home *** CD-ROM | disk | FTP | other *** search
Unknown | 1992-06-06 | 284.8 KB |
open in:
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 4e 00 |.DP1.1..|......N.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 68 04 00 00 |......00|....h...|
|00000020| 77 14 00 00 30 31 00 00 | 00 01 df 18 00 00 aa 0c |w...01..|........|
|00000030| 00 00 30 32 00 00 00 01 | 89 25 00 00 8a 13 00 00 |..02....|.%......|
|00000040| 30 33 00 00 00 01 13 39 | 00 00 5c 10 00 00 30 34 |03.....9|..\...04|
|00000050| 00 00 00 01 6f 49 00 00 | 80 0f 00 00 30 35 00 00 |....oI..|....05..|
|00000060| 00 01 ef 58 00 00 1a 0e | 00 00 30 36 00 00 00 01 |...X....|..06....|
|00000070| 09 67 00 00 25 0e 00 00 | 30 37 00 00 00 01 2e 75 |.g..%...|07.....u|
|00000080| 00 00 02 10 00 00 30 38 | 00 00 00 01 30 85 00 00 |......08|....0...|
|00000090| f2 0e 00 00 30 39 00 00 | 00 01 22 94 00 00 3d 0e |....09..|.."...=.|
|000000a0| 00 00 31 30 00 00 00 01 | 5f a2 00 00 14 0d 00 00 |..10....|_.......|
|000000b0| 31 31 00 00 00 01 73 af | 00 00 11 10 00 00 31 32 |11....s.|......12|
|000000c0| 00 00 00 01 84 bf 00 00 | a2 0f 00 00 31 33 00 00 |........|....13..|
|000000d0| 00 01 26 cf 00 00 24 0c | 00 00 31 34 00 00 00 01 |..&...$.|..14....|
|000000e0| 4a db 00 00 51 11 00 00 | 31 35 00 00 00 01 9b ec |J...Q...|15......|
|000000f0| 00 00 22 10 00 00 31 36 | 00 00 00 01 bd fc 00 00 |.."...16|........|
|00000100| 78 0f 00 00 31 37 00 00 | 00 01 35 0c 01 00 17 0c |x...17..|..5.....|
|00000110| 00 00 31 38 00 00 00 01 | 4c 18 01 00 1d 10 00 00 |..18....|L.......|
|00000120| 31 39 00 00 00 01 69 28 | 01 00 98 0c 00 00 32 30 |19....i(|......20|
|00000130| 00 00 00 01 01 35 01 00 | 13 11 00 00 32 31 00 00 |.....5..|....21..|
|00000140| 00 01 14 46 01 00 94 0e | 00 00 32 32 00 00 00 01 |...F....|..22....|
|00000150| a8 54 01 00 23 0f 00 00 | 32 33 00 00 00 01 cb 63 |.T..#...|23.....c|
|00000160| 01 00 8b 13 00 00 32 34 | 00 00 00 01 56 77 01 00 |......24|....Vw..|
|00000170| ee 10 00 00 32 35 00 00 | 00 01 44 88 01 00 4d 12 |....25..|..D...M.|
|00000180| 00 00 32 36 00 00 00 01 | 91 9a 01 00 10 12 00 00 |..26....|........|
|00000190| 32 37 00 00 00 01 a1 ac | 01 00 a6 11 00 00 32 38 |27......|......28|
|000001a0| 00 00 00 01 47 be 01 00 | 81 0c 00 00 32 39 00 00 |....G...|....29..|
|000001b0| 00 01 c8 ca 01 00 f1 0d | 00 00 33 30 00 00 00 01 |........|..30....|
|000001c0| b9 d8 01 00 7a 0c 00 00 | 33 31 00 00 00 01 33 e5 |....z...|31....3.|
|000001d0| 01 00 26 0e 00 00 33 32 | 00 00 00 01 59 f3 01 00 |..&...32|....Y...|
|000001e0| 4b 15 00 00 33 33 00 00 | 00 01 a4 08 02 00 f9 0f |K...33..|........|
|000001f0| 00 00 33 34 00 00 00 01 | 9d 18 02 00 90 0e 00 00 |..34....|........|
|00000200| 33 35 00 00 00 01 2d 27 | 02 00 c6 0e 00 00 34 30 |35....-'|......40|
|00000210| 00 00 00 01 f3 35 02 00 | 25 15 00 00 34 31 00 00 |.....5..|%...41..|
|00000220| 00 01 18 4b 02 00 c4 10 | 00 00 34 32 00 00 00 01 |...K....|..42....|
|00000230| dc 5b 02 00 e5 10 00 00 | 34 33 00 00 00 01 c1 6c |.[......|43.....l|
|00000240| 02 00 38 0e 00 00 34 34 | 00 00 00 01 f9 7a 02 00 |..8...44|.....z..|
|00000250| 08 0f 00 00 34 35 00 00 | 00 01 01 8a 02 00 52 10 |....45..|......R.|
|00000260| 00 00 34 36 00 00 00 01 | 53 9a 02 00 09 0b 00 00 |..46....|S.......|
|00000270| 34 37 00 00 00 01 5c a5 | 02 00 2a 0f 00 00 34 38 |47....\.|..*...48|
|00000280| 00 00 00 01 86 b4 02 00 | 67 0a 00 00 34 39 00 00 |........|g...49..|
|00000290| 00 01 ed be 02 00 a8 0c | 00 00 35 30 00 00 00 01 |........|..50....|
|000002a0| 95 cb 02 00 64 0b 00 00 | 35 31 00 00 00 01 f9 d6 |....d...|51......|
|000002b0| 02 00 c9 0d 00 00 35 32 | 00 00 00 01 c2 e4 02 00 |......52|........|
|000002c0| e9 0d 00 00 35 33 00 00 | 00 01 ab f2 02 00 e8 19 |....53..|........|
|000002d0| 00 00 35 34 00 00 00 01 | 93 0c 03 00 0b 0a 00 00 |..54....|........|
|000002e0| 35 35 00 00 00 01 9e 16 | 03 00 cf 0b 00 00 35 36 |55......|......56|
|000002f0| 00 00 00 01 6d 22 03 00 | db 10 00 00 35 37 00 00 |....m"..|....57..|
|00000300| 00 01 48 33 03 00 4d 0d | 00 00 35 38 00 00 00 01 |..H3..M.|..58....|
|00000310| 95 40 03 00 db 0b 00 00 | 35 39 00 00 00 01 70 4c |.@......|59....pL|
|00000320| 03 00 18 0f 00 00 36 30 | 00 00 00 01 88 5b 03 00 |......60|.....[..|
|00000330| 8a 0c 00 00 36 31 00 00 | 00 01 12 68 03 00 de 09 |....61..|...h....|
|00000340| 00 00 36 32 00 00 00 01 | f0 71 03 00 11 11 00 00 |..62....|.q......|
|00000350| 36 33 00 00 00 01 01 83 | 03 00 80 0f 00 00 36 34 |63......|......64|
|00000360| 00 00 00 01 81 92 03 00 | 1c 0c 00 00 36 35 00 00 |........|....65..|
|00000370| 00 01 9d 9e 03 00 79 0c | 00 00 36 36 00 00 00 01 |......y.|..66....|
|00000380| 16 ab 03 00 44 0f 00 00 | 36 37 00 00 00 01 5a ba |....D...|67....Z.|
|00000390| 03 00 cf 0a 00 00 36 38 | 00 00 00 01 29 c5 03 00 |......68|....)...|
|000003a0| b5 0a 00 00 36 39 00 00 | 00 01 de cf 03 00 90 0a |....69..|........|
|000003b0| 00 00 37 30 00 00 00 01 | 6e da 03 00 63 0a 00 00 |..70....|n...c...|
|000003c0| 37 31 00 00 00 01 d1 e4 | 03 00 ce 0b 00 00 37 32 |71......|......72|
|000003d0| 00 00 00 01 9f f0 03 00 | 66 0b 00 00 37 33 00 00 |........|f...73..|
|000003e0| 00 01 05 fc 03 00 12 0a | 00 00 37 34 00 00 00 01 |........|..74....|
|000003f0| 17 06 04 00 01 0d 00 00 | 37 35 00 00 00 01 18 13 |........|75......|
|00000400| 04 00 43 0b 00 00 37 36 | 00 00 00 01 5b 1e 04 00 |..C...76|....[...|
|00000410| 4f 0f 00 00 37 37 00 00 | 00 01 aa 2d 04 00 5f 13 |O...77..|...-.._.|
|00000420| 00 00 37 38 00 00 00 01 | 09 41 04 00 e4 0d 00 00 |..78....|.A......|
|00000430| 37 39 00 00 00 01 ed 4e | 04 00 bd 09 00 00 38 30 |79.....N|......80|
|00000440| 00 00 00 01 aa 58 04 00 | 12 0e 00 00 38 31 00 00 |.....X..|....81..|
|00000450| 00 01 bc 66 04 00 85 0c | 00 00 00 00 00 00 00 00 |...f....|........|
|00000460| 41 73 04 00 00 00 00 00 | 24 55 6e 69 71 75 65 5f |As......|$Unique_|
|00000470| 49 44 7b 59 52 42 31 33 | 31 30 30 7d 0d 0a 24 54 |ID{YRB13|100}..$T|
|00000480| 69 74 6c 65 7b 57 61 72 | 6e 69 6e 67 20 53 79 6d |itle{War|ning Sym|
|00000490| 70 74 6f 6d 73 20 6f 66 | 20 48 79 70 6f 67 6c 79 |ptoms of| Hypogly|
|000004a0| 63 61 65 6d 69 61 20 44 | 75 72 69 6e 67 20 54 72 |caemia D|uring Tr|
|000004b0| 65 61 74 6d 65 6e 74 20 | 57 69 74 68 20 48 75 6d |eatment |With Hum|
|000004c0| 61 6e 20 61 6e 64 20 50 | 6f 72 63 69 6e 65 20 49 |an and P|orcine I|
|000004d0| 6e 73 75 6c 69 6e 20 69 | 6e 20 44 69 61 62 65 74 |nsulin i|n Diabet|
|000004e0| 65 73 20 4d 65 6c 6c 69 | 74 75 73 7d 0d 0a 24 41 |es Melli|tus}..$A|
|000004f0| 75 74 68 6f 72 7b 42 65 | 72 67 65 72 2c 20 57 0d |uthor{Be|rger, W.|
|00000500| 0a 4b 65 6c 6c 65 72 2c | 20 55 0d 0a 48 6f 6e 65 |.Keller,| U..Hone|
|00000510| 67 67 65 72 2c 20 42 0d | 0a 4a 61 65 67 67 69 2c |gger, B.|.Jaeggi,|
|00000520| 20 45 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f | E}..$Af|filiatio|
|00000530| 6e 7b 4b 61 6e 74 6f 6e | 73 73 70 69 74 61 6c 2c |n{Kanton|sspital,|
|00000540| 20 42 61 73 65 6c 2c 20 | 53 77 69 74 7a 65 72 6c | Basel, |Switzerl|
|00000550| 61 6e 64 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 4c |and}..$J|ournal{L|
|00000560| 61 6e 63 65 74 7d 0d 0a | 24 56 6f 6c 75 6d 65 7b |ancet}..|$Volume{|
|00000570| 31 7d 0d 0a 24 50 61 67 | 65 7b 31 30 34 31 2d 31 |1}..$Pag|e{1041-1|
|00000580| 30 34 34 7d 0d 0a 24 44 | 61 74 65 7b 4d 61 79 20 |044}..$D|ate{May |
|00000590| 31 33 2c 20 31 39 38 39 | 7d 0d 0a 24 59 42 56 6f |13, 1989|}..$YBVo|
|000005a0| 6c 7b 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |l{1990 Y|ear Book|
|000005b0| 20 6f 66 20 45 6e 64 6f | 63 72 69 6e 6f 6c 6f 67 | of Endo|crinolog|
|000005c0| 79 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 31 30 2d |y}..$Cha|pter{10-|
|000005d0| 32 34 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 4a |24}..$YB|Editor{J|
|000005e0| 6f 68 6e 20 44 2e 20 42 | 61 67 64 61 64 65 2c 20 |ohn D. B|agdade, |
|000005f0| 4d 2e 44 2e 7d 0d 0a 24 | 54 61 62 6c 65 7b 7d 0d |M.D.}..$|Table{}.|
|00000600| 0a 24 43 6f 6d 6d 65 6e | 74 61 74 6f 72 7b 52 2e |.$Commen|tator{R.|
|00000610| 53 2e 20 53 68 65 72 77 | 69 6e 2c 20 4d 2e 44 2e |S. Sherw|in, M.D.|
|00000620| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00000630| 63 29 20 59 65 61 72 62 | 6f 6f 6b 20 4d 65 64 69 |c) Yearb|ook Medi|
|00000640| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00000650| 49 6e 63 2e 2c 20 31 39 | 39 30 0d 0a 0d 0a 31 39 |Inc., 19|90....19|
|00000660| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|00000670| 45 6e 64 6f 63 72 69 6e | 6f 6c 6f 67 79 20 28 52 |Endocrin|ology (R|
|00000680| 29 0d 0a 0d 0a 43 68 61 | 70 74 65 72 20 31 30 2d |)....Cha|pter 10-|
|00000690| 2d 44 69 61 62 65 74 65 | 73 20 4d 65 6c 6c 69 74 |-Diabete|s Mellit|
|000006a0| 75 73 20 61 6e 64 20 43 | 61 72 62 6f 68 79 64 72 |us and C|arbohydr|
|000006b0| 61 74 65 20 4d 65 74 61 | 62 6f 6c 69 73 6d 0d 0a |ate Meta|bolism..|
|000006c0| 0d 0a 4f 74 68 65 72 20 | 43 6f 6d 70 6c 69 63 61 |..Other |Complica|
|000006d0| 74 69 6f 6e 73 0d 0a 0d | 0a 2d 2d 2d 2d 2d 2d 2d |tions...|.-------|
|000006e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000006f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000710| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000720| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 57 61 72 6e 69 6e 67 |-------.|.Warning|
|00000730| 20 53 79 6d 70 74 6f 6d | 73 20 6f 66 20 48 79 70 | Symptom|s of Hyp|
|00000740| 6f 67 6c 79 63 61 65 6d | 69 61 20 44 75 72 69 6e |oglycaem|ia Durin|
|00000750| 67 20 54 72 65 61 74 6d | 65 6e 74 20 57 69 74 68 |g Treatm|ent With|
|00000760| 20 48 75 6d 61 6e 20 61 | 6e 64 20 50 6f 72 63 69 | Human a|nd Porci|
|00000770| 6e 65 0d 0a 49 6e 73 75 | 6c 69 6e 20 69 6e 20 44 |ne..Insu|lin in D|
|00000780| 69 61 62 65 74 65 73 20 | 4d 65 6c 6c 69 74 75 73 |iabetes |Mellitus|
|00000790| 0d 0a 0d 0a 42 65 72 67 | 65 72 20 57 2c 20 4b 65 |....Berg|er W, Ke|
|000007a0| 6c 6c 65 72 20 55 2c 20 | 48 6f 6e 65 67 67 65 72 |ller U, |Honegger|
|000007b0| 20 42 2c 20 4a 61 65 67 | 67 69 20 45 0d 0a 28 4b | B, Jaeg|gi E..(K|
|000007c0| 61 6e 74 6f 6e 73 73 70 | 69 74 61 6c 2c 20 42 61 |antonssp|ital, Ba|
|000007d0| 73 65 6c 2c 20 53 77 69 | 74 7a 65 72 6c 61 6e 64 |sel, Swi|tzerland|
|000007e0| 29 0d 0a 4c 61 6e 63 65 | 74 20 31 3a 31 30 34 31 |)..Lance|t 1:1041|
|000007f0| 2d 31 30 34 34 2c 20 4d | 61 79 20 31 33 2c 20 31 |-1044, M|ay 13, 1|
|00000800| 39 38 39 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |989..---|--------|
|00000810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000850| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00000860| 0a 0d 0a 20 20 20 20 20 | 53 75 72 76 65 79 20 72 |... |Survey r|
|00000870| 65 73 75 6c 74 73 20 68 | 61 76 65 20 73 75 67 67 |esults h|ave sugg|
|00000880| 65 73 74 65 64 20 74 68 | 61 74 20 74 72 61 6e 73 |ested th|at trans|
|00000890| 66 65 72 20 6f 66 20 70 | 61 74 69 65 6e 74 73 20 |fer of p|atients |
|000008a0| 66 72 6f 6d 20 70 6f 72 | 63 69 6e 65 20 74 6f 0d |from por|cine to.|
|000008b0| 0a 68 75 6d 61 6e 20 69 | 6e 73 75 6c 69 6e 20 6d |.human i|nsulin m|
|000008c0| 61 79 20 72 65 73 75 6c | 74 20 69 6e 20 72 65 64 |ay resul|t in red|
|000008d0| 75 63 65 64 20 77 61 72 | 6e 69 6e 67 20 73 79 6d |uced war|ning sym|
|000008e0| 70 74 6f 6d 73 20 6f 66 | 20 68 79 70 6f 67 6c 79 |ptoms of| hypogly|
|000008f0| 63 65 6d 69 61 2e 0d 0a | 48 6f 77 65 76 65 72 2c |cemia...|However,|
|00000900| 20 74 68 65 73 65 20 66 | 69 6e 64 69 6e 67 73 20 | these f|indings |
|00000910| 64 69 64 20 6e 6f 74 20 | 69 6e 64 69 63 61 74 65 |did not |indicate|
|00000920| 20 77 68 65 74 68 65 72 | 20 74 68 65 20 63 68 61 | whether| the cha|
|00000930| 6e 67 65 20 69 6e 20 73 | 79 6d 70 74 6f 6d 73 20 |nge in s|ymptoms |
|00000940| 77 61 73 0d 0a 61 74 74 | 72 69 62 75 74 61 62 6c |was..att|ributabl|
|00000950| 65 20 74 6f 20 74 68 65 | 20 63 68 61 6e 67 65 20 |e to the| change |
|00000960| 69 6e 20 69 6e 73 75 6c | 69 6e 20 74 72 65 61 74 |in insul|in treat|
|00000970| 6d 65 6e 74 20 72 65 67 | 69 6d 65 6e 20 6f 72 20 |ment reg|imen or |
|00000980| 74 6f 20 74 68 65 20 74 | 79 70 65 20 6f 66 0d 0a |to the t|ype of..|
