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Biomedical subjects

R Klein

Publications and source records attributed to R Klein.

At least 955 records · Page 53Linked to original sources
PubMedDate not supplied

Long-term incidence of lower-extremity amputations in a diabetic population.

OBJECTIVE: To describe the 10-year cumulative incidence of and risk factors for lower-extremity amputations in diabetics. DESIGN: Cohort study. SETTING: Primary care. PARTICIPANTS: Population-based sample (N = 879) of younger-onset diabetic persons (in whom diabetes was diagnosed before 30 years of age and who were taking insulin) and a stratified random sample (N = 956) of older-onset diabetic persons (diagnosis at or after 30 years of age) participating in baseline, 4-year, and 10-year examinations. MAIN OUTCOME MEASURE: Amputations of the lower extremities as reported by the participants. RESULTS: The 10-year cumulative incidence of lower-extremity amputation was 5.4% in younger-onset and 7.3% in older-onset persons. Multivariate analyses were performed by logistic regression. In younger-onset persons, age (odds ratio [OR] for 10 years, 2.0; 95% confidence interval [CI], 1.5-2.8), history of ulcers (OR,4.8; 95% CI, 2.3-9.9), diastolic blood pressure (OR, 2.1 for 10 mm Hg; 95% CI, 1.5-3.0), glycosylated hemoglobin level (OR, 1.4 for 1%; 95% CI, 1.2-1.6), sex (OR, 5.2 for men; 95% CI, 2.2-12.3), and retinopathy (OR, 1.2 for 2 steps; 95% CI, 1.1-1.4) were significantly associated with incidence of lower-extremity amputation. In older-onset persons, history of ulcers (OR, 3.3; 95% CI, 1.6-6.8), glycosylated hemoglobin level (OR, 1.3 for 1%; 95% CI, 1.1-1.5), duration of diabetes (OR, 1.6 for 10 years; 95% CI, 1.1-2.5), sex (OR, 2.6 for men; 95% CI, 1.3-4.9), diastolic blood pressure (OR, 0.7 for 10 mm Hg; 95% CI, 0.5-1.0), and proteinuria (OR, 2.4; 95% CI, 1.0-5.7) were significantly associated with incidence of lower-extremity amputation. CONCLUSION: These data show there are several risk factors for lower-extremity amputation with potential for modification and preventive strategies.

Adolescent↗
PubMedDate not supplied

Characterization and clinical relevance of a new complement-fixing antibody--anti-M8--in patients with primary biliary cirrhosis.

A new complement-fixing antimitochondrial antibody--anti-M8--was detected in patients with primary biliary cirrhosis. Anti-M8 was only found in association with anti-M2, however, not all anti-M2 positive patients had anti-M8. Thus, among 66 anti-M2 positive patients, 29 were also positive for anti-M8, whereas sera from patients who had the complement-fixing anti-M2 and anti-M4 antibodies in parallel always strongly reacted with the M8 antigen. This group was previously described as mixed form. The M8 antigen was isolated either from human liver mitochondria or pig kidney microsomes and could be clearly distinguished from the M4 antigen. In contrast to M4, M8 was trypsin sensitive and banded at sucrose densities from 1.16 to 1.24, while M4 was found at densities from 1.08 to 1.14. Like M4, the M8 antigen also co-purified with outer mitochondrial membranes. Fifty-three patients with primary biliary cirrhosis have been followed over a period of up to 16 years and were classified according to their complement-fixing antimitochondrial antibody profile. At the time of the first diagnosis, 95% of 31 patients being anti-M2 positive, but anti-M8 negative (antimitochondrial antibody Profile I) were in Stage I or II. In contrast, only 61% of 13 patients being anti-M2 and anti-M8 positive (antimitochondrial antibody Profile II) and 44% of 9 patients with anti-M2, anti-M8 and anti-M4 in parallel (antimitochondrial antibody Profile III) belonged to Stage I or II.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies↗
PubMedDate not supplied

Subtypes of antimitochondrial antibodies in primary biliary cirrhosis before and after orthotopic liver transplantation.

