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Biomedical subjects

K Irsigler

Publications and source records attributed to K Irsigler.

At least 55 records · Page 3Linked to original sources
PubMed1992

Phrenic nerve function in type 1 diabetic patients with diaphragm weakness and peripheral neuropathy.

Phrenic nerve latency was studied in 14 male type 1 diabetic patients with impaired diaphragm function and in 14 healthy control subjects. The diabetics showed significantly decreased values regarding inspiratory vital capacity and forced volume in 1 s compared with the control subjects. All other lung function parameters were similar in both groups. Although motor and sensory nerve conduction studies provided evidence for peripheral neuropathy in all patients, phrenic nerve latencies turned out to be normal. These results rule out a neuropathic disorder of the phrenic nerve. Thus, impaired diaphragm function in type 1 diabetic patients is not caused by phrenic neuropathy.

Adult↗
PubMed1992

[Hypoglycemia in diabetes mellitus].

Type 1 diabetic patients experience symptomatic hypoglycemia once or twice a week. 30% of insulin-treated patients suffer from hypoglycemic coma at least once during their life, 10% at least once a year. 3% are incapacitated by frequent and severe attacks, 3 to 4% die from hypoglycemia. In contrast the incidence of symptomatic hypoglycemia in sulfonylurea-treated patients is about 0.2 per 1000 patients' years, the mortality of severe attacks being about 8%. The cause of hypoglycemia is always an excess of insulin, in absolute or relative terms. Additional precipitating factors are defective counterregulation after longer duration of diabetes, as well as a lowered threshold for counterregulation and/or for perception of warning symptoms, as seen under strict glycemic control. Considering the risks associated with hypoglycemia, preventive measures must be emphasized.

Blood Glucose↗
PubMed1992

[Alcoholic ketoacidosis--3 episodes in one patient].

3 episodes of alcoholic ketoacidosis were observed in one female patient over a period of 19 months. The clinical picture consisted of vomiting, dehydration, hyperventilation and abdominal pain. Predominant laboratory findings were acidosis (pH less than 7) and hyperglycaemia, with blood glucose values of 354, 330 and 147 mg/dl. This disorder is an important cause of metabolic acidosis, but especially in the German literature there are only rare reports on this issue. The picture of ketoacidosis in mostly chronically malnourished alcoholics reflects not only the complex abnormalities of acid-base balance caused by excessive cumulation of ketoacids, but also the related severe depletion of electrolytes and extracellular volume. Adequate acute therapy (as for diabetic ketoacidosis) and thorough follow-up treatment of any concurrent conditions result in rapid reversal of the syndrome in most cases. Since there are few reports of repeated episodes in one patient, an overview of this disorder is presented concerning management and differential diagnosis of the basis of our case report.

Acidosis↗
PubMed1992

[4-years experience with quality control of decentralized reflectometry blood glucose measurement in the Vienna-Lainz hospital].

Since 1987 a quality control programme for ward-based blood glucose assays has been established in Lainz Hospital, Vienna. In 1991 following a decision to standardise the type of reflectometer used in the ward, 62 Reflolux IIS reflectance meters (Boehringer Mannheim) were assessed in a quality control consisting of 4 ring trials a year (blood glucose determination in two "unknown" samples) and in daily measurements of control solutions of known glucose concentrations. Experience with this quality control procedure is reported in this presentation of the relevant results of the ring trials. The most frequent errors in performing the test are discussed and the importance of instructing and training the nursing staff in the proper use and maintenance of the meters is pointed out.

Austria↗
PubMed1991

[Recurrent hypoglycemia and lactate acidosis in non-Hodgkin's lymphoma].