|00000990| 69 6e 73 75 6c 69 6e 20 | 67 69 76 65 6e 2e 20 20 |insulin |given. |
|000009a0| 41 20 72 61 6e 64 6f 6d | 69 7a 65 64 2c 20 64 6f |A random|ized, do|
|000009b0| 75 62 6c 65 2d 62 6c 69 | 6e 64 2c 20 63 72 6f 73 |uble-bli|nd, cros|
|000009c0| 73 6f 76 65 72 20 73 74 | 75 64 79 20 6f 66 20 68 |sover st|udy of h|
|000009d0| 75 6d 61 6e 20 61 6e 64 | 0d 0a 70 6f 72 63 69 6e |uman and|..porcin|
|000009e0| 65 20 69 6e 73 75 6c 69 | 6e 20 77 61 73 20 64 6f |e insuli|n was do|
|000009f0| 6e 65 20 74 6f 20 65 73 | 74 61 62 6c 69 73 68 20 |ne to es|tablish |
|00000a00| 77 68 65 74 68 65 72 20 | 74 68 65 72 65 20 69 73 |whether |there is|
|00000a10| 20 61 0d 0a 68 75 6d 61 | 6e 2d 69 6e 73 75 6c 69 | a..huma|n-insuli|
|00000a20| 6e 2d 73 70 65 63 69 66 | 69 63 20 65 66 66 65 63 |n-specif|ic effec|
|00000a30| 74 20 6f 6e 20 68 79 70 | 6f 67 6c 79 63 65 6d 69 |t on hyp|oglycemi|
|00000a40| 63 20 73 79 6d 70 74 6f | 6d 73 20 69 6e 20 70 61 |c sympto|ms in pa|
|00000a50| 74 69 65 6e 74 73 20 77 | 69 74 68 0d 0a 69 6e 73 |tients w|ith..ins|
|00000a60| 75 6c 69 6e 2d 64 65 70 | 65 6e 64 65 6e 74 20 64 |ulin-dep|endent d|
|00000a70| 69 61 62 65 74 65 73 20 | 6d 65 6c 6c 69 74 75 73 |iabetes |mellitus|
|00000a80| 20 28 49 44 44 4d 29 2e | 0d 0a 20 20 20 20 20 4f | (IDDM).|.. O|
|00000a90| 66 20 33 32 20 70 61 74 | 69 65 6e 74 73 20 77 69 |f 32 pat|ients wi|
|00000aa0| 74 68 20 6c 6f 6e 67 2d | 74 65 72 6d 20 49 44 44 |th long-|term IDD|
|00000ab0| 4d 2c 20 31 38 20 62 65 | 67 61 6e 20 74 68 65 20 |M, 18 be|gan the |
|00000ac0| 73 74 75 64 79 20 77 69 | 74 68 20 68 75 6d 61 6e |study wi|th human|
|00000ad0| 20 69 6e 73 75 6c 69 6e | 0d 0a 61 6e 64 20 31 34 | insulin|..and 14|
|00000ae0| 20 77 69 74 68 20 70 6f | 72 63 69 6e 65 20 69 6e | with po|rcine in|
|00000af0| 73 75 6c 69 6e 2e 20 20 | 54 68 65 20 32 20 69 6e |sulin. |The 2 in|
|00000b00| 73 75 6c 69 6e 20 70 65 | 72 69 6f 64 73 20 65 61 |sulin pe|riods ea|
|00000b10| 63 68 20 6c 61 73 74 65 | 64 20 66 6f 72 20 31 32 |ch laste|d for 12|
|00000b20| 20 77 65 65 6b 73 2e 0d | 0a 49 6e 73 75 6c 69 6e | weeks..|.Insulin|
|00000b30| 20 64 6f 73 65 73 20 77 | 65 72 65 20 63 6f 6d 70 | doses w|ere comp|
|00000b40| 61 72 61 62 6c 65 20 64 | 75 72 69 6e 67 20 74 68 |arable d|uring th|
|00000b50| 65 20 32 20 70 65 72 69 | 6f 64 73 2c 20 61 73 20 |e 2 peri|ods, as |
|00000b60| 77 65 72 65 20 62 6c 6f | 6f 64 20 67 6c 75 63 6f |were blo|od gluco|
|00000b70| 73 65 0d 0a 70 72 6f 66 | 69 6c 65 73 20 61 6e 64 |se..prof|iles and|
|00000b80| 20 48 62 41 31 63 76 61 | 6c 75 65 73 2e 20 20 49 | HbA1cva|lues. I|
|00000b90| 6e 20 61 6c 6c 2c 20 31 | 37 31 20 65 70 69 73 6f |n all, 1|71 episo|
|00000ba0| 64 65 73 20 6f 66 20 68 | 79 70 6f 67 6c 79 63 65 |des of h|ypoglyce|
|00000bb0| 6d 69 61 20 6f 63 63 75 | 72 72 65 64 20 77 68 65 |mia occu|rred whe|
|00000bc0| 6e 0d 0a 68 75 6d 61 6e | 20 69 6e 73 75 6c 69 6e |n..human| insulin|
|00000bd0| 20 77 61 73 20 67 69 76 | 65 6e 20 61 6e 64 20 31 | was giv|en and 1|
|00000be0| 35 30 20 65 70 69 73 6f | 64 65 73 20 77 68 65 6e |50 episo|des when|
|00000bf0| 20 70 6f 72 63 69 6e 65 | 20 69 6e 73 75 6c 69 6e | porcine| insulin|
|00000c00| 20 77 61 73 20 67 69 76 | 65 6e 2e 20 20 54 68 65 | was giv|en. The|
|00000c10| 0d 0a 69 6e 69 74 69 61 | 6c 20 77 61 72 6e 69 6e |..initia|l warnin|
|00000c20| 67 20 73 79 6d 70 74 6f | 6d 73 20 6f 66 20 68 75 |g sympto|ms of hu|
|00000c30| 6e 67 65 72 20 61 6e 64 | 20 73 77 65 61 74 69 6e |nger and| sweatin|
|00000c40| 67 20 77 69 74 68 6f 75 | 74 20 63 6f 6e 63 6f 6d |g withou|t concom|
|00000c50| 69 74 61 6e 74 0d 0a 6e | 65 75 72 6f 67 6c 79 63 |itant..n|euroglyc|
|00000c60| 6f 70 65 6e 69 63 20 73 | 79 6d 70 74 6f 6d 73 20 |openic s|ymptoms |
|00000c70| 77 65 72 65 20 73 69 67 | 6e 69 66 69 63 61 6e 74 |were sig|nificant|
|00000c80| 6c 79 20 6d 6f 72 65 20 | 66 72 65 71 75 65 6e 74 |ly more |frequent|
|00000c90| 20 64 75 72 69 6e 67 20 | 74 68 65 20 70 65 72 69 | during |the peri|
|00000ca0| 6f 64 20 6f 66 0d 0a 70 | 6f 72 63 69 6e 65 20 69 |od of..p|orcine i|
|00000cb0| 6e 73 75 6c 69 6e 20 61 | 64 6d 69 6e 69 73 74 72 |nsulin a|dministr|
|00000cc0| 61 74 69 6f 6e 20 74 68 | 61 6e 20 64 75 72 69 6e |ation th|an durin|
|00000cd0| 67 20 74 68 65 20 70 65 | 72 69 6f 64 20 6f 66 20 |g the pe|riod of |
|00000ce0| 68 75 6d 61 6e 20 69 6e | 73 75 6c 69 6e 0d 0a 61 |human in|sulin..a|
|00000cf0| 64 6d 69 6e 69 73 74 72 | 61 74 69 6f 6e 2e 20 20 |dministr|ation. |
|00000d00| 41 74 20 74 68 65 20 65 | 6e 64 20 6f 66 20 74 68 |At the e|nd of th|
|00000d10| 65 20 73 74 75 64 79 20 | 31 38 20 70 61 74 69 65 |e study |18 patie|
|00000d20| 6e 74 73 20 72 65 70 6f | 72 74 65 64 20 6c 65 73 |nts repo|rted les|
|00000d30| 73 20 61 77 61 72 65 6e | 65 73 73 0d 0a 6f 66 20 |s awaren|ess..of |
|00000d40| 68 79 70 6f 67 6c 79 63 | 65 6d 69 61 20 77 68 69 |hypoglyc|emia whi|
|00000d50| 6c 65 20 68 75 6d 61 6e | 20 69 6e 73 75 6c 69 6e |le human| insulin|
|00000d60| 20 77 61 73 20 62 65 69 | 6e 67 20 75 73 65 64 2c | was bei|ng used,|
|00000d70| 20 63 6f 6d 70 61 72 65 | 64 20 77 69 74 68 20 36 | compare|d with 6|
|00000d80| 20 77 68 69 6c 65 0d 0a | 70 6f 72 63 69 6e 65 20 | while..|porcine |
|00000d90| 69 6e 73 75 6c 69 6e 20 | 77 61 73 20 62 65 69 6e |insulin |was bein|
|00000da0| 67 20 75 73 65 64 2e 0d | 0a 20 20 20 20 20 41 6c |g used..|. Al|
|00000db0| 74 68 6f 75 67 68 20 74 | 68 65 20 66 72 65 71 75 |though t|he frequ|
|00000dc0| 65 6e 63 79 20 6f 66 20 | 69 6e 64 69 76 69 64 75 |ency of |individu|
|00000dd0| 61 6c 20 73 79 6d 70 74 | 6f 6d 73 20 64 69 64 20 |al sympt|oms did |
|00000de0| 6e 6f 74 20 63 68 61 6e | 67 65 20 77 68 65 6e 0d |not chan|ge when.|
|00000df0| 0a 73 77 69 74 63 68 69 | 6e 67 20 69 6e 73 75 6c |.switchi|ng insul|
|00000e00| 69 6e 73 2c 20 74 68 65 | 69 72 20 73 65 71 75 65 |ins, the|ir seque|
|00000e10| 6e 63 65 20 61 6e 64 20 | 74 69 6d 69 6e 67 20 64 |nce and |timing d|
|00000e20| 69 64 2e 20 20 53 77 65 | 61 74 69 6e 67 20 61 6e |id. Swe|ating an|
|00000e30| 64 20 68 75 6e 67 65 72 | 20 77 65 72 65 0d 0a 6d |d hunger| were..m|
|00000e40| 6f 72 65 20 63 6f 6d 6d | 6f 6e 20 69 6e 69 74 69 |ore comm|on initi|
|00000e50| 61 6c 20 77 61 72 6e 69 | 6e 67 20 73 79 6d 70 74 |al warni|ng sympt|
|00000e60| 6f 6d 73 20 6f 66 20 70 | 6f 72 63 69 6e 65 2d 69 |oms of p|orcine-i|
|00000e70| 6e 73 75 6c 69 6e 2d 69 | 6e 64 75 63 65 64 20 68 |nsulin-i|nduced h|
|00000e80| 79 70 6f 67 6c 79 63 65 | 6d 69 61 2e 0d 0a 4e 65 |ypoglyce|mia...Ne|
|00000e90| 75 72 6f 67 6c 79 63 6f | 70 65 6e 69 63 20 73 79 |uroglyco|penic sy|
|00000ea0| 6d 70 74 6f 6d 73 20 64 | 6f 6d 69 6e 61 74 65 64 |mptoms d|ominated|
|00000eb0| 20 64 75 72 69 6e 67 20 | 74 68 65 20 65 61 72 6c | during |the earl|
|00000ec0| 79 20 6d 61 6e 69 66 65 | 73 74 61 74 69 6f 6e 73 |y manife|stations|
|00000ed0| 20 6f 66 0d 0a 68 79 70 | 6f 67 6c 79 63 65 6d 69 | of..hyp|oglycemi|
|00000ee0| 61 20 69 6e 64 75 63 65 | 64 20 62 79 20 68 75 6d |a induce|d by hum|
|00000ef0| 61 6e 20 69 6e 73 75 6c | 69 6e 2e 20 20 50 61 74 |an insul|in. Pat|
|00000f00| 69 65 6e 74 73 20 74 72 | 61 6e 73 66 65 72 72 65 |ients tr|ansferre|
|00000f10| 64 20 66 72 6f 6d 20 61 | 6e 69 6d 61 6c 20 74 6f |d from a|nimal to|
|00000f20| 0d 0a 68 75 6d 61 6e 20 | 69 6e 73 75 6c 69 6e 20 |..human |insulin |
|00000f30| 73 68 6f 75 6c 64 20 62 | 65 20 69 6e 66 6f 72 6d |should b|e inform|
|00000f40| 65 64 20 74 68 61 74 20 | 68 79 70 6f 67 6c 79 63 |ed that |hypoglyc|
|00000f50| 65 6d 69 63 20 73 79 6d | 70 74 6f 6d 73 20 6d 69 |emic sym|ptoms mi|
|00000f60| 67 68 74 20 63 68 61 6e | 67 65 2e 0d 0a 0d 0a 50 |ght chan|ge.....P|
|00000f70| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00000f80| 20 20 20 20 54 68 69 73 | 20 73 74 75 64 79 20 63 | This| study c|
|00000f90| 6f 6d 65 73 20 74 6f 20 | 61 20 73 75 72 70 72 69 |omes to |a surpri|
|00000fa0| 73 69 6e 67 20 63 6f 6e | 63 6c 75 73 69 6f 6e 2c |sing con|clusion,|
|00000fb0| 20 6e 61 6d 65 6c 79 2c | 20 74 68 61 74 20 68 79 | namely,| that hy|
|00000fc0| 70 6f 67 6c 79 63 65 6d | 69 63 0d 0a 73 79 6d 70 |poglycem|ic..symp|
|00000fd0| 74 6f 6d 73 20 77 69 74 | 68 20 68 75 6d 61 6e 20 |toms wit|h human |
|00000fe0| 61 6e 64 20 70 6f 72 63 | 69 6e 65 20 69 6e 73 75 |and porc|ine insu|
|00000ff0| 6c 69 6e 73 20 64 69 66 | 66 65 72 2c 20 61 6e 64 |lins dif|fer, and|
|00001000| 20 74 68 61 74 20 74 68 | 69 73 20 65 66 66 65 63 | that th|is effec|
|00001010| 74 20 69 73 0d 0a 69 6e | 64 65 70 65 6e 64 65 6e |t is..in|dependen|
|00001020| 74 20 6f 66 20 67 6c 79 | 63 65 6d 69 63 20 63 6f |t of gly|cemic co|
|00001030| 6e 74 72 6f 6c 2c 20 61 | 20 66 61 63 74 6f 72 20 |ntrol, a| factor |
|00001040| 6b 6e 6f 77 6e 20 74 6f | 20 61 6c 74 65 72 20 74 |known to| alter t|
|00001050| 68 65 20 61 70 70 65 61 | 72 61 6e 63 65 20 6f 66 |he appea|rance of|
|00001060| 0d 0a 68 79 70 6f 67 6c | 79 63 65 6d 69 63 20 77 |..hypogl|ycemic w|
|00001070| 61 72 6e 69 6e 67 20 73 | 79 6d 70 74 6f 6d 73 2e |arning s|ymptoms.|
|00001080| 20 20 54 68 65 20 64 61 | 74 61 20 70 72 65 73 65 | The da|ta prese|
|00001090| 6e 74 65 64 20 61 72 65 | 20 69 6e 74 72 69 67 75 |nted are| intrigu|
|000010a0| 69 6e 67 20 61 6e 64 20 | 6d 69 67 68 74 20 62 65 |ing and |might be|
|000010b0| 0d 0a 65 78 70 65 63 74 | 65 64 20 74 6f 20 69 6e |..expect|ed to in|
|000010c0| 63 72 65 61 73 65 20 74 | 68 65 20 72 69 73 6b 20 |crease t|he risk |
|000010d0| 6f 66 20 68 79 70 6f 67 | 6c 79 63 65 6d 69 61 20 |of hypog|lycemia |
|000010e0| 69 6e 20 70 61 74 69 65 | 6e 74 73 20 74 72 65 61 |in patie|nts trea|
|000010f0| 74 65 64 20 77 69 74 68 | 20 68 75 6d 61 6e 0d 0a |ted with| human..|
|00001100| 69 6e 73 75 6c 69 6e 73 | 2e 20 20 48 6f 77 65 76 |insulins|. Howev|
|00001110| 65 72 2c 20 74 68 69 73 | 20 77 61 73 20 6e 6f 74 |er, this| was not|
|00001120| 20 74 68 65 20 63 61 73 | 65 2e 20 20 54 68 65 20 | the cas|e. The |
|00001130| 66 72 65 71 75 65 6e 63 | 79 20 6f 66 20 68 79 70 |frequenc|y of hyp|
|00001140| 6f 67 6c 79 63 65 6d 69 | 61 20 77 61 73 0d 0a 6e |oglycemi|a was..n|
|00001150| 65 61 72 6c 79 20 69 64 | 65 6e 74 69 63 61 6c 20 |early id|entical |
|00001160| 72 65 67 61 72 64 6c 65 | 73 73 20 6f 66 20 77 68 |regardle|ss of wh|
|00001170| 65 74 68 65 72 20 70 6f | 72 63 69 6e 65 20 6f 72 |ether po|rcine or|
|00001180| 20 68 75 6d 61 6e 20 69 | 6e 73 75 6c 69 6e 20 77 | human i|nsulin w|
|00001190| 61 73 20 75 73 65 64 2e | 0d 0a 46 75 72 74 68 65 |as used.|..Furthe|
|000011a0| 72 6d 6f 72 65 2c 20 73 | 65 76 65 72 65 20 68 79 |rmore, s|evere hy|
|000011b0| 70 79 67 6c 79 63 65 6d | 69 61 20 77 61 73 20 6e |pyglycem|ia was n|
|000011c0| 6f 74 20 73 69 67 6e 69 | 66 69 63 61 6e 74 6c 79 |ot signi|ficantly|
|000011d0| 20 61 6c 74 65 72 65 64 | 20 62 79 20 74 68 65 20 | altered| by the |
|000011e0| 74 79 70 65 20 6f 66 0d | 0a 69 6e 73 75 6c 69 6e |type of.|.insulin|
|000011f0| 20 75 73 65 64 2e 0d 0a | 20 20 20 20 20 54 68 69 | used...| Thi|
|00001200| 72 74 79 2d 74 77 6f 20 | 70 61 74 69 65 6e 74 73 |rty-two |patients|
|00001210| 20 77 65 72 65 20 61 73 | 6b 65 64 20 74 6f 20 69 | were as|ked to i|
|00001220| 6e 64 69 63 61 74 65 20 | 77 68 69 63 68 2c 20 61 |ndicate |which, a|
|00001230| 6d 6f 6e 67 20 61 20 76 | 61 72 69 65 74 79 20 6f |mong a v|ariety o|
|00001240| 66 0d 0a 73 79 6d 70 74 | 6f 6d 73 2c 20 77 61 73 |f..sympt|oms, was|
|00001250| 20 74 68 65 20 69 6e 69 | 74 69 61 6c 20 68 79 70 | the ini|tial hyp|
|00001260| 6f 67 6c 79 63 65 6d 69 | 63 20 73 79 6d 70 74 6f |oglycemi|c sympto|
|00001270| 6d 20 74 68 65 79 20 65 | 78 70 65 72 69 65 6e 63 |m they e|xperienc|
|00001280| 65 64 20 77 68 65 6e 20 | 74 68 65 79 0d 0a 62 65 |ed when |they..be|
|00001290| 6c 69 65 76 65 64 20 74 | 68 61 74 20 74 68 65 69 |lieved t|hat thei|
|000012a0| 72 20 62 6c 6f 6f 64 20 | 73 75 67 61 72 20 77 61 |r blood |sugar wa|
|000012b0| 73 20 74 6f 6f 20 6c 6f | 77 2e 20 20 53 77 65 61 |s too lo|w. Swea|
|000012c0| 74 69 6e 67 20 77 61 73 | 20 69 6e 64 69 63 61 74 |ting was| indicat|
|000012d0| 65 64 20 61 73 20 74 68 | 65 0d 0a 69 6e 69 74 69 |ed as th|e..initi|
|000012e0| 61 6c 20 68 79 70 6f 67 | 6c 79 63 65 6d 69 63 20 |al hypog|lycemic |
|000012f0| 73 79 6d 70 74 6f 6d 20 | 62 79 20 38 20 6f 66 20 |symptom |by 8 of |
