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Biomedical subjects

G V Gill

Publications and source records attributed to G V Gill.

At least 91 records · Page 5Linked to original sources
PubMed1989

Problems of diabetics in prison.

Providing care for diabetics is difficult in prison. Six diabetic prisoners or former prisoners were seen whose care was difficult or unsatisfactory. Three had multiple admissions to hospital during their sentences with diabetic ketoacidosis that they induced themselves by not taking insulin. The motive seemed to be removal from prison to the fairly pleasant surroundings of the local hospital. A fourth prisoner required admission in a hyperglycaemic, hyperosmolar state that had gone unnoticed as he was thought to be "acting up." The two others had imperfect long term management of diabetes during their sentences. There is clearly room for improvement in diabetic services in British prisons, but manipulative behaviour on the part of some diabetic prisoners may remain a problem.

Adult↗
PubMed1989

Eosinophilia as a marker for chronic strongyloidiasis--use of a serum ELISA test to detect asymptomatic cases.

In a previously published survey of 602 former Far East prisoners of the 2nd World War (FEPOWs), 88 (15%) were found to have Strongyloides stercoralis infections. A further 25 (4.2%) had significant blood eosinophilia for no obvious parasitological or other medical cause. We have reinvestigated this latter group several years (range nine to 19 years) later, using a recently developed serum ELISA test as well as other standard parasitological procedures. Of the 11 who were still alive and traceable five (45%) were diagnosed as having strongyloidiasis. Eosinophilia in high risk groups such as former FEPOWs is very suggestive of Strongyloides infections. The serum ELISA test appears to be a useful, sensitive and specific screening test for this diagnostically difficult infection.

Aged↗
PubMed1989

How common is diabetic nephropathy?

In a study of 1,356 diabetic patients attending a clinic in a 12 month period, 28 (2.1%) were considered to have definite diabetic nephropathy by strict diagnostic criteria. This suggests that the prevalence of overt nephropathy is less than has been previously reported. This may be because many patients with microalbuminuria or early proteinuria do not survive to develop the syndrome of established diabetic nephropathy.

Creatinine↗
PubMed1986

Tropical or malnutrition-related diabetes: a real syndrome?

The syndrome known as tropical diabetes seems to be distinct from the two main types common in developed countries. Major pancreatic exocrine disease may or may not be present, and within these two groups there are clinical and biochemical variants. For these conditions the term malnutrition-related diabetes has been proposed. Although malnutrition is a plausible unifying factor, there is a good case for retaining the term tropical diabetes until there is more information on clinical and biochemical features and on aetiology.

Abdomen↗
PubMed1986

Development of a cytochemical assay for plasma vasopressin: application to studies on water loading normal man.

A cytochemical assay has been developed to measure human plasma arginine vasopressin. It is based on the stimulation of Na+-K+, ATPase activity located in the outer medulla of the rat kidney, and is capable of detecting very low plasma arginine vasopressin concentrations, limit of detection 0.01 pmol/l. Specificity for vasopressin stimulation of the enzyme is conferred on the assay by the use of specific vasopressin antiserum. Index of precision of the assay is 0.21. Degradation of arginine vasopressin in plasma in inhibited by phenanthroline. Samples may be stored up to 8 weeks at -70 degrees C. Intra- and inter-assay coefficients of variation were 22% (n = 8) and 104% (n = 12), respectively. A sustained water load in eight healthy male adults caused a fall in plasma osmolality from a basal of 286.5 +/- 2.0 (mean +/- SEM) to 279.2 +/- 2.4 mmol/kg after the load (P less than 0.001), which was associated with a reduction in urine osmolality from 867 +/- 54 to 69 +/- 3 mmol/kg. Plasma immunoreactive arginine vasopressin fell from 1.3 +/- 0.3 pmol/l to become undetectable (less than 0.3 pmol/l), but plasma cytochemical arginine vasopressin decreased from 0.96 +/- 0.14 to 0.07 +/- 0.02 pmol/l. There was a curvilinear relationship between plasma osmolality and plasma cytochemical arginine vasopressin, which militated against the concept of an osmotic threshold for vasopressin release.

Adult↗
PubMed1986

The metabolic response to insulin deprivation in idiopathic brittle diabetes.

To test the hypothesis that frequent episodes of ketoacidosis and severe hyperglycaemia in brittle diabetes result from an exaggerated response to insulin withdrawal, the metabolic response to insulin deprivation in 16 severely brittle female diabetics has been compared with that in 6 C-peptide negative stable female diabetic patients of similar age and body weight. 4 hr after stopping insulin infusion, blood glucose was significantly higher in the brittle diabetics (22.8 vs 17.0 mmol/l, p less than 0.001) but blood 3-hydroxybutyrate was not different (1.8 vs 1.6 mmol/l). Concentrations of free insulin and counter-regulatory hormones were similar, basally and during the deprivation. Insulin antibody levels were significantly elevated in the brittle patients (11.2 vs 5.2 mmol/l, p less than 0.05) and there was no relationship between glucose or ketone body response and antibody level. Blood lactate, pyruvate, alanine and glycerol were significantly elevated basally in the brittle diabetic patients, but did not respond differently to insulin deprivation. Basal lactate and pyruvate concentrations were significantly correlated with overnight insulin requirements (lactate, rs 0.62, p less than 0.05; pyruvate, rs 0.70, p less than 0.05) suggesting that the elevated basal concentrations resulted from the higher peripheral insulin delivery rates required to maintain overnight normoglycaemia in the brittle patients. We conclude that although there are demonstrable abnormalities of intermediary metabolism in brittle diabetics, neither elevated levels of counter-regulatory hormones, nor an exaggerated response to insulin withdrawal explains the frequent episodes of ketoacidosis in these patients.

