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Biomedical subjects

J M Leiper

Publications and source records attributed to J M Leiper.

28 records · Page 2Linked to original sources
PubMed1986

Outcome of pregnancy in insulin-dependent (type 1) diabetic women between 1971 and 1984.

We have looked at the outcome of pregnancy in women with type 1 (insulin-dependent) diabetes mellitus who were confined at Glasgow Royal Maternity Hospital between 1971 and 1984. Of 134 pregnancies, 123 proceeded beyond 28 weeks' gestation and yielded 125 live infants. The perinatal mortality rate was 16/1000, due solely to congenital foetal malformation. Malformations were not related either to the severity of maternal diabetes (as graded by the White classification) or the glycaemic control in the first trimester (as judged by maternal glycosylated haemoglobin concentration). Over the period of study, there has been a marked reduction in the frequency of ketoacidosis during pregnancy and in the delivery of small-for-dates babies; more mature lecithin:sphingomyelin ratios have been obtained by amniocentesis; and better Apgar scores have been demonstrated in the infants at delivery. The Caesarean section rate has fallen from 83 to 30 per cent, and babies now spend less time separated from their mothers in paediatric units. These improvements largely reflect better diabetic treatment (improved insulin regimens and glycaemic control) and closer obstetric assessment. Foetal malformation occurred overall in 11.4 per cent of pregnancies and did not become less frequent over the period of study. Further major improvement in the outcome of diabetic pregnancy will only come from a reduction in the congenital malformation rate, which implies better diabetic control at and around the time of conception.

Adult↗
PubMed1985

Lung tissue penetration of temocillin.

Eight patients about to have the whole or part of a lung resected were given a 2g bolus dose of temocillin. A series of serum samples and a piece of peripheral lung tissue were collected and assayed for temocillin concentration. 30 minutes after drug administration, the mean serum and tissue concentrations were 172 mg/L and 45 mg/kg respectively.

Adult↗
PubMed1985

Temocillin in the treatment of chest infections.

In our study, 16 patients with acute infection complicating severe respiratory disease were treated with temocillin 2g or 3g daily for 5 to 10 days. In 10 patients, a recognised respiratory pathogen, either Haemophilus influenzae (temocillin-sensitive) or Streptococcus pneumoniae (temocillin-resistant), was isolated from sputum before the start of treatment. 13 patients improved clinically but 5 subsequently relapsed. Two patients failed to respond, and 1 died of respiratory failure. There was no clearcut relationship between the clinical progress and sensitivity of the isolated pathogen to temocillin, and there were no adverse effects associated with the administration of temocillin.

Aged↗
PubMed1985

Glycosylated albumin and glycosylated proteins: rapidly changing indices of glycaemia in diabetic pregnancy.

Serial measurements of glycosylated albumin (GAlb), glycosylated plasma proteins (GPP) and glycosylated haemoglobin (GHb) were performed by affinity chromatography throughout the course of pregnancy in 14 insulin-dependent diabetic women. In patients whose glycaemic control improved markedly during pregnancy, the concentrations of GAlb and GPP decreased by more than 50 per cent after four weeks of good diabetic control. By contrast, the rate of decrease in GHb levels in the same patients was significantly less and did not indicate a comparable improvement in glycaemia until 12 weeks after good diabetic control was established. Elevated concentrations of GAlb or GPP decrease much more rapidly than GHb concentration when diabetic control is improved; thus measurement of glycosylated proteins is a valuable adjunct to serial blood glucose monitoring in clinical circumstances such as diabetic pregnancy, where early confirmation of good diabetic control is important.

Adult↗
PubMed1984

Effects of diabetic control and biosynthetic human insulin on blood rheology in established diabetics.

Blood rheology (blood viscosity, haematocrit, plasma viscosity, erythrocyte sedimentation and deformability) was measured in 22 diabetics in a study to compare animal insulins with biosynthetic human insulin. All rheological variables were significantly abnormal in the diabetics when compared with matched normal controls, and were not influenced by the type of insulin injected. However, blood rheology was related to diabetic control, as judged by glycosylated haemoglobin levels; when diabetic control was worst (mean glycosylated haemoglobin 11%), blood viscosity was significantly higher and red cell deformability significantly lower than when control was at its best (mean glycosylated haemoglobin 9.5%). A similar correlation between mean red cell deformability and mean glycosylated haemoglobin was found when individual diabetics were compared (r = 0.66; p less than 0.001). The occurrence of abnormal blood viscosity and red cell deformability during periods of poor diabetic control may contribute to the development of diabetic vascular complications.

Adolescent↗
PubMed1984

Insulin antibodies in the maternal and foetal circulation of pregnant diabetic women treated with human insulin of recombinant DNA origin.