|00001300| 74 68 65 20 33 32 20 70 | 61 74 69 65 6e 74 73 20 |the 32 p|atients |
|00001310| 77 68 65 6e 20 74 68 65 | 79 20 72 65 63 65 69 76 |when the|y receiv|
|00001320| 65 64 0d 0a 70 6f 72 63 | 69 6e 65 20 69 6e 73 75 |ed..porc|ine insu|
|00001330| 6c 69 6e 20 61 6e 64 20 | 62 79 20 32 20 6f 66 20 |lin and |by 2 of |
|00001340| 74 68 65 20 33 32 20 70 | 61 74 69 65 6e 74 73 20 |the 32 p|atients |
|00001350| 77 68 65 6e 20 74 68 65 | 79 20 72 65 63 65 69 76 |when the|y receiv|
|00001360| 65 64 20 68 75 6d 61 6e | 20 69 6e 73 75 6c 69 6e |ed human| insulin|
|00001370| 2e 0d 0a 4f 6e 20 74 68 | 65 20 6f 74 68 65 72 20 |...On th|e other |
|00001380| 68 61 6e 64 2c 20 32 20 | 6f 66 20 74 68 65 20 33 |hand, 2 |of the 3|
|00001390| 32 20 70 61 74 69 65 6e | 74 73 20 72 65 70 6f 72 |2 patien|ts repor|
|000013a0| 74 65 64 20 22 75 6e 72 | 65 73 74 22 20 61 73 20 |ted "unr|est" as |
|000013b0| 74 68 65 20 69 6e 69 74 | 69 61 6c 0d 0a 73 79 6d |the init|ial..sym|
|000013c0| 70 74 6f 6d 20 77 68 69 | 6c 65 20 74 68 65 79 20 |ptom whi|le they |
|000013d0| 77 65 72 65 20 74 61 6b | 69 6e 67 20 70 6f 72 63 |were tak|ing porc|
|000013e0| 69 6e 65 20 69 6e 73 75 | 6c 69 6e 2c 20 61 6e 64 |ine insu|lin, and|
|000013f0| 20 39 20 6f 66 20 33 32 | 20 70 61 74 69 65 6e 74 | 9 of 32| patient|
|00001400| 73 20 72 65 70 6f 72 74 | 65 64 0d 0a 22 75 6e 72 |s report|ed.."unr|
|00001410| 65 73 74 22 20 77 68 69 | 6c 65 20 74 61 6b 69 6e |est" whi|le takin|
|00001420| 67 20 68 75 6d 61 6e 20 | 69 6e 73 75 6c 69 6e 2e |g human |insulin.|
|00001430| 20 20 41 6d 6f 6e 67 20 | 74 68 65 20 6f 74 68 65 | Among |the othe|
|00001440| 72 20 70 6f 73 73 69 62 | 6c 65 20 69 6e 69 74 69 |r possib|le initi|
|00001450| 61 6c 0d 0a 73 79 6d 70 | 74 6f 6d 73 2c 20 6e 6f |al..symp|toms, no|
|00001460| 20 64 69 66 66 65 72 65 | 6e 63 65 20 77 61 73 20 | differe|nce was |
|00001470| 61 70 70 61 72 65 6e 74 | 20 62 65 74 77 65 65 6e |apparent| between|
|00001480| 20 74 68 65 20 32 20 69 | 6e 73 75 6c 69 6e 20 74 | the 2 i|nsulin t|
|00001490| 79 70 65 73 2e 20 20 57 | 68 65 74 68 65 72 0d 0a |ypes. W|hether..|
|000014a0| 73 75 63 68 20 64 61 74 | 61 20 6a 75 73 74 69 66 |such dat|a justif|
|000014b0| 79 20 74 68 65 20 63 6f | 6e 63 6c 75 73 69 6f 6e |y the co|nclusion|
|000014c0| 20 74 68 61 74 20 73 77 | 65 61 74 69 6e 67 20 61 | that sw|eating a|
|000014d0| 6e 64 20 68 75 6e 67 65 | 72 20 64 6f 6d 69 6e 61 |nd hunge|r domina|
|000014e0| 74 65 20 74 68 65 20 70 | 69 63 74 75 72 65 0d 0a |te the p|icture..|
|000014f0| 77 69 74 68 20 70 6f 72 | 63 69 6e 65 20 69 6e 73 |with por|cine ins|
|00001500| 75 6c 69 6e 2c 20 77 68 | 65 72 65 61 73 20 6e 65 |ulin, wh|ereas ne|
|00001510| 75 72 6f 67 6c 79 63 6f | 70 65 6e 69 63 20 73 79 |uroglyco|penic sy|
|00001520| 6d 70 74 6f 6d 73 20 64 | 6f 6d 69 6e 61 74 65 20 |mptoms d|ominate |
|00001530| 74 68 65 20 65 61 72 6c | 79 0d 0a 6d 61 6e 69 66 |the earl|y..manif|
|00001540| 65 73 74 61 74 69 6f 6e | 73 20 6f 66 20 68 75 6d |estation|s of hum|
|00001550| 61 6e 20 69 6e 73 75 6c | 69 6e 2d 69 6e 64 75 63 |an insul|in-induc|
|00001560| 65 64 20 68 79 70 6f 67 | 6c 79 63 65 6d 69 61 2c |ed hypog|lycemia,|
|00001570| 20 69 73 20 71 75 65 73 | 74 69 6f 6e 61 62 6c 65 | is ques|tionable|
|00001580| 2c 0d 0a 70 61 72 74 69 | 63 75 6c 61 72 6c 79 20 |,..parti|cularly |
|00001590| 77 68 65 6e 20 6f 6e 65 | 20 63 6f 6e 73 69 64 65 |when one| conside|
|000015a0| 72 73 20 74 68 61 74 20 | 73 79 6d 70 74 6f 6d 73 |rs that |symptoms|
|000015b0| 20 74 68 6f 75 67 68 74 | 20 74 6f 20 62 65 20 69 | thought| to be i|
|000015c0| 6e 64 69 63 61 74 69 76 | 65 20 6f 66 0d 0a 6e 65 |ndicativ|e of..ne|
|000015d0| 75 72 6f 67 6c 79 63 6f | 70 65 6e 69 61 20 77 65 |uroglyco|penia we|
|000015e0| 72 65 20 74 68 65 20 66 | 69 72 73 74 20 73 79 6d |re the f|irst sym|
|000015f0| 70 74 6f 6d 73 20 69 6e | 20 74 68 65 20 6d 61 6a |ptoms in| the maj|
|00001600| 6f 72 69 74 79 20 6f 66 | 20 70 61 74 69 65 6e 74 |ority of| patient|
|00001610| 73 20 77 68 65 74 68 65 | 72 0d 0a 74 61 6b 69 6e |s whethe|r..takin|
|00001620| 67 20 68 75 6d 61 6e 20 | 6f 72 20 70 6f 72 63 69 |g human |or porci|
|00001630| 6e 65 20 69 6e 73 75 6c | 69 6e 2e 0d 0a 20 20 20 |ne insul|in... |
|00001640| 20 20 4e 65 76 65 72 74 | 68 65 6c 65 73 73 2c 20 | Nevert|heless, |
|00001650| 74 68 69 73 20 73 74 75 | 64 79 20 67 69 76 65 73 |this stu|dy gives|
|00001660| 20 66 6f 6f 64 20 66 6f | 72 20 74 68 6f 75 67 68 | food fo|r though|
|00001670| 74 20 61 6e 64 20 77 61 | 72 72 61 6e 74 73 20 61 |t and wa|rrants a|
|00001680| 20 6d 6f 72 65 0d 0a 65 | 78 74 65 6e 73 69 76 65 | more..e|xtensive|
|00001690| 20 65 76 61 6c 75 61 74 | 69 6f 6e 2e 20 20 49 74 | evaluat|ion. It|
|000016a0| 20 64 6f 65 73 20 6e 6f | 74 20 6a 75 73 74 69 66 | does no|t justif|
|000016b0| 79 20 73 77 69 74 63 68 | 69 6e 67 20 70 61 74 69 |y switch|ing pati|
|000016c0| 65 6e 74 73 20 63 75 72 | 72 65 6e 74 6c 79 20 62 |ents cur|rently b|
|000016d0| 65 69 6e 67 0d 0a 74 72 | 65 61 74 65 64 20 77 69 |eing..tr|eated wi|
|000016e0| 74 68 20 68 75 6d 61 6e | 20 69 6e 73 75 6c 69 6e |th human| insulin|
|000016f0| 20 62 61 63 6b 20 74 6f | 20 61 6e 69 6d 61 6c 20 | back to| animal |
|00001700| 69 6e 73 75 6c 69 6e 20 | 74 68 61 74 20 72 61 69 |insulin |that rai|
|00001710| 73 65 73 20 61 6e 74 69 | 2d 69 6e 73 75 6c 69 6e |ses anti|-insulin|
|00001720| 0d 0a 61 6e 74 69 62 6f | 64 69 65 73 2e 20 20 49 |..antibo|dies. I|
|00001730| 74 20 63 6f 75 6c 64 20 | 62 65 20 61 72 67 75 65 |t could |be argue|
|00001740| 64 2c 20 68 6f 77 65 76 | 65 72 2c 20 74 68 61 74 |d, howev|er, that|
|00001750| 20 75 6e 74 69 6c 20 74 | 68 65 20 69 73 73 75 65 | until t|he issue|
|00001760| 20 69 73 20 72 65 73 6f | 6c 76 65 64 2c 20 61 0d | is reso|lved, a.|
|00001770| 0a 74 72 69 61 6c 20 6f | 66 20 61 6e 69 6d 61 6c |.trial o|f animal|
|00001780| 20 69 6e 73 75 6c 69 6e | 20 61 64 6d 69 6e 69 73 | insulin| adminis|
|00001790| 74 72 61 74 69 6f 6e 20 | 6d 69 67 68 74 20 62 65 |tration |might be|
|000017a0| 20 61 74 74 65 6d 70 74 | 65 64 20 69 6e 20 70 72 | attempt|ed in pr|
|000017b0| 6f 62 6c 65 6d 20 70 61 | 74 69 65 6e 74 73 0d 0a |oblem pa|tients..|
|000017c0| 77 69 74 68 20 73 65 76 | 65 72 65 20 68 79 70 6f |with sev|ere hypo|
|000017d0| 67 6c 79 63 65 6d 69 61 | 20 75 6e 61 77 61 72 65 |glycemia| unaware|
|000017e0| 6e 65 73 73 2e 20 20 54 | 68 69 73 20 73 79 6e 64 |ness. T|his synd|
|000017f0| 72 6f 6d 65 2c 20 68 6f | 77 65 76 65 72 2c 20 61 |rome, ho|wever, a|
|00001800| 70 70 65 61 72 73 20 74 | 6f 20 62 65 0d 0a 63 61 |ppears t|o be..ca|
|00001810| 75 73 65 64 20 6d 61 69 | 6e 6c 79 20 62 79 20 61 |used mai|nly by a|
|00001820| 75 74 6f 6e 6f 6d 69 63 | 20 64 79 73 66 75 6e 63 |utonomic| dysfunc|
|00001830| 74 69 6f 6e 20 6f 72 20 | 69 6e 74 65 6e 73 69 76 |tion or |intensiv|
|00001840| 65 20 69 6e 73 75 6c 69 | 6e 20 74 68 65 72 61 70 |e insuli|n therap|
|00001850| 79 20 69 74 73 65 6c 66 | 0d 0a 28 72 65 63 75 72 |y itself|..(recur|
|00001860| 72 65 6e 74 20 68 79 70 | 6f 67 6c 79 63 65 6d 69 |rent hyp|oglycemi|
|00001870| 61 3f 29 2c 20 61 6e 64 | 20 74 68 65 72 65 66 6f |a?), and| therefo|
|00001880| 72 65 20 69 73 20 6e 6f | 74 20 6c 69 6b 65 6c 79 |re is no|t likely|
|00001890| 20 74 6f 20 64 69 73 61 | 70 70 65 61 72 20 73 69 | to disa|ppear si|
|000018a0| 6d 70 6c 79 20 62 79 0d | 0a 63 68 61 6e 67 69 6e |mply by.|.changin|
|000018b0| 67 20 74 68 65 20 73 70 | 65 63 69 65 73 20 6f 66 |g the sp|ecies of|
|000018c0| 20 69 6e 73 75 6c 69 6e | 2e 2d 2d 52 2e 53 2e 20 | insulin|.--R.S. |
|000018d0| 53 68 65 72 77 69 6e 2c | 20 4d 2e 44 2e 0d 0a 24 |Sherwin,| M.D...$|
|000018e0| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 31 33 31 |Unique_I|D{YRB131|
|000018f0| 30 31 7d 0d 0a 24 54 69 | 74 6c 65 7b 4d 61 6e 61 |01}..$Ti|tle{Mana|
|00001900| 67 65 6d 65 6e 74 20 6f | 66 20 41 73 79 6d 70 74 |gement o|f Asympt|
|00001910| 6f 6d 61 74 69 63 20 47 | 61 6c 6c 73 74 6f 6e 65 |omatic G|allstone|
|00001920| 73 20 69 6e 20 74 68 65 | 20 44 69 61 62 65 74 69 |s in the| Diabeti|
|00001930| 63 20 50 61 74 69 65 6e | 74 3a 20 20 41 20 44 65 |c Patien|t: A De|
|00001940| 63 69 73 69 6f 6e 20 41 | 6e 61 6c 79 73 69 73 7d |cision A|nalysis}|
|00001950| 0d 0a 24 41 75 74 68 6f | 72 7b 46 72 69 65 64 6d |..$Autho|r{Friedm|
|00001960| 61 6e 2c 20 4c 53 0d 0a | 52 6f 62 65 72 74 73 2c |an, LS..|Roberts,|
|00001970| 20 4d 53 0d 0a 42 72 65 | 74 74 2c 20 41 53 0d 0a | MS..Bre|tt, AS..|
|00001980| 4d 61 72 74 6f 6e 2c 20 | 4b 49 7d 0d 0a 24 41 66 |Marton, |KI}..$Af|
|00001990| 66 69 6c 69 61 74 69 6f | 6e 7b 4e 65 77 20 45 6e |filiatio|n{New En|
|000019a0| 67 6c 61 6e 64 20 44 65 | 61 63 6f 6e 65 73 73 20 |gland De|aconess |
|000019b0| 48 6f 73 70 2c 20 42 6f | 73 74 6f 6e 3b 20 48 61 |Hosp, Bo|ston; Ha|
|000019c0| 72 76 61 72 64 20 4d 65 | 64 20 53 63 68 6f 6f 6c |rvard Me|d School|
|000019d0| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 41 6e 6e 20 |}..$Jour|nal{Ann |
|000019e0| 49 6e 74 65 72 6e 20 4d | 65 64 7d 0d 0a 24 56 6f |Intern M|ed}..$Vo|
|000019f0| 6c 75 6d 65 7b 31 30 39 | 7d 0d 0a 24 50 61 67 65 |lume{109|}..$Page|
|00001a00| 7b 39 31 33 2d 39 31 39 | 7d 0d 0a 24 44 61 74 65 |{913-919|}..$Date|
|00001a10| 7b 44 65 63 65 6d 62 65 | 72 20 31 39 38 38 7d 0d |{Decembe|r 1988}.|
|00001a20| 0a 24 59 42 56 6f 6c 7b | 31 39 39 30 20 59 65 61 |.$YBVol{|1990 Yea|
|00001a30| 72 20 42 6f 6f 6b 20 6f | 66 20 45 6e 64 6f 63 72 |r Book o|f Endocr|
|00001a40| 69 6e 6f 6c 6f 67 79 7d | 0d 0a 24 43 68 61 70 74 |inology}|..$Chapt|
|00001a50| 65 72 7b 31 30 2d 32 35 | 7d 0d 0a 24 59 42 45 64 |er{10-25|}..$YBEd|
|00001a60| 69 74 6f 72 7b 4a 6f 68 | 6e 20 44 2e 20 42 61 67 |itor{Joh|n D. Bag|
|00001a70| 64 61 64 65 2c 20 4d 2e | 44 2e 7d 0d 0a 24 54 61 |dade, M.|D.}..$Ta|
|00001a80| 62 6c 65 7b 7d 0d 0a 24 | 43 6f 6d 6d 65 6e 74 61 |ble{}..$|Commenta|
|00001a90| 74 6f 72 7b 52 2e 53 2e | 20 53 68 65 72 77 69 6e |tor{R.S.| Sherwin|
|00001aa0| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00001ab0| 69 67 68 74 20 28 63 29 | 20 59 65 61 72 62 6f 6f |ight (c)| Yearboo|
|00001ac0| 6b 20 4d 65 64 69 63 61 | 6c 20 50 75 62 6c 69 73 |k Medica|l Publis|
|00001ad0| 68 65 72 73 2c 20 49 6e | 63 2e 2c 20 31 39 39 30 |hers, In|c., 1990|
|00001ae0| 0d 0a 0d 0a 31 39 39 30 | 20 59 65 61 72 20 42 6f |....1990| Year Bo|
|00001af0| 6f 6b 20 6f 66 20 45 6e | 64 6f 63 72 69 6e 6f 6c |ok of En|docrinol|
|00001b00| 6f 67 79 20 28 52 29 0d | 0a 0d 0a 43 68 61 70 74 |ogy (R).|...Chapt|
|00001b10| 65 72 20 31 30 2d 2d 44 | 69 61 62 65 74 65 73 20 |er 10--D|iabetes |
|00001b20| 4d 65 6c 6c 69 74 75 73 | 20 61 6e 64 20 43 61 72 |Mellitus| and Car|
|00001b30| 62 6f 68 79 64 72 61 74 | 65 20 4d 65 74 61 62 6f |bohydrat|e Metabo|
|00001b40| 6c 69 73 6d 0d 0a 0d 0a | 4f 74 68 65 72 20 43 6f |lism....|Other Co|
|00001b50| 6d 70 6c 69 63 61 74 69 | 6f 6e 73 0d 0a 0d 0a 2d |mplicati|ons....-|
|00001b60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001ba0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 4d |--------|-----..M|
|00001bb0| 61 6e 61 67 65 6d 65 6e | 74 20 6f 66 20 41 73 79 |anagemen|t of Asy|
|00001bc0| 6d 70 74 6f 6d 61 74 69 | 63 20 47 61 6c 6c 73 74 |mptomati|c Gallst|
|00001bd0| 6f 6e 65 73 20 69 6e 20 | 74 68 65 20 44 69 61 62 |ones in |the Diab|
|00001be0| 65 74 69 63 20 50 61 74 | 69 65 6e 74 3a 20 20 41 |etic Pat|ient: A|
|00001bf0| 20 44 65 63 69 73 69 6f | 6e 0d 0a 41 6e 61 6c 79 | Decisio|n..Analy|
|00001c00| 73 69 73 0d 0a 0d 0a 46 | 72 69 65 64 6d 61 6e 20 |sis....F|riedman |
|00001c10| 4c 53 2c 20 52 6f 62 65 | 72 74 73 20 4d 53 2c 20 |LS, Robe|rts MS, |
|00001c20| 42 72 65 74 74 20 41 53 | 2c 20 4d 61 72 74 6f 6e |Brett AS|, Marton|
|00001c30| 20 4b 49 0d 0a 28 4e 65 | 77 20 45 6e 67 6c 61 6e | KI..(Ne|w Englan|
|00001c40| 64 20 44 65 61 63 6f 6e | 65 73 73 20 48 6f 73 70 |d Deacon|ess Hosp|
|00001c50| 2c 20 42 6f 73 74 6f 6e | 3b 20 48 61 72 76 61 72 |, Boston|; Harvar|
|00001c60| 64 20 4d 65 64 20 53 63 | 68 6f 6f 6c 29 0d 0a 41 |d Med Sc|hool)..A|
|00001c70| 6e 6e 20 49 6e 74 65 72 | 6e 20 4d 65 64 20 31 30 |nn Inter|n Med 10|
