[Prognostic significance of retinal microaneurysm number and localization in type-1 diabetes mellitus]. / Retinalis microaneurysmák számának és lokalizációjának prognosztikai jelentósége 1-es típusú diabetes mellitusban.

The authors studied whether central retinal microaneurysm count predicts further progression of background retinopathy in juvenile onset type-1 diabetes mellitus. 94 patients (49 females and 45 males) were followed up longitudinally (8-17.5, mean 10 years) by evaluating fluorescein angiograms. Age at last examination was 17-32 years (mean age 22.4 years) and duration of diabetes was 8-22 years (mean duration 13.7 years). Microaneurysm counts and location were determined with the help of a grid consisting of three concentring circles and four radial lines (nine subfields) centered for the macula. 82% of the all microaneurysms were found inside the circle with 1500 micron radius. Participants were divided into three groups: those with no microaneurysms (1st group, n = 28) and those with 1-4 (2nd group, n = 35) and those with 5 or more microaneurysms (3rd group, n = 31) in the central circle with 600 micron radius at least one time during the whole follow up. Background retinopathy was found in 3 of 28 cases (approximately 10%) in the first group, 8 of 35 (approximately 23%) in the second group and in all the 31 patients (100%) in the third group. Proliferative retinopathy was found in the third group only. The authors suggest that the appearance of 5 or more microaneurysms in the macular area in type-1 diabetes mellitus may be sensitive indicator of the development of severe background and proliferative retinopathy. Study describes the importance of central microaneurysm count predicting further progression of background retinopathy could not be found in the available literature.

[Retinal microangiopathies in diabetic children and adolescents, occurring in cases of pubertal and prepubertal onset of diabetes]. / Cukorbeteg gyermekek és fiatalok retinalis microangiopathiájának alakulása prepubertális és pubertális betegségkezdet esetén.

The prevalence and development of retinal microvascular complications in pre-puberty and puberty onset insulin-dependent diabetes mellitus were studied in 109 young patients with an average follow-up of 6 years. The data suggest that the earlier childhood the diabetes began, the later the microvascular abnormalities could be found by fluorescein angiography. First signs of background retinopathy were seen in average 20--22 years of age, almost independently the age at onset of diabetes. Rapid progression of retinal vascular damage occurred mainly in postpubertal but not pubertal subjects. Diabetes with puberty onset meant worse prognosis in the respect of retinal vascular complications than pre-puberty onset. Good glycemic control would be achieved more difficult in subjects with puberty onset diabetes added to a changing hormonal balance. The authors suggest that psychological factors (altered behavior during and after puberty) and other problems of adolescents (changes in social, familial and working conditions) may also contribute to poor glycemic control. Though the effect of prepubertal duration on the risk of retinal complications appears to be smaller than later years, the attendant work in prepubertal years is as important as later.

[Effect of puberty on the development of diabetic microangiopathy]. / Pubertás hatása a diabeteses microangiopathia alakulására.

Fluorescein angiography was used to follow the development of retinal microangiopathy at the time of puberty in 34 children with type I diabetes. When the results were compared with those for the control children who had suffered from the disease for a similar length of time, it was concluded that (in contrast with certain literature data) the process of sexual maturation does not essentially influence the development of retinal microangiopathy if the diabetes is maintained under good control for a long-lasting period. Appreciable roles in the rapid progression that is frequently observed in early adulthood are attributed to the sudden changes in the previously systematic living conditions (school, family, etc.).

A postaxial polydactyly and progressive myopia syndrome of autosomal dominant origin.

A new "postaxial polydactyly-progressive myopia" syndrome of autosomal dominant inheritance is delineated on the basis of nine affected persons in four generations of one family.

[Studies of glycosylated hemoglobins and albumins in diabetes mellitus with retinopathy]. / Untersuchung des glykosylierten Hämoglobins und Albumins beim Diabetes mellitus mit Retinopathie.

The correlation between the diabetic retinopathy and the levels of glycosylated haemoglobin and albumin was examined in 133 diabetic patients. 25 healthy persons served as controls. 53 out of the 133 diabetic patients suffered in different grades of diabetic retinopathy, 80 diabetics developed no retinopathy. There was no significant difference in the age of patients with or without retinopathy. The duration of diabetes was significantly longer in diabetics with retinopathy. The glycosylated haemoglobin and albumin levels of diabetics were significantly higher as compared to the levels of the controls. There was no difference in the glycosylated haemoglobin and albumin levels of diabetic patients with or without retinopathy. According to these results there is no correlation between the formation of diabetic retinopathy and the elevated levels of glycosylated haemoglobin and albumin. Thus the development of diabetic retinopathy takes many years, the cause of our results may be the relative short period of the examinations. Following this study we do hope to get more data to this important question.

