Pancreatic antibodies as a marker for pancreatic graft rejection.
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Adult↗
Biomedical subjects
G Sundkvist
Publications and source records attributed to G Sundkvist.
A two-colour immunofluorescence test with a monoclonal human proinsulin antibody improves the assay for islet cell antibodies.
The conventional indirect immunofluorescence assay for islet cell antibodies was compared with a two-colour immunofluorescent assay to detect both islet cell antibodies with fluorescein isothiocyanate-labeled rabbit anti-human IgG and pancreatic B cells with a monoclonal human proinsulin antibody and Texas red-labeled sheep anti-mouse IgG. Determinations of end-point titres showed a correlation between the new two-colour immunofluorescent assay and the conventional indirect immunofluorescent assay in 1) selected sera positive for islet cell antibodies and insulin autoantibodies rs = 0.93 (p less than 0.01) or for islet cell antibodies alone rs = 0.99 (p less than 0.005) and 2) sera from children or young adults with newly diagnosed Type 1 (insulin-dependent) diabetes rs = 0.95 (p less than 0.0001). No interference between the monoclonal human proinsulin antibodies and islet cell antibodies with or without insulin autoantibodies or between the two second fluorescent antibodies was detected. It is concluded that the two-colour immunofluorescence assay is advantageous since it is possible to mix the reagents to avoid a more time-consuming and technically complicated assay, the presence of B cells can be confirmed in each section to permit detection of B cell cytoplasmic antibodies and microscopic evaluation is easier and more accurate, particularly in islet cell antibody negative samples.
Aged↗
Autonomic neuropathy and toe circulation. A prospective study.
Ankle and toe pressure ratios and toe temperature reactions to cold followed by indirect heating were evaluated in 23 diabetic patients with and without autonomic neuropathy (AN) in a first and in a second follow-up study after 5-7 years. In the first study, despite normal blood pressure ratios, AN patients, all with parasympathetic neuropathy, showed a markedly delayed increase in toe temperature after cooling followed by indirect heating. In the second study, most AN patients showed sympathetic neuropathy and had higher toe temperatures before cooling than those without AN. Parasympathetic neuropathy leads to increased sensitivity to cold in toe vessels and sympathetic neuropathy to vasodilation and increased toe temperatures.
Adult↗
Autonomic nerve function tests. Reference values in healthy subjects.
Autonomic nerve function was evaluated by deep breathing (E/I heart rate ratio) and tilt table tests (acceleration index, brake index, and blood pressures) in 56 healthy subjects in order to find reference values. The results showed that the E/I ratio, the acceleration index and the brake index fell with increasing age. There was no influence of age on the systolic and the diastolic blood pressure reactions to tilt. Age-related reference values are needed in the evaluation of autonomic neuropathy indices.
Adolescent↗
Oesophagus scintigraphy in patients with diabetes mellitus.
Oesophagus scintigraphy with 99mTc was used to evaluate oesophageal motility in 40 patients with insulin-dependent diabetes mellitus. Abnormal oesophageal function was found in one third of the patients, although none reported oesophageal symptoms. The patients with abnormal oesophageal motility had a high frequency of abnormal autonomic nerve function tests compared with controls.
Adult↗
Measurement of hemoglobin A1c by a new liquid-chromatographic assay: methodology, clinical utility, and relation to glucose tolerance evaluated.
A chromatographic method for determining glycated hemoglobin (Hb A1c) by use of a new monodisperse cation-exchanger has been investigated. Hb A1c was separated from other "minor hemoglobins": Hb F, Hb A3 (the glutathione adduct), and the acetaldehyde adduct in alcoholics. The method was fully automated and a single column could be used for more than 1000 runs. The normal reference interval was 4.0-5.2%; the interval for diabetic outpatients was 5.6-12.4%. Within-run and the between-run CVs were less than 0.9% and 1.7%, respectively. Carbamylation in uremic patients who were undergoing hemodialysis increased the proportion of Hb A1c to 1%. Hb A1c results were compared with results from glucose tolerance tests. In our study, Hb A1c less than 5.5% excluded diabetes: subjects with Hb A1c greater than 6.2% showed diabetes. If blood sampled during fasting had been screened with determinations of glucose and Hb A1c, only 20% of referred subjects would have needed an oral glucose tolerance test for diagnosis of diabetes.
Adult↗
Effects of chlorpropamide and alcohol on aldehyde dehydrogenase activity and blood acetaldehyde concentration.