|00001c80| 39 3a 39 31 33 2d 39 31 | 39 2c 20 44 65 63 65 6d |9:913-91|9, Decem|
|00001c90| 62 65 72 20 31 39 38 38 | 0d 0a 2d 2d 2d 2d 2d 2d |ber 1988|..------|
|00001ca0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001cb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001cc0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001cd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001ce0| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
|00001cf0| 72 61 63 74 0d 0a 0d 0a | 20 20 20 20 20 54 68 65 |ract....| The|
|00001d00| 72 65 20 69 73 20 61 20 | 70 65 72 63 65 70 74 69 |re is a |percepti|
|00001d10| 6f 6e 20 62 61 73 65 64 | 20 6f 6e 20 64 61 74 61 |on based| on data|
|00001d20| 20 6f 66 20 73 65 76 65 | 72 61 6c 20 64 65 63 61 | of seve|ral deca|
|00001d30| 64 65 73 20 74 68 61 74 | 20 65 6d 65 72 67 65 6e |des that| emergen|
|00001d40| 63 79 0d 0a 63 68 6f 6c | 65 63 79 73 74 65 63 74 |cy..chol|ecystect|
|00001d50| 6f 6d 79 20 69 73 20 61 | 20 67 72 65 61 74 20 72 |omy is a| great r|
|00001d60| 69 73 6b 20 74 6f 20 64 | 69 61 62 65 74 69 63 20 |isk to d|iabetic |
|00001d70| 70 61 74 69 65 6e 74 73 | 20 61 6e 64 20 74 68 61 |patients| and tha|
|00001d80| 74 20 70 72 6f 70 68 79 | 6c 61 63 74 69 63 0d 0a |t prophy|lactic..|
|00001d90| 73 75 72 67 65 72 79 20 | 66 6f 72 20 61 73 79 6d |surgery |for asym|
|00001da0| 70 74 6f 6d 61 74 69 63 | 20 67 61 6c 6c 73 74 6f |ptomatic| gallsto|
|00001db0| 6e 65 73 20 69 73 20 6f | 66 20 6c 65 73 73 20 72 |nes is o|f less r|
|00001dc0| 69 73 6b 2e 20 20 52 65 | 63 65 6e 74 20 72 65 70 |isk. Re|cent rep|
|00001dd0| 6f 72 74 73 2c 20 68 6f | 77 65 76 65 72 2c 0d 0a |orts, ho|wever,..|
|00001de0| 68 61 76 65 20 73 75 67 | 67 65 73 74 65 64 20 74 |have sug|gested t|
|00001df0| 68 61 74 20 64 69 61 62 | 65 74 69 63 20 70 61 74 |hat diab|etic pat|
|00001e00| 69 65 6e 74 73 20 74 6f | 6c 65 72 61 74 65 20 62 |ients to|lerate b|
|00001e10| 69 6c 69 61 72 79 20 74 | 72 61 63 74 20 73 75 72 |iliary t|ract sur|
|00001e20| 67 65 72 79 20 61 73 20 | 77 65 6c 6c 0d 0a 61 73 |gery as |well..as|
|00001e30| 20 74 68 65 20 67 65 6e | 65 72 61 6c 20 70 6f 70 | the gen|eral pop|
|00001e40| 75 6c 61 74 69 6f 6e 20 | 64 6f 65 73 2c 20 69 6e |ulation |does, in|
|00001e50| 20 77 68 6f 6d 20 6f 70 | 65 72 61 74 69 76 65 20 | whom op|erative |
|00001e60| 6d 6f 72 74 61 6c 69 74 | 79 20 66 72 6f 6d 20 65 |mortalit|y from e|
|00001e70| 6d 65 72 67 65 6e 63 79 | 0d 0a 73 75 72 67 65 72 |mergency|..surger|
|00001e80| 79 20 69 73 20 6c 6f 77 | 2e 20 20 44 65 63 69 73 |y is low|. Decis|
|00001e90| 69 6f 6e 20 61 6e 61 6c | 79 73 69 73 20 77 61 73 |ion anal|ysis was|
|00001ea0| 20 75 73 65 64 20 74 6f | 20 63 6f 6d 70 61 72 65 | used to| compare|
|00001eb0| 20 65 78 70 65 63 74 61 | 6e 74 20 6d 61 6e 61 67 | expecta|nt manag|
|00001ec0| 65 6d 65 6e 74 0d 0a 77 | 69 74 68 20 70 72 6f 70 |ement..w|ith prop|
|00001ed0| 68 79 6c 61 63 74 69 63 | 20 63 68 6f 6c 65 63 79 |hylactic| cholecy|
|00001ee0| 73 74 65 63 74 6f 6d 79 | 20 69 6e 20 61 73 79 6d |stectomy| in asym|
|00001ef0| 70 74 6f 6d 61 74 69 63 | 20 64 69 61 62 65 74 69 |ptomatic| diabeti|
|00001f00| 63 20 70 61 74 69 65 6e | 74 73 2e 20 20 44 61 74 |c patien|ts. Dat|
|00001f10| 61 0d 0a 77 65 72 65 20 | 64 65 72 69 76 65 64 20 |a..were |derived |
|00001f20| 6f 6e 20 72 65 6c 65 76 | 61 6e 74 20 70 72 6f 62 |on relev|ant prob|
|00001f30| 61 62 69 6c 69 74 69 65 | 73 20 66 72 6f 6d 20 70 |abilitie|s from p|
|00001f40| 75 62 6c 69 73 68 65 64 | 20 72 65 70 6f 72 74 73 |ublished| reports|
|00001f50| 20 61 6e 64 20 66 72 6f | 6d 20 65 78 70 65 72 74 | and fro|m expert|
|00001f60| 0d 0a 73 75 72 67 65 6f | 6e 73 20 61 6e 64 20 67 |..surgeo|ns and g|
|00001f70| 61 73 74 72 6f 65 6e 74 | 65 72 6f 6c 6f 67 69 73 |astroent|erologis|
|00001f80| 74 73 2e 0d 0a 20 20 20 | 20 20 52 65 67 61 72 64 |ts... | Regard|
|00001f90| 6c 65 73 73 20 6f 66 20 | 74 68 65 20 61 67 65 20 |less of |the age |
|00001fa0| 61 74 20 77 68 69 63 68 | 20 67 61 6c 6c 73 74 6f |at which| gallsto|
|00001fb0| 6e 65 73 20 77 65 72 65 | 20 64 69 73 63 6f 76 65 |nes were| discove|
|00001fc0| 72 65 64 2c 20 65 78 70 | 65 63 74 61 6e 74 0d 0a |red, exp|ectant..|
|00001fd0| 6d 61 6e 61 67 65 6d 65 | 6e 74 20 79 69 65 6c 64 |manageme|nt yield|
|00001fe0| 65 64 20 67 72 65 61 74 | 65 72 20 6c 69 66 65 20 |ed great|er life |
|00001ff0| 65 78 70 65 63 74 61 6e | 63 79 20 74 68 61 6e 20 |expectan|cy than |
|00002000| 64 69 64 20 70 72 6f 70 | 68 79 6c 61 63 74 69 63 |did prop|hylactic|
|00002010| 20 74 72 65 61 74 6d 65 | 6e 74 20 69 6e 0d 0a 62 | treatme|nt in..b|
|00002020| 6f 74 68 20 6d 65 6e 20 | 61 6e 64 20 77 6f 6d 65 |oth men |and wome|
|00002030| 6e 2e 20 20 46 6f 72 20 | 65 78 61 6d 70 6c 65 2c |n. For |example,|
|00002040| 20 61 20 33 30 2d 79 65 | 61 72 2d 6f 6c 64 20 6d | a 30-ye|ar-old m|
|00002050| 61 6e 20 67 61 69 6e 73 | 20 61 6e 20 61 76 65 72 |an gains| an aver|
|00002060| 61 67 65 20 6f 66 20 30 | 2e 35 31 0d 0a 79 65 61 |age of 0|.51..yea|
|00002070| 72 73 20 6f 66 20 6c 69 | 66 65 20 61 6e 64 20 61 |rs of li|fe and a|
|00002080| 20 33 30 2d 79 65 61 72 | 2d 6f 6c 64 20 77 6f 6d | 30-year|-old wom|
|00002090| 61 6e 20 67 61 69 6e 73 | 20 30 2e 34 37 20 79 65 |an gains| 0.47 ye|
|000020a0| 61 72 73 20 6f 66 20 6c | 69 66 65 20 62 79 20 63 |ars of l|ife by c|
|000020b0| 68 6f 6f 73 69 6e 67 0d | 0a 65 78 70 65 63 74 61 |hoosing.|.expecta|
|000020c0| 6e 74 20 6d 61 6e 61 67 | 65 6d 65 6e 74 20 6f 76 |nt manag|ement ov|
|000020d0| 65 72 20 70 72 6f 70 68 | 79 6c 61 63 74 69 63 20 |er proph|ylactic |
|000020e0| 73 75 72 67 65 72 79 2e | 20 20 54 68 72 65 73 68 |surgery.| Thresh|
|000020f0| 6f 6c 64 20 61 6e 61 6c | 79 73 69 73 20 73 68 6f |old anal|ysis sho|
|00002100| 77 65 64 0d 0a 74 68 61 | 74 20 66 6f 72 20 69 6e |wed..tha|t for in|
|00002110| 64 69 76 69 64 75 61 6c | 20 70 72 6f 62 61 62 69 |dividual| probabi|
|00002120| 6c 69 74 69 65 73 2c 20 | 6e 6f 20 73 69 6e 67 6c |lities, |no singl|
|00002130| 65 20 66 61 63 74 6f 72 | 20 77 61 73 20 70 6f 77 |e factor| was pow|
|00002140| 65 72 66 75 6c 20 65 6e | 6f 75 67 68 20 74 6f 0d |erful en|ough to.|
|00002150| 0a 72 65 76 65 72 73 65 | 20 74 68 65 20 73 75 70 |.reverse| the sup|
|00002160| 65 72 69 6f 72 69 74 79 | 20 6f 66 20 65 78 70 65 |eriority| of expe|
|00002170| 63 74 61 6e 74 20 6d 61 | 6e 61 67 65 6d 65 6e 74 |ctant ma|nagement|
|00002180| 2e 20 20 50 72 6f 70 68 | 79 6c 61 63 74 69 63 20 |. Proph|ylactic |
|00002190| 63 68 6f 6c 65 63 79 73 | 74 65 63 74 6f 6d 79 0d |cholecys|tectomy.|
|000021a0| 0a 77 61 73 20 73 75 70 | 65 72 69 6f 72 20 6f 6e |.was sup|erior on|
|000021b0| 6c 79 20 77 69 74 68 20 | 65 78 74 72 65 6d 65 6c |ly with |extremel|
|000021c0| 79 20 68 69 67 68 20 65 | 73 74 69 6d 61 74 65 73 |y high e|stimates|
|000021d0| 20 6f 66 20 74 68 65 20 | 6c 69 6b 65 6c 69 68 6f | of the |likeliho|
|000021e0| 6f 64 20 6f 66 0d 0a 73 | 79 6d 70 74 6f 6d 61 74 |od of..s|ymptomat|
|000021f0| 69 63 20 64 69 73 65 61 | 73 65 20 64 65 76 65 6c |ic disea|se devel|
|00002200| 6f 70 69 6e 67 2c 20 74 | 68 65 20 70 72 6f 62 61 |oping, t|he proba|
|00002210| 62 69 6c 69 74 79 20 6f | 66 20 72 65 71 75 69 72 |bility o|f requir|
|00002220| 69 6e 67 20 65 6d 65 72 | 67 65 6e 63 79 20 73 75 |ing emer|gency su|
|00002230| 72 67 65 72 79 0d 0a 61 | 66 74 65 72 20 73 79 6d |rgery..a|fter sym|
|00002240| 70 74 6f 6d 73 20 64 65 | 76 65 6c 6f 70 2c 20 61 |ptoms de|velop, a|
|00002250| 6e 64 20 65 6d 65 72 67 | 65 6e 63 79 20 73 75 72 |nd emerg|ency sur|
|00002260| 67 69 63 61 6c 20 6d 6f | 72 74 61 6c 69 74 79 20 |gical mo|rtality |
|00002270| 72 61 74 65 73 2e 0d 0a | 20 20 20 20 20 54 68 65 |rates...| The|
|00002280| 20 6d 61 6e 61 67 65 6d | 65 6e 74 20 6f 66 20 61 | managem|ent of a|
|00002290| 73 79 6d 70 74 6f 6d 61 | 74 69 63 20 67 61 6c 6c |symptoma|tic gall|
|000022a0| 73 74 6f 6e 65 73 20 73 | 68 6f 75 6c 64 20 62 65 |stones s|hould be|
|000022b0| 20 73 69 6d 69 6c 61 72 | 20 66 6f 72 20 70 61 74 | similar| for pat|
|000022c0| 69 65 6e 74 73 0d 0a 77 | 69 74 68 20 61 6e 64 20 |ients..w|ith and |
|000022d0| 77 69 74 68 6f 75 74 20 | 64 69 61 62 65 74 65 73 |without |diabetes|
|000022e0| 2e 20 20 50 72 6f 70 68 | 79 6c 61 63 74 69 63 20 |. Proph|ylactic |
|000022f0| 73 75 72 67 65 72 79 20 | 66 6f 72 20 73 69 6c 65 |surgery |for sile|
|00002300| 6e 74 20 67 61 6c 6c 73 | 74 6f 6e 65 73 20 69 6e |nt galls|tones in|
|00002310| 0d 0a 64 69 61 62 65 74 | 69 63 20 70 61 74 69 65 |..diabet|ic patie|
|00002320| 6e 74 73 20 64 6f 65 73 | 20 6e 6f 74 20 69 6e 63 |nts does| not inc|
|00002330| 72 65 61 73 65 20 6c 69 | 66 65 20 65 78 70 65 63 |rease li|fe expec|
|00002340| 74 61 6e 63 79 20 6f 72 | 20 74 68 65 20 71 75 61 |tancy or| the qua|
|00002350| 6c 69 74 79 20 6f 66 20 | 6c 69 66 65 2c 0d 0a 61 |lity of |life,..a|
|00002360| 6e 64 20 6d 61 79 20 69 | 6e 20 66 61 63 74 20 72 |nd may i|n fact r|
|00002370| 65 64 75 63 65 20 69 74 | 2e 0d 0a 0d 0a 50 6f 73 |educe it|.....Pos|
|00002380| 74 2d 43 6f 6d 6d 65 6e | 74 0d 0a 0d 0a 20 20 20 |t-Commen|t.... |
|00002390| 20 20 49 6e 20 74 68 65 | 20 61 62 73 65 6e 63 65 | In the| absence|
|000023a0| 20 6f 66 20 22 68 61 72 | 64 20 64 61 74 61 22 20 | of "har|d data" |
|000023b0| 62 61 73 65 64 20 6f 6e | 20 73 79 73 74 65 6d 61 |based on| systema|
|000023c0| 74 69 63 20 73 74 75 64 | 79 2c 20 70 61 73 74 20 |tic stud|y, past |
|000023d0| 65 78 70 65 72 69 65 6e | 63 65 73 0d 0a 61 6e 64 |experien|ces..and|
|000023e0| 20 69 6d 70 72 65 73 73 | 69 6f 6e 73 20 61 72 65 | impress|ions are|
|000023f0| 20 63 6f 6d 6d 6f 6e 6c | 79 20 72 65 6c 69 65 64 | commonl|y relied|
|00002400| 20 6f 6e 20 66 6f 72 20 | 63 6c 69 6e 69 63 61 6c | on for |clinical|
|00002410| 20 64 65 63 69 73 69 6f | 6e 20 6d 61 6b 69 6e 67 | decisio|n making|
|00002420| 2e 20 20 4f 66 74 65 6e | 2c 0d 0a 6d 65 64 69 63 |. Often|,..medic|
|00002430| 61 6c 20 64 6f 67 6d 61 | 20 70 61 73 73 65 64 20 |al dogma| passed |
|00002440| 6f 6e 20 62 79 20 70 61 | 73 74 20 6d 65 6e 74 6f |on by pa|st mento|
|00002450| 72 73 20 69 73 20 61 63 | 63 65 70 74 65 64 2c 20 |rs is ac|cepted, |
|00002460| 65 76 65 6e 20 74 68 6f | 75 67 68 20 73 75 63 68 |even tho|ugh such|
|00002470| 0d 0a 6a 75 64 67 6d 65 | 6e 74 73 20 64 69 64 20 |..judgme|nts did |
|00002480| 6e 6f 74 20 74 61 6b 65 | 20 69 6e 74 6f 20 61 63 |not take| into ac|
|00002490| 63 6f 75 6e 74 20 6e 65 | 77 20 64 65 76 65 6c 6f |count ne|w develo|
|000024a0| 70 6d 65 6e 74 73 20 69 | 6e 20 63 61 72 65 2e 20 |pments i|n care. |
|000024b0| 20 54 68 69 73 20 61 70 | 70 65 61 72 73 20 74 6f | This ap|pears to|
|000024c0| 0d 0a 62 65 20 74 68 65 | 20 63 61 73 65 20 66 6f |..be the| case fo|
|000024d0| 72 20 70 72 6f 70 68 79 | 6c 61 63 74 69 63 20 73 |r prophy|lactic s|
|000024e0| 75 72 67 65 72 79 20 6f | 66 20 61 73 79 6d 70 74 |urgery o|f asympt|
|000024f0| 6f 6d 61 74 69 63 20 67 | 61 6c 6c 73 74 6f 6e 65 |omatic g|allstone|
|00002500| 73 20 69 6e 20 64 69 61 | 62 65 74 69 63 0d 0a 70 |s in dia|betic..p|
|00002510| 61 74 69 65 6e 74 73 2e | 20 20 54 68 69 73 20 72 |atients.| This r|
|00002520| 65 70 6f 72 74 20 6d 61 | 6b 65 73 20 61 20 63 6f |eport ma|kes a co|
|00002530| 6e 76 69 6e 63 69 6e 67 | 20 61 72 67 75 6d 65 6e |nvincing| argumen|
|00002540| 74 20 66 6f 72 20 74 68 | 65 20 65 78 70 61 6e 64 |t for th|e expand|
|00002550| 65 64 20 75 73 65 20 6f | 66 0d 0a 64 65 63 69 73 |ed use o|f..decis|
|00002560| 69 6f 6e 20 6d 6f 64 65 | 6c 20 61 6e 61 6c 79 73 |ion mode|l analys|
|00002570| 69 73 2e 2d 2d 52 2e 53 | 2e 20 53 68 65 72 77 69 |is.--R.S|. Sherwi|
|00002580| 6e 2c 20 4d 2e 44 2e 0d | 0a 24 55 6e 69 71 75 65 |n, M.D..|.$Unique|
|00002590| 5f 49 44 7b 59 52 42 31 | 33 31 30 32 7d 0d 0a 24 |_ID{YRB1|3102}..$|
|000025a0| 54 69 74 6c 65 7b 43 6f | 6e 74 72 61 73 74 20 4d |Title{Co|ntrast M|
|000025b0| 61 74 65 72 69 61 6c 2d | 49 6e 64 75 63 65 64 20 |aterial-|Induced |
|000025c0| 52 65 6e 61 6c 20 46 61 | 69 6c 75 72 65 20 69 6e |Renal Fa|ilure in|
|000025d0| 20 50 61 74 69 65 6e 74 | 73 20 57 69 74 68 20 44 | Patient|s With D|
|000025e0| 69 61 62 65 74 65 73 20 | 4d 65 6c 6c 69 74 75 73 |iabetes |Mellitus|
|000025f0| 2c 20 52 65 6e 61 6c 20 | 49 6e 73 75 66 66 69 63 |, Renal |Insuffic|