Thirteen diabetic women were treated with human insulin of recombinant DNA origin from early pregnancy. One patient previously treated with conventional beef insulin showed a steady fall in insulin antibody levels whilst those previously treated with purified porcine insulin or human insulin showed no changes in species-specific insulin binding or in antibody-bound insulin. Two women with gestational diabetes, who received insulin for the first time during pregnancy, developed insulin antibodies which declined when therapy was withdrawn in the post-partum phase. Insulin antibody was detectable in the foetal circulation in all pregnancies at parturition but did not seem to be associated with any deleterious effect on carbohydrate metabolism in the neonate. Human insulin of recombinant DNA origin is a satisfactory treatment for diabetic pregnancy, is preferable to the use of conventional beef insulins in these patients and may confer a lesser risk of neonatal hypoglycaemia than purified pork insulin.

Adult↗
PubMed1982

Biosynthetic human insulin in the treatment of diabetes. A double-blind crossover trial in established diabetic patients.

94 diabetic patients established on treatment with porcine (n = 47) or bovine (n = 47) insulin took part in a double-blind crossover trial, in which 6-week periods of treatment with the appropriate animal insulin were compared with periods of treatment with biosynthetic human insulin (BHI). 6 patients withdrew during the trial, in 3 cases because of hypoglycaemia while taking BHI. In bovine-insulin-treated patients, the mean glucose level (mean of seven capillary-blood samples over 1 day), the modified M index, and total daily insulin requirement were the same on BHI and bovine-insulin treatment. For porcine-insulin-treated patients, mean glucose level and the modified M index were slightly higher on BHI than on porcine-insulin treatment (9.7 vs 9.0 mmol/l and 79.6 vs 65.0, respectively), despite an average increase of 2.3 units/day of BHI after 6 weeks of such treatment. Hypoglycaemic episodes were not significantly more or less frequent on BHI in either group of patients. In both groups fasting blood glucose was higher during BHI treatment than during animal-insulin treatment (14.2 vs 12.8 mmol/l [bovine group]; 12.1 vs 9.6 mmol/l [porcine group]). In bovine-insulin-treated patients blood glucose before the evening insulin injection was higher on BHI than on bovine insulin (11.6 vs 10.0 mmol/l). BHI appears to be a safe alternative to porcine or bovine insulin. Differences in the pharmacokinetics of BHI may account for the observed differences in blood-glucose responses.

Adult↗
PubMed1977

Uptake and transport of Imposil by the glomerular mesangium in the mouse.

The mesangial uptake and transport of particulate material has been studied using an iron-dextran complex, Imposil, as a tracer particle. The tracer was given as a single dose into the tail vein of the mouse, and animals were killed at intervals from 5 minutes to 48 hours. Light and electron microscopy showed that the iron-dextran complex was initially taken into the matrix channels of the mesangium from which it progressed over the course of 8 hours to the matrix of the juxtaglomerular apparatus and intercellular spaces of the macula densa. This delineated a continuous functional pathway from the glomerular capillary lumen to the macula densa cells of the distal tubule for material taken up by the mesangium. It is suggested that the products of inflammatory lesions in the glomerulus could affect the secretory function of the granular cells of the juxtaglomerular apparatus as it would appear that such products must circulate in the immediate environment of these cells.

Animals↗
PubMedDate not supplied

A double-blind crossover trial comparing human insulin (recombinant DNA) with animal insulins in the treatment of previously insulin-treated diabetic patients.

Ninety-four diabetic patients established on treatment with pork (N = 47) or beef insulin (N = 47) took part in a double-blind crossover trial in which 6-wk treatment periods of their animal insulin were compared with similar periods on human insulin (recombinant DNA). Six patients withdrew during the trial--in three cases for hypoglycemia while taking human insulin. In patients initially treated with beef insulin there was no significant change in the mean blood glucose, the 'M' index, the total daily insulin dose, or the frequency of hypoglycemic attacks after the change to human insulin. Home blood glucose sample values were greater before the morning and evening insulin injection on human insulin (morning: 12.8 mmol/L [beef] versus 14.2 mmol/L [human insulin] [P less than 0.05]; evening: 10.0 mmol/L versus 11.6 mmol/L [P = 0.05]). In pork insulin-treated patients greater values while on human insulin were found for mean glucose (9.0 mmol/L [pork] versus 9.7 mmol/L [human insulin], P = 0.05), 'M' index (65.0 [pork] versus 79.6 [human insulin], P less than 0.025), and total daily insulin dose (50.9 U/day [pork] versus 52.5 U/day [human insulin], P less than 0.001). The early morning glucose sample was also greater on human insulin (9.6 mmol/L [pork] versus 12.1 mmol/L [human insulin], P less than 0.001). No significant differences in either insulin antibody levels or E. coli protein antibody levels were found between either of the animal-insulin treatment periods and human insulin treatment periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