Biomedical subjects

J Jamart

Publications and source records attributed to J Jamart.

At least 37 records · Page 2Linked to original sources

PubMed2003

Combined bronchoalveolar lavage and transbronchial lung biopsy: safety and yield in ventilated patients.

The aim of this study was to evaluate the safety and diagnostic yield of bedside bronchoalveolar lavage (BAL) combined with fibrescopic transbronchial lung biopsy (TBLB) in determining the aetiology of pulmonary infiltrates in mechanically ventilated patients. The records of 38 mechanically ventilated patients who underwent BAL/TBLB to investigate unexplained pulmonary infiltrates were retrospectively reviewed. Patients were divided into two groups: immunocompetent (group 1: n = 22; group 1a: n = 11, late acute respiratory distress syndrome (ARDS); group 1b: n = 11, no ARDS) and immunocompromised (group 2, n=16). The procedure allowed a diagnosis in 28 patients (74%), inducing therapeutic modification in 24 (63%) and confirmation of clinical diagnosis in four (11%). In groups 1a, 1b and 2, diagnosis was obtained in 11 out of 11 (fibroproliferation), seven out of 11 and 10 out of 16 patients, and therapy changed in 11 out of 11 (administration of steroids), six out of 11 and seven out of 16 patients, respectively. Pneumothorax occurred in nine patients (four of group 1a), bleeding in four (<35 mL), and transient hypotension in two. No fatalities were procedure-related. Combined bronchoalveolar lavage/transbronchial lung biopsy is of diagnostic and therapeutic value in mechanically ventilated patients with unexplained pulmonary infiltrates, excluding those with late acute respiratory distress syndrome. Although complications are to be expected, the benefits of the procedure appear to exceed the risks in patients in whom a histological diagnosis is deemed necessary.

Adult↗

PubMed2002

Does inspiratory behaviour affect the efficiency of non-invasive ventilation in COPD patients?

Non-invasive ventilation (NIV) is more and more used. Some failures of the technique have been reported, and efforts are needed to understand them. Collaboration (inspiratory behaviour) of the patient during NIV could play a role in the success of this technique. We have studied the influence of this one on the efficiency of NIV. While ventilating 10 stable chronic obstructive pulmonary disease patients with a nasal pressure support ventilation (PSV), we measured their flow and volume with a pneumotachograph and oesophageal and gastric pressures during three different respiratory voluntary behaviours: relaxed inspiration, active inspiratory effort and resisted inspiration. We showed that when compared with the relaxed inspiration: (a) Active inspiratory effort increases slightly minute ventilation from 14.8 +/- 4.7 to 15.41 +/- 4.19 during PSV 10/0 without change of breathing frequency but with an important increase of inspiratory work (W(OB)) from 14.47 +/- 9.43 to 28.55 +/- 25.35 J/min (P=0.008). PEEPi increases with active behaviour during PSV but not during BiPAP. (b) A resisted inspiration decreases inspiratory work (to 7.53 +/- 8.6 J/min) at the price of a decrease of the minute ventilation to 11.47 +/- 4.20 l/min (P=0.06). Results of ventilation, PEEPi and work parameters were identical during the bilevel pressure support (15/5 cm H2O). The aims of NIV being to increase ventilation and unload the inspiratory muscles, our results suggest that during NIV, a relaxed spontaneous breathing is preferable. These differences between the inspiratory behaviours could affect the expected benefits of PSV in acutely ill patients.

Analysis of Variance↗

PubMed2002

Socioeconomic outcome of subjects experiencing asthma symptoms at work.

The aim of this study was to investigate the socioeconomic outcomes of subjects who experienced work-related asthma symptoms in the absence of demonstrable occupational asthma (OA) and to compare these outcomes with those found in subjects with documented OA. Subjects (n=157) who were being investigated for work-related asthma, were surveyed. Of these 86 had OA, ascertained by a positive specific inhalation challenge (SIC), and 71 subjects had a negative SIC response. After a median interval of 43 months (range 12-85 months), the subjects were interviewed to collect information on employment status, income changes, and asthma-related work disability. Rates of work disruption and income loss at follow-up were similar in subjects with negative SIC (46% and 59%, respectively) and in those with OA (38% and 62%). The median loss as a percentage of initial income was 23% in subjects with negative SIC and 22% in subjects with OA. Asthma-related work disability, defined as any job change or work loss due to asthma, was slightly more common in subjects with OA (72%) than in those with negative SIC (54%). This study shows that, even in the absence of demonstrable occupational asthma, work-related asthma symptoms are associated with considerable socioeconomic consequences.

