Introducing a simplified approach to insulin therapy in type 2 diabetes: a comparison of two single-dose regimens of insulin glulisine plus insulin glargine and oral antidiabetic drugs.

AIM: To investigate whether the addition of a single bolus of insulin glulisine (glulisine), administered at either breakfast or main mealtime, in combination with basal insulin glargine (glargine) and oral antidiabetic drugs (OADs), provides equivalent glycaemic control in patients with type 2 diabetes, irrespective of the time of glulisine injection. METHODS: A national, multicentre, randomized, open-label, parallel-group study of 393 patients with type 2 diabetes who were suboptimally controlled [haemoglobin A(1c) (HbA(1c)) > 6.5-9.0% and fasting blood glucose (BG) 7.0% at baseline and who reached HbA(1c)

Frequency and quantity of the parvovirus B19 genome in endomyocardial biopsies from patients with suspected myocarditis or idiopathic left ventricular dysfunction.

Parvovirus B19 (PB19) has been identified as a possible cause of myocarditis and heart failure in both children and adult patients. This study used real time PCR analysis, to determine the frequency and to quantify PB19 viral genomes in endomyocardial tissue samples from 80 adult patients with clinically suspected myocarditis or idiopathic left ventricular dysfunction and from 36 controls. Histological (Dallas classification) and immunohistological analyses were performed to detect myocardial inflammation in the endomyocardial biopsies.PB19 genomic DNA was found in nine of 80 patients (11.2%), 4 out of 31 (12.9%) patients with inflammatory infiltrates detected via immunohistological methods and 5 out of 49 (10.2%) patients with left ventricular dysfunction without myocardial inflammation. The copy numbers for PB19 DNA ranged between 30 and 3900 per microg of cellular DNA. Four patients with clinically suspected myocarditis had copy numbers for PB19 DNA of 70, 740, 3400 and 3900, respectively, per microg of cellular DNA in the endomyocardial biopsy. Five patients with idiopathic left ventricular dysfunction had copy numbers for PB19 DNA of 30, 38, 52, 58 and 90, respectively, per microg of cellular DNA in the endomyocardial biopsy. The amplicon of one of the nine positive PCR fragment was sequenced and was found to be fully identical in the highly conserved sequence of published Parvovirus B19 VP1/VP2 genes (NCBI gene bank). In all patients, acute myocarditis was excluded according to the Dallas classification. All biopsies of 36 controls with no history of myocarditis or recent viral infection were negative for myocardial inflammation and parvovirus B19 genomes. In summary, Parvovirus B19 DNA is present within the myocardium of patients with suspected myocarditis and idiopathic left ventricular dysfunction and can be detected and quantified in endomyocardial specimens via real time PCR.

Insulin Lispro in pregnancy--retrospective analysis of 33 cases and matched controls.

AIMS/HYPOTHESIS: To evaluate if the application of Lispro insulin in pregnancy increases the risk for malformations or unusual pregnancy courses. METHODS: Diabetes specialists were contacted in Germany and Austria and asked to report women with diabetes who had been treated with Lispro during pregnancy. Furthermore they were asked to report another pregnant diabetic woman treated with regular insulin with similar HbA1c and age for each Lispro case. Following data were requested: age, first HbA1c in pregnancy and time of analysis, start and duration of Lispro treatment, ultrasound examination, chorionic villi biopsy, amniocentesis, unusual pregnancy courses, standard examination of the new-born for any malformation. Two-sided 95% confidence limits (95%-CI) for risk differences of proportions of malformations or unusual pregnancy courses were calculated. RESULTS: 33 pregnant diabetic women with Lispro and 27 with regular insulin treatment were analysed (mean age 28.3 years (17-41)and 30.1 (19-40); mean HbA1c 6.9% (4.5-10.7) and 6.8% (4.7-9.8), respectively). There were four malformations or unusual pregnancy course (spontaneous abortion; elective interruption because of multiple malformations; heart malformations and hyaline membrane syndrom; premature birth) in the Lispro and one malformation (dyplastic hip) in the regular insulin group. Risk differences in proportions of malformation or unusual pregnancy courses were 8% (95%-CI: - 5% to 21%). CONCLUSIONS/INTERPRETATION: Risk differences for malformations or unusual pregnancy courses were not higher in the insulin Lispro group compared to the controls. However, we observed four malformations or unusual pregnancy courses in the Lispro group. A case-control study is suggested to get a precise risk estimate.

The effect of small amounts of alcohol on the clinical course of chronic pancreatitis.