Two weeks after partial resection of the small intestine for an intra-abdominal stenosing centroblastic non-Hodgkin lymphoma, a 65-year-old man began to experience recurrent attacks of hypoglycaemia (down to 30 mg/dl) together with lactic acidosis (lactate 5.13 mmol/l), tachycardia and sensations of heat. Very high parenteral glucose input (up to 750 g/day) was necessary to maintain normal blood sugar levels. There was close correlation between the level of glucose consumption and the degree of lactic acidosis. After chemotherapy the abnormalities improved, but recurred as the neoplasm proliferated once more. An endocrine mechanism for the hypoglycaemic attacks was excluded by the low serum concentrations of insulin and of "insulin-like growth factors" I and II and by the fact that the levels of glucagon, glucocorticoids, growth hormone and thyroid hormone were within the normal ranges. There were pleural and peritoneal effusions containing large numbers of tumour cells. Investigated in vitro, the fluids showed a decline in glucose and a rise in lactate concentration. Studies with an artificial pancreas also showed that glucose utilization rate in vivo was increased to four times the normal and that it could be raised still further by insulin stimulation. These findings provide evidence of direct consumption of glucose by the tumour cells in the form of abnormally increased anaerobic glycolysis.

Acidosis, Lactic↗
PubMed1991

Inspiratory muscle performance and pulmonary function changes in insulin-dependent diabetes mellitus.

The study examined pulmonary function parameters of 36 patients with insulin-dependent diabetes mellitus and analyzed their inspiratory muscle performance. The control group consisted of 40 healthy reference persons of a sex ratio, age, height, and weight distribution similar to those of the patients. The pulmonary function test included the measurement of the lung volumes and the maximal expiratory flow-volume curves. The values of maximal sniff esophageal (Pes) and transdiaphragmatic pressures (Pdi) were used as parameters for global inspiratory muscle strength and diaphragm strength, respectively. The 12-s maximum voluntary ventilation (MVV) test supplied the parameter of inspiratory muscle endurance. The diabetic patients showed a highly significant decreased value for their inspiratory vital capacity (VCin) compared with that of the control subjects (4.75 +/- 0.84 versus 5.36 +/- 1.37 L; p less than 0.01). Inspiratory muscle performance in the diabetic patients was also restricted. Sniff Pes was significantly lower in the diabetic group (p less than 0.05); sniff Pdi (p less than 0.01) and MVV (p less than 0.05) were also low. The results did not correlate with either the duration of diabetes or the quality of metabolic control measured by glycosylated hemoglobin concentration. The reduction of VCin in diabetic patients may have been caused partly by the reduced capacity of the inspiratory muscles.

Adult↗
PubMed1991

[Dynamic measurement of pressure distribution on the foot sole of diabetic patients and a comparison group].

A new method known as pedography enables the measurement of plantar pressure while walking. Different areas on the sole can be separately analyzed by means of a personal computer. We studied plantar pressure in 20 patients walking normally on a horizontal platform. Four different stages of weight bearing were investigated, namely 0, 10, 20, and 30 kg, in the ten diabetics and ten non-diabetics. All diabetic suffered from peripheral neuropathy, which was clinically proven as well as a reduction in nerve conduction velocity in the peroneal nerve. Non-diabetics showed no abnormal clinical findings on the lower extremities and nerve conduction velocity was within the normal range. The mean age and size differed between the diabetics and non-diabetics 52 +/- 5 versus 37 +/- 7 and 178 +/- 5 versus 185 +/- 4. Body weight was equal (84 +/- 6 versus 85 +/- 5 kg). We found no significant difference in maximum pressure on the heel, though there were differences on the fore-foot. Diabetics showed a higher maximum pressure already without weight bearing and reached a plateau at the 10 kg level, which was not exceeded at the higher stages of weight bearing. In summary, diabetic patients with neuropathy are subjected to very high plantar pressures at relatively low stages of weight bearing. Pedography enables preventive measures to be undertaken in time, e.g. prescription of orthopaedic insoles.

Body Weight↗
PubMed1991

[Hypertension in type II diabetes mellitus].