Adult↗

PubMed2002

Does negative expiratory pressure influence performances of spirometry in older patients?

The aim of this study is to assess the influence of the negative expiratory pressure (NEP) technique on the performance of maximal expiratory manoeuvre in elderly patients. Firstly, the authors studied how NEP (at 5 and 10 cmH2O, NEP5 and NEP10) influences forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in 60 young healthy volunteers, in order to assess the fluctuations of the method. In the second part of the study, 65 successive elderly inpatients (>70 yrs old) were examined. In this group, 15 elderly patients were unable to perform the manoeuvre, 27 had a normal function, 14 had a lung function with obstructive pattern and nine with restrictive pattern. In young subjects, FVC during NEP5 and NEP10 compared to baseline values was 101+/-5%, and 103+/-5%, respectively, and FEV1 was 100+/-4% and 101+/-5%, respectively. In elderly patients with normal function, FVC during NEP5 and NEP10 compared to baseline values was 99+/-14% and 109+/-23%, respectively, and FEV1 was 97+/-9% and 104+/-13%, respectively. There were no relevant effects of the NEP application on FVC or FEV1 values in elderly patients with an obstructive or restrictive pattern. In elderly patients, the use of the negative expiratory pressure technique during maximal expiratory manoeuvres provides little complementary information compared to a classical manoeuvre. The negative expiratory pressure technique did not modify the initial diagnosis when compared with the classical manoeuvre.

Adult↗

PubMed2002

TOF-tube, a new protection for acceleromyography, compared with the TOF-Guard/TOF-Watch arm board.

Neuromuscular blockade monitoring at the adductor pollicis has become easier using acceleromyography. In order to guarantee a reliable analysis of its acceleration, the thumb movement has to be free and protected from external influences. To this end, we describe here-in two hand fixation- and protection-devices for use with acceleromyography. After a bolus of 0.3 mg/kg rocuronium, we compared acceleromyography data obtained simultaneously on both hands with, on one side, the cumbersome TOF-Guard/TOF-Watch arm board, and the smaller and handier TOF-tube on the other. Results showed little differences between the two devices. Yet, a short and clinically irrelevant delay was observed for TOF-tube data during recovery. This was probably caused by a difference in thumb position and repositioning technique. In conclusion, the more convenient TOF-tube can be used as well as the TOF-Guard/TOF-Watch arm board in daily clinical practice.

Adult↗

PubMed2002

Laser-assisted surgery addressing snoring long-term outcome comparing CO2 laser vs. CO2 laser combined with diode laser.

Our study encompasses 61 patients (49 men--80.3%; 12 women--19.7%) treated from September 1998 through August 2001. Mean follow-up covers 25 months (range: 7-43 months). Our CO2-LAUP technique involves vaporizing the palatine mucosa along a rectangular surface from the palatal dimple to the base of the uvula; trimming the palatine arches under the velum; and resecting the uvula. For 22 patients, we employed intravelar diode laser coagulation in the expectation of reducing the postoperative pain whilst achieving the same therapeutic effectiveness. There is no pain difference between the CO2-LAUP technique versus that combining intravelar diode laser coagulation with CO2 laser uvula resection and trimming of the palatine arches. Mean maximal pain reaches 6.93 +/- 3.55 with CO2 laser and 6.95 +/- 3.64 with CO2 laser plus diode laser. Similarly, both techniques involve the same mean algesic period of 22 days with the day of maximal pain at 1 week after surgery. Associating base of tongue vaporization significantly increases the algesic period (p = 0.042). No long-term complications were observed in relation to intravelar coagulation or LAUP, whether combined or not with base of tongue vaporization. In terms of patients satisfaction, no significant difference exists between the various surgical techniques of the velum alone. The satisfaction rate reaches 5.26 +/- 3.92 with CO2 laser and 5.82 +/- 2.67 with the CO2 laser plus diode laser. Satisfaction is statistically identical when base of tongue vaporization is included in the procedure.

Female↗

PubMed2001

Improving the functional outcome of Tucker's reconstructive laryngectomy.

