy alone. Hypertension (systolic blood pressure greater than 150 mmHg and/or diastolic blood pressure greater than 95 mmHg) was the only other parameter significantly (p less than 0.01) related to outcome, but this relationship was no longer significant once glucose assimilation index had been taken into account. A linear logistic analysis confirmed that acute insulin sensitivity was independently associated with outcome. Neither initial clinical control of diabetes nor glycosylated haemoglobin level in the 26 survivors was related to vascular prognosis.

Blood Glucose↗
PubMed1986

Heel ulcers in patients with long-standing diabetes who wear antiembolism stockings.

Four patients with long-standing insulin-dependent diabetes mellitus developed heel ulceration while wearing correctly fitted antiembolism stockings after major surgery. These patients all had evidence of peripheral vascular disease and peripheral neuropathy. Heel ulceration appears to be a significant side-effect of this form of prophylaxis against venous thromboembolism in patients with long-standing diabetes mellitus. The use of antiembolism stockings in such patients, who are likely to have vascular and neurological impairment, should be undertaken with great care, if at all.

Aged↗
PubMed1986

A high prevalence of diabetes in a rural village in Papua New Guinea.

The prevalence of glucose intolerance was determined in a sample of 192 adults (34% of the adult population) from Wanigela in rural Central Province, Papua New Guinea. This centre was chosen to compare the high prevalence rates previously found in residents from this village who had become urbanized in Port Moresby. The age- and sex-standardised rates for abnormal glucose tolerance in Wanigela were significantly lower than those recorded in the urban community. However, the crude rates of 8.9% for diabetes and 5.7% for impaired glucose tolerance are among the highest reported for rural populations in the Pacific. These results strongly suggest that a genetic predisposition to glucose intolerance is present in this ethnic group, and argue for the early adoption of primary prevention programmes as the process of development encroaches rapidly upon the traditional lifestyles of previously isolated communities in Papua New Guinea.

Adolescent↗
PubMed1986

Interaction between HLA antigens and immunoglobulin (Gm) allotypes in susceptibility to type I diabetes.

HLA-A,B,C and DR typing was performed on 108 Caucasian type I diabetic patients, 68 being Gm typed. The expected association with B8, B18, Bw62, DR3 and DR4 was observed as well as an excess of DR3/4 heterozygotes. DR2 was decreased in frequency. In the total patient group, no Gm association was observed but when the patients were subgrouped according to HLA type, HLA/Gm interactive effects were seen. An increase in Gm(1,3;5) was observed in DR3 positive, DR4 negative patients. This association occurred predominantly in females (compared with DR4 and DR3/4 patients of the same Gm phenotype who were predominantly male). Further genetic heterogeneity was identified within DR3/4 patients. Within this group, Bw62 was increased (strongly suggestive of Bw62-DR4 haplotypes) within B8, Gm heterozygotes compared with B8, Gm homozygotes. This finding can be interpreted as indicating a three-way interaction between genes on two HLA haplotypes and Gm-linked genes. These results reflect the genetic heterogeneity and complexity of insulin-dependent diabetes mellitus and explain in part the previous failure of simple genetic models to adequately explain inheritance patterns observed.

Diabetes Mellitus, Type 1↗
PubMed1986

Fasting plasma insulin. A risk factor for abnormal electrocardiogram in Maltese residents of Australia.

Analysis of atherogenic risk factors in 493 Maltese-born residents of Melbourne showed that after adjustment for the effects of age, fasting plasma insulin was the only factor with a highly significant (p = less than 0.001) association with electrocardiogram abnormalities suggestive of atherosclerotic coronary artery disease. Absence of peripheral arterial pulses was not correlated with abnormal electrocardiogram but was significantly associated with both age and smoking. Elevation of plasma insulin appears to be a significant risk factor for atherosclerotic heart disease.

Adolescent↗
PubMed1985

Increase in remission rate in newly diagnosed type I diabetic subjects treated with azathioprine.