OBJECTIVE: To investigate the hypothesis that an increasing intake of alcohol accelerates the course of chronic pancreatitis. PATIENTS AND METHODS: In this retrospective record analysis and subsequent prospective follow-up of 372 patients with chronic pancreatitis, we separately compared the clinical course of chronic pancreatitis among the following patients: those with early-onset idiopathic chronic pancreatitis and no alcohol intake (group A [n=25]) and those with late-onset idiopathic chronic pancreatitis and no alcohol intake (group B [n=41]), low alcohol intake (< 50 g/d) (group C [n=57]), and high alcohol intake (> or = 50 g/d) (group D [n=249]). From medical records, physical examinations, questionnaires, death certificates, or autopsy reports, we obtained information on sex, age, signs and symptoms (pain severity, calcification, endocrine and exocrine insufficiency), complications, surgery, and survival. RESULTS: Group D had the highest percentage of men (72%). At the onset of chronic pancreatitis, patients in group A were significantly younger than those in groups B, C, and D (P<.05), and severity of pain was significantly greater in patients in group A than in groups B, C, and D (P<.05). The percentage of patients who eventually developed endocrine or exocrine insufficiency was similar in all groups. Among patients in groups B, C, and D, an increasing intake of alcohol from zero to less than 50 g/d to more than 50 g/d was associated with earlier inception of disease (P<.001). Pain prevalence at onset was less in group B patients than in patients in groups C and D (P<.05). Intake of a large amount of alcohol (group D) shortened time to calcification and survival (P<.05). In addition, patients in group D had more complications (fistulas, pseudocysts, abscesses, and biliary obstruction) (P<.05) than those in groups A and B. More patients in group A underwent pancreatic surgery compared with patients in groups B and C. CONCLUSIONS: Among patients with onset of chronic pancreatitis after age 35 years, alcohol intake, even less than 50 g/d, induced earlier disease characterized by more frequent severe pain, calcification, and complications. Intake of large amounts of alcohol (> or = 50 g/d) reduced time to calcification and death.

Acute pancreatitis in the postpartum period: a population-based case-control study.

OBJECTIVE: To determine relationships among pregnancy (during and postpartum), acute pancreatitis, and gallstones. PATIENTS AND METHODS: In this retrospective population-based case-control study, we identified all 12- to 50-year-old Rochester, Minn, females diagnosed between 1976 and 1991 as having acute pancreatitis (cases). For each case, we matched 4 women of the same age (+/- 6 years) with no history of acute pancreatitis (controls). Acute pancreatitis was defined as associated with pregnancy if it occurred from 10 months prior to delivery to delivery and with the postpartum period if it occurred within 10 months of the date of delivery. Logistic regression was used to assess associations between pregnancy-related acute pancreatitis, age, gallstone occurrence, and alcohol use. RESULTS: In a cohort of 61 women who developed acute pancreatitis and 244 controls, the relative risk for acute pancreatitis associated with pregnancy was 1.43 (95% confidence interval, 0.61-3.40). All 10 cases of acute pancreatitis associated with pregnancy occurred in the postpartum period. Gallstones were present in 6 of them compared with 13 of 51 women with non-pregnancy-related acute pancreatitis (P < .05). Women with postpartum-related pancreatitis were younger than those with non-pregnancy-related pancreatitis (mean, 28 vs 36 years; P < .05). Alcohol was not associated with pregnancy-related pancreatitis. CONCLUSIONS: Acute pancreatitis during the postpartum period is not directly related to pregnancy but is associated with gallstones and occurs in younger women.

Acute abdominal pain as a leading symptom for Degos' disease (malignant atrophic papulosis).

We report a case of a 16-yr-old white female patient with acute abdominal pain due to visceral involvement of Degos' disease that required extensive small bowel resection. Skin manifestations of her disease had been present for 2 yr before the correct diagnosis. She died as a result of central nervous system involvement from Degos' disease.

Nutritional support for the patient with short-bowel syndrome.

Short-bowel syndrome refers to the clinical consequences that follow extensive resection of the small bowel. As a result of resection, malabsorption of macro- and micronutrients occurs. The prognosis after resection depends on the extent and location of resection, the presence of a colon, the function of the residual intestinal mucosa, and the extent of intestinal adaptation. Intestinal adaptation is influenced by the presence of intraluminal nutrients and various trophic peptides and hormones. This article discusses the dietary management of the patient with short-bowel syndrome and the recent literature on growth factors (ie, growth hormone and glutamine) and small-bowel transplantation.