|00002600| 69 65 6e 63 79 2c 20 6f | 72 20 42 6f 74 68 7d 0d |iency, o|r Both}.|
|00002610| 0a 24 41 75 74 68 6f 72 | 7b 50 61 72 66 72 65 79 |.$Author|{Parfrey|
|00002620| 2c 20 50 53 0d 0a 47 72 | 69 66 66 69 74 68 73 2c |, PS..Gr|iffiths,|
|00002630| 20 53 4d 0d 0a 42 61 72 | 72 65 74 74 2c 20 42 4a | SM..Bar|rett, BJ|
|00002640| 0d 0a 50 61 75 6c 2c 20 | 4d 44 0d 0a 47 65 6e 67 |..Paul, |MD..Geng|
|00002650| 65 2c 20 4d 0d 0a 57 69 | 74 68 65 72 73 2c 20 4a |e, M..Wi|thers, J|
|00002660| 0d 0a 46 61 72 69 64 2c | 20 4e 0d 0a 4d 63 4d 61 |..Farid,| N..McMa|
|00002670| 6e 61 6d 6f 6e 2c 20 50 | 4a 7d 0d 0a 24 41 66 66 |namon, P|J}..$Aff|
|00002680| 69 6c 69 61 74 69 6f 6e | 7b 4d 65 6d 6f 72 69 61 |iliation|{Memoria|
|00002690| 6c 20 55 6e 69 76 2c 20 | 53 74 2e 20 4a 6f 68 6e |l Univ, |St. John|
|000026a0| 27 73 2c 20 4e 65 77 66 | 6f 75 6e 64 6c 61 6e 64 |'s, Newf|oundland|
|000026b0| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 4e 20 45 6e |}..$Jour|nal{N En|
|000026c0| 67 6c 20 4a 20 4d 65 64 | 7d 0d 0a 24 56 6f 6c 75 |gl J Med|}..$Volu|
|000026d0| 6d 65 7b 33 32 30 7d 0d | 0a 24 50 61 67 65 7b 31 |me{320}.|.$Page{1|
|000026e0| 34 33 2d 31 34 39 7d 0d | 0a 24 44 61 74 65 7b 4a |43-149}.|.$Date{J|
|000026f0| 61 6e 20 31 39 2c 20 31 | 39 38 39 7d 0d 0a 24 59 |an 19, 1|989}..$Y|
|00002700| 42 56 6f 6c 7b 31 39 39 | 30 20 59 65 61 72 20 42 |BVol{199|0 Year B|
|00002710| 6f 6f 6b 20 6f 66 20 45 | 6e 64 6f 63 72 69 6e 6f |ook of E|ndocrino|
|00002720| 6c 6f 67 79 7d 0d 0a 24 | 43 68 61 70 74 65 72 7b |logy}..$|Chapter{|
|00002730| 31 30 2d 32 36 7d 0d 0a | 24 59 42 45 64 69 74 6f |10-26}..|$YBEdito|
|00002740| 72 7b 4a 6f 68 6e 20 44 | 2e 20 42 61 67 64 61 64 |r{John D|. Bagdad|
|00002750| 65 2c 20 4d 2e 44 2e 7d | 0d 0a 24 54 61 62 6c 65 |e, M.D.}|..$Table|
|00002760| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|00002770| 7b 52 2e 53 2e 20 53 68 | 65 72 77 69 6e 2c 20 4d |{R.S. Sh|erwin, M|
|00002780| 2e 44 2e 7d 0d 0a 0d 0a | 43 6f 70 79 72 69 67 68 |.D.}....|Copyrigh|
|00002790| 74 20 28 63 29 20 59 65 | 61 72 62 6f 6f 6b 20 4d |t (c) Ye|arbook M|
|000027a0| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|000027b0| 73 2c 20 49 6e 63 2e 2c | 20 31 39 39 30 0d 0a 0d |s, Inc.,| 1990...|
|000027c0| 0a 31 39 39 30 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1990 Ye|ar Book |
|000027d0| 6f 66 20 45 6e 64 6f 63 | 72 69 6e 6f 6c 6f 67 79 |of Endoc|rinology|
|000027e0| 20 28 52 29 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 | (R)....|Chapter |
|000027f0| 31 30 2d 2d 44 69 61 62 | 65 74 65 73 20 4d 65 6c |10--Diab|etes Mel|
|00002800| 6c 69 74 75 73 20 61 6e | 64 20 43 61 72 62 6f 68 |litus an|d Carboh|
|00002810| 79 64 72 61 74 65 20 4d | 65 74 61 62 6f 6c 69 73 |ydrate M|etabolis|
|00002820| 6d 0d 0a 0d 0a 4f 74 68 | 65 72 20 43 6f 6d 70 6c |m....Oth|er Compl|
|00002830| 69 63 61 74 69 6f 6e 73 | 0d 0a 0d 0a 2d 2d 2d 2d |ications|....----|
|00002840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 43 6f 6e 74 |--------|--..Cont|
|00002890| 72 61 73 74 20 4d 61 74 | 65 72 69 61 6c 2d 49 6e |rast Mat|erial-In|
|000028a0| 64 75 63 65 64 20 52 65 | 6e 61 6c 20 46 61 69 6c |duced Re|nal Fail|
|000028b0| 75 72 65 20 69 6e 20 50 | 61 74 69 65 6e 74 73 20 |ure in P|atients |
|000028c0| 57 69 74 68 20 44 69 61 | 62 65 74 65 73 20 4d 65 |With Dia|betes Me|
|000028d0| 6c 6c 69 74 75 73 2c 0d | 0a 52 65 6e 61 6c 20 49 |llitus,.|.Renal I|
|000028e0| 6e 73 75 66 66 69 63 69 | 65 6e 63 79 2c 20 6f 72 |nsuffici|ency, or|
|000028f0| 20 42 6f 74 68 0d 0a 0d | 0a 50 61 72 66 72 65 79 | Both...|.Parfrey|
|00002900| 20 50 53 2c 20 47 72 69 | 66 66 69 74 68 73 20 53 | PS, Gri|ffiths S|
|00002910| 4d 2c 20 42 61 72 72 65 | 74 74 20 42 4a 2c 20 50 |M, Barre|tt BJ, P|
|00002920| 61 75 6c 20 4d 44 2c 20 | 47 65 6e 67 65 20 4d 2c |aul MD, |Genge M,|
|00002930| 20 57 69 74 68 65 72 73 | 20 4a 2c 20 46 61 72 69 | Withers| J, Fari|
|00002940| 64 20 4e 2c 0d 0a 4d 63 | 4d 61 6e 61 6d 6f 6e 20 |d N,..Mc|Manamon |
|00002950| 50 4a 0d 0a 28 4d 65 6d | 6f 72 69 61 6c 20 55 6e |PJ..(Mem|orial Un|
|00002960| 69 76 2c 20 53 74 2e 20 | 4a 6f 68 6e 27 73 2c 20 |iv, St. |John's, |
|00002970| 4e 65 77 66 6f 75 6e 64 | 6c 61 6e 64 29 0d 0a 4e |Newfound|land)..N|
|00002980| 20 45 6e 67 6c 20 4a 20 | 4d 65 64 20 33 32 30 3a | Engl J |Med 320:|
|00002990| 31 34 33 2d 31 34 39 2c | 20 4a 61 6e 20 31 39 2c |143-149,| Jan 19,|
|000029a0| 20 31 39 38 39 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1989..-|--------|
|000029b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000029c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000029d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000029e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000029f0| 2d 2d 2d 2d 2d 0d 0a 0d | 0a 41 62 73 74 72 61 63 |-----...|.Abstrac|
|00002a00| 74 0d 0a 0d 0a 20 20 20 | 20 20 54 68 65 20 69 6e |t.... | The in|
|00002a10| 66 6c 75 65 6e 63 65 20 | 6f 66 20 72 61 64 69 6f |fluence |of radio|
|00002a20| 67 72 61 70 68 69 63 20 | 63 6f 6e 74 72 61 73 74 |graphic |contrast|
|00002a30| 20 6d 61 74 65 72 69 61 | 6c 20 6f 6e 20 74 68 65 | materia|l on the|
|00002a40| 20 72 69 73 6b 20 6f 66 | 0d 0a 6e 65 70 68 72 6f | risk of|..nephro|
|00002a50| 74 6f 78 69 63 69 74 79 | 20 77 61 73 20 64 65 74 |toxicity| was det|
|00002a60| 65 72 6d 69 6e 65 64 20 | 69 6e 20 61 20 70 72 6f |ermined |in a pro|
|00002a70| 73 70 65 63 74 69 76 65 | 20 73 74 75 64 79 20 6f |spective| study o|
|00002a80| 66 20 63 6f 6e 73 65 63 | 75 74 69 76 65 20 70 61 |f consec|utive pa|
|00002a90| 74 69 65 6e 74 73 0d 0a | 75 6e 64 65 72 67 6f 69 |tients..|undergoi|
|00002aa0| 6e 67 20 72 61 64 69 6f | 67 72 61 70 68 69 63 20 |ng radio|graphic |
|00002ab0| 70 72 6f 63 65 64 75 72 | 65 73 20 77 69 74 68 20 |procedur|es with |
|00002ac0| 69 6e 74 72 61 76 61 73 | 63 75 6c 61 72 20 63 6f |intravas|cular co|
|00002ad0| 6e 74 72 61 73 74 20 6d | 61 74 65 72 69 61 6c 2e |ntrast m|aterial.|
|00002ae0| 0d 0a 54 68 72 65 65 20 | 67 72 6f 75 70 73 20 6f |..Three |groups o|
|00002af0| 66 20 70 61 74 69 65 6e | 74 73 20 77 65 72 65 20 |f patien|ts were |
|00002b00| 73 74 75 64 69 65 64 3a | 20 20 38 35 20 77 69 74 |studied:| 85 wit|
|00002b10| 68 20 64 69 61 62 65 74 | 65 73 20 6d 65 6c 6c 69 |h diabet|es melli|
|00002b20| 74 75 73 20 61 6e 64 20 | 6e 6f 72 6d 61 6c 0d 0a |tus and |normal..|
|00002b30| 72 65 6e 61 6c 20 66 75 | 6e 63 74 69 6f 6e 2c 20 |renal fu|nction, |
|00002b40| 31 30 31 20 77 69 74 68 | 20 70 72 65 65 78 69 73 |101 with| preexis|
|00002b50| 74 69 6e 67 20 72 65 6e | 61 6c 20 69 6e 73 75 66 |ting ren|al insuf|
|00002b60| 66 69 63 69 65 6e 63 79 | 20 77 69 74 68 6f 75 74 |ficiency| without|
|00002b70| 20 64 69 61 62 65 74 65 | 73 2c 20 61 6e 64 0d 0a | diabete|s, and..|
|00002b80| 33 34 20 77 69 74 68 20 | 62 6f 74 68 20 64 69 61 |34 with |both dia|
|00002b90| 62 65 74 65 73 20 61 6e | 64 20 72 65 6e 61 6c 20 |betes an|d renal |
|00002ba0| 69 6e 73 75 66 66 69 63 | 69 65 6e 63 79 2e 20 20 |insuffic|iency. |
|00002bb0| 41 6c 73 6f 20 69 6e 63 | 6c 75 64 65 64 20 77 65 |Also inc|luded we|
|00002bc0| 72 65 20 33 20 63 6f 6e | 74 72 6f 6c 0d 0a 67 72 |re 3 con|trol..gr|
|00002bd0| 6f 75 70 73 20 77 68 6f | 20 75 6e 64 65 72 77 65 |oups who| underwe|
|00002be0| 6e 74 20 43 54 20 73 63 | 61 6e 6e 69 6e 67 20 6f |nt CT sc|anning o|
|00002bf0| 72 20 61 62 64 6f 6d 69 | 6e 61 6c 20 69 6d 61 67 |r abdomi|nal imag|
|00002c00| 69 6e 67 20 70 72 6f 63 | 65 64 75 72 65 73 20 77 |ing proc|edures w|
|00002c10| 69 74 68 6f 75 74 0d 0a | 69 6e 66 75 73 69 6f 6e |ithout..|infusion|
|00002c20| 20 6f 66 20 63 6f 6e 74 | 72 61 73 74 20 6d 61 74 | of cont|rast mat|
|00002c30| 65 72 69 61 6c 3a 20 20 | 35 39 20 70 61 74 69 65 |erial: |59 patie|
|00002c40| 6e 74 73 20 77 69 74 68 | 20 64 69 61 62 65 74 65 |nts with| diabete|
|00002c50| 73 20 6d 65 6c 6c 69 74 | 75 73 2c 20 31 34 35 0d |s mellit|us, 145.|
|00002c60| 0a 6e 6f 6e 64 69 61 62 | 65 74 69 63 20 70 61 74 |.nondiab|etic pat|
|00002c70| 69 65 6e 74 73 20 77 68 | 6f 20 68 61 64 20 70 72 |ients wh|o had pr|
|00002c80| 65 65 78 69 73 74 69 6e | 67 20 72 65 6e 61 6c 20 |eexistin|g renal |
|00002c90| 69 6e 73 75 66 66 69 63 | 69 65 6e 63 79 2c 20 61 |insuffic|iency, a|
|00002ca0| 6e 64 20 36 34 20 70 61 | 74 69 65 6e 74 73 0d 0a |nd 64 pa|tients..|
|00002cb0| 77 68 6f 20 68 61 64 20 | 64 69 61 62 65 74 65 73 |who had |diabetes|
|00002cc0| 20 61 6e 64 20 72 65 6e | 61 6c 20 69 6e 73 75 66 | and ren|al insuf|
|00002cd0| 66 69 63 69 65 6e 63 79 | 2e 0d 0a 20 20 20 20 20 |ficiency|... |
|00002ce0| 49 6e 20 64 69 61 62 65 | 74 69 63 20 70 61 74 69 |In diabe|tic pati|
|00002cf0| 65 6e 74 73 20 77 69 74 | 68 20 6e 6f 72 6d 61 6c |ents wit|h normal|
|00002d00| 20 72 65 6e 61 6c 20 66 | 75 6e 63 74 69 6f 6e 20 | renal f|unction |
|00002d10| 61 6e 64 20 6e 6f 6e 64 | 69 61 62 65 74 69 63 20 |and nond|iabetic |
|00002d20| 70 61 74 69 65 6e 74 73 | 0d 0a 77 69 74 68 20 70 |patients|..with p|
|00002d30| 72 65 65 78 69 73 74 69 | 6e 67 20 72 65 6e 61 6c |reexisti|ng renal|
|00002d40| 20 69 6e 73 75 66 66 69 | 63 69 65 6e 63 79 2c 20 | insuffi|ciency, |
|00002d50| 63 6c 69 6e 69 63 61 6c | 6c 79 20 61 63 75 74 65 |clinical|ly acute|
|00002d60| 20 72 65 6e 61 6c 20 66 | 61 69 6c 75 72 65 2c 20 | renal f|ailure, |
|00002d70| 64 65 66 69 6e 65 64 0d | 0a 61 73 20 61 6e 20 69 |defined.|.as an i|
|00002d80| 6e 63 72 65 61 73 65 20 | 6f 66 20 3e 35 30 25 20 |ncrease |of >50% |
|00002d90| 69 6e 20 73 65 72 75 6d | 20 63 72 65 61 74 69 6e |in serum| creatin|
|00002da0| 69 6e 65 20 6c 65 76 65 | 6c 2c 20 61 74 74 72 69 |ine leve|l, attri|
|00002db0| 62 75 74 61 62 6c 65 20 | 74 6f 20 63 6f 6e 74 72 |butable |to contr|
|00002dc0| 61 73 74 0d 0a 6d 61 74 | 65 72 69 61 6c 2c 20 64 |ast..mat|erial, d|
|00002dd0| 69 64 20 6e 6f 74 20 6f | 63 63 75 72 2e 20 20 41 |id not o|ccur. A|
|00002de0| 6d 6f 6e 67 20 74 68 6f | 73 65 20 77 68 6f 20 77 |mong tho|se who w|
|00002df0| 65 72 65 20 64 69 61 62 | 65 74 69 63 20 61 6e 64 |ere diab|etic and|
|00002e00| 20 61 6c 73 6f 20 68 61 | 64 20 72 65 6e 61 6c 0d | also ha|d renal.|
|00002e10| 0a 69 6e 73 75 66 66 69 | 63 69 65 6e 63 79 2c 20 |.insuffi|ciency, |
|00002e20| 38 2e 38 25 20 68 61 64 | 20 6d 6f 72 65 20 74 68 |8.8% had| more th|
|00002e30| 61 6e 20 61 20 35 30 25 | 20 69 6e 63 72 65 61 73 |an a 50%| increas|
|00002e40| 65 20 69 6e 20 73 65 72 | 75 6d 20 63 72 65 61 74 |e in ser|um creat|
|00002e50| 69 6e 69 6e 65 20 6c 65 | 76 65 6c 73 0d 0a 61 66 |inine le|vels..af|
|00002e60| 74 65 72 20 74 68 65 20 | 69 6e 66 75 73 69 6f 6e |ter the |infusion|
|00002e70| 20 61 73 20 63 6f 6d 70 | 61 72 65 64 20 74 6f 20 | as comp|ared to |
|00002e80| 31 2e 36 25 20 6f 66 20 | 74 68 65 20 63 6f 6e 74 |1.6% of |the cont|
|00002e90| 72 6f 6c 73 2e 20 20 41 | 6d 6f 6e 67 20 61 6c 6c |rols. A|mong all|
|00002ea0| 20 70 61 74 69 65 6e 74 | 73 0d 0a 77 69 74 68 20 | patient|s..with |
|00002eb0| 70 72 65 65 78 69 73 74 | 69 6e 67 20 72 65 6e 61 |preexist|ing rena|
|00002ec0| 6c 20 69 6e 73 75 66 66 | 69 63 69 65 6e 63 79 2c |l insuff|iciency,|
|00002ed0| 20 74 68 65 72 65 20 77 | 61 73 20 61 6e 20 31 31 | there w|as an 11|
|00002ee0| 2e 38 25 20 69 6e 63 69 | 64 65 6e 63 65 20 6f 66 |.8% inci|dence of|
|00002ef0| 20 61 63 75 74 65 0d 0a | 72 65 6e 61 6c 20 69 6e | acute..|renal in|
|00002f00| 73 75 66 66 69 63 69 65 | 6e 63 79 2c 20 64 65 66 |sufficie|ncy, def|
|00002f10| 69 6e 65 64 20 61 73 20 | 61 6e 20 69 6e 63 72 65 |ined as |an incre|
|00002f20| 61 73 65 20 6f 66 20 3e | 32 35 25 20 69 6e 20 74 |ase of >|25% in t|
|00002f30| 68 65 20 73 65 72 75 6d | 20 63 72 65 61 74 69 6e |he serum| creatin|
|00002f40| 69 6e 65 0d 0a 6c 65 76 | 65 6c 73 20 61 66 74 65 |ine..lev|els afte|
|00002f50| 72 20 69 6e 66 75 73 69 | 6f 6e 20 6f 66 20 63 6f |r infusi|on of co|
|00002f60| 6e 74 72 61 73 74 20 6d | 61 74 65 72 69 61 6c 2e |ntrast m|aterial.|
|00002f70| 20 20 41 66 74 65 72 20 | 65 78 63 6c 75 64 69 6e | After |excludin|
|00002f80| 67 20 66 6f 72 20 61 63 | 75 74 65 20 72 65 6e 61 |g for ac|ute rena|
|00002f90| 6c 0d 0a 69 6e 73 75 66 | 66 69 63 69 65 6e 63 79 |l..insuf|ficiency|
