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P Perros

Publications and source records attributed to P Perros.

At least 37 records · Page 2Linked to original sources
PubMed2000

Evaluation of an on-call diabetes service in a large teaching hospital.

AIMS: To assess prospectively the activity and effectiveness of a diabetes specialist on-call service. METHODS: All requests for specialist advice received by the doctor on-call for diabetes in a large teaching hospital were recorded and analysed over a period of 3 weeks. RESULTS: The total number of calls was 135 (mean 45 per week) of which 48.1% were outside normal working hours. Requests for advice from surgical and medical ward staff accounted for 43% of calls, the remainder were from staff in the maternity ward (12.6%), staff in other hospitals in the city (3.7%), general practitioners (13.3%) and patients (27.4%). The time spent by the on-call doctor for diabetes responding to calls was a mean of 8.6 h per week. The number of acute admissions prevented by this service was estimated to be 11 (3.6 per week). CONCLUSIONS: Open access to specialist advice provided by a doctor with expertise in diabetes is an effective adjunct to the delivery of diabetes care in the setting of a large teaching hospital.

Adult↗
PubMed2000

Serum S-100beta protein is a potential biochemical marker for cerebral oedema complicating severe diabetic ketoacidosis.

CASE REPORT: A 39-year-old man with Type 1 diabetes mellitus was hospitalized with severe diabetic ketoacidosis (DKA). Sixteen hours after admission he suddenly deteriorated having a respiratory then cardiac arrest. A brain computed tomography scan performed 2 h after the respiratory arrest showed severe cerebral oedema. Serial serum samples were stored and analysed for S-100beta protein. The S-100beta protein concentration was initially normal (0.12 microg/l) then rose significantly before the onset of the respiratory arrest (8.5 h = 0.61 microg/l, 14.5 h = 0.9 microg/l, 18 h = 1.6 microg/l, 25.5 h = 3.1 microg/l, 34 h = 4.6 microg/l and44 h = 19.5 microg/l). CONCLUSIONS: In this case of DKA, serum S-100beta concentration rose coinciding with the onset of cerebral oedema, before it became clinically evident. Monitoring serum S-100beta may have a useful role in the management of DKA.

Adult↗
PubMed2000

Prevalence of pernicious anaemia in patients with Type 1 diabetes mellitus and autoimmune thyroid disease.

AIMS: To determine the prevalence of pernicious anaemia in patients with Type 1 diabetes mellitus and autoimmune thyroid disease. METHODS: A randomly selected asymptomatic group of 63 patients with Type 1 diabetes who also had autoimmune thyroid disease was studied. Blood samples were taken and assayed for serum B12. Those subjects with serum B12 concentrations below the reference range had a further blood sample taken for determination of intrinsic factor antibody. RESULTS: One patient had been diagnosed previously to have pernicious anaemia. Three patients had low serum B12 concentration and positive intrinsic factor antibody, confirming the diagnosis of pernicious anaemia. The prevalence of pernicious anaemia in this population with Type 1 diabetes and concomitant autoimmune thyroid disease was 6.3%. In female patients the prevalence of pernicious anaemia was 8.5%. CONCLUSIONS: Patients who have both Type 1 diabetes mellitus and autoimmune thyroid disease are at risk of developing pernicious anaemia.

Aged↗
PubMed2000

Association analysis of the cytotoxic T lymphocyte antigen-4 (CTLA-4) and autoimmune regulator-1 (AIRE-1) genes in sporadic autoimmune Addison's disease.

