[Experiences with a diet-training program in patients with obesity associated diseases including follow-up]. / Erfahrungen mit einem Diät-Trainingsprogramm an Patienten mit adipositasassoziierten Krankheiten einschliesslich Nachkontrollen.

In 158 inpatients (61 m., 97 f.) with obesity-associated diseases were performed a diet-training-programme for about four weeks. We used a PSMF (protein sparing modified fasting) as a 350 kcal diabetic mixed diet, adequate to 4 carbohydrate units (40g carbohydrate, 30g protein, 5g fat) with weekly tea-vegetable-days, additionally wheat brain. The training programme was adapted individually. Reexamination were made by questionnaires and diabetic control cards concerning the body weight. The favourable influence of blood pressure and metabolism was registered. The diet schedule consist natural foodstuffs, fibers, minerals and vitamins. It can be varied, is very effective especially in combination with exercise. The middle term results are rather good more for women than men. Our diet-training-programme can be recommended for outpatients as well as for cures.

[Treatment of newly diagnosed type II diabetic patients with special reference to prescribing glibenclamide in low doses]. / Die Behandlung neuerfasster Typ-II-Diabetiker unter besonderer Berücksichtigung der Verordnung von Glibenclamid in niedriger Dosierung.

In the period of 15 months 90% of all newly registered type II diabetics of a district area (70 males, 122 females) were prospectively thoroughly examined above all in hospital, standardizedly stabilized and have been followed up for 1 year with regard to their therapy behaviour. From the features obtained (age, body weight, heredity, symptomatology, blood glucose and insulin concentrations basally and after 75 g oGTT) subgroupings were worked out relevant for the therapy. 64% of the newly registered type II diabetics could be stabilized purely dietetically (males 70%, females 60.7%). Female type II diabetics revealed the worse course of therapy. Younger age, overweight, genetic load and higher insulin concentrations are markers of the importance of the insulin resistance and a domain of the basis therapy. Older age, normal weight in connection with higher blood glucose and lower insulin concentrations as an expression of the insulin deficit of higher degree render in most cases possible a treatment with SH-preparations. Small doses of glibenclamide proved to be very favourable both in not purely dietetically manageable younger patients and in older patients. 68% of all SH-cases did with a dosage of 1-3 mg glibenclamide a day, 28% with 1 mg a day. The pathophysiologic and pharmacologic mechanisms are discussed.

Remission of the newly diagnosed type 1 diabetes by radiation of the pancreas.

The process of autoaggression of the IDDM causes an "insulitis" leading to the destruction of the beta-cells. By photons (9 MV) in a total dose of 10 Gy, divided into 5 single doses at an interval of 2 days in each case we could get a total remission in 3 out of 4 diabetics, a partly remission in the fourth patient. The therapeutic effect lasts till now (1-6 months) without any further treatment. The combination of a radiation of 5 x 1 Gy with 1 mg methylprednisolon/kg body weight at the beginning of the treatment leads to a partly remission in 5 out of 7 patients lasting 3-7 months hitherto. Beside the antiinflammatory effect of the radiation on the "insulitis" an effect on the activated lymphocytes can be supposed. Side effects were not observed. They need not to be expected in a local therapy in a relatively small field size with a low radiation dose. Further research is necessary to confirm the results.

[Selected social medicine problems of the diabetic patient]. / Ausgewählte sozialmedizinische Probleme des Diabetikers.

Corresponding publications above all consider social medical problems of the diabetic, which still is in occupation. As more than the half of all diabetics are recipients of pension, we have to engage in them, too. We examined 1397 diabetics. 72% of them were able to get alone in the consulting hour. The rest (28%) had a significantly longer duration of illness and were disabled workers very often. We refer to the insufficient insulin therapy in old diabetics. We demonstrate possibilities for enforcement of the insulin injection.

[Lipid parameters in newly detected type II diabetic patients and relations to coronary heart disease]. / Lipidparameter bei neuerfassten Typ-II-Diabetikern und Beziehungen zur koronaren Herzkrankheit.

In a prospective study 192 new manifested type 2 (noninsulin dependent) diabetics were checked in view of prevalence of coronary heart disease (CHD) and hypertension in relation to concentration of lipids in serum. CHD was found in 49%, hypertension in 53% dominating females. Increased triglycerides (1.98 mmol/l) and decreased HDL-cholesterol i.s. (1.28 mmol/l) were characteristically, cholesterol (6.6 mmol/l) were within references, the lipoprotein-screening test was pathologically. Prevalence of CHD was associated with age, sex, hypertension, partly with triglycerides and weight and inverse with HDL-cholesterol i.s. but not with the concentration of blood glucose and insulin i.s. basal as well as stimulated (75 g oGTT). In conformity with other studies the differences in lipids alone would'nt be allowed to explain the high prevalence of CHD in new manifested type 2 diabetics.

