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Biomedical subjects

L Delbridge

Publications and source records attributed to L Delbridge.

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

Total thyroidectomy in the management of differentiated thyroid cancer: a review of 258 cases.

Controversy continues to surround the management of differentiated thyroid cancer. For the past 20 years, a standardized protocol of total thyroidectomy followed by radioiodine ablation has been followed at Royal North Shore Hospital. During the period 1966-83, 327 cases of thyroid malignancy were treated surgically and, of these, 258 were differentiated thyroid cancer. Following total thyroidectomy, the incidence of recurrent nerve palsy was 2.8% and that of permanent hypoparathyroidism 3.2%. The overall 10 year cumulative survival for these patients was 87%. Whilst there were apparent differences in survival depending on the pathological type of tumour (papillary, follicular, mixed), further analysis shows that most of the differences in prognosis can be explained on the basis of age and sex alone. Young patients (less than 60 years) have an excellent 10 year survival (96%) whilst that for the elderly is only 61%. Males have a worse prognosis at 10 years than females. Total thyroidectomy is a safe procedure for the treatment of differentiated thyroid cancer. It allows the subsequent evaluation and treatment of unrecognized metastatic disease and offers the young patient a potentially normal lifespan.

Adenocarcinoma↗
PubMed1986

Histiocytic necrotizing lymphadenitis (Kikuchi's disease).

We report a typical case of histiocytic necrotizing lymphadenitis. To our knowledge, this is the first reported case in Australasia. Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a distinct disorder originally reported in Japan. It commonly affects young females and involves mainly cervical lymph nodes. The condition is benign. The etiology of histiocytic necrotizing lymphadenitis and its distinction from other causes of benign and malignant lymphadenopathies are discussed. The clinical importance of this disorder is that, histopathologically, it could be misdiagnosed as malignant lymphoma and therefore patients may receive incorrect treatment.

Adult↗
PubMed1986

The prevention and reversibility of tissue non-enzymatic glycosylation in diabetes.

The time course of non-enzymatic glycosylation (NEG) of liver, kidney, tail collagen, and haemoglobin was studied in diabetic rats. Increased NEG of liver, kidney, and collagen was detectable within 4 weeks of diabetes. The abnormal NEG of liver, kidney, and haemoglobin present after 4 weeks of untreated diabetes could be normalized by 4-8 weeks of intensive insulin therapy given by continuous subcutaneous infusion. However, the same treatment was ineffective in reversing the abnormal NEG and thermal stability of tail collagen. The differences in the development and reversibility of these tissue changes may be due to different tissue turnover rates. Insulin therapy, given from the onset of diabetes, was effective in preventing the development of collagen abnormalities. This suggests that early and vigorous treatment of diabetes is necessary to prevent collagen changes which are potentially irreversible.

Animals↗
PubMed1986

Abnormalities of granulation tissue and collagen formation in experimental diabetes, uraemia and malnutrition.

The formation of granulation tissue and collagen was studied in rats made diabetic with streptozotocin. Granulation tissue was harvested from the inside of steelmesh cylinders implanted in the back of diabetic and control animals. Four weeks after implantation there was a reduction in the quantity of granulation tissue and its collagen content in diabetic animals compared to controls. Rats with renal failure or malnutrition but no diabetes also formed less granulation tissue but in these animals the content of collagen in the granulation tissue was normal. These results suggest that the decrease of collagen, but not granulation tissue, in diabetes is a relatively specific phenomenon which was not due to the toxic effects of streptozotocin as the changes were prevented by insulin treatment. The hydroxyproline/proline ratio of diabetic collagen was found to be normal, excluding defective hydroxylation of proline as an important factor in the reduction of collagen in diabetes. Treatment with an aldose reductase inhibitor did not prevent the abnormalities of granulation tissue and collagen in diabetes, making it unlikely that increased activity of this enzyme played an important pathogenetic role. The observed reduction of granulation tissue mass and collagen content in diabetes may be important factors in the impairment of wound healing in diabetes.

Aldehyde Reductase↗
PubMed1986

The role of autonomic neuropathy in diabetic foot ulceration.

Five standard, non-invasive tests of cardiovascular, autonomic function were performed in each of four groups of 30 subjects: controls, group 1, diabetics without clinical evidence of neuropathy; group 2, diabetics with neuropathy, but without foot ulceration; group 3, diabetics with neuropathic ulceration of the foot. The results showed a significant impairment of autonomic function in diabetics without clinically demonstrable somatic neuropathy compared with controls diabetics with somatic neuropathy compared with those without diabetics with neuropathic ulceration compared with those with neuropathy without ulceration. Parasympathetic function was more seriously affected than sympathetic. In patients who had only mild sensory neuropathy on clinical assessment, those with ulcers had significantly greater impairment of autonomic neuropathy compared with those with uncomplicated neuropathy.

