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Biomedical subjects

U Keller

Publications and source records attributed to U Keller.

At least 307 records · Page 17Linked to original sources
PubMed1980

Somatostatin and cimetidine in peptic-ulcer haemorrhage. A randomised controlled trial.

In a randomised controlled trial somatostatin was compared with cimetidine in the treatment of severe and persistent gastrointestinal bleeding due to peptic ulcer. The study was of a sequential design and lasted 2.5 years, when the designated level of significance had been reached. Of the 20 patients studied, 10 received somotostatin and 10 received cimetidine. In 7 of the 10 pairs of patients somatostatin was more effective than cimetidine; in 2 pairs somatostatin and cimetidine were both ineffective; and in 1 pair they were equally effective. Somatostatin may therefore be suitable for controlling peptic-ulcer bleeding in many patients who are unsuitable for surgery.

Adult↗
PubMed1980

[Hypoglycemia: clarification and etiology].

Spontaneous hypoglycemia occurs when the blood sugar falls below 50 mg/dl (2.8 mmol/l) and when neuroglycopenic symptoms appear. For clinical differential diagnosis separation of the hypoglycemias into fasting and postprandial hypoglycemias is suggested. Fasting hypoglycemia may be a symptom of insulinoma. The most important diagnostic tool in detecting insulinoma is still the simultaneous determination of glucose and insulin in plasma during fasting. A raised insulin level during hypoglycemia renders the presence of an insulinoma suspect; during fasting there is an inappropriate fall in blood glucose in relation to the course of the plasma insulin concentration, resulting in an increased insulin-glucose ratio. Recently determination of the fasting proinsulin level has been recommended as raised concentrations are pathognomonic for the presence of insulinoma. Evaluation of postprandial hypoglycemia is performed by oral glucose tolerance test with late glucose concentration determinations after three and four hours. This makes it possible to differentiate between reactive hypoglycemia in mild diabetes mellitus and "functional" reactive hypoglycemia, the most frequent cause of hypoglycemia.

Adenoma, Islet Cell↗
PubMed1980

Effect of hyperglycemia independent of changes in insulin or glucagon on lipolysis in the conscious dog.

In the face of fixed basal levels of insulin (9 microunits/ml) and glucagon (63 pg/ml) maintained by the infusion of somatostatin and replacement amounts of the two pancreatic hormones, the mean arterial plasma glucose concentration was elevated from 102 to 217 mg/dl by continuous glucose infusion. Hyperglycemia resulted in a significant decrease in the arterial blood glycerol (35%) and plasma free fatty acid concentrations (46%). The drop in the blood glycerol level was paralleled by a decline in hepatic glycerol uptake indicating that hyperglycemia did not alter the fractional extraction of glycerol by the liver. These results support the view that glucose has a direct antilipolytic effect in vivo.

Animals↗
PubMed1980

Effects of insulin at two dose levels on gluconeogenesis from alanine in fasting man.

We have determined the effect of insulin infused at 1 and 5 mU/kg/min on gluconeogenesis from alanine in 48-hr fasted men. The conversion of alanine to glucose was measured by the arterial-hepatic venous catheterization technique combined with the infusion of 14C-alanine. During insulin infusion, euglycemia was maintained by variable glucose infusion. When insulin was infused at 1 mU/kg/min the net splanchnic production of 14C-glucose was suppressed by 80% but glucagon infused at the end of the study resulted in substantial release of 14C-glucose from the liver suggesting marked accumulation of labeled glucose in glycogen. When insulin was infused at 5 mU/kg/min the splanchnic release of 14C-glucose was also markedly suppressed but in contrast to the lower insulin dose very little labeled glucose accumulated in glycogen. Neither the high nor the low dose insulin infusion had any effect on net splanchnic alanine uptake and plasma glucagon levels fell by 35% in both protocols. These data demonstrate that in 48-hr fasted man, (1) a small increment in insulin concentration will suppress glucose production but mostly by diverting the newly formed glucose into glycogen; (2) at higher concentrations, insulin will inhibit glucose production mainly by suppressing glucoeogenesis; and (3) this insulin-induced suppression of gluconeogenesis is due to an intrahepatic effect rather than an effect on the splanchnic extraction of alanine.