Antimitochondrial antibodies are markers for primary biliary cirrhosis and probably reflect a specific defect in immunoregulation underlying this disease. Antimitochondrial antibodies and their primary biliary cirrhosis-specific subtypes were tested before and up to 6 years after orthotopic liver transplantation. Sera from 31 consecutive patients were tested, 15 patients had primary biliary cirrhosis and 16 non-primary biliary cirrhosis. Antimitochondrial antibodies were investigated under code by immunofluorescence, and primary biliary cirrhosis-specific subtypes were determined by radioimmunoassay (anti-p62, anti-p48) and complement fixation test (anti-M2, anti-M4, anti-M8). Before orthotopic liver transplantation, antimitochondrial antibodies were detected by immunofluorescence in 13 of 15 patients with primary biliary cirrhosis. Of these patients, 12 were positive for anti-p62 and 8 for anti-p48. Ten patients were positive for anti-M2, 4 patients for anti-M4 and 7 patients for anti-M8. Two primary biliary cirrhosis patients and all non-primary biliary cirrhosis patients were negative with all tests. One month after orthotopic liver transplantation, antimitochondrial antibodies titers declined or became negative by antimitochondrial antibodies immunofluorescence, 3 patients became negative by radioimmunoassay for anti-p62 and 1 for anti-p48. With complement fixation test, 4 patients became negative for anti-M2, 2 for anti-M4 and 4 for anti-M8. Antimitochondrial antibody titer reduction observed 1 month after orthotopic liver transplantation remained unchanged in most sera during the following years. A rise was observed in two patients after 4 and 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

A pipette method for rapid karyotyping in prenatal diagnosis.

The "pipette method' is introduced as a method of prenatal diagnosis which is in competition with the "in situ' and the "trypsinization' technique. It is sufficiently standardized for routine diagnosis and the banding techniques currently used in prenatal diagnosis (G, Q, C-banding and NOR) have been adapted for it. In 180 cases from 27 different centres, the "pipette method' was employed for chromosomal harvesting in order to save time. An average of 6 X 6 days was taken to achieve a result. There was a pathological karyotype in 28 cases (16.1 per cent) and this high proportion can be related to cases where ultrasound scan has led to a diagnosis of "suspected chromosomal abnormality.' This technique is also of use in advanced stages of pregnancy. The early recognition of the fetal karyotype can contribute to the future management of the pregnancy. The "pipette method' can also be used in chromosomal harvesting of tumour cells and fibroblast cultures.

Chromosome Aberrations↗
PubMedDate not supplied

Leisure time, sunlight exposure and cataracts.

Leisure time sunlight exposure is a small or insignificant portion of total sunlight exposure experienced by most people at high risk for cataract. Few studies have been undertaken to evaluate a possible causal relationship, and these have largely been in Western countries. Analyses of data from the National Health and Nutrition Examination Survey (1971-1972) failed to confirm a relationship between leisure time exposure and cataract, but suggested that total exposure to sunlight was significantly related to cataract. A case-control study of cataract in Iowa suggested that controls were more likely to have shielded their eyes from sunlight than cases. A study in Italy suggested a positive relationship between leisure time sunlight exposure and lens opacities. In the large population-based Beaver Dam Eye Study population, we evaluated estimates of sunlight exposure and cataracts. We did not find that more leisure time sunlight exposure was associated with lens opacities. However, in men, estimates of lifetime exposure to ultraviolet-B were associated with cortical cataract. In summary, there is evidence to suggest that sunlight exposure may be related to cataract in diverse populations. Leisure time sunlight exposure is probably responsible for a small portion of that exposure.

Adult↗
PubMedDate not supplied

Biosynthesis and operating mechanism of estrogens in ovariectomized animals under the effect of -SH groups.

This paper is part of a series aimed to investigate the mechanism of the action of Folcysteine, a substance that has the capacity to release in the body active -SH groups and has been proved to be effective in the control of menopausal troubles. As an experimental model the ovariectomized rat, rather similar, from the viewpoint of the hormonal balance, to the aged female, has been considered. Under these conditions, the effect, at the uterine and adrenalian level of the treatment with two different doses of estradiol with Folcysteine alone as well as associated with estradiol, has been investigated. Our results indicate that the active -SH groups released by Folcysteine intensify the effect of estrogens upon the uterine tissue and stimulate the estrogen biosynthesis at adrenalian level.