Although autoimmune Addison's disease (AAD) may occur as a component of the monogenic autoimmune polyendocrinopathy type 1 syndrome (APS1), it is most commonly found as an isolated disorder or associated with the autoimmune polyendocrinopathy type 2 syndrome (APS2). It is likely that sporadic (non-APS1) AAD is inherited as a complex trait; however, apart from the major histocompatibility complex, the susceptibility genes remain unknown. We have examined polymorphisms at two non-major histocompatibility complex candidate susceptibility loci in sporadic (non-APS1) AAD: the cytotoxic T lymphocyte antigen-4 (CTLA-4) gene and the autoimmune regulator (AIRE-1) gene. DNA samples from AAD subjects (n = 90) and local controls (n = 144 for CTLA-4; n = 576 for AIRE-1) were analyzed for the CTLA-4A/G polymorphism in exon 1 of the CTLA-4 gene and for the common mutant AIRE-1 allele (964de113) in United Kingdom subjects with APS1, by using the restriction enzymes Bst7II and BsrBI, respectively. There was an association of the G allele at CTLA-4A/G in AAD subjects (P = 0.008 vs. controls), which was stronger in subjects with AAD as a component of APS2 than in subjects with isolated AAD. In contrast, the mutant AIRE-1 964del13 allele was carried in one each of the 576 (0.2%) control subjects and the 90 (1.1%) AAD subjects as a heterozygote (P = 0.254, not significant), suggesting that this common AIRE-1 gene abnormality does not have a major role in sporadic (non-APS1) AAD.

Abatacept↗
PubMed2000

Current awareness

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 Intervention: a&rpar General; b&rpar Pharmacology; 9 Pathology: a&rpar General; b&rpar Cardiovascular; c&rpar Neurological; d&rpar Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (8 Weeks journals - Search completed at 23rd Feb. 2000)

Journal Article↗
PubMed2000

Do diabetes guidelines influence the content of referral letters by general practitioners to a diabetes specialist clinic?

OBJECTIVE: To ascertain whether local guidelines for diabetes management influence the content of GP referral letters to a diabetes specialist clinic. DESIGN: Retrospective survey of hospital outpatient clinic casenotes and GP referral letters of patients with Type 2 diabetes. METHODS: An examination was made of 200 GP referral letters submitted before (Set 1), and 200 GP referral letters submitted after (Set 2), local guidelines on the management of adult diabetes had been issued to GPs in Lothian. The frequency with which micro- and macrovascular complications of diabetes were documented in the GP referral letters was compared with the frequency ascertained at the first attendance to the specialist clinic. MAIN RESULTS: Following the distribution of diabetes guidelines, no significant change was noted in the frequency with which specific conditions were documented in GP referral letters (Set 1 vs Set 2): hypertension (72% vs 79%); cerebrovascular disease (89% vs 80%); ischaemic heart disease (74% vs 79%); peripheral vascular disease (42% vs 64%); cataract (35% vs 44%); retinopathy (18% vs 40%) and peripheral neuropathy (17% vs 12%). At the diabetic clinic many unreported diabetic complications were found in patients who had been referred after varying periods of treatment in primary care. However, the guidelines did appear to have encouraged the active treatment of hyperglycaemia by GPs before referral of newly-diagnosed diabetic patients. CONCLUSIONS: Diabetes guidelines per se appeared to have very little effect on increasing the information provided in GP referral letters on relevant medical problems and did not appear to have influenced screening for complications in patients with Type 2 diabetes by GPs before specialist referral. Methods other than the issue of written guidelines are required to achieve optimal assessment of diabetic patients in the community.

Correspondence as Topic↗
PubMed1999

The cytotoxic T lymphocyte antigen-4 is a major Graves' disease locus.