Alanine↗
PubMed1980

Effect of glucose, independent of changes in insulin and glucagon secretion, on alanine metabolism in the conscious dog.

To study the effects of hyperglycemia on the metabolism of alanine and lactate independent of changes in plasma insulin and glucagon, glucose was infused into five 36-h-fasted dogs along with somatostatin and constant replacement amounts of both insulin and glucagon. Hepatic uptakes of alanine and lactate were calculated using the arteriovenous difference technique. [14C]Alanine was infused to measure the conversion of alanine and lactate into glucose. Hyperglycemia (delta 115 mg/dl) of 2 h duration caused the plasma alanine level to increase by over 50%. This change was caused by an increase in the inflow of alanine into plasma since the net hepatic uptake of the amino acid did not change. Taken together, the above findings indicate that glucose per se can significantly impair the fractional extraction of alanine by the liver. Hepatic extraction of lactate was also affected by hyperglycemia and had fallen to zero within 90 min of starting the glucose infusion. This fall was associated with a doubling of arterial lactate level. Conversion of [14C]-alanine and [14C]lactate into [14C]glucose was suppressed by 60 +/- 11% after 2 h of hyperglycemia, and because this fall could not be entirely accounted for by decreased lactate extraction an inhibitory effect of glucose on gluconeogenesis within the liver is suggested. These studies indicate that the plasma glucose level per se can be an important determinant of the level of alanine and lactate in plasma as well as the rate at which they are converted to glucose.

Alanine↗
PubMed1980

[Somatostatin and cimetidine in peptic ulcer hemorrhage. A randomized controlled study].

The efficacy of somatostatin in 20 patients with severe and persistent gastrointestinal bleeding due to peptic ulcer was investigated in a randomised controlled trial in comparison with cimetidine. Seven of the 10 pairs of patients showed a result favourable for somatostatin, but no pair showed an outcome in favour of cimetidine. Three pairs were tied: 2 with double failure and 1 with double success.

Cimetidine↗
PubMed1980

[A rehabilitation unit for geriatric amputees (author's transl)].

Elderly leg amputees are patients with the most somatic, emotional and social problems requiring rehabilitation assistance. Expensive artificial limbs often cannot be used because many detailed questions are left to chance. In order to coordinate the rehabilitation of these patients in an optimal manner and utilise the invested means efficiently, a specialised rehabilitation centre was organised at the Medizinisch-Geriatrische Klinik I of the Felix-Platter-Spital Basle and its mode of organisation was intentionally designed to be simple and flexible. The rehabilitation team consists of staff members of the Orthopedic and Geriatric Department of the hospital. From 1974-1978, 59 geriatric amputees aged 60-90 years were cared for and 75% could later be discharged to their own homes. In spite of the advanced age and various illnesses of these patients, the results of the rehabilitation unit are encouraging. However, prime importance should be given to finding a suitable milieu after dismissal.

Aged↗
PubMed1979

[Advantages and disadvantages of insulin therapy in elderly diabetics with asymptomatic hyperglycemia].

15 elderly diabetic patients with fasting blood glucose levels above 160 mg/100 ml, without hyperglycemic symptoms and previously treated with oral antidiabetic agents, were put on insulin. The change of treatment regimen was made in the outpatient department. Frequent clinical and laboratory controls were performed and the patients were given full instructions for injection technique and diet. On the insulin regimen a prompt and lasting improvement was observed in the metabolic parameters (blood glucose levels both fasting and after food intake, Hb A1c, serum insulin, glucagon and serum lipid concentrations). The so-called "asymptomatic" patients noticed a marked improvement in their general status and performance. Three months after insulin therapy was started 13 of our 15 patients preferred the insulin treatment to oral agents. However, weight gain and a tendency to hypoglycemia were noticed in less disciplined patients. In addition, considerable time was spent on instruction of the patients. Bearing these factors in mind, insulin therapy in elderly diabetics with so-called "sysmptomatic hyperglycemia" can be regarded as worthwhile.

