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Biomedical subjects

S B Leichter

Publications and source records attributed to S B Leichter.

At least 19 recordsLinked to original sources
PubMed1995

Phospholipid and glutamic acid decarboxylase autoantibodies in diabetic neuropathy.

OBJECTIVE: To determine the prevalence and significance of phospholipid autoantibodies (PLAs) and glutamic acid decarboxylase (GAD) autoantibodies in the circulation of normal patients and diabetic patients with and without neuropathy. RESEARCH DESIGN AND METHODS: We measured PLAs in a total of 78 patients (a diabetic group with somatic or autonomic neuropathy [n = 40] another group without neuropathy [n = 38]), and GAD autoantibodies in a subset of 22 patients. RESULTS: PLAs are found in 2% of the general population. We found PLAs in 32% of the diabetic population without neuropathy, in 88% of those with neuropathy, in 55% of those with retinopathy, and in 25% of those with established nephropathy. The frequencies of immunoglobulins in the neuropathic group were: IgG = 78%, IgM = 33%, and IgA = 23%. There was no correlation between PLAs and microalbuminuria, macrovascular disease, fibrinogen, duration of diabetes, or neuropathy, but there was a strong correlation with total neuropathy score. Sera with high PLA IgG titers bound to the surface of neuroblastoma cells and inhibited cell growth. Antibodies to GAD65 were present in 32% and to GAD67 in 0% of patients. No titers of GAD65, GAD67, or the GAD65 ratio were associated with the degree of neuropathy of the presence of PLAs. CONCLUSIONS: PLAs occur frequently in the sera of patients with diabetes and correlate with the extent of neuropathy, suggesting a role for PLAs in the etiology thereof. The measurement of PLAs may constitute a marker for ongoing damage to nerves.

Analysis of Variance↗
PubMed1991

New concepts in managing diabetic foot infections.

Recent enhanced attention to diabetic foot infection--in both clinical care and research--has yielded a modified picture of this disorder. It suggests that certain diabetic patients may have important risk factors for the development of infection, and further, infections in these patients may not have the same clinical characteristics as the soft tissue or bony infections found in nondiabetic subjects. Treatment of diabetic patients should therefore be modified to conform to the particular characteristics of their infections.

Anti-Bacterial Agents↗
PubMed1988

Clinical characteristics of diabetic patients with serious pedal infections.

The clinical characteristics of 55 diabetic patients referred for treatment of serious pedal infections were surveyed. These patients had been infected for 22.5 +/- 5.0 weeks prior to referral. A majority had received therapy with oral antibiotics and approximately one third had received no antibiotic therapy. The average age of the patients was 53.5 years; average duration of disease, 18 years; and mean weight, 135% of ideal. All had poor glycemic control, as judged by hemoglobin A1c determinations. The patients had a high prevalence of diabetic complications, particularly peripheral neuropathy and nephropathy. Approximately 69% were hypertensive. Although their corrected ESRs were elevated, mean total WBC counts were not. A majority of the patients had zinc deficiency. Most of their infections involved multiple organisms, particularly staphylococcus species, enterococcus, and gram-negative aerobes. These observations suggest that the clinical characteristics of these patients in part explain the difficult nature of their infections and argue the need for early, aggressive antibiotic therapy.

Anti-Bacterial Agents↗
PubMed1985

Long-term follow-up of diabetic patients using insulin infusion pumps. Considerations for future clinical application.

Current debate about the use of insulin infusion pumps in the treatment of diabetes mellitus is partly attributable to a lack of available data about the long-term course of patients who use pumps. We evaluated the course of our first 20 patients treated with insulin infusion pumps. Two or more years after the inception of therapy, only half of these patients were still using the insulin infusion pump. Psychosocial stresses, which affected glycemic control, were identified retrospectively in a majority of patients, but were not appreciated when pump therapy was initiated, despite our best attempts to do so. Mean hemoglobin A1 levels decreased significantly for the entire group and for the subgroup that did not discontinue pump therapy. These results suggest that insulin pump programs must have the resources to provide appropriate support for all candidates, including unsuitable candidates, who present for treatment with insulin infusion pumps.

Adult↗
PubMed1981

Exogenous, but not endogenous, cyclic GMP reduces hepatic pyruvate kinase activity.