BACKGROUND: The goal of reconstructive laryngectomy addressing glottic carcinoma, as described by Tucker, is twofold: achieve local control and preserve as much as possible the physiological laryngeal function. METHODS: The study consisted of long-term assessment of oncological, deglutitory, and vocal outcome in 34 patients following Tucker's reconstructive laryngectomy. Postoperative follow-up included fiberscopic examination, videoradiography, and voice assessment after speech rehabilitation. RESULTS: The 5-year overall survival rate was 92% +/- 5%. Fiberscopic examination and videoradiography contributed to observing and understanding the rehabilitation process and impairment to its progress. Two main compensatory movements were identified: the anticipatory backward movement of the tongue base (50%) and the anticipatory upward laryngeal motion (15%). Both movements occurred simultaneously at the beginning of the pharyngeal stage of the swallow (35%). The median duration prior to tracheostomy tube removal was 14 days. Swallowing of solids resumed on day 9 (median), and liquid intake (water and soup) resumed on day 12 (median). The median duration of hospitalization was 16 days. Following speech rehabilitation, the latest follow-up visit measured as follows: the mean conversational voice intensity at 64 dB (range, 57-79 dB); the mean maximum intensity at 87 dB (range, 78-96 dB); the minimum intensity at 54 dB (range, 45-65 dB); the mean maximum phonation time at 16 seconds (range, 10-29 seconds); and the mean phonation quotient at 284 mL/second (range, 205-341 mL/second). According to our classification, voice spectral analysis revealed 19 class-III patients, 12 class-II patients, and three class-I patients. CONCLUSION: Tucker's reconstructive laryngectomy is reliable in terms of both the oncological and functional outcome. Fiberscopic examination and videoradiography are two complementary methods for assessing postoperative deglutition.

Adult↗

PubMed2001

Medialization framework surgery for voice improvement after endoscopic cordectomy.

Seven dysphonic patients who had previously undergone total or extended cordectomy underwent laryngeal framework medialization. A minimum 6-month period between cordectomy and framework surgery was enforced to allow the vocal cord to scar and form a fibrous "neocord", to evaluate the voice recovery achieved by speech therapy alone and avoid the risk of operating on a patient with undiagnosed early recurrence. The operation is performed with fiberscopic control under general anesthesia. These operating conditions are required because undermining the fibrous tissue at the inner side of the thyroid ala is a lengthy and laborious procedure. This step is necessary to ensure easy placement of the implant. Caution must be taken to avoid tearing the fibrous tissue, with consequent risk of prosthesis extrusion. The cartilage window is left intact. Whereas cartilage implants remain indicated for minor gaps, we advocate Friedrich's implant for wider gaps. The vocal outcome revealed an increased median maximum phonation time from 5 s (range 2-12 s) to 7.5 s (range 3-23 s); a reduced phonation quotient from 516.5 ml/s (range 235-1000 ml/s) to 222 ml/s (range 146-595 ml/s); a slightly increased modal intensity from 61.5 dB (range 57-75 dB) to 67 dB (range 46-68 dB); an improved intensity range from 24.5 dB (range 16-36 dB) to 30 dB (range 16-62 dB); a steady fundamental frequency from 150 Hz (range 132-290) to 152 Hz (range 125-200); and an increased median spectral analysis class from 2 (range 1-3) to 3 (range 2-4). Subjectively, the patients noted that, throughout the day, phonation required less effort and induced less vocal fatigue.

Durapatite↗

PubMed2001

Six hundred consecutive carotid endarterectomies with temporary shunt and vein patch angioplasty: early and long-term results.

PURPOSE: This retrospective study evaluates the long-term clinical outcome and the survival of 600 consecutive carotid endarterectomies performed with a temporary shunt. All arteriotomies were closed by vein patch angioplasty. MATERIALS AND METHODS: Between November 1989 and November 1998, 600 isolated carotid endarterectomies (CEA) were performed in 540 patients by a uniform surgical technique at the University Clinic of Mont-Godinne. An intraluminal shunt and patch closure were systematically used. The mean age was 68 yr (ranging from 41 to 91 yr), 400 patients were men. The risk factors included hypertension in 73%, smoking history in 60%, coronary artery disease in 51% and hyperlipidemia in 35%. The indications were asymptomatic stenosis in 47%, transient ischemic attack in 40%, vertebrobasilar symptoms in 7% and stroke in 6%. EARLY RESULTS: The combined 30-day stroke and death rate was 0.9%. There were four deaths. The stroke and TIAs rates were 0.2% and 1.5% respectively. The incidence of early carotid occlusion was 0.5%. Cranial or cervical nerve dysfunction was identified in 6.3%. LATE RESULTS: The median follow-up was 49 months with a range of 2-124 months. Cumulative survival rates at 5 and 10 yr were 92+/-1% and 89+/-2% respectively. Thirty-two patients died during long-term follow-up; the death was stroke-related in only three patients. CONCLUSION: Carotid endarterectomy using an intraluminal shunt and vein patch closure is a safe and effective procedure associated with low morbidity and mortality rates at short and long-term follow-up.