Azathioprine (2 mg/kg) was given, in addition to routine insulin treatment, to alternate patients presenting with recent-onset type I diabetes. Treated (N = 13) and untreated (N = 11) patients did not differ significantly at diagnosis with respect to age, duration of symptoms, body weight, blood glucose, hemoglobin A1c, or presence of ketosis. Eight patients were treated for 12 mo, three elected to stop treatment at 6 mo, and treatment was stopped in two because of side effects. Seven treated patients had a remission compared with one untreated patient. At 12 mo these seven patients were distinguished by significantly higher basal and glucagon-stimulated levels of C-peptide (1.98 +/- 0.52 and 3.88 +/- 0.34 micrograms/L, respectively) compared with the other six treated patients (0.93 +/- 0.52 and 1.32 +/- 0.85 microgram/L, respectively), and by the persistence of islet cell cytoplasmic antibodies. Remissions were not sustained in the 1-2 yr after treatment, although relapsed patients required less insulin for control. These results corroborate those from nonrandomized trials using cyclosporine and suggest that protracted treatment with nonspecific immunosuppressive drugs may be necessary to avert insulin dependence.

Adolescent↗
PubMed1984

Glucose tolerance and mortality in diabetes mellitus in Maltese-born residents of Victoria.

In view of the recognized high prevalence of diabetes mellitus in Malta compared with Australia, 75 g oral glucose tolerance tests were performed on 396 Maltese-born residents of Melbourne. Eighteen (4.5%) were found to have diabetes mellitus and 19 (4.8%) were found to have impaired glucose tolerance by current criteria. Glucose tolerance was correlated with family history of diabetes, with age, with obesity and with parity in women, but not with length of residence in Australia. Analysis of statistical data of death certification showed that Maltese-born residents of Victoria had a higher age-specific mortality from both diabetes mellitus and ischaemic heart disease than did Victorian Italian-born residents or the total Victorian population. This was most marked in women. The results suggest that Maltese immigrants to Australia after years of residence, still run a higher risk of becoming affected with diabetes mellitus or ischaemic heart disease than the average for the Australian population. The relative importance of genetic and environmental factors involved in this difference should be the subject of continuing study in the future.

Adolescent↗
PubMed1984

DR4 related antisera pattern differences in insulin dependent diabetes mellitus and rheumatoid arthritis.

Three allosera patterns of reactivity are described which appear to define subtypes of DR4 and segregate in families with different DR4 bearing haplotypes. There appears to be a preponderance of one particular subtype (termed DR4.3) occurring in type I insulin dependent diabetes mellitus, while in rheumatoid arthritis the distribution of subtypes within DR4 individuals is similar to that seen in controls. Although we refer to DR4 subtypes the proof that these sera are detecting a determinant on the DR molecule and not a product of another locus, an allele of which is linkage disequilibrium with DR4, awaits immunochemical confirmation.

Arthritis, Rheumatoid↗
PubMed1983

A comparison between islet transplantation and parenteral insulin in the control of diabetes and prevention of renal complications in mice.

The control of diabetes and the prevention of renal complications were studied in mice that received different treatment regimes for six months. Transplantation of syngeneic cultured fetal pancreas completely reversed streptozotocin-induced diabetes (mean FBG 5.1 +/- 0.4 mmole/liter six months after transplantation, versus 5.8 +/- 0.2 mmole/liter in normal mice). The mean fasting blood glucose (FBG) level of insulin-treated mice was lower than the mean FBG level of untreated diabetic mice (9.0 +/- 1.2 mmole/liter versus 11.5 +/- 1.3 mmole/liter, P less than 0.05) but exceeded the FBG level of transplanted mice (P less than 0.001) or normal controls (P less than 0.001). There were no significant differences between the mean level of glycosylated hemoglobin (HbA1c) of normal (4.8 +/- 0.3%), transplanted (4.5 +/- 0.3%), or insulin-treated mice (5.3 +/- 0.4%), but the HbA1c level in the untreated diabetic group was increased (7.0 +/- 0.5%; P less than 0.001). Six months after transplantation, the thickness of the glomerular capillary basement membrane (GCBM) was not different in the transplanted group and normal controls (156.4 +/- 5.7 nm versus 157.3 +/- 12.6 nm); the GCBM was thicker in the insulin-treated mice than in the transplanted mice (179.8 +/- 4.2 nm versus 156.4 +/- 5.7 nm; P less than 0.02), but thinner than in untreated diabetic mice (179.8 +/- 4.2 nm versus 202.2 +/- 4.4 nm; P less than 0.001). It is concluded that islet transplantation, in contrast to good control as judged by normalization of HbA1c levels achieved with parenteral insulin, prevents GCBM thickening in experimental diabetes.

Animals↗
PubMed1982

Breast tumors in patients with hyperprolactinemia.