We investigated the effects of exogenous cyclic GMP and stimulants of endogenous cyclic GMP accumulation on L-form (hepatic) pyruvate kinase (ATP: pyruvate 2-O-phosphotransferase, EC 2.7.1.40) activity in isolated rat hepatocytes. Exogenous cyclic GMP (200 muM) reduced pyruvate kinase activity, but was less potent than exogenous cyclic AMP (50 muM) (Ki congruent to 120 muM vs. 30 muM, respectively), had a slower onset of action (1.0 vs. 0.3 min, respectively) and a less rapid maximal effect (5.0 vs. 1.0 min, respectively). Similar results were noted with dibutyryl cyclic GMP or dibutyryl cyclic AMP. 1.0 muM acetylcholine increased cyclic GMP concentrations in isolated hepatocytes from 233 +/- 16 to 447 +/- 3 pmol/g cell protein (P less than 0.001), but did not alter pyruvate kinase activity. Similar results were noted with carbamylcholine, NaN3 or acetylcholine plus eserine sulfate. The results suggest a differential effect of exogenous vs. endogenous cyclic GMP on L-form pyruvate kinase activity, and question the physiological relevance of observations with exogenous cyclic GMP in this system.

Acetylcholine↗
PubMed1980

Clinical and metabolic aspects of glucagonoma.

The features of 41 proven or suspected cases of pancreatic glucagonoma and one possible case of renal glucagonoma have been reviewed. Glucagonoma is one form of islet cell neoplasm and involves pancreatic alpha cells. It may occur more frequently in women and is more likely to be malignant than insulinoma. Patients may present with glucose intolerance, an erythematous, eczematous dermatitis, glossitis, stomatitis, vaginitis and unexplained weight loss. Anemia, hypoproteinemia, hypoaminoacidemia and hypolipidemia may also be present. Malignant glucagonoma metastasizes frequently to liver. An evaluation for possible glucagonoma may be considered in a patient with the characteristic eczematous dermatitis, glossitis or stomatitis and glucose intolerance, an unusual or atypical history of diabetes mellitus, or hepatomegaly with other characteristics of glucagonoma. Initial evaluation may include measurement of fasting plasma glucagon concentration, and an oral glucose tolerance test with measurements of plasma glucose and glucagon levels. Extreme fasting hyperglucagonemia, and a paradoxical rise in plasma glucagon concentrations after glucose ingestion should strongly suggest the presence of glucagonoma. Radiographic demonstration of pancreatic glucagonoma is best carried out by celiac arteriography. Surgical excision of the tumor is the treatment of choice. Nonresectable lesions may respond to chemotherapy with streptozotocin. Treatment for the various dermatologic or metabolic complications of glucagonoma which include glucose intolerance, hypoproteinemia, hypocholesterolemia and anemia may not be satisfactory. Glucose intolerance is usually mild and may be adequately treated with dietary or insulin therapy. Rarely, glucagonoma with massive destruction of the pancreas or other factors may induce severe glucose intolerance. In contrast, the anemia, skin rash, and hypoproteinemia do not respond to conservative therapies tested thus far. Glucagonoma is a model for studying the importance of glucagon in causing the hyperglycemia of diabetes mellitus. Study of patients with glucagonoma does suggest that glucagon has some role in the etiology of hyperglycemia in diabetic states; however, as in studies on diabetes, investigations on glucagonoma do not demonstrate that glucagon has a primary role in producing severe glucose intolerance.

Adult↗
PubMed1980

Survey of knowledge among primary health care workers in diabetes.

The knowledge of diabetes mellitus held by allied health professionals in Kentucky and the short-term and long-term effectiveness of a symposium in altering this knowledge was studied. The groups investigated consisted of: 136 primary health workers (nurses, dieticians, health educators, and other health professionals) surveyed before and after the 12-hour symposium (group 1); 37 of these primary health professionals studied again one year after the first symposium (group 2); and 26 nurses who work at a university hospital, and who did not attend the symposium (group 3). Before training, all groups performed similarly on this survey. Group 1 scored 58.5 +/- 0.2% correct, group 2, 56.9 +/- 3.1% correct, and group 3, 52.7 +/- 5.0% correct. Performance did not correlate with educational level, job description, or geographic location within Kentucky. There was a negative correlation between performance and age for group 1 (r = -0.3494, P < .001). Follow-up studies immediately after the symposium showed that a significant improvement occurred in the performance of group 1 and group 2 on this knowledge survey (correct score +/- SEM = 82.5 +/- 0.3%, and 81.7 +/- 2.4% respectively, P < .005) compared to pretraining scores. A repeat survey of group 2 one year later showed a significant deterioration of knowledge (P < .05), but not to pretraining levels (mean correct score = 69.2 +/- 3.4% at one year versus 56.9 +/- 3.1% before training, P < .02). These results suggest that more emphasis on professional education in diabetes and study of effective methods for providing this education is required.

Adult↗