Improvement of lipoprotein lipid composition in type II diabetic patients with concomitant hyperlipoproteinemia by acipimox treatment. Results of a multicenter trial.

OBJECTIVE: To study the tolerability and efficacy of acipimox on hyperlipidemia and diabetes compensation in patients with NIDDM under conditions of a routine clinical practice. RESEARCH DESIGN AND METHODS: We recruited 121 patients (60 men and 61 women) from 10 participating clinical centers. They were randomly divided into two groups and treated for 3 mo either with acipimox (250 mg three times a day) or placebo, using an open study design. RESULTS: Acipimox treatment led to a significant drop in fasting serum total triglyceride levels (by 28%) after 1 mo of drug administration. This decrease prevailed up to the end of the 3-mo study. Serum total cholesterol levels declined by 14%, and high-density lipoprotein tended to rise in acipimox-treated patients. These changes in lipid metabolism were not accompanied by any adverse effects of acipimox on glucose metabolism as judged by HbA1c measurements and the oral glucose tolerance test. Eight patients (out of 82 treated with acipimox) reported moderate adverse events of transient character, such as skin reactions and gastric disturbances. CONCLUSIONS: Acipimox seems to be a useful agent for treatment of diabetic dyslipidemia and does not deteriorate glycemic control.

[Treatment of obesity with a very low-energy dietetic regimen--the endocrine parallels]. / Lechenie na zatlustiavaneto s mnogo niskoenergien dietichen rezhim--endokrinni paraleli.

25 patients with various degree of obesity treated with a very low-caloric diet (Dresden diet) were followed up dynamically. By an average clinical stay of 22 days a satisfactory reduction of the body mass with mean 6.6 kg was achieved at mean reduction of the body mass index from 34 to 31. The blood sugar level, immunoreactive insulin in the course of the oral glucose tolerance test, the 24 h rhythm of the plasma cortisol and the aldosterone level at rest and in orthostatic position at the beginning and the end of the dietetic treatment were followed up. The results achieved are discussed in relation to the reduction of the body mass.

The largest convex patches: a boundary-based method for obtaining object parts.

The importance of boundaries for shape decomposition into component parts has been discussed from different points of view by Koenderink and van Doorn (1982), and by Hoffman and Richards (1984). The former define part boundaries as parabolic contours, whereas the latter propose that part boundaries should be defined by contours of negative minima (or maxima) of principal curvature. In this article, building on aspects of both approaches, we develop a new method for shape decomposition. This method relies exclusively on global properties of the surface which are fully characterized by local surface properties. We propose that a useful parcellation of shapes into parts can be obtained by decomposing the shape boundary into the largest convex surface patches and the smallest nonconvex surface patches. The essential computational steps of this method are the following: (i) build initial parts from the largest locally convex patches, (ii) consider an initial part as a constituent part if it is essentially convex, and (iii) obtain the remaining constituent parts by merging adjacent initial parts generated by the largest locally convex and the smallest nonconvex patches of nearly the same sizes. The method is illustrated on both smooth and continuous shapes. We show that the decomposition of shapes into the largest convex patches aims to maximize the "thingness" in an object, and to minimize its "non-thingness". The method is conducive to a natural parcellation of shapes into constituent parts useful for recognition and for inferring function.

[Effect of biostator control on levels of contra-insulin hormones]. / Efekt na biostatorniia kontrol Vurkhu nivoto na niakoi kontrainsularni khormoni.

A 24 hour biostator control was carried out on 30 patients with insulin dependent diabetes, mean age 34 years (16-61 years) and mean duration of the disease 7 years (1-33 years). All patients had normal body mass (+/- 10% according to Broka's formula). The plasma levels of glucagon, growth hormone, cortisol and C-peptide were determined at the beginning and at the end of the biostator control. With the decrease of glycemia (from 12.71 +/- 4.3 to 5.75 +/- 1.5 mmol/l, p less than 0.001) only the cortisol level fell reliably (p less than 0.001), the growth hormone and glucagon levels fell statistically insignificantly. There is no reliable correlation between the contra-insulin hormones studied and the glycemia level.

[The level of glycosylated hemoglobin in obese patients]. / Nivo na glikiraniia khemoglobin u bolni sus zatlustiavane.

The glycosylated hemoglobin level was examined in 37 obese patients without manifested diabetes mellitus. The level was in the reference ranges. The patients who had lowered carbohydrate tolerance showed a tendency toward a higher glycohemoglobin level. The reduction of body mass was accompanied by a decrease of glycohemoglobin.

[Dynamics of blood glucose, serum insulin and lipids during the oral glucose tolerance test in hyperthyroidism]. / Dinamika na kruvna gliukoza, serumen insulin i lipidi v khoda na oralen gliukozotoleransen test pri khipertireoidizum.