[Presentation of an insulin-treated patient group within the scope of a 5-year study of the Diabetes Intervention Study (DIS)]. / Darstellung der insulinisierten Patientengruppe im Rahmen der Fünfjahresuntersuchungen der Diabetesinterventionsstudie (DIS).

The diabetes intervention study (DIS) is an intervention and examination programme which in dietetically conducible diabetics who freshly became manifest shall decrease the incidence of cardiovascular diseases and analyse the influence of various steps of intervention on the course of diabetes. In the course of 5 years 54 out of 988 patients were insulinized by reason of deteriorations of metabolism. There were no significant differences between the intervention and control group concerning age, sex, index of ideal weight, fasting blood glucose, quantity of injected insulin and duration of the insulin treatment. By means of a C-peptide short-time test following glucagon stimulation an attempt of differentiation into type 1 and type 2 diabetics, was performed and compared with the results in literature.

[Value of sonography in assessing nodular changes of the thyroid in an endemic goiter area]. / Zur Wertigkeit der Sonographie für die Beurteilung nodöser Schilddrüsenveränderungen im Strumaendemiegebiet.

In an area of endemic goiter 304 patients with an increased thyroid gland were examined by palpation, sonographically and partly scintigraphically. The average age was 37 (12-78) years, the average age of the patients with nodular changes of the thyroid gland 38-44 years. Patients with a diffuse struma were significantly younger with an average age of 33 years. A false-positive enlargement of the thyroid gland established by palpation occurred in 16.1% (n = 49/304). In the sonographic examination 148 out of 304 patients revealed a diffuse enlargement of the thyroid gland without provable nodular change. However, in about one third already more or less clearly characterized regressive changes could be observed. In 156 of the 304 patients 109 times solitary nodes and 47 times multinodular changes were established sonographically. In more than one third of all nodular goiters or one fifth of all patients examined a cyst was demonstrated sonographically. Two thirds of the sonographically established nodular changes were, however, solid. In 53 of all 304 examined patients could sonographically be established additional, unexpected nodes which had escaped the palpation and partly also the scintigraphic investigation. In 14% the node suspected by palpation could not be ascertained sonographically. According to the echo structure echo-poor and echo-equal solid nodes dominated. The frequency of carcinomata of the solid nodes was 6.7%. Apart from 4 echo-poorly and 2 complexly structured nodes a carcinoma of the thyroid gland demonstrated itself sonographically to the same echo. Finally conclusions are drawn for the diagnostics of the thyroid gland in the endemic area of goiter.

[Frequency of a positive result in the chlorpropamide-alcohol flush test in type I and type II diabetes]. / Häufigkeit des positiven Ausfalls des Chlorpropamid-Alkohol-Flushtests bei Typ-I- und Typ-II-Diabetes.

146 newly manifested diabetics (91 type I, 55 type II) and 20 non-diabetics were examined with the help of the chlorpropamide alcohol flush test. Also under different criteria of valuation of the increase of skin temperature (1.5 and 1.8 degrees C, respectively) no significant differences between the positive findings of the test in type I and type II diabetics were the result. Decisive for a positive result is according to our investigations the pre-existing initial temperature of the skin area, the room temperature and the air humidity. In such a case the initial temperature of the skin area depends on the moment of the last food intake.

[Type 2 diabetes--etiopathogenetic aspects]. / Typ-II-Diabetes--ätiopathogenetische Gesichtspunkte.

Prevalence of diabetes and increasing incidence mainly concern the type II diabetes, the etiopathogenesis of which is finally still unclarified. While the behaviour of the insulin secretion of type II diabetes is clarified as far as possible, research of the last years concentrates to disturbances of the insulin binding at the receptor, of the insulin efficiency after receptor binding as well as to the complicated interrelations between insulin secretion and peripheral effectiveness. On the one hand, metabolic sequels of malnutrition and obesity as well as decreasing muscle activity and muscle mass, on the other hand the genetic disposition plays an important role. Recently, insights into disturbed intracellular biochemical courses could be obtained and newer approaches for therapy could be found out. Significant could be the separation into perhaps still reversible findings in the manifestation of the irreversible late findings at the level of postreceptors after longer course of diabetes at least for the type IIb (adipose type). The diversity of etiopathogenetic factors demands substandardizations which would give only beginnings for prevention and optimized differential therapy. It cannot be denied that type II diabetes and arteriosclerosis partly have common genetic and exogenic causes.