Aged↗
PubMed1979

[Mortality from diabetic coma at the Basle Cantonal Hospital during 2 consecutive observation periods 1968-1973 abd 1973-1978, using conventional insulin therapy and treatment with lose dose insulin].

163 patients were admitted to the Cantonal Hospital, Basel, during the decade 1968--1978 with severe diabetic ketoacidosis or non-ketotic coma. The hospital mortality rate was 28% in the first period (1968--1973) but decreased to 14% (p less than 0.025) in the second period (1973--1978). The lower mortality rate in the second period was due to diminished early mortality within 3 days after admission. The decline in the mortality rate during the second period was assumed to be due to a general improvement of treatment and possibly to a direct effect of low-dose insulin therapy. The latter conclusion followed from the fact that the remaining recompensation therapy, such as fluid and electrolyte replacement, was similar during both periods. However, in the non-ketotic patients low-dose insulin therapy resulted in a delayed fall in blood glucose and distinctly diminished potassium retention. The fatalities in the second period of treatment were mainly due to thromboembolic complications. This points to the need for a search for preventive measures against thromboembolism in order to resuce mortality in severe diabetic coma further.

Blood Glucose↗
PubMed1979

[Dosage dependence of the effect of somatostatin on human splanchnic blood flow].

The effect of three different doses of somatostatin on splanchnic blood flow (SBF) and on arterial plasma insulin, glucagon and glucose was determined. 125, 250 and 500 microgram/h of somatostatin was infused during 60 minutes in 3 groups of 6 patients undergoing arterial-hepatic-venous catheterization; no patient had clinical evidence of metabolitic or hepatic disease. Continuous infusion of 125 microgram/h somatostatin was without significant effect on SBF, whereas 250 microgram/h resulted in a mean 28% reduction of SBF (p less than 0.05). Doubling the dose to 500 microgram/h affected SBF similarly (21% reduction of SBF). In contrast, administration of all three doses of somatostatin suppressed the circulating insulin and glucagon levels significantly. In a recent report somatostatin had been administered in a dose of 250 microgram/h to control gastric ulcer hemorrhage. The present studies demonstrate that this dose results in a significant reduction of SBF which cannot be further depressed by increasing the dose.

Adult↗
PubMed1979

[Clinical and hemodynamic studies before and after mitral valve replacement (author's transl)].

Clinical and hemodynamic studies were carried out before and after replacement of stenotic mitral valves in 17 patients, 10 of whom received Björk-Shiley (low profile mechanical) prostheses and 7 who received (porcine heterograft) bioprostheses. Mitral valve replacement led to amelioration of symptoms, improvement of phonocardiographic findings and, partially, to a lowering of pressure in the pulmonary circulation, augmentation of cardiac output, lessening of the pulmonary arteriolar and mitral valvular resistances as well as incrementation of mitral valve orifice area. Preexistent ECG changes, radiologic heart size, right ventricular filling pressure and stroke volume remained unaltered. In consideration of variables such as prosthetic size, severity of the disease and post-operative follow-up periods, the results obtained with both types of prostheses were comparable. The prostheses, however, inherently are responsible for a moderate degree of mitral stenosis which compromises exercise capacity and generally does not lead to normalization of pressure in the pulmonary circulation. Irreversible myocardial damage appears responsible for the fact that electrocardiographic abnormalities, the heart size, the right ventricular filling pressure and stroke volume remain unaltered postoperatively. Thus, patients who have undergone mitral valve replacement continue to require limitation of physical activities, a tailored medical regimen and close cardiologic follow-up.

Adult↗