|00002fa0| 20 66 72 6f 6d 20 6f 74 | 68 65 72 20 63 61 75 73 | from ot|her caus|
|00002fb0| 65 73 2c 20 74 68 65 20 | 69 6e 63 69 64 65 6e 63 |es, the |incidenc|
|00002fc0| 65 20 77 61 73 20 37 2e | 30 25 20 61 73 20 63 6f |e was 7.|0% as co|
|00002fd0| 6d 70 61 72 65 64 20 74 | 6f 20 31 2e 35 25 20 69 |mpared t|o 1.5% i|
|00002fe0| 6e 0d 0a 74 68 65 20 63 | 6f 6e 74 72 6f 6c 20 67 |n..the c|ontrol g|
|00002ff0| 72 6f 75 70 2e 20 20 54 | 68 65 72 65 66 6f 72 65 |roup. T|herefore|
|00003000| 2c 20 74 68 65 20 72 69 | 73 6b 20 6f 66 20 72 65 |, the ri|sk of re|
|00003010| 6e 61 6c 20 69 6e 73 75 | 66 66 69 63 69 65 6e 63 |nal insu|fficienc|
|00003020| 79 20 61 74 74 72 69 62 | 75 74 61 62 6c 65 20 74 |y attrib|utable t|
|00003030| 6f 0d 0a 74 68 65 20 63 | 6f 6e 74 72 61 73 74 20 |o..the c|ontrast |
|00003040| 6d 61 74 65 72 69 61 6c | 20 77 61 73 20 34 2e 37 |material| was 4.7|
|00003050| 25 2e 20 20 48 69 67 68 | 20 6f 72 20 6c 6f 77 20 |%. High| or low |
|00003060| 6f 73 6d 6f 6c 61 72 69 | 74 79 20 6f 66 20 74 68 |osmolari|ty of th|
|00003070| 65 20 63 6f 6e 74 72 61 | 73 74 0d 0a 6d 61 74 65 |e contra|st..mate|
|00003080| 72 69 61 6c 20 64 69 64 | 20 6e 6f 74 20 61 66 66 |rial did| not aff|
|00003090| 65 63 74 20 74 68 65 73 | 65 20 72 61 74 65 73 2e |ect thes|e rates.|
|000030a0| 0d 0a 20 20 20 20 20 46 | 6f 72 20 70 61 74 69 65 |.. F|or patie|
|000030b0| 6e 74 73 20 77 69 74 68 | 20 64 69 61 62 65 74 65 |nts with| diabete|
|000030c0| 73 20 61 6e 64 20 6e 6f | 72 6d 61 6c 20 72 65 6e |s and no|rmal ren|
|000030d0| 61 6c 20 66 75 6e 63 74 | 69 6f 6e 20 6f 72 20 6e |al funct|ion or n|
|000030e0| 6f 6e 64 69 61 62 65 74 | 69 63 0d 0a 70 61 74 69 |ondiabet|ic..pati|
|000030f0| 65 6e 74 73 20 77 69 74 | 68 20 70 72 65 65 78 69 |ents wit|h preexi|
|00003100| 73 74 69 6e 67 20 72 65 | 6e 61 6c 20 69 6e 73 75 |sting re|nal insu|
|00003110| 66 66 69 63 69 65 6e 63 | 79 2c 20 74 68 65 72 65 |fficienc|y, there|
|00003120| 20 69 73 20 6c 69 74 74 | 6c 65 20 72 69 73 6b 20 | is litt|le risk |
|00003130| 6f 66 0d 0a 63 6c 69 6e | 69 63 61 6c 6c 79 20 69 |of..clin|ically i|
|00003140| 6d 70 6f 72 74 61 6e 74 | 20 6e 65 70 68 72 6f 74 |mportant| nephrot|
|00003150| 6f 78 69 63 69 74 79 20 | 61 74 74 72 69 62 75 74 |oxicity |attribut|
|00003160| 61 62 6c 65 20 74 6f 20 | 63 6f 6e 74 72 61 73 74 |able to |contrast|
|00003170| 20 6d 61 74 65 72 69 61 | 6c 2e 20 20 46 6f 72 0d | materia|l. For.|
|00003180| 0a 74 68 6f 73 65 20 77 | 69 74 68 20 62 6f 74 68 |.those w|ith both|
|00003190| 20 64 69 61 62 65 74 65 | 73 20 61 6e 64 20 70 72 | diabete|s and pr|
|000031a0| 65 65 78 69 73 74 69 6e | 67 20 72 65 6e 61 6c 20 |eexistin|g renal |
|000031b0| 69 6e 73 75 66 66 69 63 | 69 65 6e 63 79 2c 20 74 |insuffic|iency, t|
|000031c0| 68 65 20 72 69 73 6b 20 | 69 73 0d 0a 61 62 6f 75 |he risk |is..abou|
|000031d0| 74 20 39 25 2c 20 77 68 | 69 63 68 20 69 73 20 6c |t 9%, wh|ich is l|
|000031e0| 6f 77 65 72 20 74 68 61 | 6e 20 72 65 70 6f 72 74 |ower tha|n report|
|000031f0| 65 64 20 70 72 65 76 69 | 6f 75 73 6c 79 2e 0d 0a |ed previ|ously...|
|00003200| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|00003210| 0d 0a 20 20 20 20 20 48 | 6f 73 70 69 74 61 6c 69 |.. H|ospitali|
|00003220| 7a 65 64 20 70 61 74 69 | 65 6e 74 73 20 61 72 65 |zed pati|ents are|
|00003230| 20 72 6f 75 74 69 6e 65 | 6c 79 20 65 78 70 6f 73 | routine|ly expos|
|00003240| 65 64 20 74 6f 20 72 61 | 64 69 6f 67 72 61 70 68 |ed to ra|diograph|
|00003250| 69 63 20 63 6f 6e 74 72 | 61 73 74 0d 0a 6d 61 74 |ic contr|ast..mat|
|00003260| 65 72 69 61 6c 2e 20 20 | 41 6c 74 68 6f 75 67 68 |erial. |Although|
|00003270| 20 74 68 65 20 69 6e 63 | 69 64 65 6e 63 65 20 6f | the inc|idence o|
|00003280| 66 20 61 63 75 74 65 20 | 72 65 6e 61 6c 20 66 61 |f acute |renal fa|
|00003290| 69 6c 75 72 65 20 66 6f | 6c 6c 6f 77 69 6e 67 20 |ilure fo|llowing |
|000032a0| 69 6e 74 72 61 76 65 6e | 6f 75 73 0d 0a 70 79 65 |intraven|ous..pye|
|000032b0| 6c 6f 67 72 61 70 68 79 | 2c 20 61 6e 67 69 6f 67 |lography|, angiog|
|000032c0| 72 61 70 68 79 2c 20 6f | 72 20 43 54 20 73 63 61 |raphy, o|r CT sca|
|000032d0| 6e 6e 69 6e 67 20 69 73 | 20 6c 6f 77 2c 20 69 74 |nning is| low, it|
|000032e0| 20 68 61 73 20 62 65 65 | 6e 20 73 75 67 67 65 73 | has bee|n sugges|
|000032f0| 74 65 64 20 74 68 61 74 | 0d 0a 64 69 61 62 65 74 |ted that|..diabet|
|00003300| 69 63 20 70 61 74 69 65 | 6e 74 73 20 61 72 65 20 |ic patie|nts are |
|00003310| 6d 6f 72 65 20 76 75 6c | 6e 65 72 61 62 6c 65 20 |more vul|nerable |
|00003320| 74 6f 20 74 68 69 73 20 | 63 6f 6d 70 6c 69 63 61 |to this |complica|
|00003330| 74 69 6f 6e 2c 20 70 61 | 72 74 69 63 75 6c 61 72 |tion, pa|rticular|
|00003340| 6c 79 20 69 66 0d 0a 74 | 68 65 79 20 68 61 76 65 |ly if..t|hey have|
|00003350| 20 6e 65 70 68 72 6f 70 | 61 74 68 79 2e 20 20 54 | nephrop|athy. T|
|00003360| 68 69 73 20 73 74 75 64 | 79 20 72 65 70 72 65 73 |his stud|y repres|
|00003370| 65 6e 74 73 20 74 68 65 | 20 6d 6f 73 74 20 65 78 |ents the| most ex|
|00003380| 74 65 6e 73 69 76 65 20 | 61 73 73 65 73 73 6d 65 |tensive |assessme|
|00003390| 6e 74 20 6f 66 0d 0a 74 | 68 65 20 70 72 6f 62 6c |nt of..t|he probl|
|000033a0| 65 6d 20 74 6f 20 64 61 | 74 65 3b 20 64 61 74 61 |em to da|te; data|
|000033b0| 20 77 65 72 65 20 70 72 | 6f 73 70 65 63 74 69 76 | were pr|ospectiv|
|000033c0| 65 6c 79 20 63 6f 6c 6c | 65 63 74 65 64 2c 20 6c |ely coll|ected, l|
|000033d0| 61 72 67 65 72 20 6e 75 | 6d 62 65 72 73 20 6f 66 |arger nu|mbers of|
|000033e0| 0d 0a 70 61 74 69 65 6e | 74 73 20 77 65 72 65 20 |..patien|ts were |
|000033f0| 61 6e 61 6c 79 7a 65 64 | 2c 20 61 6e 64 20 70 72 |analyzed|, and pr|
|00003400| 6f 70 65 72 20 63 6f 6e | 74 72 6f 6c 20 67 72 6f |oper con|trol gro|
|00003410| 75 70 73 20 77 65 72 65 | 20 69 6e 63 6c 75 64 65 |ups were| include|
|00003420| 64 2e 20 20 54 68 65 20 | 64 61 74 61 0d 0a 63 6f |d. The |data..co|
|00003430| 6e 66 69 72 6d 20 70 72 | 65 76 69 6f 75 73 20 72 |nfirm pr|evious r|
|00003440| 65 70 6f 72 74 73 20 6f | 66 20 61 20 68 69 67 68 |eports o|f a high|
|00003450| 65 72 20 72 69 73 6b 20 | 6f 66 20 63 6f 6e 74 72 |er risk |of contr|
|00003460| 61 73 74 2d 69 6e 64 75 | 63 65 64 20 64 65 74 65 |ast-indu|ced dete|
|00003470| 72 69 6f 72 61 74 69 6f | 6e 20 6f 66 0d 0a 72 65 |rioratio|n of..re|
|00003480| 6e 61 6c 20 66 75 6e 63 | 74 69 6f 6e 20 69 6e 20 |nal func|tion in |
|00003490| 64 69 61 62 65 74 69 63 | 20 70 61 74 69 65 6e 74 |diabetic| patient|
|000034a0| 73 20 77 69 74 68 20 6d | 69 6c 64 20 61 7a 6f 74 |s with m|ild azot|
|000034b0| 65 6d 69 61 20 28 73 65 | 72 75 6d 20 63 72 65 61 |emia (se|rum crea|
|000034c0| 74 69 6e 69 6e 65 20 6c | 65 76 65 6c 0d 0a 62 65 |tinine l|evel..be|
|000034d0| 74 77 65 65 6e 20 31 2e | 37 20 61 6e 64 20 34 2e |tween 1.|7 and 4.|
|000034e0| 30 20 6d 67 2f 64 4c 29 | 2e 20 20 54 68 65 20 69 |0 mg/dL)|. The i|
|000034f0| 6e 63 69 64 65 6e 63 65 | 20 6f 66 20 61 20 73 65 |ncidence| of a se|
|00003500| 72 75 6d 20 63 72 65 61 | 74 69 6e 69 6e 65 20 72 |rum crea|tinine r|
|00003510| 69 73 65 20 69 6e 20 74 | 68 69 73 0d 0a 70 6f 70 |ise in t|his..pop|
|00003520| 75 6c 61 74 69 6f 6e 20 | 67 72 6f 75 70 20 77 61 |ulation |group wa|
|00003530| 73 20 61 62 6f 75 74 20 | 39 25 2c 20 77 68 69 63 |s about |9%, whic|
|00003540| 68 20 74 68 65 20 61 75 | 74 68 6f 72 73 20 73 75 |h the au|thors su|
|00003550| 67 67 65 73 74 20 77 61 | 73 20 6c 6f 77 65 72 20 |ggest wa|s lower |
|00003560| 74 68 61 6e 20 74 68 61 | 74 0d 0a 72 65 70 6f 72 |than tha|t..repor|
|00003570| 74 65 64 20 62 79 20 6f | 74 68 65 72 20 67 72 6f |ted by o|ther gro|
|00003580| 75 70 73 2e 20 20 48 6f | 77 65 76 65 72 2c 20 65 |ups. Ho|wever, e|
|00003590| 61 72 6c 69 65 72 20 73 | 74 75 64 69 65 73 20 69 |arlier s|tudies i|
|000035a0| 6e 76 6f 6c 76 65 64 20 | 70 61 74 69 65 6e 74 73 |nvolved |patients|
|000035b0| 20 77 69 74 68 0d 0a 6d | 6f 72 65 20 73 65 76 65 | with..m|ore seve|
|000035c0| 72 65 20 61 7a 6f 74 65 | 6d 69 61 2e 20 20 46 75 |re azote|mia. Fu|
|000035d0| 72 74 68 65 72 6d 6f 72 | 65 2c 20 66 65 77 65 72 |rthermor|e, fewer|
|000035e0| 20 70 61 74 69 65 6e 74 | 73 20 69 6e 20 74 68 65 | patient|s in the|
|000035f0| 20 63 75 72 72 65 6e 74 | 20 73 74 75 64 79 0d 0a | current| study..|
|00003600| 72 65 63 65 69 76 65 64 | 20 69 6e 74 72 61 76 65 |received| intrave|
|00003610| 6e 6f 75 73 20 70 79 65 | 6c 6f 67 72 61 70 68 79 |nous pye|lography|
|00003620| 2c 20 61 20 70 72 6f 63 | 65 64 75 72 65 20 74 68 |, a proc|edure th|
|00003630| 61 74 20 6d 61 79 20 62 | 65 20 6d 6f 72 65 20 72 |at may b|e more r|
|00003640| 69 73 6b 79 20 62 65 63 | 61 75 73 65 0d 0a 6f 66 |isky bec|ause..of|
|00003650| 20 64 65 68 79 64 72 61 | 74 69 6f 6e 20 73 65 63 | dehydra|tion sec|
|00003660| 6f 6e 64 61 72 79 20 74 | 6f 20 74 68 65 20 75 73 |ondary t|o the us|
|00003670| 65 20 6f 66 20 6c 61 78 | 61 74 69 76 65 20 70 72 |e of lax|ative pr|
|00003680| 65 70 61 72 61 74 69 6f | 6e 73 2e 0d 0a 20 20 20 |eparatio|ns... |
|00003690| 20 20 54 68 65 20 6d 65 | 73 73 61 67 65 20 6f 66 | The me|ssage of|
|000036a0| 20 74 68 65 20 73 74 75 | 64 79 20 69 73 20 63 6c | the stu|dy is cl|
|000036b0| 65 61 72 3a 20 20 4f 6e | 65 20 73 68 6f 75 6c 64 |ear: On|e should|
|000036c0| 20 74 61 6b 65 20 70 61 | 75 73 65 20 62 65 66 6f | take pa|use befo|
|000036d0| 72 65 20 6f 72 64 65 72 | 69 6e 67 0d 0a 72 61 64 |re order|ing..rad|
|000036e0| 69 6f 67 72 61 70 68 69 | 63 20 63 6f 6e 74 72 61 |iographi|c contra|
|000036f0| 73 74 20 73 74 75 64 69 | 65 73 20 69 6e 20 61 7a |st studi|es in az|
|00003700| 6f 74 65 6d 69 63 20 64 | 69 61 62 65 74 69 63 20 |otemic d|iabetic |
|00003710| 70 61 74 69 65 6e 74 73 | 20 61 6e 64 20 73 68 6f |patients| and sho|
|00003720| 75 6c 64 20 62 65 0d 0a | 63 6f 67 6e 69 7a 61 6e |uld be..|cognizan|
|00003730| 74 20 6f 66 20 74 68 65 | 20 70 6f 74 65 6e 74 69 |t of the| potenti|
|00003740| 61 6c 20 72 69 73 6b 73 | 20 69 6e 76 6f 6c 76 65 |al risks| involve|
|00003750| 64 2e 20 20 53 70 65 63 | 69 61 6c 20 61 74 74 65 |d. Spec|ial atte|
|00003760| 6e 74 69 6f 6e 20 73 68 | 6f 75 6c 64 20 62 65 20 |ntion sh|ould be |
|00003770| 67 69 76 65 6e 0d 0a 74 | 6f 20 61 76 6f 69 64 20 |given..t|o avoid |
|00003780| 64 65 68 79 64 72 61 74 | 69 6f 6e 20 62 65 66 6f |dehydrat|ion befo|
|00003790| 72 65 20 61 6e 64 20 69 | 6d 6d 65 64 69 61 74 65 |re and i|mmediate|
|000037a0| 6c 79 20 61 66 74 65 72 | 20 74 68 65 20 70 72 6f |ly after| the pro|
|000037b0| 63 65 64 75 72 65 2e 20 | 20 4f 6e 20 74 68 65 20 |cedure. | On the |
|000037c0| 6f 74 68 65 72 0d 0a 68 | 61 6e 64 2c 20 74 68 65 |other..h|and, the|
|000037d0| 20 64 65 74 65 72 69 6f | 72 61 74 69 6f 6e 20 6f | deterio|ration o|
|000037e0| 66 20 72 65 6e 61 6c 20 | 66 75 6e 63 74 69 6f 6e |f renal |function|
|000037f0| 20 72 65 70 6f 72 74 65 | 64 20 68 65 72 65 20 77 | reporte|d here w|
|00003800| 61 73 20 67 65 6e 65 72 | 61 6c 6c 79 20 6d 69 6c |as gener|ally mil|
|00003810| 64 20 61 6e 64 0d 0a 6e | 6f 74 20 6f 66 20 73 75 |d and..n|ot of su|
|00003820| 66 66 69 63 69 65 6e 74 | 20 6d 61 67 6e 69 74 75 |fficient| magnitu|
|00003830| 64 65 20 74 6f 20 61 72 | 67 75 65 20 61 67 61 69 |de to ar|gue agai|
|00003840| 6e 73 74 20 74 68 65 20 | 75 73 65 20 6f 66 20 63 |nst the |use of c|
|00003850| 6f 6e 74 72 61 73 74 20 | 77 68 65 6e 0d 0a 61 70 |ontrast |when..ap|
|00003860| 70 72 6f 70 72 69 61 74 | 65 2e 20 20 54 68 65 20 |propriat|e. The |
|00003870| 73 74 75 64 79 20 61 6c | 73 6f 20 70 72 6f 76 69 |study al|so provi|
|00003880| 64 65 73 20 65 76 69 64 | 65 6e 63 65 20 74 68 61 |des evid|ence tha|
|00003890| 74 20 74 68 65 20 70 72 | 6f 62 6c 65 6d 20 6f 66 |t the pr|oblem of|
|000038a0| 0d 0a 63 6f 6e 74 72 61 | 73 74 2d 69 6e 64 75 63 |..contra|st-induc|
|000038b0| 65 64 20 6e 65 70 68 72 | 6f 74 6f 78 69 63 69 74 |ed nephr|otoxicit|
|000038c0| 79 20 69 73 20 6c 69 6d | 69 74 65 64 20 74 6f 20 |y is lim|ited to |
|000038d0| 74 68 6f 73 65 20 64 69 | 61 62 65 74 69 63 73 20 |those di|abetics |
|000038e0| 77 69 74 68 20 63 6f 65 | 78 69 73 74 69 6e 67 0d |with coe|xisting.|
|000038f0| 0a 6e 65 70 68 72 6f 70 | 61 74 68 79 2e 2d 2d 52 |.nephrop|athy.--R|