[Value of sonographic representation of the portal artery in clinical practice]. / Stellenwert der sonographischen Pfortaderdarstellung in der klinischen Praxis.

While in chronic liver diseases we up to now above all depended on laparoscopic indices of the hypertension of the portal vein, also the non-invasive sonography is able to prove an adequate morphological substrate in form of the dilated splenic vein and the portal vein. A comparative study of 50 patients with liver cirrhosis who underwent laparoscopy shows significantly higher values in patients with clear portal hypertension. Provided a correct valuation of the findings by the clinical and a subtle examination technique, the non-invasive sonographic estimation of the portal vein represents a prognostically important diagnostic contribution in patients with chronic liver diseases.

[Preliminary studies on iodine administration during parenteral nutrition]. / Orientierende Untersuchungen zur Frage der Jodzufuhr bei parenteraler Ernährung.

Iodine deficiency is the main cause of endemic goiter. To estimate the iodine supply during parenteral nutrition, the iodine content of some important solutions used for infusions and routine parenteral nutrition has been assessed. It varied from 21 micrograms I/l to 68 micrograms I/l and is considered to be sufficient to supply the daily iodine requirement.

[The radioiodine test for the evaluation of iodine deficiency in the district of Karl-Marx-Stadt and in East Germany]. / Der Radiojodtest zur Beurteilung des Jodmangels im Bezirk Karl-Marx-Stadt und in der DDR.

The values of the per cent 24 h radioiodine uptake in the GDR are above 60--70% and speak for a low alimentary intake of iodine or renal excretion of iodine below 40 micrograms J/d. Like the struma prevalences they show a tendency increasing from north to south and characterize the whole European situation of iodine deficiency including its decrease from west to east. The mean values of radioiodine uptake of 71.7 +/- 13.2% (n = 110) in euthyroids of the district of Karl-Marx-Stadt correspond to the iodine deficiency as it occurs approximately in the districts of Erfurt, Dresden, Munich or Freiburg/B. The alimentary iodine intake of 38.4 +/- 17.2 micrograms J/d and the renal iodine excretion of 29.9 +/- 16.1 micrograms J/d, calculated from the 24 h radioiodine accumulation values of 40 euthyroid persons by means of a mathematical model developed by Oddie and co-workers were low. The latter only slightly differed (P less than 0.05) from its chemically estimated excretion of iodine in the urine: 23.1 +/- 16.9 micrograms J/g creatinine (n = 73). Between the calculated and chemically estimated excretion of iodine there was a relatively strict correlation of r = 0.68 (n = 26; P less than 0.001). The introduction of an iodine prophylaxis is regarded as an urgent necessity. Later on a new estimation of the regional "normal values" is necessary for the per cent radioiodine uptake.

[Infusion therapy and parenteral feeding in diabetes mellitus]. / Zur Infusionstherapie und parenteralen Ernährung beim Diabetes mellitus.

Infusion therapy and parenteral nutrition demand the consideration of diabetes-specific peculiarities in coma diabeticum, in the pre-, intra- and postoperative phase and in the parenteral nutrition which is to be performed for a long time. Adequate points of the centre of the coma therapy are: substitution of fluid, insulin and electrolytes. There exist partly still diverging opinions on the way of the practical approach. The nowadays usual methods are demonstrated as guide lines. The care of the diabetic in the pre-, intra- and postoperative phase is described and the author enters the particular problems of the parenteral nutrition in diabetes mellitus from the pragmatic points of view.

The XX male -- report on a child and an adult.

Two XX males are described. The first patient with a typical phenotype of XX males has aplasia of the left kidney. The second one is a boy, who shows an additional chromosome translocation and also signs of the Prader-Willi syndrome.

[Incidence of gestational diabetes and changes in insulin secretion of pregnant women (author's transl)]. / Häufigkeit des Gestationaldiabetes sowie der Veränderungen der Insulinsekretion bei Schwangeren.

The 50-g oGTT was applied to pregnant women suspected of having contracted diabetes. Carbohydrate tolerances were pathological in 23.6 per cent of all probands and in borderline vicinity in 17.9 per cent. The oral glucose tainting test thus worked according to expectation by revealing a relatiively high frequency of disorders of the carbohydrate tolerance. Yet, impaired insulin secretion was established rarely, with high response having been recorded from only seven per cent and delayed insulin secretion from 4.1 per cent. Low response was not found at all. No correlations were found to exist, by the 50-g oGTT, between disorders of the carbohydrate tolerance and insulin secretion. The groups involved differed but little with regard to their IRI mean value curves. Sugar excretion in urine was found to be increased with significance in response to pathological carbohydrate tolerance in early pregnancy and may be used as a complementary criterion for diagnosis.