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Biomedical subjects

J L Selam

Publications and source records attributed to J L Selam.

At least 91 records · Page 5Linked to original sources
PubMed1986

Beneficial effect of glycaemic improvement in non-ischaemic forms of diabetic retinopathy: a 3-year follow-up.

Recent studies have suggested that optimal glucose control fails to arrest or even worsens background retinopathy possibly by aggravating retinal ischaemia. Fourteen insulin-dependent diabetic patients, aged 34 +/- 11 years (mean +/- SD) treated by long-term intraperitoneal insulin infusion using portable pumps, were followed for 3 years. Preproliferative or proliferative lesions on ophthalmoscopy and large non-perfused areas on fluorescein angiography were exclusion criteria. Six patients were found to have minimal and 8 mild background retinopathy. The patients were retrospectively assigned to two comparable groups except for their glycaemic equilibrium under insulin infusion: average control (n = 6) and excellent control (n = 8), although glycaemic control was significantly improved in all cases when compared to previous conventional therapy. Fluorescein changes were scored blindly and independently by 3 ophthalmologists according to modifications of fluorescein diffusion and capillary abnormalities. The two types of retinal lesions improved gradually in 10 patients and deteriorated in only 1 patient, although not progressing to proliferative retinopathy. Structural improvements were significantly more frequent in the excellently controlled group. We conclude that non-ischaemic lesions may still be arrested and even improved by tight metabolic control.

Adult↗
PubMed1985

Experience with long-term peritoneal insulin infusion from external pumps.

The long-term acceptability and feasibility of continuous peritoneal insulin infusion (CPII) from external pumps was evaluated in 40 insulin-dependent diabetic patients continuously treated for 1-27 months (mean 12 months). Blood glucose control was satisfactory and did not deteriorate with time (glycosylated haemoglobin 8.1 +/- 1.1%, mean +/- S.D., normal range 5.5-7.5%). Major problems included 1 episode of local peritonitis, 12 hypoglycaemic comas, 7 severe hyperglycaemic episodes, all cured without sequelae. Minor problems were frequent, mostly pump and catheter-related. Pump and catheter survival rates were 46% and 70% at one year, respectively. No peritoneal reaction was noted apart from occasional tissue growth around the catheter. This method of insulin treatment was judged satisfactory and acceptable by most of the subjects. Only one patient dropped out, after 1.5 years. These results were achieved through stringent selection of patients, intensive education with strict instructions, careful medical care, and possibly through the inherent physiological advantages of intraperitoneal insulin infusion.

Adult↗
PubMed1985

[Improvement of retinopathy in the diabetic treated with an intraperitoneal insulin pump].

The recent development of continuous insulin infusion by pump as a treatment method of diabetics and the fact that several publications have shown some doubt as to the efficiency of this method of treatment on the development of diabetic retinopathy, have led us to study this problem. In our study we have followed 24 patients for an average of 22 months (13-41). These patients were diabetics type I, non-obese, normotensive and were divided into three groups based on the extent of their diabetic retinopathy. Group I: no retinopathy, 5 patients. Group 2: background retinopathy without ischaemia, 14 patients. Group 3: ischaemic retinopathy, 5 patients. Only patients from group 3 where subjected to photocoagulation. The above classification was based on angiographic findings and we compared angiograms before and after treatment. In group I, none of the patients developed diabetic retinopathy. In group 2, there was only one aggravation of the preexisting retinopathy, however without the development of proliferative changes. In group 3, the favourable outcome was mainly due to treatment by photocoagulation. The different classification of diabetic retinopathy that we have adopted into ischaemic and non-ischaemic forms based on angiographic findings might explain our favourable results. The classification into background and proliferative retinopathy does not indicate in the background type the relative importance of the oedema and the ischaemia. We suggest that the improved glycemic control obtained by continuous insulin infusion has a favourable outcome on non-ischaemic type of diabetic retinopathy, whereas photocoagulation remains the treatment of choice in ischaemic retinopathy.

Adult↗
PubMed1985

Pharmacokinetics of insulin infused intra-peritoneally via portable pumps.

Plasma free insulin was measured repeatedly for 4 hours following a standardized breakfast in 20 C-peptide negative chronically pumped type I diabetic patients and 5 normal subjects. In the former group, insulin was given as a 1 u/h basal infusion and a 1h superimposed meal-dose of 6 u via a peritoneal (IP) catheter lying in the low (n = 10), or in the mid-abdomen (n = 10). The results of the IP patients were correlated with glycosylated haemoglobin and home capillary blood glucose. Fasting free insulin of IP patients was lower than those of normals (14.7 +/- 0.5 vs 21.0 +/- 1.3 mU/l, p less than 0.01). Dose-induced peak occurred similarly in IP patients and normals (70 +/- 6 vs 70 +/- 12 min.). Values tended to baseline after 165 +/- 15 and 185 +/- 22 min. in IP patients and normals (NS). Results of the mid--and low peritoneum subgroups differed only for peak values (31.5 +/- 2.9 vs 25.0 +/- 1.6 mU/l respectively) and did not correlate with diabetic control.

Adult↗
PubMed1984

Optimal routes for chronic insulin infusion with portable and implantable devices.

The optimal route for chronic insulin infusion via portable or implantable pumps is still a subject of controversy. Through the literature reports and personal experience (representing 70 patient-years of continuous treatment), the authors have found that the subcutaneous route is the ideal route in terms of comfort, safety, and cost. However, owing to sluggish and unpredictable insulin resorption, it appears that subcutaneous infusion is often not more effective than intensive conventional insulin therapy. The intravenous route gives the best diabetic control, but with a high risk of infection and obstruction. The intramuscular route, although more efficient than the subcutaneous, can be envisaged for only short periods because of its poor tolerance. The portal route is still at an experimental stage. The authors chose the intraperitoneal route because of the following advantages: near physiological insulin resorption kinetics; better diabetes control than subcutaneous infusion although comparable to intravenous; a 30% reduction of insulin requirements; and satisfactory local tolerance and acceptability with respect to severe asepsy precautions, patient selection, intensive education, and careful medical follow-up. The intraperitoneal route is feasible for portable insulin pumps, but basically more adaptable to implantable devices.

Humans↗
PubMed1984

[Blood glucose self-monitoring: visual or automated read-out? Comparative study of 6 methods of blood glucose determination by reactive strips].

Home blood glucose monitoring is becoming increasingly popular in diabetic patients. The purpose of this work was to determine the accuracy of this technique. We have compared plasma glucose obtained in the laboratory and two reagent strips (Dextrostix and Haemoglukotest 20-800). No differences were found among visually-read values and meter-read values using either Dextrometer, Glukometer, Hypocount or Glucochek. Thus, visually-read strips seem to be sufficient for clinical purposes with best results for HGT. The performances of different meters are similar. Nevertheless must patients favoured the use of a meter because of the apparent "objectivity" of the values. Furthermore, meters provide to patients a better involvement in the management of their disease.

Automation↗