Effect of growth hormone suppression on glycemic control and other hormonal changes in diabetic retinopathy

The study was carried out on ten insulin dependent diabetics suffering from different types of diabetic retinopathy to evaluate the effect of growth hormone suppression on glycemic control and other hormonal changes in diabetic retinopathy. Blood levels of HGH, prolactin, C-peptide, glucagon and A.C.T.H. were determined by RIA. Tests of glycemic control including glycosylated hemoglobin [HbA[1c]], fasting and postprandial blood sugar and total blood lipids were also estimated. Retinal changes were studied by fluorescein angiography. Bromocriptine was given to all cases for 12 weeks, in addition to standard therapy [insulin+ diet]. Pretreatment investigations were repeated at the end of the study. Pretreatment investigations showed significant elevation of glycosylated hemoglobin, fasting and postprandial blood sugar. Serum growth hormone, plasma glucagon and A.C.T.H. were significantly high. C-peptide was measurable in 30% of patients. After three months treatment, tests of glycemic control were significantly decreased. Serum GH and prolactin decreased significantly, while C-peptide was increased. Glucagon and A.C.T.H. showed no change. After treatment, retinal changes deteriorated in 60% of patients and this was attributed to a hypoglycemic effect

Hormonal and biochemical studies in diabetic retinopathy

Twenty type I [insulin-dependent] diabetic patients suffering from different grades of diabetic retinopathy were included in the study. The study aimed at investigating glycemic control and different hormones suspected to be sharing in the pathogenesis of diabetic retinopathy. Bad glycemic control was found in almost all patients with diabetic retinopathy. Significant elevation of serum growth hormone, glucagon and A.C.T.H. was found in diabetic retinopathy, while serum prolactin level was within normal. Residual beta cell function was found in 64% of patients with BDR [background diabetic retinopathy], while patients with PPDR [preproliferative diabetic retinopathy] and PDR [proliferative diabetic retinopathy] had no residual beta cell function. Higher grades of diabetic retinopathy were associated with bad glycemic control, higher levels of serum growth hormone and glucagon and absent residual beta cell function

ACID-base status in predialysis patients

The aim of the present study was to characterize the nature of acid-base disturbance in predialysis patients and to study its possible relation to various clinical and biochemical data. Acid-base parameters including PH, serum bicarbonate and PCO[2] were studied in 50 predialysis patients [24 hours before dialysis], in addition to blood urea, serum creatinine and serum electrolytes; sodium, potassium, calcium and phosphorus. Renal metabolic acidosis was detected in 74% of patients, with significant reduction of serum bicarbonate, blood PH and PCO[2]. PH concentration decreased a bicarbonate concentration fell and PCO[2] decreased in direct relation to the fall in bicarbonate. No constant relation was found between the severity of acid-base disturbance and other clinical and biochemical data, although advanced forms of CRF were associated with some degree of renal metabolic acidosis. Mild electrolyte changes were detected in predialysis patients

Study of fibrinopeptide A, fibrin monomer and fibrin degradation products in non-insulin dependent diabetes mellitus

The study was carried out on 20 non-insulin dependent diabetics and 10 healthy adult control subjects. The work aimed at estimation of fibrinopeptide A [FPA], fibrin monomer [FM] and fibrin degradation products [FDP] in non-insulin dependent diabetic patients with and without vascular complications, in addition to euglobulin clot lysis time [EGCLT], blood sugar, serum triglycerides, serum cholesterol, HDL-cholesterol and LDL-cholesterol. Serum fibrinopeptide-A [FPA] level was elevated in diabetics with vascular complications, reflecting augmented thrombin activity. EGCLT showed significant prolongation in diabetics with vascular complications. Pathological levels of FDP were detected in three diabetic patients [30%] with vascular complications. The significance of these findings were then analyzed and discussed

Effects of propranolol and verapamil on portal pressure and blood coagulation in patients with bleeding oesophageal varices secondary to schistosomal hepatic fibrosis

