Microalbuminuria and nerve conduction velocity in type-I diabetics during conventional therapy and during continuous I.V. insulin infusion

Summary The objective of this study was to follow the development of microalbuminuria and nerve conduction velocity under continuous i.v. insulin therapy over a limited period of 4 months. For this purpose, 8 labile type I diabetics were selected (age 33±8 years, duration of diabetes 16±9 years) and treated conventionally with two insulin injections daily over 4 months. Afterwards, the same patients were treated with continuous i.v. insulin infusion and finally again with two injections daily over 4 months each. This procedure allowed each diabetic to serve as his own control. HbA₁, microalbuminuria, nerve conduction velocity and relative refractory period of the ulnar nerve were checked at montly intervals. During the continuous i.v. infusion over 4 months, blood sugar values were significantly lower, glucosuria had disappeared almost completely and the glycosylated hemoglobin had fallen to near normal values. The mean rate of albumin excretion was 16±5 μg/min at rest and 76±26 μg/min during exercise (normal: 3.9±0.4 and 4.8±1.2 μg/min, respectively) and did not change significantly. Nerve conduction velocity in the ulnar nerve rose significantly under i.v. insulin therapy from 47.9±0.6 m/sec to 52±0.6 m/sec. Similarly, the relative refractory period of the same nerve fell significantly from 3.7±0.2 to 1.9±0.1 msec (i.e. to within normal range). It is concluded that functional disturbances of peripheral nerve can regress by improved blood sugar control with continuous i.v. insulin infusion over 4 months. On the other hand, incipient microangiopathy measured as microalbuminuria remains unchanged over the same period of time. If an improvement is at all possible, considerably longer periods of euglycemia are likely to be necessary. Supported by Grant No. 3.964-0.80 from the Swiss National Science Foundation.     

Glucose and Fructose Supplementation and Their Acute Effects on Anaerobic Endurance and Resistance Exercise Performance in Healthy Individuals: A Double-Blind Randomized Placebo-Controlled Crossover Trial

Background: The effects of glucose, fructose and a combination of these on physical performance have been subject of investigation, resulting in diverse findings. Objective: The aim of this study was to investigate how an individualized amount of glucose, fructose, and a combination of these compared to placebo (sucralose) alter endurance performance on a cycle ergometer, lower and upper body resistance exercise performance at individualized thresholds in healthy young individuals. Methods: A total of 16 healthy adults (9 females) with an age of 23.8 ± 1.6 years and a BMI of 22.6 ± 1.8 kg/m² (body mass (BM) 70.9 ± 10.8 kg, height 1.76 ± 0.08 m) participated in this study. During the screening visit, the lactate turn point 2 (LTP2) was defined and the weights for chest-press and leg-press were determined. Furthermore, 30 min prior to each exercise session, participants received either 1 g/kg BM of glucose (Glu), 1 g/kg BM of fructose (Fru), 0.5 g/kg BM of glucose/fructose (GluFru) (each), or 0.2 g sucralose (placebo), respectively, which were dissolved in 300 mL of water. All exercises were performed until volitional exhaustion. Time until exhaustion (TTE) and cardio-pulmonary variables were determined for all cycling visits; during resistance exercise, repetitions until muscular failure were counted and time was measured. During all visits, capillary blood glucose and blood lactate concentrations as well as venous insulin levels were measured. Results: TTE in cycling was 449 ± 163 s (s) (Glu), 443 ± 156 s (Fru), 429 ± 160 s (GluFru) and 466 ± 162 s (Pla) (p = 0.48). TTE during chest-press sessions was 180 ± 95 s (Glu), 180 ± 92 s (Fru), 172 ± 78 s (GluFru) and 162 ± 66 s (Pla) (p = 0.25), respectively. Conclusions: Pre-exercise supplementation of Glu, Fru and a combination of these did not have an ergogenic effect on high-intensity anaerobic endurance performance and on upper and lower body moderate resistance exercise in comparison to placebo.     

Carimune NF Liquid is a Safe and Effective Immunoglobulin Replacement Therapy in Patients with Primary Immunodeficiency Diseases

Subjects with primary immune deficiency diseases treated with intravenous immunoglobulin (n=42) received intravenous infusions of Carimune NF Liquid every 3–4 weeks for 6 months without routine premedication. The mean dose/patient/infusion was 278.5–800.7 mg/kg. Also, 80.4% of infusions achieved maximum rates of ≥3.5 mg/kg/min; 32% of infusions were associated with adverse events during or within 48 h of their end (upper 95% confidence interval was 39.4%, meeting the Food and Drug Administration (FDA) criterion for acceptable tolerability), and 54.8% of subjects had at least one temporally associated adverse event considered at least possibly drug-related (headache: 35.7% of subjects, 12.4% of infusions; nausea: 14.3%, 3.5%; myalgia: 14.3%, 3.2%; fatigue: 11.9%, 5.7%). The frequencies of these were highest after the first infusion. There were no serious drug-related adverse events or acute serious bacterial infections. Serum IgG trough levels were unchanged from baseline. Carimune NF Liquid, a ready-to-use, high-concentration, liquid immunoglobulin preparation is safe and effective. On behalf of the study group     

Management of acute small bowel obstruction from intestinal adhesions: indications for laparoscopic surgery in a community teaching hospital

Purpose  

The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery.     

