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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 17 (1979), S. 195-212 
    ISSN: 1432-0428
    Keywords: Diabetic autonomic neuropathy ; morphology ; pathogenesis ; clinical features ; assessment ; cardiovascular reflexes ; natural history ; prognosis ; treatment ; diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This review attempts to outline the present understanding of diabetic autonomic neuropathy. The clinical features have been increasingly recognised but knowledge of the localization and morphology of the lesions and their pathogenesis remains fragmentary. A metabolic causation as postulated in somatic nerves accords best with clinical observations. Most bodily systems, particularly the cardiovascular, gastrointestinal and urogenital, are involved with added disturbances of thermoregulatory function and pupillary reflexes. Possible effects on neuroendocrine and peptidergic secretion and respiratory control await definition. Current interest centres around the development of a new generation of tests of autonomic nerve function that are simple, non-invasive, reproducible and allow precision in diagnosis and accurate quantitation. Most are based on cardiovascular reflexes and abnormality in them is assumed to reflect autonomic damage elsewhere. Probably no single test suffices and a battery of tests reflecting both parasympathetic and sympathetic function is preferable. Little is known of the natural history. The prevalence may be greater than previously suspected and although symptoms are mild in the majority, a few develop florid features. The relation of control and duration of diabetes to the onset and progression of autonomic neuropathy is not clearly established. Once tests of autonomic function become abnormal they usually remain abnormal. Symptomatic autonomic neuropathy carries a greatly increased mortality rate possibly due to indirect mechanisms such as renal failure and direct mechanisms such as cardio-respiratory arrest. Improved treatment of some of the more disabling symptoms has been possible in recent years.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; autonomic neuropathy ; QT interval ; sudden death ; autonomic function tests
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary QT intervals were measured over RR intervals ranging from 500 ms to 1000 ms in 13 normal male subjects, 13 male diabetic subjects without and 13 with autonomic neuropathy. There was a close linear relationship between QT and RR in all subjects. The slope of the regression line was significantly greater in the autonomic neuropathy group than the normal group. Thirty-two male diabetic subjects with varying degrees of autonomic dysfunction had repeat QT measurements 3 (range 2–6) years later. QT and QTC lengthened significantly at the second visit, unrelated to age or time between recordings, but which corresponded with changes in autonomic function. Of 71 male diabetic subjects under 60 years followed for 3 years, 13 had died, 8 unexpectedly. Of those with autonomic neuropathy, QT and QTC were significantly longer in those who subsequently died, despite similar ages and duration of diabetes. We conclude that QT/RR interval relationships are altered in diabetic autonomic neuropathy, and that changes in QT length with time parallel changese in autonomic function. There may be an association between QT interval prolongation and the risk of dying unexpectedly in diabetic autonomic neuropathy.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 33 (1990), S. 180-181 
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 24 (1983), S. 166-171 
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; sexual function ; women ; autonomic neuropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Sexual responsiveness in 82 Type 1 (insulin-dependent) diabetic women was compared with that of 47 normal control subjects, using an interview method for rating various aspects of sexual response, and attitude questionnaires. The diabetic women were questioned about symptoms of autonomic neuropathy, and cardiovascular autonomic nerve function tests were performed. There were differences between the two groups in the reports of vaginal lubrication, but in most other respects the groups were similar. The diabetic women were not less orgasmic, and reported significantly fewer unpleasant feelings during sexual intercourse. They saw themselves and their husbands as less ‘potent’ than did the normal subjects. The possible enhancing effect of diabetes on the marriage of some diabetic women possibly counteracted the relatively mild physiological deficits involved. There was very little difference in sexual response between women with and without symptomatic autonomic neuropathy.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 3 (1989), S. 0 
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Nineteen diabetic patients with autonomic neuropathy were enrolled in a double-blind crossover study of cisapride, metoclopramide and placebo. Symptoms were evaluated from diary cards and from assessments undertaken at the end of each eight week treatment period. Measurements of oesophageal transit, gastric emptying and whole gut transit were made before treatment began and at the end of each treatment period. Three patients dropped out early in the study, and the results from 16 patients were analysed.The severity of autonomic neuropathy, judged from cardiovascular reflex tests, correlated with delayed oesophageal transit and prolonged gastric emptying, but abnormal oesophageal transit and gastric emptying were often unrelated to the presence of upper gastrointestinal symptoms. Neither cisapride nor metoclopramide had a statistically significant effect on oesophageal transit, gastric emptying or whole-gut transit, nor was any significant effect on symptoms identified, although a trend towards reduced nausea and vomiting with metoclopramide and reduced epigastric fullness and diarrhoea with cisapride was suggested.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-0428
    Keywords: Diabetic neuropathy ; glycaemic control ; microvascular complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The progression of subclinical polyneuropathy over 2.5 years has been studied in a representative group of 75 young patients with Type 1 (insulin-dependent) diabetes (initial age 16–19 years). The relationships between changes in nerve function, glycaemic control and concurrently developing microvascular complications (retinopathy, microproteinuria) were investigated. Deterioration of motor, sensory and autonomic nerve function, retinopathy and microproteinuria was related to poor glycaemic control. In addition, there was an association between developing neural and microvascular complications which was not diminished when their common relationship to hyperglycaemia was taken into account. These findings suggest that, although poor glycaemic control is an essential permissive factor in the early development of diabetic polyneuropathy, other influences, shared with microvascular complications, must also be important.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    International journal of fracture 13 (1977), S. 467-479 
