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Biomedical subjects

M Leutenegger

Publications and source records attributed to M Leutenegger.

At least 55 records · Page 3Linked to original sources

Remission of insulin requirement in late secondary failure to oral hypoglycemic agents (IRD): results at 24 months and analysis of predictive factors.

Over the last four years, we have done a prospective study of insulin requiring diabetes (IRD). We offered 59 patients insulin therapy during 10 to 14 days by means of continuous subcutaneous insulin injection with the help of a pump in order to maintain the patient under oral hypoglycemic agents (OHA). We divided our population into two characteristic groups and isolated parameters that were predictive of post-insulin therapy evolution by means of C peptide assays. In one group, in 50% of cases, endogenous insulin production appeared impaired and could not be restored by insulin therapy. The patients in this group suffered a renewed drug failure within 3 months. In the other group, 50% of cases, endogenous insulin production was preserved and the CP/blood glucose level ratio improved. On insulin treatment interruption, we observed a significantly improved fasting blood glucose level and we observed decreased insulin needs. The patients, who were probably insulin resistant, suffered only late failures or went into remission, often for longer than one year. The data bring us to the logical conclusion of IRD heterogeneity. Only some of these patients can benefit from temporary insulin therapy and the remission attempt should be limited to them.

Biomarkers↗

[Assay of fructosamine. Value and limits in diabetology].

Fructosamine test using a Nitroblue Tetrazolium (NBT) method offers many advantages: quickness, reproducibility, easy automation and unexpansiveness, but a standardization of the different methods is needed. The results can be expressed in absolute value of equivalent DMF per liter, except in pregnancy where mumol per g of protein is used. The interpretation of the results can be difficult in case of quantitative and/or qualitative proteins abnormalities: icterus and severe chronic renal insufficiency. Fructosamine is significantly higher in diabetic patients. It gives a good correlation with glycated haemoglobin but the provided information is different, concerning a shorter period of 2 to 3 weeks and perhaps more sensitive to recent glycaemic variations. Fructosamine test does not seem to be a good screening test for diabetes and impaired glucose tolerance. The test indications of the assay could be: situations where the dosage of glycated haemoglobin is not interpretable, diabetic pregnancy follow-up and short term evaluation of a therapeutic change on glycaemic control. However, the individual significance of fructosamine concentration remains to be assessed and seems to be less accurate than glycated albumin.

Biological Assay↗

[Cutaneous mucormycosis in a diabetic woman. Diagnostic and therapeutic problems].

We report a new case of cutaneous mucormycosis in a diabetic woman. The major favouring circumstances are found in this patient: ketoacidosis diabetes, use of bandages, local corticosteroid applications, renal insufficiency. The diagnosis, rarely made on the clinical aspect, is based on the histological and mycological data. A trial of treatment by ketoconazole has been carried out, but without success. The usual treatment by intravenous amphotericine B has been successful.

Amphotericin B↗

Plasma and tissue fibronectin in diabetes.

Plasma fibronectin was determined by laser immunonephelometry in controls (90 women, 66 men) and 167 diabetic patients between 10 and 60 years of age, 72 insulin-dependent males, 45 insulin-dependent females, 29 noninsulin-dependent males and 21 non-insulin-dependent females. The distribution and intensity of immunofluorescent tissue fibronectin were also studied in the patients using skin biopsies. The diabetic patients had a significantly lower plasma fibronectin level than the controls of the same age-groups and did not exhibit the strong age-dependent increase found for controls. This was true for both females and males, and especially pronounced for the insulin-dependent male patients below 45 years. The duration (less or more than 10 years), and control of diabetes (judged by the glycosylated hemoglobin A1C levels, presence or absence of retinopathy), had a lesser influence on plasma fibronectin levels, although the duration of the disease tended to increase plasma fibronectin levels. Tissue fibronectin appeared to increase as estimated by the intensity and distribution of immunofluorescence in the papillary dermis, and in vascular and dermo-epidermal basement membranes, suggesting an inverse variation of tissue and plasma fibronectin in diabetes.

Adolescent↗

Distribution of fibronectin in diabetic skin.

Distribution of the fibronectin (FN) present in the forearm skin was studied in 23 controls and 34 insulin dependent diabetics. All the subjects were lean males under 50 years. After biopsy FN was studied by an indirect immunofluorescence technic. A semi-quantitative evaluation was attempted by giving a score to the fluorescent intensity read at the three following sites: vascular basement membranes, papillary dermis, and the dermo-epidermal basement membranes. We found an increased amount of FN-immunofluorescence in diabetic skins. This increase was seen not only in vascular basement membranes but also at the two other sites. No correlation was found between apparent FN levels and the duration or equilibration of diabetes. These results are consistent with other findings of the literature concerning the involvement of the intercellular matrix in diabetes.

Adult↗

[Contact (prekallikrein) and fibrinolytic (plasminogen/antiplasmin value) system in the physiopathology of vascular complications of diabetes].

Both micro and macro-angiopathy involve interaction of blood vessel and plasma factors which may be altered in diabetes. Little is known concerning changes in contact and fibrinolysis factors as prekallikrein, plasminogen and fast antiplasmin in diabetes. We tested also the plasminogen/antiplasmin ratio in 151 diabetics and 64 normal subjects (18 to 74 years old). Our conclusion is:--the absence of correlation between the clinical characteristic of diabetes and prekallikrein level,--the decrease of plasminogen/antiplasmin ratio in complicated diabetes,--in complicated diabetes, correlation between antithrombin III, VIII factor and fibrinogen levels, perhaps, in relation with inflammation signs.

Adolescent↗

[Glycosylated hemoglobin and diabetes mellitus].

Properly estimated glycosylated hemoglobin A1c (HbA1c) is a good objective indicator of diabetic control over the previous eight weeks. It is essential to eliminate the labile fraction (pre-HbA1c). A valuable tool in diabetes research, prospectives studies using this index will permit clarification of the relationships between the complications of diabetes and chronic hyperglycemia. Glycosylation of hemoglobin is an example of a reaction secondary to hyperglycemia which can also occur with numerous circulating or tissue proteins. This may explain pathogenesis of some diabetic complications. Its value as a prognostic indicator depends critically upon methodology and this report summarises the current'state of the art in this respect.

Chromatography, Ion Exchange↗