3-Hydroxybutyric Acid↗
PubMed1986

The management of severe brittle diabetes with "Infusaid" implantable pumps.

Two severely brittle diabetic patients were treated with "Infusaid" implantable insulin infusion pumps. Both were young females with recurrent ketoacidosis, prolonged or repeated hospital admissions, and subcutaneous insulin resistance. They also had psychological problems, and had seriously interfered with their treatment to induce glycaemic instability. Delivery of insulin from the pumps was intravenous (i.v.) in one patient, and intraperitoneal (i.p.) in the other. Following implantation, there was a marked improvement in glycosylated haemoglobin level (HbA1), fasting blood glucose (BG), daily insulin dose and hospitalizations. The beneficial effect has continued to date (9 months, and 12 months follow-up) with no major problems.

Adult↗
PubMed1986

Improving diabetic control in adverse social conditions. A home blood glucose monitoring study in Soweto, South Africa.

In order to explore the feasibility of home blood glucose monitoring (HBGM) in Type 1 diabetics in developing countries, we introduced the technique to Type 1 patients below the age of 30 yr attending the Diabetic Clinic serving Soweto in South Africa. Despite initial problems, HBGM with visually-read strips was applied to 45 of the 64 young Type 1 diabetics identified ("HBGM group"). The remaining 19 were continued on urine glucose monitoring only ("HUGM group"), usually because of attendance and compliance problems. After 4 months' follow-up, glycosylated haemoglobin (HbA1) fell from 10.5 +/- 2.6% (mean +/- SD) to 9.0 +/- 1.7 (p less than 0.001) in the HBGM group, but was unchanged (10.1 +/- 2.1 vs 9.9 +/- 1.9, pn.s.) in HUGM patients. HBGM can thus be introduced in adverse social conditions, and may be associated with improved diabetic control. Costs, in terms of finance and medical time, were not excessive. Unfortunately, a significant minority were excluded by attendance and other problems, and analysis of diabetic complication rates (before the programme began) showed that these patients had significantly more complications than those deemed suitable for HBGM (42.1% vs 15.5%, p less than 0.05).

Adult↗
PubMed1985

Clinical and subclinical nutritional neurological damage in former war prisoners of the Japanese.

Five former war prisoners of the Japanese were clinically evaluated and intensively investigated for evidence of neurological disease. On release from imprisonment 36 years previously they were known to have a single neurological problem each, attributable to nutritional damage to the nervous system (four had optic atrophy and one a peripheral neuropathy). The present assessment confirmed these persisting neurological problems; but in addition two patients were found to have extrapyramidal and one pyramidal disease, one was demented, and two had evidence of non-dominant hemisphere damage on psychometric testing. Nutritional damage to the nervous system may be permanent, and more extensive than usually recognized.

Aged↗
PubMed1985

Changes in plasma solutes after food.

In experiments on 8 healthy young male volunteers, the ingestion of a large meal was found to cause plasma osmolality to rise from 288.8 +/- 0.8 (mean +/- s.e. mean) to 295.6 +/- 0.9 mmol/kg at 4 hours (P less than 0.001). There was an accompanying rise in plasma sodium (Na) from 141.9 +/- 0.8 to 144.6 +/- 0.8 mmol/l, also at 4 hours (P less than 0.01), but little change in other plasma electrolytes. Serum total amino acids rose slightly, non-esterified fatty acid fell minimally and changes in blood glucose concentrations were unremarkable. Thirst was experienced at plasma osmolality of 294.8 +/- 0.7 mmol/kg. Repeating the experiment either without food, or with the salt content of the meal only, was without effect on plasma Na, other solutes or osmolality. Postprandial hypersomolality and hypernatraemia is probably due to movement of water from the vascular compartment to the gut, or into cells. Plasma osmolality is best measured in the fasting state.

Amino Acids↗
PubMed1984

Intensive health screening of young black diabetics.

Black-insulin-dependent diabetics under the age of 30 years attending a busy South African diabetic clinic were intensively screened for a 4-month period. In the 66 patients studied, the following previously undiagnosed conditions were discovered: cataract (1), peripheral neuropathy (16), retinopathy (8), tuberculosis (4) and anaemia (3). In addition, 29 (43,9%) were on insulin regimens that were not ideal. Attempts were made to improve glycaemic control, especially in those patients with complications, and defective insulin regimens were corrected. The screening programme was carried out with normal manpower and investigative facilities, and the extra time involved was not excessive. This programme could be used (in either an expanded or a limited form) in any diabetic clinic, and would probably considerably improve the health of young insulin-dependent diabetic patients.

Adolescent↗