Adult↗
PubMed1986

Serum osteocalcin concentrations in Paget's disease of bone.

Total body scintiscans, serum alkaline phosphatase estimations, and serum osteocalcin radioimmunoassays were performed in 49 consecutive patients with Paget's disease of bone. Eleven were receiving calcitonin (salmon synthetic) at the time of the study. The serum alkaline phosphatase activities were elevated in all but one patient, with the highest value almost 50 times the upper limit of the reference range. Serum osteocalcin concentrations were elevated in 53% of patients and normal in the rest. The highest serum osteocalcin value was 4.2 times the upper limit of the reference range. The correlation coefficient between the extent of skeletal involvement and serum osteocalcin level was .70, while that between skeletal involvement and serum alkaline phosphatase level was .55. In spite of the better correlation between bone scintiscans and serum osteocalcin level, osteocalcin measurements are diagnostically less useful than serum alkaline phosphatase estimations in patients with Paget's disease of bone.

Aged↗
PubMed1985

Non-enzymatic glycosylation of keratin from the stratum corneum of the diabetic foot.

Non-enzymatic glycosylation of keratin from the stratum corneum of the sole of the foot was measured by the thiobarbituric acid technique in thirty diabetic and thirty control subjects. A significant increase in the level of glycosylation was demonstrated in the diabetic subjects (P less than 0.001). HbA1 levels were measured in a further eighteen subjects at the same time as keratin was removed, and in this group a significant association between non-enzymatic glycosylation of that protein and diabetic control was demonstrated (P less than 0.01). In vitro incubation of keratin in the presence of free glucose produced increased non-enzymatic glycosylation (P less than 0.01) and this effect was blocked by incubation in the presence of increasing concentrations of aspirin (P less than 0.01). Measurement of non-enzymatic glycosylation of keratin in a further group of twenty diabetics with neuropathic ulceration showed a significant increase in levels when compared with a group of diabetics without ulcers (P less than 0.05). As keratin is the principle structural protein of the stratum corneum of the sole of the foot, it is possible that changes in this protein associated with non-enzymatic glycosylation may contribute to abnormalities seen in the skin of the feet of diabetics.

Adult↗
PubMed1985

The effects of cyclooxygenase and lipoxygenase inhibitors on the collagen abnormalities of diabetic rats.

The importance of cyclooxygenase and lipoxygenase pathways in the determination of collagen abnormalities in diabetes was investigated. Pharmacological agents with antiprostaglandin activity, such as indomethacin, naproxen, and aspirin, were able to prevent the rise in thermal rupture time of tail collagen in diabetic rats. Paracetamol was without effect. The action of indomethacin on diabetic collagen was abolished by concurrent administration of sodium benoxaprofen, an inhibitor of lipoxygenase, to the diabetic rats. Collagen abnormalities in diabetes may be regulated by a balance of the cyclooxygenase and lipoxygenase pathways. Antiprostaglandin agents may have a role in the prevention of some diabetic complications.

Acetaminophen↗
PubMed1985

Vein, Gore-tex or a composite graft for femoropopliteal bypass.

Experience with a variety of graft materials has suggested that the nature of the material significantly affects long term graft patency. In 126 femoropopliteal bypass grafts performed during a 54 month period, the over-all patency rate for RSV (68.0 per cent at three years) was significantly superior to either Gore-tex alone (34.1 per cent at three years) or a composite graft of RSV below the knee anastomosed to Gore-tex above the knee (49.3 per cent at three years). The composite graft performed significantly better than Gore-tex alone, however, in patients with poor runoff or when a distal anastomosis was performed below the knee. The reason for the superior performance of RSV or the composite over Gore-tex alone probably relates to compliance mismatch at the site of the distal anastomosis. While RSV remains the graft material of choice for femoropopliteal bypass grafting, a extensive role exists for the use of a composite graft rather than Gore-tex graft alone especially in patients with poor runoff with an anastomosis below the knee.

Aged↗
PubMed1984

The effect of salicylates on nonenzymatic glycosylation and thermal stability of collagen in diabetic rats.

