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Biomedical subjects

G V Gill

Publications and source records attributed to G V Gill.

At least 73 records · Page 4Linked to original sources
PubMed1994

Serious unexpected sinus infection discovered by CT scanning for presumed neurological disease.

Serious infection in the paranasal sinuses may present with symptoms suggestive of neurological disease and thus lead to delay in the diagnosis and subsequent treatment. We present three such cases in whom the initial diagnoses had been acute optic neuritis, a posterior communicating aneurysm and an intracranial space occupying lesion. The fourth patient had meningitis but the paranasal sinuses had not initially been considered as a possible source of infection. The current methods of diagnosing sinusitis are discussed.

Adult↗
PubMed1993

Hypoglycaemic admissions among diabetic patients in Soweto, South Africa.

An audit of hypoglycaemic admissions among diabetic patients to Baragwanath Hospital, Soweto, South Africa was carried out prospectively during a recent 5-month period. A total of 51 episodes of biochemically confirmed hypoglycaemia (blood glucose < 2.2 mmol l-1 with coma or pre-coma, and requiring intravenous glucose) were observed in 43 patients. There was a wide range of ages (22-88 years) and an excess of males (27 M:16 F). Fourteen (33%) cases were associated with sulphonylurea (gliclazide) treatment. Doses of insulin or sulphonylureas were not excessive. The major cause precipitating the event was a missed meal (36%), though alcohol (22%), gastrointestinal upset (20%), and inappropriate treatment (18%) were also important contributory factors. Following recovery from the event, doses of drugs or insulin were frequently reduced, and three patients were successfully taken off insulin, and six off gliclazide. There was no mortality in this series, and no obvious long-term morbidity. We conclude that severe hypoglycaemia is a frequent and important acute diabetic complication in Soweto. Patient education and care in prescribing for Type 2 diabetic patients may help reduce its occurrence and severity.

Adult↗
PubMed1993

Insulin treatment, time-zones and air travel: a survey of current advice from British diabetic clinics.

To investigate current advice given to insulin-treated diabetic patients undertaking international flights crossing time-zones, we have conducted a survey of UK physicians running diabetic clinics. Consultants were asked to give the general advice they would give to travellers on twice-daily short- and intermediate-acting insulins in four different flight situations: westward London to New York (morning and evening departures) and eastward Manchester to Singapore (morning and evening departures). Response rate was poor (37%). Six percent of replies were unhelpful (e.g. 'ring the BDA', 'carry on as usual'), and 14% liable to cause hypoglycaemia. Thirteen percent advocated change to a 'basal-bolus' system of insulin administration. The rest used variants of additional insulin for westward flights and reduced flights eastward. There was great variation in advice, and many regimens were excessively complicated. We recommend simple individualized advice, without attempts at over-zealous glycaemic control during travel. Local arrival and departure times may fit in easily with insulin and meals at standard times before and after flying, and little or no dosage alteration may be needed.

Aviation↗
PubMed1993

Severe insulin-induced lipohypertrophy successfully treated by liposuction.

OBJECTIVE: To examine the usefulness of liposuction surgery on diabetic patients with lipohypertrophy. RESEARCH DESIGN AND METHODS: We treated a diabetic patient who suffered from severe localized thigh lipohypertrophy. When she did not respond to conventional treatment of resting the injection site, we recommended liposuction surgery. RESULTS: Our patient's lipohypertrophy was immediately cured by the liposuction procedure. CONCLUSIONS: Liposuction surgery could be useful in patients with diabetic lipohypertrophy who do not respond to more conservative treatments.

Adipose Tissue↗
PubMed1993

Albendazole is effective treatment for chronic strongyloidiasis.

A total of 301 British ex-Far East prisoners of war, many of whom worked on the Thai-Burma Railway during World War II, consecutively attended The Liverpool School of Tropical Medicine for clinical review between January 1987 and August 1990. Fifty-two (17%) were found to have chronic strongyloidiasis. Diagnostic criteria included any of the following: characteristic larva currens rash, positive Strongyloides serology, and positive stool examination. Forty-seven were evaluable 6 months, after therapy with albendazole 400 mg twice daily for 3 days, which resulted in a 75% cure rate. Cure was defined as disappearance of the rash, if present, negative serology and negative stool examination. Patients who had more than one positive diagnostic feature were only considered cured if both or all had disappeared or become negative. All 12 of the patients in whom initial treatment failed were given a second course of albendazole: three further cures were obtained in eight evaluable patients. The overall cure rate was 81%. The only side-effects recorded were mild nausea and diarrhoea in one patient. We suggest that albendazole should be the treatment of choice for chronic strongyloidiasis.

