Basal insulin dose in 40 type 1 diabetic patients remains stable 1 year after educational training in flexible insulin therapy.

AIM: Basal insulin dose (BID) determination is the key to successful flexible insulin therapy (FIT). As our hypothesis was that BID changes over time, the primary objective of the present study was to determine the changes in BID 1 year after a therapeutic educational programme on FIT. METHODS: This single-centre retrospective study recruited the first 40 type 1 adult diabetic patients undergoing an educational FIT programme, which was conducted over a 4-day hospital stay and included a carbohydrate-fasting test. RESULTS: Patients' BIDs decreased between Day 0 and Day 4 after the programme (0.31±0.11IU/kg/day vs 0.27±0.09IU/kg/day; P<0.0001), and was increased at 1 year (0.29±0.09IU/kg/day; P=0.004). There was no significant variation in prandial insulin requirements. A tendency toward a reduction in HbA(1c) was observed at 1 year (8.3±1.4% vs 8.1±1.6%; P=0.075), with a decrease by more than 0.5% in 37.5% of patients. Body weight increased at 1 year (66.9±10.4 kg vs 68.1±10.7 kg; P=0.003), and the gain was greater than 5% in 7.5% of patients. Frequency of mild hypoglycaemia either remained stable (40%) or decreased (30%). Only nine patients (baseline HbA(1c) 8.03±1.7%, baseline BID 0.27±0.09IU/kg/day) had BID increases more than 20%, with no changes in prandial insulin requirements and no distinctive phenotype. Baseline HbA(1c), and BID have an impact on the BID at 1 year of approximately 0.3IU/kg/day in most patients. CONCLUSION: The stability of BID over 1 year, with values close to 0.3IU/kg/day associated with a trend towards improvement in HbA(1c), reduction in the frequency of mild hypoglycaemic episodes and absence of major weight gain, supports the relevance of FIT educational training.

Non-invasive determination of effective pulmonary blood flow: evaluation of a simplified rebreathing method.

PRIMARY OBJECTIVE: To evaluate a new technical approach to measuring effective pulmonary blood flow (PBF) in mechanically ventilated patients. RESEARCH DESIGN: Prospective clinical study; evaluation of accuracy and reproducibility. METHODS: Effective pulmonary blood flow was determined non-invasively in 32 mechanically ventilated patients by using a new rebreathing system (PBF(rb)). Cardiac output corrected for intrapulmonary shunt was taken as reference value (PBF(thd)). Bias, precision and reproducibility of the rebreathing method were calculated from duplicate measurements in each patient. MAIN RESULTS: The mean difference between PBF(rb) and PBF(thd) was - 0.67 +/- 0.83 l min(-1). The mean difference between duplicate measurements with the rebreathing system was 0.16 +/- 0.36 l min(-1). However, the accuracy of the rebreathing system tended to decrease in patients with PBF levels greater than 6 l min(-1). CONCLUSIONS: The new device appears to be reliable for determination of PBF values below 6 l min(-1). With this limitation, the present method may be used as a trend-indicator of PBF in mechanically ventilated patients.

[Pregnancy and labor in adolescent patients]. / Schwangerschaft und Geburt bei Adoleszenten.

During the investigation period from 1978 to 1986 the adolescents had been compared with two control groups. When comparing obstetrical parameters such as pre-eclampsia, prematurity, operative delivery, Apgar under 4, acidosis with a pH-value of blood under 7.10, malformation and perinatal death significant differences could not been proved. The statistically guaranteed high quota of perinatal mortality in prematurities under 2.500 g gives occasion to pay attention to predisposing factors in the prenatal care as well as focusing the good neonatal management. The investigations exhibit the delivery in adolescents as a small side group, which portion shows a falling tendency in the whole delivery group. They must be cared for attentively in fundamental prenatal care, whereas there is no higher obstetrical risk for adolescent primipara. The comparatively higher portion of primigravida teenagers in the whole interruptio group points out the problems in applying contraceptional measures at this age.

[Behavior of T-lymphocytes during the normal menstrual cycle]. / Verhalten der T-Lymphozyten im normalen mensuellen Zyklus.

FSH, LH, estradiol-17 beta, progesterone, and T-lymphocytes were examined daily in 12 biphasic cycles of 6 healthy women (age 19-29 years). T-lymphocytes were estimated by the alpha-naphthyl-acetate-esterase-reaction as T-cell-marker. There was a significant reduction of T-cells in the first and a nonsignificant reduction in the second cycle phase. The suppressions were related to the high estradiol levels in the follicular as well as the luteal phase. If there is a causative connection and whether the whole immune system is depressed or other regulatory mechanisms interfere isn't quite clear.

[Behavior of T-lymphocytes in patients with a gynecologic malignancy]. / Das Verhalten der T-Lymphozyten bei Patientinnen mit einem gynäkologischen Malignom.

The proportion of T-lymphocytes was estimated by the alpha-naphthylacetate-esterase-reaction as a T-cell marker in blood smears of 40 patients with gynecologic malignancies and 30 healthy controls. In addition the red and white blood cell counts were determined. A lymphopenia and a reduction of T-lymphocytes were found in the peripheral blood of the tumorgroup, on the other hand the number of B-lymphocytes was elevated in this patients. This method of lymphocyte differentiation may be of value for controls in patients suffering from malignant tumors.