The effects of glucose on the nonenzymatic glycosylation and thermal rupture time of rat tail collagen were examined by (1) in vitro incubation of collagen fibers in glucose and (2) in vivo in diabetic rats. In vitro, glucose caused a dose-dependent rise in both nonenzymatic glycosylation and thermal rupture time and there was a good correlation between these two parameters (r = 0.68, P less than 0.0001). Aspirin, a known inhibitor of nonenzymatic glycosylation, was effective in preventing the glucose-induced rise in nonenzymatic glycosylation and thermal rupture time when present at concentrations of 0.78, 1.56, and 3.12 mM. Sodium salicylate at concentrations of 1.56 and 3.12 mM was also effective. In vivo, the nonenzymatic glycosylation and thermal rupture time of collagen fibers were both increased by 2-3-fold in rats with streptozotocin-induced diabetes of 4 wk duration. Aspirin or sodium salicylate treatment for 4 wk (240 mg/kg/day) from the onset of diabetes was able to prevent the rise in thermal rupture time without affecting nonenzymatic glycosylation of collagen or glycosylated hemoglobin levels. Aspirin or sodium salicylate treatment did not have detectable effect on properties of collagen in normal rats. The in vitro findings are consistent with the hypothesis that nonenzymatic glycosylation leads to the increased thermal stability of collagen fibers. The significance of nonenzymatic glycosylation in vivo is less certain, as thermal rupture time can be altered independently. The action of aspirin and sodium salicylate in vivo suggests new therapeutic options in the prevention and treatment of diabetic complications.

Animals↗
PubMed1984

Cyclohexanone extraction: an improvement in the thiobarbituric acid method for the determination of nonenzymatic glycosylation of hair and epidermal keratin.

Colorimetric techniques such as the thiobarbituric acid assay are widely used for the determination of nonenzymatic glycosylation of proteins. One of the major problems associated with this technique is the high nonspecific background absorbance which, due to its variability, results in loss of sensitivity. This report describes a method of removing the nonspecific absorbance by extracting the final chromogen into cyclohexanone. Using this method for the determination of nonenzymatic glycosylation of hair and epidermal keratin, at least 90% of the background absorbance is removed, increasing the sensitivity of the technique. This allows more effective discrimination of the level of glycolsylation of proteins from control and diabetic patients, by reducing the degree of overlap. The requirement for individual borohydride reduced samples is also avoided, thus simplifying the technique. Cyclohexanone extraction provides a simple addition to the standard thiobarbituric acid technique with significant improvement in results.

Aged↗
PubMed1983

The thermal stability of collagen in diabetic rats: correlation with severity of diabetes and non-enzymatic glycosylation.

The thermal stability of collagen fibres from rat tail tendon was studied in both normal and diabetic rats. Results were correlated with the age of the animals, glycosylated haemoglobin level and the degree of non-enzymatic glycosylation of the collagen. Age was found to be the most important single determinant of the thermal rupture time of collagen fibres (r = 0,87, p less than 0.005). Thermal rupture time was also increased in diabetes and showed good correlation with glycosylated haemoglobin (r = 0.69, p less than 0.005) and non-enzymatic glycosylation of collagen (r = 0.51, p less than 0.005). The correlation of glycosylated haemoglobin level and thermal rupture time was significant, independent of age and non-enzymatic glycosylation of collagen. Experiments in vitro showed that incubation of collagen fibres with glucose increased the thermal stability of collagen. These results demonstrated an independent effect of severity of diabetes on the physical properties of collagen. The role of non-enzymatic glycosylation in causing the changes in collagen properties in diabetes remains to be fully elucidated.

Aging↗
PubMed1983

Factors associated with development of foot lesions in the diabetic.

A prospective study was undertaken of 80 diabetic patients over the age of 50 years, with the aim of determining which factors were important in the development of foot lesions. It was found that factors associated with diabetic management, including HbAlc levels and frequency of previous admissions to hospital for diabetic control, appeared to play little part in the development of foot lesions. However, both vascular impairment and cigarette smoking were significantly associated with an increased incidence of lesions, while neuropathy was found to occur commonly in control subjects as well as patients with foot lesions. There was also a significant relationship between the level of patient understanding as measured by a questionnaire and the development of foot lesions. The importance of the education of both patients and doctors concerning the significance of diabetic foot lesions is emphasized.

Aged↗
PubMed1982

Paraganglioma of the falciform ligament: a case report.

A single case of an extra-adrenal paraganglioma removed at laparotomy from the falciform ligament of a 16 year-old girl is reported. Whilst extra-adrenal paragangliomata have been frequently documented in specific sites in relation to the vascular axis, the occurrence of these tumours in other areas is rare. This is the first report of a paraganglioma occurring within the falciform ligament in the midline in apposition to the anterior abdominal wall.

Adolescent↗
PubMed1975

Educational and psychological factors in the management of diabetes in childhood.

Thirty-seven diabetic children and their parents were studied with respect to their level of understanding of the nature and management of diabetes as well as their attitude towards, and acceptance of the disease. These were then compared with the adequacy of their management, as evidenced by the frequency of hospital readmissions. In those families in which the child's disease was poorly managed, the parents were found to know significantly less about diabetes than those parents whose children were well managed. Similarly, those families in which the child's management was poor, were found to have a high level of family maladjustment, while the parents had a poor attitude towards and were unable to accept their child and his disease. It was also found taht diabetic children as a whole have a high level of social maladjustment but do not feel they are greatly "different" from their fellows.

Attitude to Health↗