|00003900| 2e 53 2e 20 53 68 65 72 | 77 69 6e 2c 20 4d 2e 44 |.S. Sher|win, M.D|
|00003910| 2e 0d 0a 24 55 6e 69 71 | 75 65 5f 49 44 7b 59 52 |...$Uniq|ue_ID{YR|
|00003920| 42 31 33 31 30 33 7d 0d | 0a 24 54 69 74 6c 65 7b |B13103}.|.$Title{|
|00003930| 49 6e 63 69 64 65 6e 63 | 65 20 6f 66 20 53 70 6f |Incidenc|e of Spo|
|00003940| 6e 74 61 6e 65 6f 75 73 | 20 41 62 6f 72 74 69 6f |ntaneous| Abortio|
|00003950| 6e 20 41 6d 6f 6e 67 20 | 4e 6f 72 6d 61 6c 20 57 |n Among |Normal W|
|00003960| 6f 6d 65 6e 20 61 6e 64 | 20 49 6e 73 75 6c 69 6e |omen and| Insulin|
|00003970| 2d 44 65 70 65 6e 64 65 | 6e 74 20 44 69 61 62 65 |-Depende|nt Diabe|
|00003980| 74 69 63 20 57 6f 6d 65 | 6e 20 57 68 6f 73 65 20 |tic Wome|n Whose |
|00003990| 50 72 65 67 6e 61 6e 63 | 69 65 73 20 57 65 72 65 |Pregnanc|ies Were|
|000039a0| 20 49 64 65 6e 74 69 66 | 69 65 64 20 57 69 74 68 | Identif|ied With|
|000039b0| 69 6e 20 32 31 20 44 61 | 79 73 20 6f 66 20 43 6f |in 21 Da|ys of Co|
|000039c0| 6e 63 65 70 74 69 6f 6e | 7d 0d 0a 24 41 75 74 68 |nception|}..$Auth|
|000039d0| 6f 72 7b 4d 69 6c 6c 73 | 2c 20 4a 4c 0d 0a 53 69 |or{Mills|, JL..Si|
|000039e0| 6d 70 73 6f 6e 2c 20 4a | 4c 0d 0a 44 72 69 73 63 |mpson, J|L..Drisc|
|000039f0| 6f 6c 6c 2c 20 53 47 0d | 0a 4a 6f 76 61 6e 6f 76 |oll, SG.|.Jovanov|
|00003a00| 69 63 2d 50 65 74 65 72 | 73 6f 6e 2c 20 4c 0d 0a |ic-Peter|son, L..|
|00003a10| 56 61 6e 20 41 6c 6c 65 | 6e 2c 20 4d 0d 0a 41 61 |Van Alle|n, M..Aa|
|00003a20| 72 6f 6e 73 2c 20 4a 48 | 0d 0a 4d 65 74 7a 67 65 |rons, JH|..Metzge|
|00003a30| 72 2c 20 42 0d 0a 42 69 | 65 62 65 72 2c 20 46 52 |r, B..Bi|eber, FR|
|00003a40| 0d 0a 4b 6e 6f 70 70 2c | 20 52 48 0d 0a 48 6f 6c |..Knopp,| RH..Hol|
|00003a50| 6d 65 73 2c 20 4c 42 0d | 0a 50 65 74 65 72 73 6f |mes, LB.|.Peterso|
|00003a60| 6e 2c 20 43 4d 0d 0a 57 | 69 74 68 69 61 6d 2d 57 |n, CM..W|ithiam-W|
|00003a70| 69 6c 73 6f 6e 2c 20 4d | 0d 0a 42 72 6f 77 6e 2c |ilson, M|..Brown,|
|00003a80| 20 5a 0d 0a 4f 62 65 72 | 2c 20 43 0d 0a 48 61 72 | Z..Ober|, C..Har|
|00003a90| 6c 65 79 2c 20 45 0d 0a | 4d 61 63 70 68 65 72 73 |ley, E..|Macphers|
|00003aa0| 6f 6e 2c 20 54 41 0d 0a | 44 75 63 6b 6c 65 73 2c |on, TA..|Duckles,|
|00003ab0| 20 41 0d 0a 4d 75 65 6c | 6c 65 72 2d 48 65 75 62 | A..Muel|ler-Heub|
|00003ac0| 61 63 68 2c 20 45 0d 0a | 74 68 65 20 4e 61 74 6c |ach, E..|the Natl|
|00003ad0| 20 49 6e 73 74 20 6f 66 | 20 43 68 69 6c 64 20 48 | Inst of| Child H|
|00003ae0| 65 61 6c 74 68 20 61 6e | 64 20 48 75 6d 61 6e 20 |ealth an|d Human |
|00003af0| 44 65 76 65 6c 6f 70 6d | 65 6e 74 2d 44 69 61 62 |Developm|ent-Diab|
|00003b00| 65 74 65 73 20 69 6e 20 | 45 61 72 6c 79 20 50 72 |etes in |Early Pr|
|00003b10| 65 67 6e 61 6e 63 79 20 | 53 74 75 64 79 7d 0d 0a |egnancy |Study}..|
|00003b20| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 4e 61 74 |$Affilia|tion{Nat|
|00003b30| 6c 20 49 6e 73 74 20 6f | 66 20 43 68 69 6c 64 20 |l Inst o|f Child |
|00003b40| 48 65 61 6c 74 68 20 61 | 6e 64 20 48 75 6d 61 6e |Health a|nd Human|
|00003b50| 20 44 65 76 65 6c 6f 70 | 6d 65 6e 74 2c 20 42 65 | Develop|ment, Be|
|00003b60| 74 68 65 73 64 61 2c 20 | 4d 64 3b 20 4e 6f 72 74 |thesda, |Md; Nort|
|00003b70| 68 77 65 73 74 65 72 6e | 20 55 6e 69 76 3b 20 42 |hwestern| Univ; B|
|00003b80| 72 69 67 68 61 6d 20 61 | 6e 64 20 57 6f 6d 65 6e |righam a|nd Women|
|00003b90| 27 73 20 48 6f 73 70 2c | 20 42 6f 73 74 6f 6e 3b |'s Hosp,| Boston;|
|00003ba0| 20 43 6f 72 6e 65 6c 6c | 20 55 6e 69 76 2c 20 4e | Cornell| Univ, N|
|00003bb0| 65 77 20 59 6f 72 6b 3b | 20 55 6e 69 76 20 6f 66 |ew York;| Univ of|
|00003bc0| 20 57 61 73 68 69 6e 67 | 74 6f 6e 7d 0d 0a 24 4a | Washing|ton}..$J|
|00003bd0| 6f 75 72 6e 61 6c 7b 4e | 20 45 6e 67 6c 20 4a 20 |ournal{N| Engl J |
|00003be0| 4d 65 64 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 33 31 |Med}..$V|olume{31|
|00003bf0| 39 7d 0d 0a 24 50 61 67 | 65 7b 31 36 31 37 2d 31 |9}..$Pag|e{1617-1|
|00003c00| 36 32 33 7d 0d 0a 24 44 | 61 74 65 7b 44 65 63 20 |623}..$D|ate{Dec |
|00003c10| 32 32 2c 20 31 39 38 38 | 7d 0d 0a 24 59 42 56 6f |22, 1988|}..$YBVo|
|00003c20| 6c 7b 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |l{1990 Y|ear Book|
|00003c30| 20 6f 66 20 45 6e 64 6f | 63 72 69 6e 6f 6c 6f 67 | of Endo|crinolog|
|00003c40| 79 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 31 30 2d |y}..$Cha|pter{10-|
|00003c50| 32 37 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 4a |27}..$YB|Editor{J|
|00003c60| 6f 68 6e 20 44 2e 20 42 | 61 67 64 61 64 65 2c 20 |ohn D. B|agdade, |
|00003c70| 4d 2e 44 2e 7d 0d 0a 24 | 54 61 62 6c 65 7b 54 61 |M.D.}..$|Table{Ta|
|00003c80| 62 6c 65 20 4f 6d 69 74 | 74 65 64 7d 0d 0a 24 43 |ble Omit|ted}..$C|
|00003c90| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 52 2e 53 2e 20 |ommentat|or{R.S. |
|00003ca0| 53 68 65 72 77 69 6e 2c | 20 4d 2e 44 2e 7d 0d 0a |Sherwin,| M.D.}..|
|00003cb0| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 63 29 20 |..Copyri|ght (c) |
|00003cc0| 59 65 61 72 62 6f 6f 6b | 20 4d 65 64 69 63 61 6c |Yearbook| Medical|
|00003cd0| 20 50 75 62 6c 69 73 68 | 65 72 73 2c 20 49 6e 63 | Publish|ers, Inc|
|00003ce0| 2e 2c 20 31 39 39 30 0d | 0a 0d 0a 31 39 39 30 20 |., 1990.|...1990 |
|00003cf0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 45 6e 64 |Year Boo|k of End|
|00003d00| 6f 63 72 69 6e 6f 6c 6f | 67 79 20 28 52 29 0d 0a |ocrinolo|gy (R)..|
|00003d10| 0d 0a 43 68 61 70 74 65 | 72 20 31 30 2d 2d 44 69 |..Chapte|r 10--Di|
|00003d20| 61 62 65 74 65 73 20 4d | 65 6c 6c 69 74 75 73 20 |abetes M|ellitus |
|00003d30| 61 6e 64 20 43 61 72 62 | 6f 68 79 64 72 61 74 65 |and Carb|ohydrate|
|00003d40| 20 4d 65 74 61 62 6f 6c | 69 73 6d 0d 0a 0d 0a 4f | Metabol|ism....O|
|00003d50| 74 68 65 72 20 43 6f 6d | 70 6c 69 63 61 74 69 6f |ther Com|plicatio|
|00003d60| 6e 73 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ns....--|--------|
|00003d70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003da0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003db0| 2d 2d 2d 2d 0d 0a 49 6e | 63 69 64 65 6e 63 65 20 |----..In|cidence |
|00003dc0| 6f 66 20 53 70 6f 6e 74 | 61 6e 65 6f 75 73 20 41 |of Spont|aneous A|
|00003dd0| 62 6f 72 74 69 6f 6e 20 | 41 6d 6f 6e 67 20 4e 6f |bortion |Among No|
|00003de0| 72 6d 61 6c 20 57 6f 6d | 65 6e 20 61 6e 64 20 49 |rmal Wom|en and I|
|00003df0| 6e 73 75 6c 69 6e 2d 44 | 65 70 65 6e 64 65 6e 74 |nsulin-D|ependent|
|00003e00| 0d 0a 44 69 61 62 65 74 | 69 63 20 57 6f 6d 65 6e |..Diabet|ic Women|
|00003e10| 20 57 68 6f 73 65 20 50 | 72 65 67 6e 61 6e 63 69 | Whose P|regnanci|
|00003e20| 65 73 20 57 65 72 65 20 | 49 64 65 6e 74 69 66 69 |es Were |Identifi|
|00003e30| 65 64 20 57 69 74 68 69 | 6e 20 32 31 20 44 61 79 |ed Withi|n 21 Day|
|00003e40| 73 20 6f 66 20 43 6f 6e | 63 65 70 74 69 6f 6e 0d |s of Con|ception.|
|00003e50| 0a 0d 0a 4d 69 6c 6c 73 | 20 4a 4c 2c 20 53 69 6d |...Mills| JL, Sim|
|00003e60| 70 73 6f 6e 20 4a 4c 2c | 20 44 72 69 73 63 6f 6c |pson JL,| Driscol|
|00003e70| 6c 20 53 47 2c 20 4a 6f | 76 61 6e 6f 76 69 63 2d |l SG, Jo|vanovic-|
|00003e80| 50 65 74 65 72 73 6f 6e | 20 4c 2c 20 56 61 6e 20 |Peterson| L, Van |
|00003e90| 41 6c 6c 65 6e 20 4d 2c | 20 41 61 72 6f 6e 73 0d |Allen M,| Aarons.|
|00003ea0| 0a 4a 48 2c 20 4d 65 74 | 7a 67 65 72 20 42 2c 20 |.JH, Met|zger B, |
|00003eb0| 42 69 65 62 65 72 20 46 | 52 2c 20 4b 6e 6f 70 70 |Bieber F|R, Knopp|
|00003ec0| 20 52 48 2c 20 48 6f 6c | 6d 65 73 20 4c 42 2c 20 | RH, Hol|mes LB, |
|00003ed0| 50 65 74 65 72 73 6f 6e | 20 43 4d 2c 20 57 69 74 |Peterson| CM, Wit|
|00003ee0| 68 69 61 6d 2d 57 69 6c | 73 6f 6e 20 4d 2c 0d 0a |hiam-Wil|son M,..|
|00003ef0| 42 72 6f 77 6e 20 5a 2c | 20 4f 62 65 72 20 43 2c |Brown Z,| Ober C,|
|00003f00| 20 48 61 72 6c 65 79 20 | 45 2c 20 4d 61 63 70 68 | Harley |E, Macph|
|00003f10| 65 72 73 6f 6e 20 54 41 | 2c 20 44 75 63 6b 6c 65 |erson TA|, Duckle|
|00003f20| 73 20 41 2c 20 4d 75 65 | 6c 6c 65 72 2d 48 65 75 |s A, Mue|ller-Heu|
|00003f30| 62 61 63 68 20 45 2c 20 | 61 6e 64 0d 0a 74 68 65 |bach E, |and..the|
|00003f40| 20 4e 61 74 6c 20 49 6e | 73 74 20 6f 66 20 43 68 | Natl In|st of Ch|
|00003f50| 69 6c 64 20 48 65 61 6c | 74 68 20 61 6e 64 20 48 |ild Heal|th and H|
|00003f60| 75 6d 61 6e 20 44 65 76 | 65 6c 6f 70 6d 65 6e 74 |uman Dev|elopment|
|00003f70| 2d 44 69 61 62 65 74 65 | 73 20 69 6e 20 45 61 72 |-Diabete|s in Ear|
|00003f80| 6c 79 0d 0a 50 72 65 67 | 6e 61 6e 63 79 20 53 74 |ly..Preg|nancy St|
|00003f90| 75 64 79 0d 0a 28 4e 61 | 74 6c 20 49 6e 73 74 20 |udy..(Na|tl Inst |
|00003fa0| 6f 66 20 43 68 69 6c 64 | 20 48 65 61 6c 74 68 20 |of Child| Health |
|00003fb0| 61 6e 64 20 48 75 6d 61 | 6e 20 44 65 76 65 6c 6f |and Huma|n Develo|
|00003fc0| 70 6d 65 6e 74 2c 20 42 | 65 74 68 65 73 64 61 2c |pment, B|ethesda,|
|00003fd0| 20 4d 64 3b 20 4e 6f 72 | 74 68 77 65 73 74 65 72 | Md; Nor|thwester|
|00003fe0| 6e 0d 0a 55 6e 69 76 3b | 20 42 72 69 67 68 61 6d |n..Univ;| Brigham|
|00003ff0| 20 61 6e 64 20 57 6f 6d | 65 6e 27 73 20 48 6f 73 | and Wom|en's Hos|
|00004000| 70 2c 20 42 6f 73 74 6f | 6e 3b 20 43 6f 72 6e 65 |p, Bosto|n; Corne|
|00004010| 6c 6c 20 55 6e 69 76 2c | 20 4e 65 77 20 59 6f 72 |ll Univ,| New Yor|
|00004020| 6b 3b 20 55 6e 69 76 20 | 6f 66 0d 0a 57 61 73 68 |k; Univ |of..Wash|
|00004030| 69 6e 67 74 6f 6e 29 0d | 0a 4e 20 45 6e 67 6c 20 |ington).|.N Engl |
|00004040| 4a 20 4d 65 64 20 33 31 | 39 3a 31 36 31 37 2d 31 |J Med 31|9:1617-1|
|00004050| 36 32 33 2c 20 44 65 63 | 20 32 32 2c 20 31 39 38 |623, Dec| 22, 198|
|00004060| 38 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |8..-----|--------|
|00004070| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004080| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004090| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040b0| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|000040c0| 0a 20 20 20 20 20 54 6f | 20 64 65 74 65 72 6d 69 |. To| determi|
|000040d0| 6e 65 20 77 68 65 74 68 | 65 72 20 69 6e 73 75 6c |ne wheth|er insul|
|000040e0| 69 6e 2d 64 65 70 65 6e | 64 65 6e 74 20 64 69 61 |in-depen|dent dia|
|000040f0| 62 65 74 65 73 20 6d 65 | 6c 6c 69 74 75 73 20 69 |betes me|llitus i|
|00004100| 6e 63 72 65 61 73 65 73 | 20 61 0d 0a 77 6f 6d 61 |ncreases| a..woma|
|00004110| 6e 27 73 20 72 69 73 6b | 20 6f 66 20 68 61 76 69 |n's risk| of havi|
|00004120| 6e 67 20 61 20 73 70 6f | 6e 74 61 6e 65 6f 75 73 |ng a spo|ntaneous|
|00004130| 20 61 62 6f 72 74 69 6f | 6e 2c 20 61 6e 64 20 74 | abortio|n, and t|
|00004140| 6f 20 61 73 73 65 73 73 | 20 74 68 65 20 72 65 6c |o assess| the rel|
|00004150| 61 74 69 6f 6e 73 68 69 | 70 0d 0a 62 65 74 77 65 |ationshi|p..betwe|
|00004160| 65 6e 20 6d 65 74 61 62 | 6f 6c 69 63 20 63 6f 6e |en metab|olic con|
|00004170| 74 72 6f 6c 20 61 6e 64 | 20 6c 6f 73 73 20 6f 66 |trol and| loss of|
|00004180| 20 70 72 65 67 6e 61 6e | 63 79 20 69 6e 20 64 69 | pregnan|cy in di|
|00004190| 61 62 65 74 69 63 73 2c | 20 33 38 36 20 77 6f 6d |abetics,| 386 wom|
|000041a0| 65 6e 20 77 69 74 68 0d | 0a 69 6e 73 75 6c 69 6e |en with.|.insulin|
|000041b0| 2d 64 65 70 65 6e 64 65 | 6e 74 20 64 69 61 62 65 |-depende|nt diabe|
|000041c0| 74 65 73 20 61 6e 64 20 | 34 33 32 20 6e 6f 6e 64 |tes and |432 nond|
|000041d0| 69 61 62 65 74 69 63 20 | 77 6f 6d 65 6e 20 77 65 |iabetic |women we|
|000041e0| 72 65 20 73 74 75 64 69 | 65 64 20 62 65 66 6f 72 |re studi|ed befor|
|000041f0| 65 20 6f 72 0d 0a 77 69 | 74 68 69 6e 20 32 31 20 |e or..wi|thin 21 |
|00004200| 64 61 79 73 20 61 66 74 | 65 72 20 63 6f 6e 63 65 |days aft|er conce|
|00004210| 70 74 69 6f 6e 20 61 6e | 64 20 66 6f 6c 6c 6f 77 |ption an|d follow|
|00004220| 65 64 20 70 72 6f 73 70 | 65 63 74 69 76 65 6c 79 |ed prosp|ectively|
|00004230| 2e 0d 0a 20 20 20 20 20 | 4c 6f 73 73 20 6f 66 20 |... |Loss of |
|00004240| 70 72 65 67 6e 61 6e 63 | 79 20 6f 63 63 75 72 65 |pregnanc|y occure|
|00004250| 64 20 69 6e 20 36 32 20 | 64 69 61 62 65 74 69 63 |d in 62 |diabetic|
|00004260| 20 77 6f 6d 65 6e 20 28 | 31 36 25 29 20 61 6e 64 | women (|16%) and|
|00004270| 20 69 6e 20 37 30 0d 0a | 6e 6f 6e 64 69 61 62 65 | in 70..|nondiabe|
|00004280| 74 69 63 20 77 6f 6d 65 | 6e 20 28 31 36 25 29 2e |tic wome|n (16%).|