Adult↗

PubMed2001

Protective effect of glove on median nerve compression in the carpal tunnel.

OBJECTIVES: To determine the protective effect of gel padded glove on median nerve compression in the carpal tunnel. METHODS: Median nerve conduction parameters, skin temperature, laser Doppler flowmetry and pain modifications were measured during and after a 30-min carpal tunnel external compression protocol performed with and without glove in a random order on six healthy volunteers. RESULTS: Compression induced a rapidly reversible increase in sensory and motor distal latencies, a decrease in sensory amplitude, finger laser Doppler flowmetry and hand skin temperature supporting the hypothesis of a reversible conduction block of ischemic origin. There was no statistical difference between the tests (with or without glove) except for pain that was significantly reduced by glove protection. CONCLUSION: Gel padded glove does not seem to have a protective effect on the carpal tunnel syndrome induced by compression but provides significant comfort.

Action Potentials↗

PubMed2001

Occupational asthma in symptomatic workers exposed to natural rubber latex: evaluation of diagnostic procedures.

BACKGROUND: Natural rubber latex (NRL) has been increasingly identified as a cause of occupational asthma (OA). OBJECTIVE: We sought to examine the accuracy of the clinical history, immunologic tests, and assessment of nonspecific bronchial hyperresponsiveness in diagnosing OA caused by latex compared with that of the specific inhalation challenge (SIC). METHODS: Forty-five consecutive patients referred for investigation of possible OA caused by latex underwent a diagnostic protocol, including an open medical questionnaire, skin prick testing against latex, measurement of bronchial responsiveness to histamine, and inhalation challenge with latex gloves. Recorded clinical history was judged retrospectively by 4 physicians who were blinded for the results of other objective tests. RESULTS: The clinical history, skin prick testing against NRL, and assessment of nonspecific bronchial hyperresponsiveness showed a high sensitivity (87%, 100%, and 90%, respectively) but a low specificity (14%, 21%, and 7%, respectively) when compared with the results of the SIC. Logistic regression analysis showed that combining the results of skin prick tests against latex with the clinical history enhanced the negative predictive value from 50% to 71%, whereas the positive predictive value remained virtually unchanged (75% vs 76%). CONCLUSION: The clinical history and immunologic tests were the most useful procedures in diagnosing NRL-induced asthma, although combining the 2 procedures remained less accurate than SIC. Further examination of the predictive values of available tests is warranted to recommend diagnostic strategies that are specific to the various agents causing OA.

Adult↗

PubMed2001

Effects of acute decrease in systemic afterload on accuracy of Doppler-derived left ventricular rate of pressure rise measurement in anesthetized patients.

OBJECTIVES: This study was designed to describe exactly the effects of acute decrease in systemic afterload on the accuracy of Doppler-derived left ventricular rate of pressure rise (LV DeltaP/Delta(t)) measurements compared with other routinely used indices of systolic function. METHODS: Twelve patients scheduled for coronary artery bypass grafting were studied. After induction of anesthesia (T0), afterload was modified by incremental administrations of nicardipine (T1-4). At each step of the procedure, thermodilution-derived cardiac index, left ventricular (LV) fractional area change, and LV DeltaP/Delta(t) were measured, and systemic vascular resistances were calculated. RESULTS: During the procedure, the systemic vascular resistances decrease averaged 13.4%. Systemic vascular resistances were correlated with LV DeltaP/Delta(t) (r = 0.843, P =.003) but inversely correlated with cardiac index (r = -0.782, P =.005) and LV fractional area change (r = -0.887, P =.003). CONCLUSION: In conclusion, and inversely to cardiac index or LV fractional area change, LV DeltaP/Delta(t) does not overestimate LV contractility in the presence of an acute decrease in systemic afterload.

Aged↗

PubMed2001

Primary prevention of glucocorticoid-induced osteoporosis with intravenous pamidronate and calcium: a prospective controlled 1-year study comparing a single infusion, an infusion given once every 3 months, and calcium alone.