Aldehyde dehydrogenase (ALDH) activity is increased in Type 2 diabetics with macrovascular disease, and is a critical factor determining the chlorpropamide-alcohol flush (CPAF), a phenomenon possibly related to diabetic complications. To evaluate the possible effects of chlorpropamide (CP) on ALDH activity we studied 8 Type 1 and 20 Type 2 diabetics. Blood acetaldehyde concentration after intake of CP and alcohol was higher in patients with CPAF than in those without CPAF (p less than 0.005), and in those with low basal erythrocyte ALDH activity than in those with high basal enzyme activity (p less than 0.05). Administration of CP reduced ALDH activity in 20 of 26 patients (p less than 0.05). Alcohol intake was observed to have an additional inhibitory effect on ALDH activity. Accordingly, a combination of CP and alcohol decreases the activity of erythrocyte ALDH which might explain the CPAF phenomenon. Absent correlation between CP level and reduction of ALDH activity indicates a major role for alcohol in CPAF. A therapeutic dose of CP or a small amount of alcohol might be used when a reduction of ALDH activity is considered.
Acetaldehyde↗
Glomerular filtration rate, autonomic nerve function, and orthostatic blood pressure in patients with diabetes mellitus.
Glomerular filtration rate (GFR) measured by the 51Cr-EDTA clearance method, autonomic nerve function evaluated by the heart rate reaction to deep breathing (E/I ratio) and to tilting (acceleration and brake indices), and orthostatic blood pressures were followed up after 5-7 yr in 43 patients with Type 1 diabetes. At follow up, 20 patients showed a decrease in GFR greater than expected. In the first study, these patients showed low E/I ratios and brake indices indicating vagal neuropathy, while the acceleration index fell, indicating sympathetic denervation, between the studies. Accordingly, vagal neuropathy preceded decreases in GFR and sympathetic denervation favoured deteriorations in GFR. The present report provides evidence that sympathetic denervation might be behind the development of diabetic kidney complications.
Adult↗
Responses of plasma catecholamines to tilt in patients with diabetes mellitus.
The immediate heart rate acceleration, blood pressure reaction, plasma adrenaline (PA), and plasma noradrenaline (PNA) responses to a 90 degrees and 2 sec tilt were evaluated in 13 male patients with type I diabetes. A disturbed immediate acceleration, as measured by a previously described acceleration index (AI), was found in 5 patients. All patients with normal AI but only one of those with abnormal AI showed an increase in PA during the first minute after tilt (p less than 0.02). A late diastolic blood pressure fall occurred in 6 patients and the fall was minor (5 mmHg) in 5 of these. Patients with a late diastolic blood pressure fall showed a significantly lower increase in PNA 1-8 min after tilt than those without (55 +/- 13% versus 163 +/- 24% (mean +/- SE), p less than 0.005). An abnormal immediate acceleration to tilt is associated with an impaired sympatho-adrenal reaction, and even a minor diastolic blood pressure fall indicates peripheral sympathetic denervation.
Adult↗
Growth hormone and endothelial function during exercise in diabetics with and without retinopathy.
Changes in plasma growth hormone (GH), factor VIII related antigen (VIIIR:Ag), and plasminogen activator activity (PAA) during exercise were evaluated in 50 insulin-dependent diabetics. In patients with a short to moderately long duration of diabetes (5-19 years, mean 11), GH increased only in those with retinopathy. VIIIR:Ag and PAA increased most pronouncedly in retinopathy patients as well. In diabetics with long duration of the disease (21-49 years, mean 35), GH, VIIIR:Ag and PAA increased almost equally in those with and without retinopathy.
Adult↗
Influence of autonomic neuropathy on leg circulation and toe temperature in diabetes mellitus.
The relationship between neuropathy and peripheral circulation was assessed in 26 patients with a short to moderate duration (less than 20 years, mean 11 years) and in 26 patients with a long duration (greater than 20 years, mean 35 years) of diabetes mellitus. Peripheral nervous function was evaluated from measurements of vibration thresholds and ankle reflexes and autonomic nervous function from deep breathing, Valsalva, and tilt table tests. Peripheral circulatory tests included plethysmography, systolic blood pressure ratios, and thermography. A markedly delayed toe temperature increase after cooling followed by indirect heating occurred in diabetics of short duration with autonomic neuropathy (AN). Judging from blood flows and pressure ratios, functional vasospasm caused abnormal toe temperature reactions in short duration diabetics. No correlation existed between AN and abnormal toe temperature reactions in diabetics of long duration. Macroangiopathy rather than AN seemed to be responsible for abnormal toe temperature reactions in long duration diabetics. Thus, an abnormal toe temperature reaction indicates AN in patients with a short duration and macroangiopathy in patients with a long duration of diabetes.
