The prevalence and predictors of gestational diabetes mellitus in Hungary.

There are conflicting results regarding the frequency of gestational diabetes (GDM) in Hungary. The aim of this study was to estimate the prevalence of GDM and to clarify the association between selected maternal characteristics and GDM risk. In a population-based screening program of GDM in Tolna County, Hungary, 75 g OGTTs were offered to all pregnant women between 24-28 weeks of gestation and evaluated according to WHO criteria in 2000 (WHO GDM). Women were also classified based on the IADPSG criteria (IADPSG GDM). Selected risk factors were recorded by district nurses. OGTT results were available for 1,835 (81.2%) pregnancies out of 2,261. Altogether 159 (8.7%) were diagnosed as WHO GDM and 304 (16.6%) as IADPSG GDM. Gestational diabetes was related to older age, higher BMI, and an increasing number of deliveries (all p<0.005). The risk of IADPSG GDM monotonously increased with age, -pre-pregnancy BMI and number of deliveries. The risk of WHO GDM increased linearly with age, however, women with the highest BMI (≥ 29.2 kg/m2) had decreased risk compared to women with a BMI of 26.1-29.1 kg/m2 (p<0.05). There was an inverse U-shaped association between GDM risk and number of deliveries with the highest risk observed in those with 3 deliveries (p quadratic term=0.008). We found a high prevalence of GDM in this Caucasian Hungarian population. Our results suggest that pre-pregnancy BMI and previous deliveries elevate the risk of WHO GDM only to a certain level, above which the risk decreases.

[Diabetic coma and bases of proper treatment]. / A diabeteses coma és kezelésének alapjai.

Hyperglycaemic, hyperosmolar coma developing in diabetes mellitus-with or without ketoacidosis-is a perilous metabolic catastrophe, preserving its clinical importance even nowadays. The features of the two basic forms of diabetic coma, the development and characteristics of clinical symptoms and laboratory alterations caused by absolute or relative lack of insulin are reported by the author. The importance of early diagnosis and up-to-date intensive treatment is emphasized, regarding the need of decreasing of the still now considerable mortality rate. Fundamental principles of the therapeutic interventions are the following: improvement of the microcirculation through appropriate compensation of fluid and elektrolytes, intravenous or intramuscular administration of low-dose insulin, prevention of hypokalemic condition, and correction of acidosis under pH 7,1 value. Moreover, the well-planned supportive treatment is also essential: prevention of thromboembolism, averting the occasional development of shock caused usually by infections, and prophylaxis of the often fatal cerebral oedema. The estimation and follow-up of osmolality and the prevention of rapid changes in serum glucose and electrolyte levels are of particular importance in every cases. Careful observation of the patients regarding the cardiorespiratory and renal functions is of great significance in both (first and second) phases of the treatment. Improvement of patients' education, controlled care of diabetic patients, reduction of the number of recidive cases and increasing knowledge regarding diabetes among the general practitioners are determined by the author as the future possibilities for the prevention of this severe metabolic disorder.

[Diabetic ketoacidosis (169 episodes in 131 patients in the course of 10 years)]. / Ketoacidosis diabetica (169 epizód 131 betegen 10 év alatt).

Diabetic patient material--presenting hyperglycaemic ketoacidotic episode--observed in Gyula and Szekszárd County Hospitals in period 1980-89, was reviewed by authors. 131 patients were admitted with 169 ketoacidotic episodes (among them 23 patients had 62 recurrences). The mean age of patients were 49.4 years (14-84 years), duration of diabetes 9.5 years (from one month to 45 years). The common cause of diabetic ketoacidosis was respiratory (26 per cent) and enteral (35.5 per cent) infection. The consciousness of patients had shown close correlation with the increase of blood sugar and urea nitrogen level as well as with the decreasing of the pH value of capillary blood. The first step of the therapy was the parenteral fluid intake with isotonic solution (in the first hour the average 1351 ml). In 18 patients fast-acting insulin (Novo Actrapid MC) was given by constant infusion, in the remaining cases intravenous or intramuscular low doses of the same insulin were administered. The importance of early potassium replacement, and the dangers of forced and rapid correction of acidosis is emphasized. Lethality related to episodes was 10 per cent, related to the patients 12.9 per cent. The number of ketoacidotic cases did not decrease parallel with the improvement of therapeutic possibilities, as it was experienced by their earlier evaluations. The importance of the prevention of acute metabolic disorders is outlined might be resulted from increasing the efficacy of patients education and better knowledge of GP's, as well.