The aim of this study was to compare the action of two regimens of intravenous (iv) pamidronate in the primary prevention of glucocorticoid-induced osteoporosis (GC-OP). The primary purpose of the study was to determine whether any differences in bone mineral density (BMD) appeared after 1 year. A secondary endpoint aimed at assessing the remodeling parameters in order to better understand the mechanisms of action of the various regimens. Thirty-two patients, who required first-time, long-term glucocorticoid therapy at a daily dose of at least 10 mg of prednisolone, were studied. Simultaneously with the initiation of their glucocorticoid treatment, patients also were randomly allocated to receive a single iv infusion of 90 mg of pamidronate at the start (group A); a first infusion of 90 mg of pamidronate followed, subsequently, by an iv infusion of 30 mg pamidronate every 3 months (group B); and a daily 800-mg elemental calcium supplement given as calcium carbonate (group C), which also was taken by patients in groups A and B. Patients were matched for starting glucocorticoid doses, sex, menopausal status, and hormonal replacement therapy. Lumbar spine and hip (total and subregions) BMDs were measured at the outset and repeated at 6-month intervals by dual-energy X-ray absorptiometry (DXA; Hologic QDR-2000). Bone turnover was assessed by measurement of total and bone-specific serum alkaline phosphatase activity (B-ALP), serum osteocalcin (OC), and serum C-telopeptide cross-links of type I collagen (CTX). After 1 year, the mean BMD changes for groups A, B, and C were, respectively, 1.7, 2.3, and -4.6% at the lumbar spine; 1.2, 1.2, and -3.1% at the femoral neck; 1.0, 2.6, and -2.2% for the total hip region. No difference was observed between pamidronate regimens but a highly significant difference was observed between both pamidronate regimens and the control group at the lumbar spine (p < 0.001), at the femoral neck (p < 0.01), and for the total hip (p < 0.05). A significant decrease of serum C-telopeptide was observed, after 3 months, in groups A and B (p = 0.029), but a sustained decrease of bone resorption over time was observed only in group B. As far as BMD evolution over 1 year was concerned, iv pamidronate, given either as a single infusion or once every 3 months, effectively achieved primary prevention of GC-OP.

Alkaline Phosphatase↗

PubMed2001

Biochemical analysis of the sperm and infertility.

The clinical value of biochemical analysis of sperm is still unclear. In this study, we evaluated the potential of several biochemical markers in the seminal plasma (zinc, citrate, acid phosphatase, fructose and neutral alpha-glucosidase) as a screening method in male infertility investigation.

Acid Phosphatase↗

PubMed2001

Hepatic perfusion parameters in chronic liver disease: dynamic CT measurements correlated with disease severity.

OBJECTIVE: The aim of our study was to determine if hepatic perfusion parameters measured with CT change in relation to disease severity in patients with chronic liver disease. SUBJECTS AND METHODS: Dynamic contrast-enhanced single-section CT scans of the liver were obtained in 40 individuals who included six control subjects, 16 patients with noncirrhotic chronic liver disease, and 18 patients with cirrhosis. Hepatic, aortic, and portal venous time-density curves were fitted to a dual-input one-compartment model to calculate the liver perfusion, arterial fraction, distribution volume, and mean transit time. RESULTS: Liver perfusion decreased in patients with cirrhosis (67 +/- 23 mL. min(-1). 100 mL(-1) versus 108 +/- 34 mL. min(-1). 100 mL(-1) in control subjects [p = 0.009] and 98 +/- 36 mL. min(-1). 100 mL(-1) in patients with noncirrhotic chronic liver disease [p = 0.003]), and the arterial fraction and the mean transit time increased (41 +/- 27% and 51 +/- 79 sec versus 17 +/- 16% and 16 +/- 5 sec in control subjects, and 19 +/- 6% and 17 +/- 8 sec in patients with noncirrhotic chronic liver disease [p < 0.05]). A significant correlation was seen between these three perfusion parameters and the severity of chronic liver disease based on clinical and biologic data (p < 0.001). No significant change in distribution volume was observed. CONCLUSION: Hepatic perfusion parameters measured with CT were significantly altered in cirrhosis and correlated with the severity of chronic liver disease.

Case-Control Studies↗

PubMed2001

Value of multislice helical CT scans and maximum-intensity-projection images to improve detection of ureteral stones at abdominal radiography.