The histology of breast lumps in five patients with hyperprolactinemia showed benign mammary dysplasia with vacuolation of acinar and duct lining cells. In two cases, foci of lobular development resembling lactating breast tissue were also noted. In the past, focal secretory change has been considered to be idiopathic, but these cases indicate a possible association with hyperprolactinemia. Among other causes hyperprolactinemia may be a manifestation of occult pituitary adenoma. Therefore it is suggested that patients with benign breast nodules showing focal secretory change should be screened for clinical and laboratory evidence of hyperprolactinemia. Although it is accepted that in mice and rats prolactin plays an important role in chemically induced mammary tumorigenesis, a consensus has not been reached with regard to its role in man.

Adult↗
PubMed1982

Insulin secretion by fetal human pancreas in organ culture.

Whole fetal human pancreases of 12-22 weeks gestation, showed histological growth and differentiation in vitro over 3 weeks. At glucose concentrations of 1-4 g/l, there was no difference in insulin secretion into culture medium over 1 h. There was no stimulation of insulin release by D-glyceraldehyde, thus defective glucose-stimulated insulin release was probably not due to impairment of an early step in glycolysis. In the presence of 0.5 mmol/l dibutyryl cyclic AMP, insulin secretion was enhanced (0.188 +/- 0.030 versus 0.100 +/- 0.012 mU x mg tissue-1 x h-1, p less than 0.001) independently of glucose concentrations. It thus appears that impairment of glucose-stimulated insulin release was unlikely to be due to insufficient intracellular cyclic AMP. Insulin release increased in response to tolbutamide and theophylline. Insulin secretion was stimulated in the presence of a fivefold increase in amino acid concentration (0.118 +/- 0.018 versus 0.031 +/- 0.008 mU x mg tissue-1 x h-1, p less than 0.001). There was a fourfold increase in basal insulin secretion from islets previously grown in high concentration of amino acids compared with standard culture medium, (0.284 +/- 0.052 versus 0.067 +/- 0.011 mU x mg tissue-1 x h-1, p less than 0.001), emphasizing the important role of amino acids as substrates for B cell metabolism and development.

Amino Acids↗
PubMed1982

Mortality and morbidity of diabetes in Papua New Guinea.

A 95% follow-up of all known diabetic patients in one racial group in Papua New Guinea was performed. Mortality was high with an average life-span of 4-5 years from the time of diagnosis. Microvascular diabetic complications were detected in over half of the surviving diabetic patients whose average duration of known disease was 3.8 years. At present, diabetes mellitus is both a rapidly fatal and morbid disease in Papua New Guinea.

Adolescent↗
PubMed1981

Evaluation of home glucose measuring devices.

A large number of glucose-monitoring systems suitable for home use are now available. The Glucochek, an early model (Mk I) and a later (Mk II), the Stan Clark RAHC, the Glucometer, and 20-800 BM glycemie strips were evaluated with regard to accuracy, precision, model variability and operator variability before a particular system was recommended for patient use. Whole blood glucose, on samples samples taken in the Diabetic Clinic of The Royal Melbourne Hospital, Melbourne, was measured with the system under test and in the Biochemistry Department. Accuracy was indicated by the mean of the differences between the two results, and precision by the standard deviation of these differences-the closer these results to zero, the better the system. The 20-800 BM Glycemia strips gave the best results in the hands of an experienced operator, but showed the greatest interoperator differences. These differences decreased when a machine-based system was employed. The Glucochek Mk I did not perform satisfactorily. All the systems tested showed a marked decrease in accuracy and precision when blood glucose levels were greater than 15.0 mmol/L. These results show that a machine is not a necessary part of a home glucose-monitoring system; that patients on home glucose-monitoring must be trained and their results checked against a reference method initially and, ideally, at regular intervals; that home glucose-monitoring in patients with marked hyperglycaemia unreliable.

Blood Glucose↗
PubMed1981

Fallibility of postal questionnaire follow-up for detection of hypothyroidism after iodine-131 therapy.

Four hundred and twelve patients who received radioactive iodine for thyrotoxicosis were followed up for periods from one to three years by postal questionnaire. Hypothyroidism was detected in only three instances, and, despite intensive efforts to trace subjects, 41% of them were lost to follow-up because of either failure to participate or change of address over three years. It is apparent that a postal questionnaire is an unsatisfactory method for following up a Melbourne inner-suburban population over a prolonged period.

False Negative Reactions↗