Graves' disease (GD) is an autoimmune thyroid disorder that is inherited as a complex trait. We have genotyped 77 affected sib-pairs with autoimmune thyroid disease for eight polymorphic markers spanning the cytotoxic T lymphocyte antigen-4 ( CTLA-4 ) region of chromosome 2q31-q33, and for five markers spanning the major histocompatibility complex ( MHC ) region of chromosome 6p21. Non-parametric analysis showed linkage of GD to the CTLA-4 region with a peak non-parametric linkage (NPL) score of 3.43 ( P = 0.0004) at the marker D2S117. The proportion of affected full-sibs sharing zero alleles (z0) reached a minimum of 0.113 close to D2S117, giving a locus-specific lambdas for this region of 2.2. Families with brother-sister sib-pairs showed a peak NPL of 3.46 ( P = 0.0003, lambdas > 10) at D2S117, compared with 2.00 ( P = 0.02, lambdas = 1.9) in the families with only affected females, suggesting a stronger influence in families with affected males. Association between GD and the G allele of the Thr17Ala polymorphism within the CTLA-4 gene ( CTLA4A/G ) was observed using unaffected sib controls ( P = 0.005). Lesser evidence for linkage was found at the MHC locus, with a peak NPL score of 1.95 ( P = 0.026), between the markers D6S273 and TNFalpha. We demonstrate that the CTLA-4 locus (lambdas = 2.2) and the MHC locus (lambdas = 1.6) together confer approximately 50% of the inherited susceptibility to GD disease in our population.

Abatacept↗
PubMed1999

Recombinant human thyroid-stimulating hormone (rhTSH) in the radioablation of well-differentiated thyroid cancer: preliminary therapeutic experience.

Iodine-131 (I-131) ablation of thyroid remnant and/or persistent, recurrent or metastatic tumour is part of the initial and subsequent management of well-differentiated thyroid carcinoma. Key to optimizing the safety and efficacy of radioablation is maximizing the selective uptake of radioiodine by normal or neoplastic thyroid tissue. This is achieved by ensuring adequate serum concentrations of thyroid-stimulating hormone (TSH). Exogenous TSH administration obviates the thyroid hormone suppression therapy withdrawal that is necessary for endogenous TSH elevation. It also avoids the marked morbidity, discomfort, and impairment in professional and educational pursuits and quality of life that often result from such withdrawal. Multicentre clinical studies have documented the safety and efficacy of recombinant human TSH (rhTSH) in promoting radioiodine uptake in the diagnostic scanning of well-differentiated thyroid cancer. Study of the use of rhTSH to facilitate radioablation of remnant and malignant thyroid tissue is at an earlier stage, with formal clinical investigation underway. Since April 1995, however, rhTSH has been employed as a radioablative adjunct in over 100 patients in the manufacturer's Compassionate Use Program. Twelve of these cases, reported or reviewed in the present paper, provide preliminary evidence that rhTSH is safe and effective in the radioablation setting. More data are needed to confirm these observations and to provide guidelines for optimal radioiodine dosing, and should be furnished by ongoing clinical investigation. rhTSH is the only acceptable treatment option in a subgroup of patients with well-differentiated thyroid cancer, including those with hypopituitarism, ischaemic heart disease, a history of "myxoedema madness," debilitation due to very advanced disease or inability to produce TSH due to continued production of thyroxine by thyroid remnant or metastatic tumour. Therapeutic use of rhTSH may be considered in an increasing number of other cases.

Adenocarcinoma, Follicular↗
PubMed1998

Factors influencing preference of insulin regimen in people with type 1 (insulin-dependent) diabetes.

The two commonest insulin regimens in current use in the UK are twice daily administration of short- and intermediate-acting insulins in combination, and soluble insulin before meals with intermediate-acting insulin at bed-time (basal-bolus regimen). A cross-sectional sample of patients with type 1 diabetes was studied using either a twice daily insulin regimen (n = 30) or a basal-bolus regimen (n = 30), to assess their satisfaction with choice of insulin regimen and to examine the relationships between type of insulin regimen, personality, demographic variables and glycaemic control. Patients treated with a basal-bolus insulin regimen tended to be younger (P = 0.07), had an earlier onset of type 1 diabetes (P = 0.04), adjusted their dose of insulin more frequently (P = 0.01), had received more secondary and further education (P = 0.03), belonged to a higher socio-economic class, tended to be unmarried (P = 0.07) and were less likely to be smokers (P = 0.03), than the group treated with twice daily administration of insulin. Current and previous glycaemic control assessed by glycated haemoglobin concentration, showed no correlation with type of insulin regimen, demographic data or personality variables.

Adult↗