Treatment of hypertension in patients with NIDDM should be administered with special attention not to increase insulin resistance nor to impair insulin secretion capacity. The coexisting risk for coronary artery disease and myocardial infarction should not be increased by undesired drug effects on the plasma lipoprotein profile. Late lesions of diabetes mellitus (nephropathy, neuropathy) have also to be taken into account. Consequently angiotensin converting enzyme inhibitors, if necessary combined with calcium channel blockers, should be administered first. If blood pressure is thus not sufficiently controlled, alpha-adrenergic blockers, vasodilating agents or sympatholytics may be added. Once insulin treatment is installed, or if required for other reasons (nephropathy, congestive heart failure, cardiac arrhythmia), also diuretics and beta-adrenergic blockers are indicated in antihypertensive treatment of diabetic patients.

Antihypertensive Agents↗
PubMed1989

[ExacTech--a new measuring system for personal control of blood glucose].

ExacTech is a pen-sized glucose meter that uses an amperometric principle for blood glucose determination. Accuracy was assessed in 94 capillary blood samples by comparing the ExacTech values to the hexokinase method. Correlation between the methods was 0.983. 76% of ExacTech measurements were within +/- 10% of the reference method. Coefficients of variation for within run precision determined in two different blood glucose levels were 3.2% (81 mg/dl) and 4.2% (222 mg/dl) resp. 12 diabetic patients compared ExacTech to their reflectance meters. The ExacTech readings when correlated with the hexokinase method gave slightly better results than those obtained with common glucose meters. Patients acceptability of this novel measuring system was excellent.

Blood Glucose↗
PubMed1989

[Nyctometry and flicker discrimination in diabetic retinopathy].

98 diabetics and 34 healthy probands were recruited for ophthalmoscopic evaluation of the retina with a fundus camera, and for functional tests of the retina using a flicker frequency analyzer and a nyctometer. One year later, funduscopic evaluation of the ocular fundal state was carried out, and the results compared with the original baseline set of functional parameters. In the control group of healthy probands, a result only partially duplicated in the group of diabetics. An age-corrected comparison of the two groups revealed no difference between the diabetics and the healthy probands. Attempts were made to identify groups displaying significant differences in retinal performance as evaluated by the procedures mentioned above, but neither taking duration of diabetes as a criterion, nor selecting for differences in the course of diabetic retinopathy enabled the identification of such groups. A decrease in retinal performance was seen in very severe stages of diabetic retinopathy. These functional tests are not suitable in the early stages of diabetic retinopathy for defining that group of high-risk patients in which rapid progression of diabetic retinopathy is to be expected.

Adult↗
PubMed1989

[Comparison of the accuracy and precision of 7 reflectometers in self-control of blood glucose].

7 types of reflectance meters (Hypocount GA and MXB, Glucometer II and M, Petita B and B II, Reflolux II) were tested for accuracy and for within-run precision. To test the accuracy blood sugar was measured in 30 venous blood samples in the blood glucose ranges from 30 to 70, 71 to 180 and 181 to 300 mg/dl resp. on 4 instruments of each meter-type and by the hexokinase method as a reference method. With Hypocount MXB and Glucometer II great differences between correlation coefficients within the 4 instruments occurred. In the low blood glucose range all meters correlated best with the hexokinase method whereas poorer results were obtained in the low and the high glucose range. As regards the mean percental deviation, Reflolux II correlated closely with the reference method in the blood glucose range from 30 to 70 mg/dl, Hypocount MXB in the range from 71 to 180 mg/dl and Petita B in the range from 181-300 mg/dl. The greatest differences were found with both types of Hypocount- and Petita-meters in low blood sugar levels. With none of the tested meters a linear correlation with the hexokinase method was observed over the whole blood glucose range. Coefficients of variation for within-run precision ranged from 1.9% (Reflolux II) to 8.1% (Hypocount GA) depending on blood glucose concentration.

Blood Glucose Self-Monitoring↗
PubMed1988

[Treatment of resistance to subcutaneous insulin with implanted insulin infusion pumps].