The study included 20 patients with history of hematemesis secondary to schistosomal hepatic fibrosis. Upper gastrointestinal endoscopy was performed for all the patients to confirm the presence of esophageal varices. Blood coagulation studies and measurement of the portal venous pressure by the trans-splenic route were performed for all patients before and after intravenous administration of propranolol and verapamil, in order to evaluate the effect of these two drugs on portal pressure and blood coagulation in patients suffering from hematemesis secondary to schistosomal hepatic fibrosis. The study should a statistically significant decrease of portal pressure after intravenous administration of propranolol and verapamil. The decrease of portal pressure after propranolol was significantly more than the decrease after verapamil. As regards the effect on blood coagulation, both drugs showed no significant effect on the studied blood coagulation parameters. These results were analyzed and discussed

Upper gastrointestinal endoscopy in portal hypertension secondary to schistosomal hepatic fibrosis

Upper gastrointestinal endoscopy was performed for 24 patients with portal hypertension secondary to schistosomal hepatic fibrosis, twelve of them were bleeders and twelve were non-bleeders. Significant esophageal and gastric changes were detected in both groups. There was a positive correlation between the grade and extent of esophageal varices and the incidence and severity of variceal bleeding. The presence of erosions, ulcerations, cherry red spots and microtelangectasia on the esophageal mucosa and the variceal wall were considered as risk factors. The presence of gastric varices added further to the liability of upper gastrointestinal bleeding. Mosaic pattern of the gastric mucosa, cherry red spots and gastric erosions contributed to the risk of upper gastrointestinal bleeding

Significance of serum ferritin estimation in various clinical disorders

The present study aimed at estimation of serum ferritin concentration, as an index of iron stores, in normal subjects and in patients with iron deficiency anemia, chronic renal failure, chronic rheumatoid arthritis and Hodgkin's disease and to evaluate the clinical significance of its estimation in these various clinical disorders. Higher serum ferritin level was detected in normal healthy males than females and was attributed to the higher storage iron present in males. A significantly low level of both serum iron and serum ferritin was found in patients with iron deficiency anemia. Patients with chronic renal failure and chronic rheumatoid arthritis showed a significantly low level of serum iron, while serum ferritin level was within the normal range. In patients with Hodgkin's disease, the serum iron level was significantly lower than that of the normal control subjects while the serum ferritin level was higher than that of the control subjects, although it did not reach a statistically significant level. The clinical significance of these findings was discussed

Study of systolic time intervals in diabetes mellitus before and after exercise

The study included 20 diabetic patients, six of them had insulin-dependent diabetes mellitus and 14 had non-insulin-dependent diabetes mellitus. Ten normal subjects were taken as a control group. All the subjects included in the study were chosen to be free from any cardiopulmonary disease with normal electrocardiogram and normal X-ray chest and heart. Systolic time intervals were recorded at rest and after exercise. Abnormal systolic time intervals were detected in diabetic patients at rest. This was considered as an indication of early left ventricular dysfunction. Such patients could be at high risk of developing cardiovascular complications. After exercise, PEP/LVET ratio showed improvement in the complications. After exercise, PEP/LVET ratio showed improvement, in the diabetic patients, as in the controls. This might suggest the presence of myocardial reserve to myocardial reserve to correct the resting abnormality on adequate stimulation

Some minerals and trace elements in acute myocardial infarction

The serum level of magnesium, zinc, copper, sodium and potassium was studied in forty patients with acute myocardial infarction. Serum for detection of these minerals and trace elements was obtained on the first day of hospital admission and after seven days. Significant hypomag-nesaemia was detected in patients with ventricular arrhythmia, cardiogenic shock and pulmonary oedema. Some patients with uncomplicated myocardial infarction showed hypomagnesaemia. A significantly subnormal zinc concentration was observed, but the lowest values, being observed in patients with serious complications. The serum copper level was elevated, but the elevation was not statistically significant. Ventricular ectopic beats and ventricular tachycardia were seen more frequently in hypokalaemic patients

Study of different insulin regimens in the management of diabetic ketoacidosis

Diabetic ketoacidosis was invariably fatal before the introduction of insulin therapy. Small doses of insulin are sufficient to lead to a smooth recovery from ketoacidosis. In this work, a comparative study was done between big and small doses regimens in the management of ketoacidosis. It was conducted on 24 patients with varying degrees of diabetic ketoacidosis. All patients were subjected to complete physical examination including the level of conciousness, cardiac, chest, and neurological examination, blood sugar level, urine for glycosuria, ketoaciduria, pus cells and casts, complete blood picture serum sodium and potassium, blood urea and ECG. The results were discussed in details