Skin tuberculosis with atypical mycobacteria 8 years after combined pancreas-kidney transplantation

We report on a Mycobacterium marinum infection in a diabetic woman 8 years after undergoing a combined pancreas-kidney transplantation. This is, to our knowledge, the first case report on an isolated skin infection with atypical mycobacteria after simultaneous pancreas-kidney transplantation. A genetic probe categorization revealed an infection with M. marinum. Skin tuberculosis caused by M. marinum is an uncommon complication in kidney or pancreas-kidney transplant recipients, hence the diagnosis can be delayed.     

Mitral valve repair provides improved outcome over replacement in active infective endocarditis

OBJECTIVES: Mitral repair in active infective endocarditis still remains controversial. Several studies demonstrate the feasibility of mitral repair in infective endocarditis; however, superiority of repair has never been shown. The aim of the investigation was to compare valve repair and valve replacement in respect to the extent of destruction and to analyze survival, recurrent endocarditis, and reoperation (event-free survival). METHODS: Sixty-eight consecutive patients underwent surgical intervention for mitral endocarditis. Thirty-four (50%) patients had valve repair, and 34 (50%) patients had valve replacement. Leaflet destruction involving at least one mitral leaflet was present in 15 (44.1%) patients of the repair group and 11 (32.4%) patients of the replacement group. Repair of the mitral annulus with pericardium was performed in 4 (11.8%) patients in the repair group and 3 (8.8%) patients in the replacement group. Patients in both groups were similar concerning the progression of valvular destructions and comorbidities. RESULTS: Hospital mortality was 11.8% (8 patients). No significant differences were found in all baseline parameters, with the exception of a higher incidence of previous septic embolism and sepsis in the repair group. Actuarial event-free survival at 1 year was 88.2% in the repair group compared with 67.7% in the replacement group, and 5-year event-free survival was 80.4% in the repair group and 54.6% in the replacement group (P = .015). Mitral valve repair remained the superior treatment regarding event-free survival in the multivariate analysis (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .02). CONCLUSIONS: Mitral valve repair offers excellent early and late results and is the preferable treatment option in the surgical therapy of native infective endocarditis.     

Interexaminer repeatability of antidromic ulnar sensory nerve conduction velocity measurements

OBJECTIVE: To determine the interexaminer repeatability of the ulnar antidromic sensory nerve conduction velocity (NCV). DESIGN: Test-retest design. Based on a randomization list of various combinations and sequences from 2 of a total of 3 examiners, the measurement was repeated within half an hour by a second examiner blinded to the results of the first examiner. SETTING: Outpatient department. PARTICIPANTS: Twenty-four consecutive healthy subjects (mean age, 38 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The intraclass correlation coefficient (ICC) and the coefficient of repeatability (CR) were determined for the below elbow to wrist (BE-to-W), above elbow to below elbow (AE-to-BE), and axilla to above elbow (AX-to-AE) segments. RESULTS: The ICC was .42 for the BE-to-W, .15 for the AE-to-BE, and -.05 for the AX-to-AE segment. The CR was 12.2m/s for the BE-to-W, 16.2m/s for the AE-to-BE, and 21.4m/s for the AX-to-AE segment. CONCLUSIONS: During the assessment of the antidromic sensory NCV of the ulnar nerve, a moderate amount of interexaminer variability must be taken into account for the BE-to-W segment. More proximally, an extremely large amount of interexaminer variability must be taken into account. This calls into question the usefulness of the antidromic ulnar sensory NCV for the AX-to-AE and AE-to-BE segments.     

Dissociating beliefs about heart rates and actual heart rates in patients with cardiac pacemakers.

Performance on heartbeat counting tasks is usually interpreted in terms of cardiac sensitivity. We tested the hypothesis that heartbeat counting is influenced by beliefs about heart rates by dissociating beliefs about heart rates and actual heart rates. In a within-subjects design, heart rates of 50 patients with cardiac pacemakers were set to a low (50 bpm), medium (75 bpm), or high (110 bpm) pacing rate unknown to the patients via remote control while they performed a heartbeat tracking task. Results showed that patients' heartbeat counting did not follow the shifts in their actual heart rates adequately, although their overall performance was comparable to that of young and healthy control participants. As a result, tracking scores decreased significantly in the high pacing rate condition where beliefs about heart rates and actual heart rates were most extremely dissociated. The findings suggest that tracking scores reflect beliefs about heart rates rather than cardiac sensitivity.