[Possibilities of early diagnosis of autonomic neuropathy in diabetics]. / A cukorbetegek autonom neuropathiájának koraibb kórismézési lehetösége.

The possibilities of the diagnosis of autonomous neuropathy were investigated by the authors in 71 insulin-treated diabetes mellitus patients with the use of dynamic esophageal scintigraphy and determination of cardiac reflex tests. It has been found that the extent and severity of the lesion can be earlier and more exactly recognized with the help of these two methods. Important information can be obtained by the determination of esophageal transit time about the functional condition of vagal nerves supplying gastrointestinal organs. In patients suffering from autonomous neuropathy the esophageal transit time proved to be significantly prolonged (p less than 0.01). The injury of parasympathetic heart innervation is earlier indicated by the pulmo-cardiac reflexes, while the troubles of symphathic functions are shown more responsively by the sustained handgrip test. Cases with considerable degree of orthostatic hypotension were not observed, its incidence may be probably higher only in advanced forms of autonomous neuropathy. The injury of vegetative nerve fibers develops mostly parallel in diabetes mellitus, but partial functional disorders can be also observed. Detailed neurological examinations were performed in 30 patients, and it has been found, that the lesion of peripheral nerves can be only later observed. Specific complications involving the nervous system are more frequent in cases with longer duration of the disease. In the authors opinion, for investigation and follow-up of larger number of diabetic patients, the dynamic esophageal scintigraphy and determination of pulmo-cardiac reflex and sustained handgrip tests seem to be suitable.

[Prognostic factors affecting survival in multiple myeloma]. / A túlélést befolyásoló kórjósló tényezök myeloma multiplexben.

70 patients suffering from multiple myeloma were observed by authors in the last 15 years and three months. In the meantime fifty-two out of them have died, and 18 patients are under permanent care. 43 IgG, 17 IgA, 6 Bence-Jones, 2 IgD types were diagnosed according to the paraprotein distribution, one patient proved to be nonsecretory, and an other one to osteosclerotic form as well. The median survival time was 27 months in the group of deceased patients. In the group followed-up 50.8 months survival time was observed up to the closing of the study. Several prognostic factors were investigated. According to the classification by Durie and Salmon the survival time was 60 months in the patients with stage I, 33 months in stage II., and 9 months in stage III respectively. The prognosis is much poorer in patients into the "B" category: the survival time was 14 months. Classified in the basis of the type of the myeloma-cell, the cases with well matured cells have had the best prognosis with survival time of 46 months, while the most unfavourable prognosis was observed in patients with blast-cell type, with a median survival time of 10 months. The greatest number of patients suffered from multiple myeloma of IgG paraprotein type, in this group the serum IgA level was found to be significantly decreased in the patients died due to inevitable infections. The survival was injured significantly by the occurrence of concomitant severe diseases, to.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognostic role of immunoglobulin levels in chronic B cell lymphoid leukemia]. / Az immunglobulin mennyiségének prognosztikai szerepe B sejtes chronikus lymphoid leukaemiában.

The authors analyse the prognostic role of the immunoglobulins detected in the sera of 83 patients with B-cell chronic lymphocytic leukaemia. They have found, that the decreased level of IgG, IgA and IgM itself has no significant prognostic role. In those cases, where the IgA level was the lowest at the recognition of the disease, the expected life-span was significantly shorter. As far as the immunoglobulin level and the clinical stage did not show any significant correspondence, the relative reduction of the IgA level at the recognition of the disease can be considered as a poor prognostic sign.

[The significance of Campylobacter pylori infection in gastroenterologic and diabetic practice]. / Campylobacter pylori fertözés jelentösége a gasztroenterologiai és diabetologiai gyakorlatban.

The presence of Campylobacter pylori was investigated in gastric antral biopsy specimens. In 50 consecutive patients undergoing upper gastrointestinal tract endoscopy microbiological cultures, histological examination and rapid urease test were parallel performed, and a 92 per cent sensitivity and 100 per cent specificity of rapid and cheap urease test were determined. Afterwards--in a prospective study--311 patients were examined for C. p. by the rapid urease test only. C. p. was detected in 92 per cent of duodenal ulcer patients, in 52 per cent of patients with gastric ulcer, in 67 per cent of non-ulcer dyspepsia, in 62 per cent of mixed diabetic patient material, and in 21 per cent only of asymptomatic volunteers. It has been found by the authors, that the rate of C. p. infection increased parallel with the continuance of diabetes and did not follow the increasing with age as in the general population. This is the first observation in the world literature concerning the correlation between C. p. and diabetes mellitus. Very close, significant correlation has been found between C. p. infection and chronic active gastritis. C. p. may play an important role in the recurrences of duodenal ulcer and in the pathogenesis of non-ulcer and diabetic dyspepsia. Further studies are planned to the correct evaluation of pathogeneity of Campylobacter pylori.