Aged↗
PubMed1992

Diabetes in prison: can good diabetic care be achieved?

OBJECTIVE: To investigate the clinical characteristics and metabolic control of diabetic patients given structured diabetic care in prison. DESIGN: Survey of diabetic men serving prison sentences during a 22 month period in a large British prison. SETTING: HM Prison, Walton, Liverpool. SUBJECTS: 42 male diabetic prisoners, of whom 23 had insulin dependent and 19 non-insulin dependent diabetes. MAIN OUTCOME MEASURES: Episodes of diabetic instability, glycated haemoglobin concentrations, body mass index. RESULTS: No serious diabetic instability occurred. Between the initial assessment by the visiting consultant diabetologist and a second assessment 10 weeks later glycated haemoglobin concentrations had fallen from 10.8 (SD 2.9)% to 9.8 (2.4)% (p less than 0.05) in prisoners with insulin dependent diabetes and from 8.7 (1.9)% to 7.6 (1.2)% (p less than 0.05) in those with non-insulin dependent diabetes. Good glycaemic control continued, a mean glycated haemoglobin concentration of 7.6 (1.5)% being recorded in seven men remaining in prison for six to 18 months. Mean body mass index (weight (kg)/(height(m))2) did not change during the study (insulin dependent prisoners 23.3 (SD 2.1), non-insulin dependent prisoners 27.9 (3.8)). CONCLUSIONS: Good diabetic metabolic control is usual in prison, probably due to the rigid dietary regimen, no alcohol, and compliance with treatment. Many younger men had defaulted from their home diabetic clinics, and imprisonment allowed screening for diabetic complications and reassessment of treatment. Structured diabetic care should be offered in all prisons.

Adult↗
PubMed1992

The spectrum of brittle diabetes.

A group of 42 severely brittle insulin dependent diabetic patients were studied, and compared with a similar number of 'stable' diabetic patients. Brittle diabetics were predominantly female (86% v 45%, P < 0.01), were of younger age (mean +/- SD 27.9 +/- 12.8 years v 40.1 +/- 13.6 years, P < 0.001), and of shorter duration of diabetes (13.7 +/- 9.4 years v 19.6 +/- 11.2 years, P < 0.01). Control as measured by glycosylated haemoglobin (HbA1) was poorer (13.7 +/- 3.1% v 10.1 +/- 1.5%, P < 0.001), and daily insulin dose higher (98 +/- 81 u v 47 +/- 14 u, P << 0.001). There was no difference in diabetic complication rates, but psychosocial disturbances (74% v 17%) and factitious instability (40% v 2%) were highly significantly more common amongst brittle patients. Examination of patterns of admission revealed most brittle diabetics to have hyperglycaemic problems (70%), mainly due to recurrent ketoacidosis (52%). Recurrent hypoglycaemia accounted for 12% of the group, and only 5/42 patients (12%) had mixed forms of instability. Brittle diabetes is thus characterized by young age and female sex, and usually manifests itself as recurrent ketoacidosis or other forms of hyperglycaemic instability. Psychosocial problems and factitious metabolic decompensation are common.

Adult↗
PubMed1991

'Brittle' diabetes.

Explore the source record for details and available documents.

Diabetes Mellitus, Type 1↗
PubMed1991

Unexplained deaths of type 1 diabetic patients.

The suggestion of an increase in the number of sudden deaths of young people with Type 1 diabetes in the UK has been investigated. It was suggested that such deaths were due to hypoglycaemia and related to the increasing use of human insulin. In total we were notified of 50 deaths of people with Type 1 diabetes under age 50 years in the UK in 1989 which our informants (relatives, physicians, and pathologists) considered sudden and unexpected. An autopsy had been done in all cases and we supplemented this with detailed clinical information from relatives and case records. Of the 50 cases we excluded five with a definite cause of death, 11 suicides or self-poisonings, six cases of ketoacidosis, and four in which there was insufficient information about the circumstances of death to drawn any conclusions. Of the other 24 cases, two patients had been found with irreversible hypoglycaemic brain damage and died after a period of artificial ventilation. The most puzzling group were 22, aged 12-43 years, most of whom had gone to bed in apparently good health and been found dead in the morning. Nineteen of the 22 were sleeping alone at the time of death and 20 were found lying in an undisturbed bed. Most had uncomplicated diabetes and in none were anatomical lesions found at autopsy. There are major difficulties in diagnosing hypoglycaemia post-mortem, but the timing of death and other circumstantial evidence suggests that hypoglycaemia or a hypoglycaemia-associated event was responsible. All patients were taking human insulin at the time of death but most had been changed from animal insulin between 6 months and 2 years earlier and there was nothing to implicate the species of insulin as a factor in these deaths.