Animals↗
PubMedDate not supplied

The Wisconsin Epidemiologic Study of Diabetic Retinopathy: VIII. The incidence of retinal photocoagulation.

The incidence of focal and panretinal photocoagulation and its relationship to demographic and other characteristics were examined in a population-based study of people with diabetes in southern Wisconsin. For participants whose age at diagnosis was less than 30 years, who were taking insulin, and who had not been previously treated with photocoagulation, the 4 year incidence of panretinal photocoagulation (10.8%) was significantly higher (p less than .0001) than the rate of focal and/or grid photocoagulation of the macula (4.3%). For those whose age at diagnosis was 30 years or older and who had not been previously treated with photocoagulation, the incidence rates of panretinal photocoagulation (4.4%) and focal and/or grid photocoagulation of the macula (3.1%) were not significantly different (p = .11). At follow-up examination, 33.8% of the eyes of younger onset persons and 57.7% of the eyes of older onset persons with Diabetic Retinopathy Study high risk characteristics for severe visual loss had never received panretinal photocoagulation. These relatively high frequencies of untreated eyes in need of panretinal photocoagulation remain a concern.

Adult↗
PubMedDate not supplied

Factors associated with compliance following diabetic eye screening.

Compliance with screening recommendations was evaluated following an eye examination administered to a population-based sample of diabetic individuals (The Wisconsin Epidemiologic Study of Diabetic Retinopathy). The relationship between certain characteristics and compliance with a recommendation to seek ophthalmologic follow-up care was examined among 819 study subjects found to have retinopathy at examination. Compliance with the screening recommendations was reported by 77% of all subjects, and was lowest among older-onset non-insulin taking subjects (65%). A history of ophthalmologic care strongly influenced compliance. Subjects who had never seen an ophthalmologist were far less likely to follow the recommendation (50%) than were those who had seen an ophthalmologist in the previous two years (87%). A previous diagnosis of retinopathy, and more severe retinopathy, were determinants of compliance among subjects taking insulin. Increasing duration of diabetes was also an important predictor. Better blood glucose control was found more frequently among subjects who received the recommended ophthalmologic follow-up. Certain demographic factors, such as increasing age, higher education, and being a woman, were associated with compliance in the younger-onset group. Among older-onset non-insulin taking subjects, compliance was more likely if subjects were urban residents. In order to optimize the effectiveness of a screening program for diabetic eye disease, the results of this study might be used to identify subjects who may be unlikely to receive appropriate diagnosis and treatment following screening.

Adult↗
PubMedDate not supplied

Education to increase ophthalmologic care in older onset diabetes patients: indications from the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

Both physicians and diabetic persons must be educated about the need for regular ophthalmologic examinations to prevent blindness. A large population-based study of diabetic persons living in Southern Wisconsin (Wisconsin Epidemiologic Study of Diabetic Retinopathy), designed to evaluate the incidence and associated risk factors for diabetic retinopathy, provided the opportunity to evaluate an intervention to increase ophthalmologic care. As part of this study, a sample of persons less than 80 years of age with older onset diabetes of less than 15 years duration was identified and examined in both 1980-1982 and 1984-1986 (n = 619) using standardized protocols. Study subjects received educational material on diabetic eye disease, and examination findings were conveyed to each participant and their primary physician. To evaluate the effect of this intervention, a random representative sample of diabetic persons who were not selected for examination (a nonintervention control group) was identified and interviews were completed with 241 (80%) of the surviving subjects. The two study groups were similar with respect to demographic factors, employment status, medical history, and frequency of physician visits and hospitalizations, but not for income. Self-assessments of general health were also identical between the selected and nonintervention groups. Overall, both groups reported very similar patterns of ophthalmologic care, visual impairment, and knowledge of retinopathy. These results suggest that a more intensive intervention is needed to improve the ophthalmologic care patterns of the diabetic population at risk of eye disease.

Adult↗