Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Apr 1984
Review[Pathophysiology and therapy of diabetic ketoacidosis and of non-ketoacidotic hyperosmolar diabetic coma].
Metabolic derangements in diabetic coma are the sequelae of insulin deficiency. These defects are aggravated by the actions of insulin counteracting ("diabetogenic") hormones and hypertonic dehydration, which both impair insulin action. Conversely, it has been shown that hypo-osmolar rehydration of a hyperosmolar, severely hyperglycaemic diabetic patient reduces insulin resistance and restores biological responsiveness of previously dehydrated insulin-dependent tissues towards insulin. ⋯ This approach probably avoids a too rapid fall in plasma osmolarity, minimizes the risk of cerebral oedema and hypokalaemia, and improves survival. The development of severe diabetic ketoacidosis or of hyperosmolar non-ketotic diabetic coma should be prevented by advice to patients on the importance of metabolic monitoring, which can be done by proper self-monitoring of blood glucose. In addition, information should be provided on the detrimental metabolic effects of both dehydration and stress.
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Wien. Klin. Wochenschr. · Jan 1984
The development and rationale of pressure-controlled intermittent coronary sinus occlusion--a new approach to protect ischemic myocardium.
The early concept of global retroperfusion and arterialisation of the coronary sinus was discarded because of unacceptable damage to the myocardium, although many authors provided evidence on the improvement of cardiac function during ischemia. Furthermore, the exact mechanism of coronary sinus retroperfusion remained poorly understood. The lack of a strong physiological basis for retroperfusion as well as the development of coronary bypass grafting lessened interest in this revascularisation technique. ⋯ This report explains the proposed nature of action of enhanced washout of myocardial edema induced by P-ICSO. Moreover, beneficial effects of P-ICSO observed during canine studies are summarized. It is concluded that this new simple retroperfusion technique has the clinical potential to serve as interim support to protect deprived myocardium until definite reperfusion is available.
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Genital herpes simplex virus (HSV-)infection is a disease of growing importance in sexually transmitted diseases. It is the most common cause of genital ulcerations throughout the industrialized nations. It is caused by either herpes simplex virus type 1 or 2. ⋯ The most promising antiviral drug seems to be acyclovir. It is effective in reducing some of the manifestations of genital HSV infections. However, the most important problems like the prevention of recurrent infections in patients with genital herpes and the transmission of the disease to newborns or to sexual partners, have not yet been solved.
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Wien. Klin. Wochenschr. · Nov 1983
Case Reports[Initial description of hemoglobin D Punjab in an Austrian family].
Haemoglobin D Punjab was detected in a slightly overweight, but otherwise healthy pregnant woman when she was tested for gestational diabetes within the framework of a screening programme. Chromatographic evaluation of the haemolysate by high-pressure liquid chromatography (HPLC) revealed an unusual "splitting" of the A1 peak into two minor peaks. A diabetes-independent haemoglobin variant was suspected and further investigations, including electrophoresis, purification and sequential analysis of the tryptic peptide, identified the abnormal haemoglobin as haemoglobin D Punjab (beta 121 Glu-Gln). ⋯ An investigation of 6 out of 7 living members of the family was undertaken. In 3 instances haemoglobin D Punjab was confirmed by HPLC and electrophoresis. The investigation of the family is currently being expanded to include a total of five generations.
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Wien. Klin. Wochenschr. · Nov 1983
[Non-enzymatic glycosylation of hemoglobin and serum protein in children with galactosemia].
Non-enzymatic galactosylation has been investigated by in vitro incubation of red cell haemolysate, a HbAo-preparation and of GBM of healthy children. The effects of non-enzymatic galactosylation of haemoglobin has been studied by high pressure liquid chromatography, the effects of GBM galactosylation by immunoelectrophoresis. Subsequently, the occurrence of elevated values for HbAIa-c and GSP was evaluated in 14 galactosaemic children (11 transferase deficiency, 3 galactokinase deficiency), as well as urinary acid glycosaminoglycae excretion and GBM immunoelectrophoretic mobility in 6 of these 14 children measured. ⋯ After exclusion of significant non-enzymatic glucosylation by measuring postprandial blood glucose values the galactosaemic children showed significantly increased values for HbAIa-c (8.85 +/- 2.0% versus 7.7 +/- 0.3%; p less than 0.02), for GSP (0.43 +/- 0.13 mmol 5-HMF/mg protein versus 0.32 +/- 0.07 mmol 5-HMF/mg protein; p less than 0.005) as well as for urinary acid glycosaminoglycane excretion (45.3 +/- 23.4 micrograms/mg kreatinine versus 9.9 +/- 2.3 micrograms/mg Kreatinine; p less than 0.01). 3 out of the 6 children showed alpha 1-immunoelectrophoretic mobility of GBM antigens which was found also after incubation of GMB with galactose. The other 3 children had alpha 2-immobility, which was found in the healthy controls as well as in the control incubations. The impact of galactose on increased non-enzymatic glycosylation in children with galactosaemia as well as the significance of this finding for diagnostic purposes or for clarifying pathophysiological aspects of the disease remains to be studied further.