Adolescent↗
PubMed1991

Deterioration in blood glucose control in females with diabetes changed to a basal-bolus regimen using a pen-injector.

Although the basal-bolus regimen of insulin delivery is more physiological than conventional twice daily insulin it does not usually improve blood glucose control. Having recently withdrawn 3 patients from pen-injector therapy for deteriorated blood glucose control we examined the records of all our diabetic patients on a pen-injector for at least 1 year. Of the 51 patients identified, 3 had died, 2 moved away, and 4 patients (3 females) had pen-injector therapy withdrawn for poor control; 3 patients had inadequate records. The remaining 21 males and 18 females were well matched for age, duration of diabetes, and duration of pen-injector treatment. Blood glucose control deteriorated significantly during pen-injector therapy in female patients (9.6 +/- 1.2 to 10.7 +/- 1.4%, p = 0.02), but not in the males (9.3 +/- 1.3 vs 9.4 +/- 1.4%, NS). Weight and insulin dose did not change significantly in any patient. Blood glucose control may deteriorate in young women with diabetes changed to insulin therapy with a pen-injector.

Adult↗
PubMed1991

Horizontal transmission of hepatitis B virus amongst British 2nd World War soldiers in South-East Asia.

Infection with hepatitis B virus (HBV) is much more common in tropical than in temperate countries. Visitors to the tropics are thus at risk from HBV, though the degree of risk, and the routes of infection involved are uncertain. We report serological markers of HBV in two groups of 2nd World War soldiers, who served in the Thai/Burma jungles. The groups comprised 100 ex-prisoners of the Japanese (POW), and 100 Burma Campaign Veterans (BCV). Surface antigen to HBV (HbsAg) was positive in 0% of POW and 2% of BCV (P = not significant). Surface antibody (anti-HBs) and core antibody (anti-HBc) were both positive in 40% POW and 13% BCV (P less than 0.001). Quoted UK prevalence rates for these markers are 0.1% for HBsAg, 1.5% for anti-HBs and 0.7% for anti-HBc. Both groups thus show very high rates of past HBV infection. For the POW there were many possible reasons, including contaminated surgical instruments and needles, blood transfusions, and multiple beatings with common weapons. None of these factors operated significantly for BCV. Malarial transmission was, however, intense in both groups, though more so in POW. The data thus again raise the possibility of horizontal transmission of HBV by biting insects in tropical countries.

Hepatitis B↗
PubMed1991

Patterns of insulin dependence in an African diabetic clinic.

Analysis of the age of onset of diabetes amongst insulin-treated patients in a large African diabetic clinic revealed a bimodal type of distribution, 23 per cent having an age of onset before 30 years and 77 per cent with onset at greater than or equal to 30 years of age. All 66 of the young insulin-treated group (21.7 +/- 4.8 years (mean +/- 1 SD)), and a random selection of 50 older insulin-treated patients (49.7 +/- 10 years), were studied. The older group were better controlled (HbA1 8.4 +/- 1.7 per cent vs. 10.8 +/- 2.6 per cent, p less than 0.001), on lower doses of insulin (49 +/- 23 vs. 71 +/- 23 u/day, p less than 0.001) and had higher body mass index (26.0 +/- 5.6 vs. 21.8 +/- 3.5, p less than 0.001). Serum C-peptide (0.24 +/- 0.15 vs. 0.07 +/- 0.10 nmol/l, p less than 0.0001), and C-peptide/glucose ratio (2.57 +/- 2.65 vs. 0.56 +/- 0.98 nmol/mmol x 10(2), p less than 0.001) were very significantly higher in older patients. Patients with later onset disease thus had better preservation of pancreatic function, higher body mass index and better glycaemic control on lower doses of insulin. These features suggest that older insulin-treated patients could in fact be 'Type 2' or non-insulin dependent patients, and the condition may be controllable with diet and/or oral hypoglycaemic agents, at least in some.

Adult↗