Care of pregnant diabetics: medical aspects.

A method has been worked out for the intensive care of pregnant diabetics with the object of preventing damage both to the mother and the fetus. The method requires close cooperation between a team of doctors including obstetrician, internist and pediatrician. The present paper reports the experience of the first two years of application of the method and refers to a total of 75 women. The main point consists in an attempt to maintain a normal blood glucose level by administering increasing doses of insulin. Periods of inpatient management alternated with close outpatient control. Of the 75 insulin-dependent diabetics 45% had severe diabetes (White classes D-F); nevertheless, perinatal mortality was only 5.78 per cent. It is worth stressing that the 25 diabetics who came under intensive care before conception or in the early stages of pregnancy all gave birth to live healthy babies.

Early retinal vascular signs in hyperlipoproteinaemia.

A total of 23 hyperlipoproteinaemic patients between 24 and 46 years of age were subjected to fluorescein retinography. Early microangiopathy was demonstrated in 12 cases. In 3 of these, the oral glucose tolerance test was normal and the family history of diabetes was negative. It is suggested that hyperlipoproteinaemia, mainly hypertriglyceridaemia, constitutes one of the factors accounting for the microangiopathy. The frequency of angiopathy was particularly high in the group marked by a family history of diabetes with a normal glucose tolerance test.

Vasodilating effect of ethyl apovincaminate on conjunctival vessels and simultaneous observation of parameters indicating adverse effect.

The vasodilator effect of ethyl apovincaminate (RGH-4405, Cavinton) on conjunctival vessels and its possible adverse effects have been studied in 17 patients of varying age (16-78 years) and diagnosis, as well as in healthy individuals. Intravenous 10 mg doses of the drug increased the arteriolar lumen in each case, the most markedly at 30 sec after administration of the drug, but at 90 sec effect was still significant. Before starting Cavinton, on the next day following injection and on other mornings after administration, haemoglobin, the leukocyte count, SGOT, SGPT, thymol turbidity, and blood sugar were determined. In the eight cases of juvenile hypertension urinary serum proteins were also registered after quantitative testing. The parameters investigated did not reveal any sign pointing to toxicity.

Preliminary report on the use of ethyl apovincaminate in affections of the eyeground.

26 ophthalmological patients have been given daily doses of three times 1 tablet (15 mg) ethyl apovincaminate (RGH-4405, Cavinton) for periods of from two weeks to three months. Improvement of visual acuity lasted as long as the course of treatment, in agreement with the results of other authors. On Cavinton effect blood flow increased in the retinal precapillary and capillary system, supply of hypoxic areas improved. Improvement noted in choroid sclerosis bears witness to the effect of Cavinton on choroid capillaries.

[Early diagnosis of microangiopathy in infantile diabetes (author's transl)]. / Frühdiagnose der Mikroangiopathie bei kindlichem Diabetes

The authors have carried out fluorescein angiography in infantile diabetics--negative by ophthalmoscopy,--looking for the earliest symptoms of microangiopathy. The study concerned 161 diabetics in the age between 3-18, and 50 non-diabetic children in the same age. There is no significant difference between diabetics and control-group in the frequency of symptoms, described in literature as early signs of microangiopathy, as multiple capillary-, and peripapillary-filling and early venous dilatation. Increased capillary filling was found at anxious children with strained cervical muscles during the examination. In 54% of the 161 diabetic patients-negative by ophthalmoscopy,-solitary or multiple microaneurysms were found fluorescence angiographically. The increase of number of the microaneurysms is correlated to the duration of the diabetics and advance in age. In the authors opinion the presence of microaneurysms is in some cases due to genetic factors and is independent from the metabolic changes of diabetes.

A case of IgD-lambda myeloma.

A case of IgD myeloma is presented. The severe damage of both kidneys resulted in uraemia, and death. Fluorescein angiography failed to reveal a typical paraproteinaemic fundus. The elevated serum IgD level decreased form 1000 mg to 400 mg per 100 ml during cytostatic therapy. The effect of the antineoplastic drugs on the plasmocytes was demonstrated by microphotograms. The caryograms revealed multiple changes.