Blood glucose, serum level of IRI, NEFA, total and HDL-cholesterol during oral loading with 100 g glucose were studied in 42 patients (37 females and 5 males), at an average age of 46,3, with various forms of hyperthyroidism. Diabetes mellitus was established in 3 patients, and in 10--reduced glucose tolerance. The basal insulinemia is increased in the patients with normal glucose tolerance (mean value 36,34 microU/ml), as compared with those with reduced tolerance (22,94 microU/ml). It manifested a moderate increase but slowed down reduction during the test. The insulin-glucose ratio, an indirect index for tissue insulin resistance, is four-fold increased as compared with the healthy. The total cholesterol and NEFA in the patients with normal and reduced glucose tolerance were with similar levels but during the test NEFA were more pronouncedly reduced in case of normal tolerance. The level of HDL-cholesterol in patients with reduced tolerance is lower (means +/- S = 0,77 +/- 0,42 mmol/l), though insignificantly, as compared with that of normal tolerance (1,03 +/- 0,4 mmol/l). The changes in triglycerides are but opposite: higher (2,21 +/- 0,67 mmol/l) with reduced and lower (1,74 +/- 1,46 mmol/l) in normal glucose tolerance. The differences in HDL-cholesterol and in triglycerides grow in the course of the test. The role of the altered lipid indices is discussed, particularly in reduced glucose tolerance, in the genesis of cardiac complications in hyperthyroidism.

[Use of the artificial endocrine pancreas in the clinic]. / Prilozhenie na izkustveniia endokrinen pankreas v klinikata.

Via the artificial endocrine pancreas--apparatus "BIOSTATOR" 100 patients were studied and treated, namely: 90 with diabetes mellitus, 7 with hyperinsulinism and 3 with obesity. The 24-h insulin needs of the diabetics with insulin-dependent and non-insulin dependent with secondary exhaustion type of diabetes, were determined. The following subcutaneous insulin dosage was determined, depending on the insulin amount spent during the 24-h biostator control. It was established that the necessary reduction of the intravenously administered insulin is 30% on the average with the passing over to subcutaneous regime. The indices of lipid metabolism were also studied as well as numerous hormones with which the carbohydrate compensation leads to a change. The problem of the "morning" phenomenon is discussed.

[Dynamics of the serum lipid indices in thyrotoxicosis]. / Dinamika na serumni lipidni pokazateli pri tireotoksikoza.

Total cholesterol, HDL-cholesterol, triglycerides, NEFA and phospholipids were studied in the sera, before the treatment, in 45 patients (40 females and 5 males) aged from 14 to 73 with various forms of hyperthyroidism. In 16 of them the studies were repeated about one month after the initiation of the thyreostatic treatment, when the hyperthyroid symptomatics has obviously been controlled. The results obtained about the separate serum lipid indices of the patients were discussed, compared with the data of the control group (n = 14), as well as the role of the low serum HDL-cholesterol and increased triglycerides in the genesis of thyreotoxic cardiomyopathy.

[Clinical x-ray studies of arterial calcifications in the lower extremities of diabetics]. / Kliniko-rentgenologichni prouchvaniia na arterialnite kaltsifikatsii v dolnite krainitsi pri diabetno bolni.

The authors studied the X-ray grams of soft tissues of the lower limbs of 120 patients with diabetes mellitus--54 males and 66 females and 42 control subjects (18 males and 24 females). The average age of the latter was 56.3 and of the patient--52. According to their characteristic the calcifications were localized in intima (spotted) and in media (linear). Besides localization, the extend (whole artery or partial) and degree (light, pronounced) of calcifications were determined. Mediocalcinosis in the arteries of lower limbs of diabetics was established to be almost four times more frequent than that among the controls, the arteries of the thighs, legs and foot being equally affected. In 1/3 of the cases the whole vascular system of the lower limbs was involved, being more frequent in males, as compared with females, with a statistical significance, and correlated significantly with age and duration of the disease. Mediocalcinosis was more frequent with statistical significance, in patients, treated with sulfonylurea preparations. Attempt was made to explain that fact, besides by the older age of those patients with some humoral and hormonal characteristics of diabetes of the elderly, sensitive to SU preparations namely: the presence of hyperlipoproteinemia, hypersomatotropism and relative hyperinsulinism, favouring the proliferation of the cells of media and deposition of calcium salts in it. No statistically significant correlation was found between the incidence of mediocalcinosis on the one hand and the type of diabetes, severity of the disease, occupation, past infections, the presence of hypertension, obesity, retinopathy and disorders of lipid metabolism--on the other.

[Secondary amyloidosis in Hodgkin's disease]. / Vtorichna amiloidoza pri bolestta na Hodgkin.

One case with secondary amyloidosis is described, manifested by a nephrotic syndrome, 13 years after the establishment of lymphogranulomatosis in a male, ages 46. Amyloidosis diagnosis with biopsy, after a long-term remission in a patient with a relatively restricted lymphogranulomatosis is of certain interest. The diagnostic difficulties of secondary amyloidosis in Hodgkin disease are discussed as well as the mechanism origination and the role of certain medicaments in amyloidosis origination and treatment.