Four female patients, resistant to insulin administered subcutaneously, were treated with an implanted insulin infusion pump (Infusaid; constant rate infusion). They had all experienced as many as four episodes of ketoacidosis per month despite extremely high doses of insulin injected subcutaneously or intramuscularly, and none of the treatment approaches attempted--insulin delivery via subclavian catheter, Schade-port, insulin infusion with an external portable pump or various insulin additives--had been successful. After implantation of the pump the daily insulin dose, which had been between 300 and 3000 units during subcutaneous therapy, was reduced to 30 to 70 units per day. The patients' condition improved, no further episodes of ketoacidosis occurred and hospital stays were reduced significantly. In the further course of treatment pump and catheter-related complications had to be overcome.

Adult↗
PubMed1988

[Hypoglycemic and hyperinsulinemic clamp technic to determine the secretory behavior of insulinoma].

In two female patients of 62 and 76 years of age, respectively, who had insulinomas subsequently confirmed by histology, the secretion pattern of insulin-producing tumours was studied. In the 62-year old patient complete reproducible suppression of insulinoma secretion was achieved by means of large exogenous doses of insulin, whereas this was not possible in the 76-year old patient. A modified hypoglycaemic clamping technique was used in the study. It is concluded that, depending on plasma insulin levels, relative suppression of insulinoma is possible, and it is recommended to use the described differentiated clamping procedure to investigate the secretion pattern of autonomous insulin-producing tumours.

Adenoma, Islet Cell↗
PubMed1988

[The status of managing the type I diabetic patient in Austria. Organization].

During the Annual Meeting of the Austrian Diabetes Association various diabetic centres presented their success and failure rates with respect to metabolic control and prevention of late complications in diabetic patients on a country-wide basis. The analysis revealed that only 30% of all type I diabetic patients are adequately controlled. Intensive education in diabetes self-management, capable of leading to optimal metabolic control in up to 50% of the instructed patients, is however available only to a small minority of the diabetic patients to date. Despite the enormous improvement which has been achieved in the management of pregnant diabetic women, intensive specialized care is often commenced far too late. In rural areas, in particular, even conventional therapy is not fully implemented and late complications are, thus, inevitable.

Austria↗
PubMed1988

The correlation of the results of vitreous fluorophotometry and fluorescein angiography in nonproliferative diabetic retinopathy.

The authors examined 103 eyes of 53 patients with insulin-dependent diabetes mellitus simultaneously by fluorescein angiography and vitreous fluorophotometry and correlated the stage of diabetic retinopathy with the posterior vitreous leakage (PVL) level, calculated from the preinjection-, bolus-, and measurement scans. There was a significant correlation between stage of retinopathy and PVL level, but there was a large variation of PVL readings within each group of retinopathy stages. All eyes were reexamined after a mean period of 11.84 months. In 15 of 16 eyes with progressive retinopathy the first PVL readings were within the distribution range of the respective retinopathy level. A progression of retinopathy was not accompanied by a significant change of the PVL. It was concluded that vitreous fluorophotometry alone is not sufficient for the grading of diabetic retinopathy and has only little prognostic value for the course of the disease.

Diabetic Retinopathy↗
PubMed1988

No sign of amyloidosis in pump-treated diabetics.

Serum concentrations of amyloid A (SAA) and C-reactive protein (CRP) were measured in 122 diabetic patients treated by continuous insulin infusion, 40 patients receiving conventional injection therapy and in 28 healthy controls. Of the patients on pump therapy, 63 had an implanted, constant basal rate device (36 i.p., 27 i.v.) and 59 extracorporal, portable programmable pumps (8 i.p., 3 i.v., 48 s.c.). SAA and CRP-values did not significantly differ between the diabetics, irrespective of the method of insulin substitution used, and the healthy controls. Elevated SAA-levels were either associated with raised CRP, indicating a non-specific acute phase reaction, or were markedly diminished or normalized in a six-month follow-up, in spite ongoing pump therapy. Increased SAA-concentrations did not correlate with sex or age of patients, diabetes duration, diabetes type, duration of pump treatment, route of insulin, insulin preparation, catheter material and pump model, indicating that pump treatment does not stimulate a specific amyloidogenic reaction.

Adult↗