[Possibility of early diagnosis of diabetic nephropathies]. / Cukorbetegek nephropathiájának koraibb kórismézési lehetösége.

The serum and urine level of beta-2-microglobulin was examined by the authors in different stages of nephropathy of 250 patients suffering from diabetes mellitus (I type 178 pts, II type 72 pts). Beta-2-microglobulin values measured in diabetic patients without renal microangiopathy did not show any difference compared with that of the controls. In patients with freshly discovered diabetes mellitus significantly decreased beta-2-microglobulin levels were found, probably due to the increased glomerular filtration rate. Increasing beta-2-microglobulin values indicating an early glomerular lesion--were observed in incipient diabetic nephropathy. These values were significantly higher compared with that of healthy individuals and diabetic patients without renal microangiopathy. In the IV stage of disease the serum and urine beta-2-microglobulin levels were equally found to be elevated, indicating an impaired function of proximal tubuli beside the vascular lesions. The most expressed beta-2-microglobulin value elevations were observed in the stage of nephropathy. The authors emphasize the importance of determination and common evaluation of 24 hours protein excretion and serum urine beta-2-microglobulin values the earliest diagnosis of incipient renal lesion. According to their results, the introduction of this method may be very useful for early indication and follow-up of specific renal complications in diabetes mellitus patients.

T-lymphocytes bearing Fc-receptors for IgG in B-cell chronic lymphocytic leukaemia.

Peripheral venous blood lymphocytes of 10 untreated B-CLL patients at stages Rai 0-III and of 10 healthy individuals were studied. In B-CLL the absolute number of T lymphocytes present in peripheral blood was similar to that in healthy controls; however, the ratio of T lymphocyte subpopulations in B-CLL was changed in favour of TG cells, the absolute number of which was found to be increased. In B-CLL DNA synthesis of the TG cells in response to PHA stimulation was more intense than in healthy individuals. These observations are discussed in the light of the conflicting reports on the numerical and functional changes in B-CLL T-cells.

[Arterial occlusion in the ocular fundus induced by oral contraceptives]. / Oralis anticoncipiens szedése során kialakult szemfenéki arteriás occlusio.

PIP: To counter the paucity of documention on thromboembolic disorders caused by oral contraceptives (OC), a case study is presented describing the incidence of occlusion of arteria centralis retinae in a 24-year old woman after prolonged use of an OC, Bisecurin. She had taken Bisecurin for 4.5 years and had gained 20 kg during that time, but stopped usage 1 month before admission. She was hospitalized with severe deterioration of vision in the left eye. An eye examination indicated an edematous condition of the retina and reddening of the macula. Acuity of vision value for the left eye was .01 vs. 1.0 for the right, which was confirmed by fluorescein fundus angiography. Moderately decreased antithrombin III (AT III) activity was also ascertained. Treatment consisted of immediate retrobulbar injection with Tolazolin followed by Rheomacrodex, Cavinton infusions, B1 and B12 injections, Oradexon subconjunctival injection as well as vitamin B complex, Cavinton, and Colfarit tablets and a fat-free diet. Significant improvement of the left eye condition appeared 4 weeks later. Periodic follow-ups showed the healing of the condition around the macula; however, the patient suffered permanent damage to the retina due to the arterial occlusion above and below the macula. The disturbed lipid values of metabolism were also returned to normal, as borne out by normal dextrose loading results 8 months later (glucose tolerance was abnormal during examination at admission). The estrogen and progesterone components of OCs have been shown to reduce AT III levels, shorten heparin-thrombin coagulation time, increase fibrinogen levels, decrease HDL cholesterol levels, and produce excess TXA2 (thromboxan) resulting in vasoconstriction and thrombocyte aggregation. The risk of thrombosis is 6 times higher in OC users than in nonusers, although other susceptibility factors (obesity, diabetes, hypertension) also contribute to thrombosis.^ieng