OBJECTIVE: The purpose of this study was to assess the improvement in the detection of ureteral stones on abdominal radiographs when the stones were viewed on multislice helical CT scans and maximum-intensity-projection (MIP) images. SUBJECTS AND METHODS: The study included 72 patients with renal colic who underwent abdominal radiography and multislice helical CT. For each patient, a frontal MIP image was generated, and the stone, when present, was marked with a cross on the transverse CT scan. The cross appeared automatically on the corresponding MIP image. The CT examination was used as the standard of reference. The presence and location of ureteral stones on the abdominal radiographs were assessed during three interpretation sessions. In the first session, the abdominal radiographs were viewed alone. In the second, they were viewed with the transverse CT scans. In the third, the abdominal radiographs were viewed with the CT scans and the MIP images. RESULTS: Ureteral stones were present in 58 patients. The percentage of stones detected on the abdominal radiographs was 45% when the radiographs were viewed alone, 66% when they were viewed with the CT scans (p = 0.002 vs radiographs alone), and 78% when viewed with the CT scans and MIP images (p = 0.016 vs radiographs with CT scans). CONCLUSION: The sensitivity of stone detection on abdominal radiographs was greatest when the interpreters viewed the radiographs in conjunction with the CT scans and MIP images.

Adult↗

PubMed2001

Erectile dysfunction and lower androgenicity in type 1 diabetic patients.

OBJECTIVE: To analyse the clinical characteristics and relevant hormonal profile in type 1 diabetic patients with and without ED. MATERIAL AND METHODS: Fifty one type 1 diabetic patients were studied. ED was assessed by direct interview. Chronic diabetic complications, smoking and alcohol status as well as current use of medications were recorded. Hormonal profile consisted of plasma LH, FSH, prolactin, androstenedione (Delta(4)), dehydroepiandrosterone (DHEA), DHEA-sulfate (DHEA-S), free testosterone (FT), estradiol (E(2)), sex hormone binding globulin (SHBG), dihydrotestosterone (DHT), cortisol, TSH and free thyroxine (FT(4)). RESULTS: ED was present in 24 patients (47%) (group 1), who were older (P<0.001), had a longer diabetes duration (P<0.001) and a higher systolic blood pressure (P=0.017) when compared to the subjects who did not complain (group 2). ED was positively correlated to all diabetes-related complications (P<0.02). Antidepressive drug(s) were more frequent in group 1 (P=0.007), as well as prokinetics (P=0.043) and ACE-inhibitors (P=0.010). HbA(1)c was comparable. Patients with ED had lower levels of Delta(4) (P=0.003), DHEA (P<0.001), DHEA-S (P=0.002), FT (P=0.08) while SHBG (P=0.010) and LH (P=0.022) were higher compared to group 2. Multiple logistic regression analysis showed an independent association of ED with Delta(4) (P=0.016), DHEA-S (P=0.037), SHBG (P=0.001) and insulin dose (P=0.025). There was no significant difference for all other measured hormones. CONCLUSION: ED is impressively prevalent in type 1 diabetes and is associated with age, diabetes duration, chronic complications and decreased androgens.

Age Factors↗

PubMed2001

Micro- and macrovascular complications and hyperhomocysteinaemia in type 1 diabetic patients.

OBJECTIVE: To determine the range of plasma homocysteine values in a cohort of type 1 diabetic subjects and to analyse the relationship between homocysteine levels and chronic degenerative complications. MATERIAL AND METHODS: 71 type 1 diabetic inpatients admitted for poor glycaemic control and/or treatment of complications, especially macroangiopathic, were included in this study. Chronic diabetic complications, smoking prevalence, as well as current use of drugs were recorded, alongside fasting plasma homocysteine. RESULTS: Age and diabetes duration were 51 (34-63) and 23 (13-32) years respectively (median [percentile 25-75]). HbA(1)c was 9.3% (8.2-10.5). Homocysteine was 9.2 (7.1-13.6) micromol/l, and 17% of patients had elevated homocysteinaemia on the basis of a laboratory cutoff value of 15 micromol/l. Folic acid and vitamin B(12) levels were within the normal range. Univariate statistical analysis showed a significant positive association between homocysteine and age (P<0.001), diabetes duration (P<0.001), systolic blood pressure (P<0.001), plasma creatinine (P<0.001), cholesterol/HDL-C (P=0.021) as well as with retinopathy (P=0.016) and all complications (P<0.001), and a negative correlation with folic acid (P=0.004) and creatinine clearance (P<0.001). Using a multiple regression analysis taking into account major variables, we confirmed an independent association of homocysteine with age (P=0.003), creatinine (P<0.001) and folic acid (P=0.014), but not with vascular complications. CONCLUSIONS: Increased homocysteine is present in 17% of a limited group of poorly controlled type 1 diabetic patients, and is associated with age, creatinine and folic acid levels. In this type 1 population, there was no independent correlation of homocysteine with vascular complications, in particular macroangiopathy.

Adult↗