Adult↗
Disturbances of autonomic nervous function and peripheral circulation in diabetes mellitus.
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Adult↗
Effect of the degree and speed of tilt on the immediate heart rate reaction.
The effect of the degree and speed of tilt on the immediate heart rate reaction measuring cardiac autonomic nerve function was evaluated in nine healthy subjects. The results showed that the tilt angle determined the immediate increase in heart rate. The increase in heart rate was maximal when a 90 degrees tilt was performed. After the immediate increase there was a transient decrease in heart rate after rapid tilts (2-5 s). A rapid 90 degrees tilt is preferred when automatic nerve function should be evaluated from the immediate heart rate response.
Adult↗
Fibrinolytic activity, autonomic neuropathy, and circulation in diabetes mellitus.
In diabetes mellitus the vascular endothelium often produces and releases abnormally low amounts of plasminogen activator, leading to an impaired fibrinolytic system, which might be of importance for the development of angiopathy. In this study tests of autonomic neuropathy (AN) were performed on diabetics without autonomic symptoms. It was discovered that diabetics without AN had a significantly lower mean fibrinolytic response to stimulation than nondiabetic controls, whereas this reduction was not found in those with AN. The suggestion that asymptomatic AN might induce a normalization of the impaired fibrinolytic system in diabetes, and thus have a modifying effect on the rate of development of angiopathy, requires further study to be properly evaluated.
Adult↗
Autonomic nerve function in rheumatoid arthritis of varying severity.
Autonomic nerve function was evaluated by deep breathing and tilt table tests in 17 patients with rheumatoid arthritis (RA) and in 24 healthy control subjects. The results showed that all RA patients had increased heart rates at rest, irrespective of the severity of the disease. Patients with severe RA had increased systolic and diastolic blood pressures before and after tilting. Pronounced abnormalities in the immediate heart rate reaction to tilting indicating autonomic neuropathy (AN) were also demonstrated in patients with severe RA. The abnormal immediate reaction to tilting was mainly the result of vagal neuropathy. From the present study it is evident that severe RA may be accompanied by AN and the consequences need to be elucidated.
Adult↗
Endothelial factors, toe temperature and leg circulation in diabetics with and without autonomic neuropathy.
A low plasminogen activator response to venous occlusion is frequently found in diabetes. The aims of this investigation were to study any relationships between plasminogen activator activity and autonomic neuropathy (AN), and between abnormal toe temperature reactions and AN. Asymptomatic AN is frequently found in insulin dependent diabetics. The results might be an abnormal balance between the parasympathetic and sympathetic innervation of the vessels, which in turn will lead to a change of the reaction to cooling of the feet followed by indirect heating. In this study 52 insulin dependent diabetics were examined with a combination of tests for AN and blood flow measurements as well as plasminogen activator activities of the blood and vascular walls. In patients with a short duration of diabetes (mean 11 years) the prevalence of AN was high in those with abnormally slow increase in toe temperature after cooling followed by indirect heating. The mechanism behind appeared to be a functional vasospasm. In diabetics of short as well as of long duration (mean 35 years), an abnormally low plasminogen activator activity of the blood during venous occlusion was found in those without AN, while those with AN showed a normal activity. Thus, AN might influence the deterioration of the circulation in diabetes.
Adult↗
Deep breathing, Valsalva, and tilt table tests in diabetics with and without symptoms of autonomic neuropathy.
Autonomic neuropathy (AN) test results (Valsalva manoeuvre, deep breathing, and tilting) are frequently impaired in diabetics without symptoms of AN, particularly in those with peripheral neuropathy (PN). We have investigated 24 asymptomatic diabetics with PN, 17 diabetics with symptoms of AN and 24 healthy controls. The heart rate reactions to the three tests were impaired in both patient groups. The Valsalva manoeuvre could not distinguish between the patient groups. The heart rate reaction to deep breathing, estimated as the expiration/inspiration (E/I) ratio, was slightly more disturbed in patients with AN than those with PN (1.04 vs. 1.09, p less than 0.05) but the frequency of abnormally low E/I ratios was high in both groups (76.5 vs. 54.2%, NS). The immediate heart rate reaction to tilting, estimated as the brake index, clearly separated the patient groups. An abnormally low brake index was shown in 82.3% of AN patients and in 33.3% of PN patients (p less than 0.01). The study shows that the deep breathing test is sensitive for AN but an impaired immediate heart rate reaction to tilting is more specific for symptomatic AN.
Adult↗
Testing for autonomic neuropathy.
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Autonomic Nervous System Diseases↗