    ISSN: 1573-2673
    Source: Springer Online Journal Archives 1860-2000
    Topics: Mechanical Engineering, Materials Science, Production Engineering, Mining and Metallurgy, Traffic Engineering, Precision Mechanics
    Notes: Abstract The general role played by thermal and residual (TR) stresses in fracture mechanics is still unclear. It is sometimes argued (a) that in the linear elastic fracture mechanics (LEFM) regime TR stresses are secondary (rather than primary) i.e. that the overall loading is relaxed (rather than maintained) as well as redistributed as the crack grows, and (b) that because TR stresses do not influence the plastic limit load of a structure they have little influence on the post yield fracture mechanics (PYFM) regime. This paper demonstrates the dangers of these views. Examples are given of TR stresses behaving in either primary or secondary manner in both the LEFM and PYFM regimes. The danger of drawing general conclusions in fracture mechanics from the nearness of a structure to its plastic limit load is demonstrated, and it is shown that “local” rather than global (limit-analysis) collapse parameters must be used in empirical formulae that interpolate between LEFM and plastic-collapse regimes. In LEFM it is shown that the standard Green's function (weight or influence function) method can be applied to TR stress calculations. The method also applies in the PYFM regime if the Dugdale-type strip yield model is assumed. A general method of analysing fixed-grip loadings in the plastic regime, based on Rice's J contour integral is also given.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    International journal of fracture 14 (1978), S. 101-117 
    ISSN: 1573-2673
    Source: Springer Online Journal Archives 1860-2000
    Topics: Mechanical Engineering, Materials Science, Production Engineering, Mining and Metallurgy, Traffic Engineering, Precision Mechanics
    Description / Table of Contents: Résumé Le modèle d'écoulement plastique d'une bande proposée par Dugdale et Bilby, Cottrell et Swinden a été appliquée à l'analyse de l'incubation et de la croissance des fissures de fluage. Ce travail constitue une extension d'un travail précédent par Vitek (sur l'incubation) et par Heaton et Chan (d'après To) sur la croissance. En suivant Vitek et Heaton et Chan, le critère principal de croissance de la fissure utilisé est un critère basé sur le COD. On suppose que la fissure augmente à une valeur constante du COD (φ=φc) et que la déformation de fluage ∈t à l'extrémité de la fissure est φ/h pour une longueur de référence considérée comme une constante du matériau. La théorie basée sur le COD indique que les temps d'incubationt iet de rupturet fsont contrôlés par le facteur d'intensité des contraintesK à des contraintes élevées et par la contrainte nette à des contraintes très faibles. Une faiblesse de la théorie réside dans ce qu'elle néglige les effets du fluage primaire; ces effets doivent être absorbés en modifiant l'index relatif au fluage secondaire. Si cette opération est réalisée, la comparaison de deux expériences effectuées indépendamment l'une de l'autre montre un accord raisonnablement bon avec la théorie basée sur le COD, aussi bien dans le cas det ique dans le cas det f.
    Notes: Abstract The strip yield model of Dugdale and Bilby, Cottrell and Swinden is applied to analyse the incubation and growth of creep cracks. This extends previous work by Vitek (on incubation) and by Heaton and Chan (following To) on growth. Following both Vitek and Heaton and Chan, the main criterion of crack growth used is a COD-based one. The crack is assumed to grow at constant crack opening displacement (COD) φ=φc and the creep strain ∈t at the crack tip is assumed to be φ/h, where the gauge length is a material constant. The COD-based theory indicates that the incubation and failure timest i,t fare controlled by the stress intensity factorK at large stresses, but by the net stress at very low stresses. A weakness of the theory is that it neglects primary-creep effects: these have to be absorbed by modifying the secondary-creep index. If this is done, then comparison with two independent experiments shows moderately good agreement with the COD-based theory for botht iandt f.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1619-1560
    Keywords: Chronic renal failure ; Autonomic nervous system ; Parasympathetic ; Heart rate ; Heart rate variability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Heart rate variability was measured from 24-h electrocardiograms in 61 patients with end stage chronic renal failure. The method used counts the number of times successive RR intervals differ by more than 50 ms over the 24-h period, and is a reliable indicator of cardiac parasympathetic activity. Also analysed were the frequency and type of ectopic beats and other arrhythmias. Twentyone subjects (34%) had varying numbers of ventricular ectopic beats, and twelve (20%) had frequent supraventricular ectopics. Total 24-h count values were abnormal in 30 (76%) of the 41 subjects whose tapes were technically suitable for this analysis. There were no sex differences, but those patients maintained on haemodialysis had significantly lower counts than those on continuous ambulatory peritoneal dialysis. We conclude that about three-quarters of patients with chronic renal failure have abnormal cardiac parasympathetic activity. This may increase susceptibility to cardiac arrhythmias and sudden death and contribute to the high mortality of patients with chronic renal failure.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1619-1560
    Keywords: Autonomic neuropathy ; Diabetes mellitus ; Postural hypotension ; Xamoterol ; Beta1 partial agonist
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recent reports have suggested that xamoterol, a beta1 adrenoceptor partial agonist with 43% intrinsic sympathomimetic activity improves symptomatic postural hypotension in patients with primary autonomic failure. To evaluate the use of xamoterol in eleven insulin dependent patients with diabetes mellitus who had postural hypotension (over 20 mmHg systolic blood pressure) secondary to autonomic neuropathy, we performed a double-blind, randomized, placebo controlled crossover study with xamoterol (200 mg bd orally) for 1 month. Treatment with xamoterol raised supine systolic blood pressure by 11 mmHg but a reduced standing systolic blood pressure by 11 mmHg with an increase in the standing-supine systolic blood pressure difference. No significant differences were observed in symptom score, HbA1 or plasma glucose. We conclude that oral xamoterol raises supine systolic blood pressure but paradoxically lowers standing systolic blood pressure further in insulin dependent diabetes mellitus, Xamoterol is unlikely to be of value in the management of postural hypotension in diabetic patients with autonomic neuropathy.
    Type of Medium: Electronic Resource
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