Objective: Motor disturbances are a relevant aspect of depression. Kinematical analysis of movements can be applied to explore which type of motor dysfunction is associated with depression. We ...hypothesized that depressed patients draw and write significantly slower than controls and that motor disturbances become more pronounced under bi‐manual demands.
Method: We examined 37 depressed patients and 37 healthy controls using a digitizing graphic tablet and subsequent kinematical analysis of handwriting and rapid drawing movements.
Results: Depressed patients performed drawing with significantly less regular velocity than controls (P < 0.001), but normal velocity. Motor differences between patients and controls did not increase under bi‐manual demands. Handwriting of patients was abnormally slow (P = 0.04).
Conclusion: Irregular patterns of velocity peaks in depressed patients point to basal ganglia dysfunction and/or deficient activity of the sensorimotor cortex and the supplementary motor area as a possible substrate of hand‐motor disturbances in depression.
The aim of the study was to assess scintigraphically the relationship between myocardial blood flow response and sympathetic dysinnervation in long-term Type 1 diabetic patients. Effects of the iron ...chelator deferoxamine on myocardial blood flow were studied and they were investigated according to the presence of cardiac sympathetic dysfunction.
Myocardial blood flow (MBF) was assessed with N-13 ammonia positron emission tomography in 13 long-term Type 1 diabetic patients and 13 control subjects at rest and in response to sympathetic stimulation (cold pressor test (CPT)). In diabetic patients, the study was repeated after preinfusion with deferoxamine. Furthermore, 123I metaiodobenzylguanidine (MIBG) scintigraphy was applied to assess regional cardiac sympathetic dysinnervation (uptake score 1 = normal, homogeneous uptake em leader 6 = no uptake).
In diabetic patients, MBF increased in response to CPT from 78 +/- 18 ml/100 g/min to 84 +/- 26 ml/100 g (8%, P < 0.001). Control subjects demonstrated an increase from 63 +/- 17 ml/100 g to 84 +/- 26 ml/100 g (33%, P < 0.001), respectively. Resting MBF was higher in diabetic patients than in control subjects (P < 0.001). In diabetic patients, increase in MBF in response to CPT was significant in regions with a MIBG uptake score of <or= 3. Regions with a MIBG uptake score of > 3 did not exhibit a significant increase in MBF in response to CPT. After administration of deferoxamine, the increase in MBF in response to CPT was 23% and the magnitude of increase was related to the MIBG uptake score (r = 0.40, P < 0.0001).
Myocardial blood flow response to sympathetic stimulation is significantly impaired in long-term Type 1 diabetes. After preinfusion with deferoxamine the impairment is partially reversed and a relationship between myocardial blood flow and the extent of cardiac sympathetic dysfunction is observed.
Background: Patients with insulin dependent diabetes require frequent advice if their metabolic control is not optimal. This study focuses on the fiscal and administrative aspects of telemanagement, ...which was used to establish a supervised autonomy of patients on intensified insulin therapy.
Methods: A prospective, randomised trial with 43 patients on intensified insulin therapy was conducted. Travelling distance to the diabetes centre was 50 min one way; all patients had undergone a diabetes education course with lessons in dose adaptation. Patients were randomly assigned to telecare (
n=27) or conventional care (
n=16). They used BG-meters with a storage capacity of 120 values (Precision QID™ Abbott/Medisense) and transmitted their data over a combined modem/interface via telephone line to the diabetes centre. Data were displayed and stored by a customised software (Precision Link Plus™, Abbott/Medisense). Advice for proper dose adjustment was given by telephone.
Results: Average time needed for instruction in the telemedical system was 15 min. Data were transmitted every 1–3 weeks and a teleconsultation was performed by phone every 2–4 weeks, depending on the extent of specific problems. On average, personal visits in the control group were performed once a month. Physician's time expenditure for telemanagement, compared to conventional advice was moderately higher (50 vs. 42 min per month). A substantial amount of time on the patients side could be saved through replacing personal communications by telephone contacts and data transmission reduction (96 vs. 163 min/month including data transmission time). Setting up an optimal telemanagement scenario, a cost analysis was carried out yielding savings of ≈650 EURO per year per patient. HbA
1c dropped significantly from 8.2 to 7.0% after 8 months of observation, but there was no significant difference between the intervention and control groups. Major technical problems with the telematic system did not occur during the study.
Conclusions: Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management.
A computer-based system has been developed for the generation of medical expert opinions on the insulin-resistance syndrome, based on clinical data obtained from primary care physicians.
An expert ...opinion for each patient was generated by using a decision tree for entering individual text modules and by adding optional free text. The expert opinions were returned by e-mail, telefax or by ordinary mail.
1389 primary care physician sent anonymous data sets and requested expert opinions for a total of 3768 patients. Through the set up of a rule-based system an automation of the generation of the expert opinions could be achieved and the generation time dropped from initially 40 minutes to less than 5 minutes at the end.
By using predefined text modules and a rule based system, a large number of medical expert opinions can be generated with relatively few additional resources.
Effects of oxygen-derived free radicals are suggested to be a potential pathogenic factor for endothelial dysfunction. In this study we sought to evaluate the effect of hydroxyl radicals on the human ...coronary vascular bed in type I diabetes mellitus using positron emission tomography (PET). Thirteen patients with type 1 diabetes underwent PET using nitrogen-13 ammonia at rest and during sympathetic stimulation with the cold pressor test (CPT). The rest-stress study protocol was repeated twice (on different days) using pre-stress infusion of either saline as placebo or deferoxamine, an iron chelator which inhibits generation of hydroxyl radicals. At rest, global MBF was higher in diabetics than in normal controls (78.1+/-17.5 vs 63.2+/-14.9 mg 100 g(-1) min(-1), P<0.05) and myocardial vascular resistance (MVR) showed a trend towards lower values (patients, 1.28+/-0.35; controls, 1.55+/-0.32, P=NS). CPT increased MBF in all controls while 7/13 diabetics responded normally. CPT decreased MVR in 10/13 controls but in only 4/13 diabetics. There was no significant difference in the duration of diabetes, HbA1c, daily insulin dose, body mass index, or lipid profiles between patients with and patients without abnormal MBF or MVR responses. Pre-stress infusion of deferoxamine normalized MBF response in all six patients, and MVR response in six of the nine patients. Another group consisting of seven patients underwent a rest-rest protocol after infusion of deferoxamine and saline to investigate the effect of deferoxamine on resting MBF. Deferoxamine did not change the resting MBF (deferoxamine, 81+/-17 ml 100 g(-1) min(-1); saline, 75+/-19 ml 100 g(-1) min(-1), P=NS) or MVR (deferoxamine, 1.0+/-0.5 mmHg ml(-1) 100 g(-1) min(-1); saline, 1.2+/-0.6 mmHg ml(-1) 100 g(-1) min(-1), P=NS). In conclusion, inhibition of hydroxyl radical formation using deferoxamine significantly improved the responses of coronary microvasculature to sympathetic stimulation. Hydroxyl radicals may play a role in the pathogenesis of flow abnormalities in type 1 diabetes.
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