|00004290| 20 20 41 66 74 65 72 20 | 61 64 6a 75 73 74 6d 65 | After |adjustme|
|000042a0| 6e 74 20 66 6f 72 20 6b | 6e 6f 77 6e 20 72 69 73 |nt for k|nown ris|
|000042b0| 6b 20 66 61 63 74 6f 72 | 73 20 66 6f 72 0d 0a 73 |k factor|s for..s|
|000042c0| 70 6f 6e 74 61 6e 65 6f | 75 73 20 61 62 6f 72 74 |pontaneo|us abort|
|000042d0| 69 6f 6e 2c 20 74 68 65 | 20 72 61 74 65 20 77 61 |ion, the| rate wa|
|000042e0| 73 20 73 74 69 6c 6c 20 | 6e 6f 74 20 73 69 67 6e |s still |not sign|
|000042f0| 69 66 69 63 61 6e 74 6c | 79 20 68 69 67 68 65 72 |ificantl|y higher|
|00004300| 20 61 6d 6f 6e 67 0d 0a | 64 69 61 62 65 74 69 63 | among..|diabetic|
|00004310| 20 77 6f 6d 65 6e 20 28 | 46 69 67 20 31 30 2d 36 | women (|Fig 10-6|
|00004320| 29 2e 20 20 48 6f 77 65 | 76 65 72 2c 20 61 6d 6f |). Howe|ver, amo|
|00004330| 6e 67 20 74 68 65 20 64 | 69 61 62 65 74 69 63 20 |ng the d|iabetic |
|00004340| 77 6f 6d 65 6e 2c 20 6d | 6f 73 74 20 6f 66 20 77 |women, m|ost of w|
|00004350| 68 6f 6d 0d 0a 68 61 64 | 20 67 6f 6f 64 20 6d 65 |hom..had| good me|
|00004360| 74 61 62 6f 6c 69 63 20 | 63 6f 6e 74 72 6f 6c 2c |tabolic |control,|
|00004370| 20 74 68 6f 73 65 20 77 | 68 6f 20 68 61 64 20 73 | those w|ho had s|
|00004380| 70 6f 6e 74 61 6e 65 6f | 75 73 20 61 62 6f 72 74 |pontaneo|us abort|
|00004390| 69 6f 6e 73 20 68 61 64 | 20 68 69 67 68 65 72 0d |ions had| higher.|
|000043a0| 0a 66 61 73 74 69 6e 67 | 20 61 6e 64 20 70 6f 73 |.fasting| and pos|
|000043b0| 74 70 72 61 6e 64 69 61 | 6c 20 67 6c 75 63 6f 73 |tprandia|l glucos|
|000043c0| 65 20 6c 65 76 65 6c 73 | 20 69 6e 20 74 68 65 20 |e levels| in the |
|000043d0| 66 69 72 73 74 20 74 72 | 69 6d 65 73 74 65 72 20 |first tr|imester |
|000043e0| 74 68 61 6e 20 74 68 6f | 73 65 0d 0a 77 68 6f 73 |than tho|se..whos|
|000043f0| 65 20 70 72 65 67 6e 61 | 6e 63 69 65 73 20 63 6f |e pregna|ncies co|
|00004400| 6e 74 69 6e 75 65 64 20 | 74 6f 20 64 65 6c 69 76 |ntinued |to deliv|
|00004410| 65 72 79 2e 20 20 49 6e | 20 74 68 65 20 73 6d 61 |ery. In| the sma|
|00004420| 6c 6c 20 73 75 62 67 72 | 6f 75 70 20 6f 66 20 64 |ll subgr|oup of d|
|00004430| 69 61 62 65 74 69 63 0d | 0a 77 6f 6d 65 6e 20 77 |iabetic.|.women w|
|00004440| 69 74 68 20 70 6f 6f 72 | 20 63 6f 6e 74 72 6f 6c |ith poor| control|
|00004450| 2c 20 77 68 6f 20 68 61 | 64 20 69 6e 63 72 65 61 |, who ha|d increa|
|00004460| 73 65 64 20 76 61 6c 75 | 65 73 20 66 6f 72 20 67 |sed valu|es for g|
|00004470| 6c 79 63 6f 73 79 6c 61 | 74 65 64 20 68 65 6d 6f |lycosyla|ted hemo|
|00004480| 67 6c 6f 62 69 6e 0d 0a | 69 6e 20 74 68 65 20 66 |globin..|in the f|
|00004490| 69 72 73 74 20 74 72 69 | 6d 65 73 74 65 72 2c 20 |irst tri|mester, |
|000044a0| 65 61 63 68 20 69 6e 63 | 72 65 61 73 65 20 6f 66 |each inc|rease of|
|000044b0| 20 31 20 53 44 20 61 62 | 6f 76 65 20 74 68 65 20 | 1 SD ab|ove the |
|000044c0| 6e 6f 72 6d 61 6c 20 72 | 61 6e 67 65 20 77 61 73 |normal r|ange was|
|000044d0| 0d 0a 61 73 73 6f 63 69 | 61 74 65 64 20 77 69 74 |..associ|ated wit|
|000044e0| 68 20 61 6e 20 69 6e 63 | 72 65 61 73 65 20 6f 66 |h an inc|rease of|
|000044f0| 20 33 2e 31 25 20 69 6e | 20 74 68 65 20 72 61 74 | 3.1% in| the rat|
|00004500| 65 20 6f 66 20 70 72 65 | 67 6e 61 6e 63 79 20 6c |e of pre|gnancy l|
|00004510| 6f 73 73 2e 0d 0a 20 20 | 20 20 20 44 69 61 62 65 |oss... | Diabe|
|00004520| 74 69 63 20 77 6f 6d 65 | 6e 20 77 69 74 68 20 67 |tic wome|n with g|
|00004530| 6f 6f 64 20 6d 65 74 61 | 62 6f 6c 69 63 20 63 6f |ood meta|bolic co|
|00004540| 6e 74 72 6f 6c 20 61 72 | 65 20 6e 6f 20 6d 6f 72 |ntrol ar|e no mor|
|00004550| 65 20 6c 69 6b 65 6c 79 | 20 74 6f 20 6c 6f 73 65 |e likely| to lose|
|00004560| 20 61 0d 0a 70 72 65 67 | 6e 61 6e 63 79 20 74 68 | a..preg|nancy th|
|00004570| 61 6e 20 6e 6f 6e 64 69 | 61 62 65 74 69 63 20 77 |an nondi|abetic w|
|00004580| 6f 6d 65 6e 2e 20 20 48 | 6f 77 65 76 65 72 2c 20 |omen. H|owever, |
|00004590| 64 69 61 62 65 74 69 63 | 20 77 6f 6d 65 6e 20 77 |diabetic| women w|
|000045a0| 69 74 68 20 69 6e 63 72 | 65 61 73 65 64 0d 0a 62 |ith incr|eased..b|
|000045b0| 6c 6f 6f 64 20 67 6c 75 | 63 6f 73 65 20 61 6e 64 |lood glu|cose and|
|000045c0| 20 67 6c 79 63 6f 73 79 | 6c 61 74 65 64 20 68 65 | glycosy|lated he|
|000045d0| 6d 6f 67 6c 6f 62 69 6e | 20 6c 65 76 65 6c 73 20 |moglobin| levels |
|000045e0| 69 6e 20 74 68 65 20 66 | 69 72 73 74 20 74 72 69 |in the f|irst tri|
|000045f0| 6d 65 73 74 65 72 20 68 | 61 76 65 20 61 0d 0a 73 |mester h|ave a..s|
|00004600| 69 67 6e 69 66 69 63 61 | 6e 74 6c 79 20 67 72 65 |ignifica|ntly gre|
|00004610| 61 74 65 72 20 72 69 73 | 6b 20 6f 66 20 73 70 6f |ater ris|k of spo|
|00004620| 6e 74 61 6e 65 6f 75 73 | 20 61 62 6f 72 74 69 6f |ntaneous| abortio|
|00004630| 6e 2e 0d 0a 0d 0a 50 6f | 73 74 2d 43 6f 6d 6d 65 |n.....Po|st-Comme|
|00004640| 6e 74 0d 0a 0d 0a 20 20 | 20 20 20 54 68 69 73 20 |nt.... | This |
|00004650| 72 65 70 6f 72 74 20 69 | 73 20 65 6e 63 6f 75 72 |report i|s encour|
|00004660| 61 67 69 6e 67 20 62 65 | 63 61 75 73 65 20 69 74 |aging be|cause it|
|00004670| 20 73 75 67 67 65 73 74 | 73 20 74 68 61 74 20 64 | suggest|s that d|
|00004680| 69 61 62 65 74 69 63 20 | 77 6f 6d 65 6e 2c 20 69 |iabetic |women, i|
|00004690| 66 0d 0a 74 68 65 79 20 | 70 61 79 20 63 61 72 65 |f..they |pay care|
|000046a0| 66 75 6c 20 61 74 74 65 | 6e 74 69 6f 6e 20 74 6f |ful atte|ntion to|
|000046b0| 20 74 68 65 69 72 20 68 | 65 61 6c 74 68 2c 20 61 | their h|ealth, a|
|000046c0| 72 65 20 6e 6f 74 20 61 | 74 20 69 6e 63 72 65 61 |re not a|t increa|
|000046d0| 73 65 64 20 72 69 73 6b | 20 6f 66 0d 0a 73 70 6f |sed risk| of..spo|
|000046e0| 6e 74 61 6e 65 6f 75 73 | 20 61 62 6f 72 74 69 6f |ntaneous| abortio|
|000046f0| 6e 20 77 68 65 6e 20 63 | 6f 6d 70 61 72 65 64 20 |n when c|ompared |
|00004700| 74 6f 20 74 68 65 69 72 | 20 6e 6f 6e 64 69 61 62 |to their| nondiab|
|00004710| 65 74 69 63 20 63 6f 75 | 6e 74 65 72 20 70 61 72 |etic cou|nter par|
|00004720| 74 73 2e 20 20 4f 6e 6c | 79 0d 0a 77 6f 6d 65 6e |ts. Onl|y..women|
|00004730| 20 77 69 74 68 20 76 65 | 72 79 20 70 6f 6f 72 20 | with ve|ry poor |
|00004740| 6d 65 74 61 62 6f 6c 69 | 63 20 63 6f 6e 74 72 6f |metaboli|c contro|
|00004750| 6c 20 64 65 6d 6f 6e 73 | 74 72 61 74 65 64 20 61 |l demons|trated a|
|00004760| 20 68 69 67 68 65 72 20 | 72 61 74 65 20 6f 66 0d | higher |rate of.|
|00004770| 0a 73 70 6f 6e 74 61 6e | 65 6f 75 73 20 61 62 6f |.spontan|eous abo|
|00004780| 72 74 69 6f 6e 2e 20 20 | 50 72 65 76 69 6f 75 73 |rtion. |Previous|
|00004790| 20 61 72 74 69 63 6c 65 | 73 20 68 61 64 20 73 75 | article|s had su|
|000047a0| 67 67 65 73 74 65 64 20 | 74 68 61 74 20 64 69 61 |ggested |that dia|
|000047b0| 62 65 74 69 63 20 77 6f | 6d 65 6e 20 69 6e 0d 0a |betic wo|men in..|
|000047c0| 70 6f 6f 72 20 6d 65 74 | 61 62 6f 6c 69 63 20 63 |poor met|abolic c|
|000047d0| 6f 6e 74 72 6f 6c 20 61 | 72 65 20 6d 6f 72 65 20 |ontrol a|re more |
|000047e0| 6c 69 6b 65 6c 79 20 74 | 6f 20 68 61 76 65 20 73 |likely t|o have s|
|000047f0| 70 6f 6e 74 61 6e 65 6f | 75 73 20 61 62 6f 72 74 |pontaneo|us abort|
|00004800| 69 6f 6e 73 2e 20 20 49 | 74 20 77 61 73 0d 0a 75 |ions. I|t was..u|
|00004810| 6e 63 65 72 74 61 69 6e | 2c 20 68 6f 77 65 76 65 |ncertain|, howeve|
|00004820| 72 2c 20 77 68 65 74 68 | 65 72 20 74 68 65 20 69 |r, wheth|er the i|
|00004830| 6d 70 65 72 66 65 63 74 | 20 6d 65 74 68 6f 64 73 |mperfect| methods|
|00004840| 20 6f 66 20 74 72 65 61 | 74 6d 65 6e 74 20 61 76 | of trea|tment av|
|00004850| 61 69 6c 61 62 6c 65 20 | 74 6f 64 61 79 0d 0a 77 |ailable |today..w|
|00004860| 65 72 65 20 73 75 66 66 | 69 63 69 65 6e 74 20 74 |ere suff|icient t|
|00004870| 6f 20 70 72 65 76 65 6e | 74 20 65 61 72 6c 79 20 |o preven|t early |
|00004880| 66 65 74 61 6c 20 77 61 | 73 74 61 67 65 2e 20 20 |fetal wa|stage. |
|00004890| 43 6f 6e 73 69 64 65 72 | 69 6e 67 20 74 68 61 74 |Consider|ing that|
|000048a0| 20 74 68 69 73 20 72 65 | 70 6f 72 74 0d 0a 69 6e | this re|port..in|
|000048b0| 76 6f 6c 76 65 64 20 6c | 61 72 67 65 20 6e 75 6d |volved l|arge num|
|000048c0| 62 65 72 73 20 6f 66 20 | 70 61 74 69 65 6e 74 73 |bers of |patients|
|000048d0| 2c 20 77 61 73 20 77 65 | 6c 6c 20 63 6f 6e 74 72 |, was we|ll contr|
|000048e0| 6f 6c 6c 65 64 2c 20 61 | 6e 64 20 75 73 65 64 0d |olled, a|nd used.|
|000048f0| 0a 73 74 61 74 65 2d 6f | 66 2d 74 68 65 2d 61 72 |.state-o|f-the-ar|
|00004900| 74 20 61 73 73 65 73 73 | 6d 65 6e 74 20 74 65 63 |t assess|ment tec|
|00004910| 68 6e 69 71 75 65 73 2c | 20 6f 6e 65 20 63 61 6e |hniques,| one can|
|00004920| 20 62 65 20 72 65 61 73 | 6f 6e 61 62 6c 79 20 63 | be reas|onably c|
|00004930| 6f 6e 66 69 64 65 6e 74 | 20 74 68 61 74 0d 0a 74 |onfident| that..t|
|00004940| 68 65 20 61 6e 73 77 65 | 72 20 69 73 20 61 66 66 |he answe|r is aff|
|00004950| 69 72 6d 61 74 69 76 65 | 2e 2d 2d 52 2e 53 2e 20 |irmative|.--R.S. |
|00004960| 53 68 65 72 77 69 6e 2c | 20 4d 2e 44 2e 0d 0a 24 |Sherwin,| M.D...$|
|00004970| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 31 33 31 |Unique_I|D{YRB131|
|00004980| 30 34 7d 0d 0a 24 54 69 | 74 6c 65 7b 49 6d 70 61 |04}..$Ti|tle{Impa|
|00004990| 69 72 65 64 20 4e 65 75 | 72 6f 67 65 6e 69 63 20 |ired Neu|rogenic |
|000049a0| 61 6e 64 20 45 6e 64 6f | 74 68 65 6c 69 75 6d 2d |and Endo|thelium-|
|000049b0| 4d 65 64 69 61 74 65 64 | 20 52 65 6c 61 78 61 74 |Mediated| Relaxat|
|000049c0| 69 6f 6e 20 6f 66 20 50 | 65 6e 69 6c 65 20 53 6d |ion of P|enile Sm|
|000049d0| 6f 6f 74 68 20 4d 75 73 | 63 6c 65 20 46 72 6f 6d |ooth Mus|cle From|
|000049e0| 20 44 69 61 62 65 74 69 | 63 20 4d 65 6e 20 57 69 | Diabeti|c Men Wi|
|000049f0| 74 68 20 49 6d 70 6f 74 | 65 6e 63 65 7d 0d 0a 24 |th Impot|ence}..$|
|00004a00| 41 75 74 68 6f 72 7b 53 | 61 65 6e 7a 20 64 65 20 |Author{S|aenz de |
|00004a10| 54 65 6a 61 64 61 2c 20 | 49 0d 0a 47 6f 6c 64 73 |Tejada, |I..Golds|
|00004a20| 74 65 69 6e 2c 20 49 0d | 0a 41 7a 61 64 7a 6f 69 |tein, I.|.Azadzoi|
|00004a30| 2c 20 4b 0d 0a 4b 72 61 | 6e 65 2c 20 52 4a 0d 0a |, K..Kra|ne, RJ..|
|00004a40| 43 6f 68 65 6e 2c 20 52 | 41 7d 0d 0a 24 41 66 66 |Cohen, R|A}..$Aff|
|00004a50| 69 6c 69 61 74 69 6f 6e | 7b 42 6f 73 74 6f 6e 20 |iliation|{Boston |
|00004a60| 55 6e 69 76 7d 0d 0a 24 | 4a 6f 75 72 6e 61 6c 7b |Univ}..$|Journal{|
|00004a70| 4e 20 45 6e 67 6c 20 4a | 20 4d 65 64 7d 0d 0a 24 |N Engl J| Med}..$|
|00004a80| 56 6f 6c 75 6d 65 7b 33 | 32 30 7d 0d 0a 24 50 61 |Volume{3|20}..$Pa|
|00004a90| 67 65 7b 31 30 32 35 2d | 31 30 33 30 7d 0d 0a 24 |ge{1025-|1030}..$|
|00004aa0| 44 61 74 65 7b 41 70 72 | 20 32 30 2c 20 31 39 38 |Date{Apr| 20, 198|
|00004ab0| 39 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 39 30 20 |9}..$YBV|ol{1990 |
|00004ac0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 45 6e 64 |Year Boo|k of End|
|00004ad0| 6f 63 72 69 6e 6f 6c 6f | 67 79 7d 0d 0a 24 43 68 |ocrinolo|gy}..$Ch|
|00004ae0| 61 70 74 65 72 7b 31 30 | 2d 32 38 7d 0d 0a 24 59 |apter{10|-28}..$Y|
|00004af0| 42 45 64 69 74 6f 72 7b | 4a 6f 68 6e 20 44 2e 20 |BEditor{|John D. |
|00004b00| 42 61 67 64 61 64 65 2c | 20 4d 2e 44 2e 7d 0d 0a |Bagdade,| M.D.}..|
|00004b10| 24 54 61 62 6c 65 7b 7d | 0d 0a 24 43 6f 6d 6d 65 |$Table{}|..$Comme|
|00004b20| 6e 74 61 74 6f 72 7b 52 | 2e 53 2e 20 53 68 65 72 |ntator{R|.S. Sher|
|00004b30| 77 69 6e 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |win, M.D|.}....Co|
|00004b40| 70 79 72 69 67 68 74 20 | 28 63 29 20 59 65 61 72 |pyright |(c) Year|
|00004b50| 62 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |book Med|ical Pub|
|00004b60| 6c 69 73 68 65 72 73 2c | 20 49 6e 63 2e 2c 20 31 |lishers,| Inc., 1|
|00004b70| 39 39 30 0d 0a 0d 0a 31 | 39 39 30 20 59 65 61 72 |990....1|990 Year|
|00004b80| 20 42 6f 6f 6b 20 6f 66 | 20 45 6e 64 6f 63 72 69 | Book of| Endocri|
|00004b90| 6e 6f 6c 6f 67 79 20 28 | 52 29 0d 0a 0d 0a 43 68 |nology (|R)....Ch|
|00004ba0| 61 70 74 65 72 20 31 30 | 2d 2d 44 69 61 62 65 74 |apter 10|--Diabet|
|00004bb0| 65 73 20 4d 65 6c 6c 69 | 74 75 73 20 61 6e 64 20 |es Melli|tus and |
|00004bc0| 43 61 72 62 6f 68 79 64 | 72 61 74 65 20 4d 65 74 |Carbohyd|rate Met|
|00004bd0| 61 62 6f 6c 69 73 6d 0d | 0a 0d 0a 4f 74 68 65 72 |abolism.|...Other|
|00004be0| 20 43 6f 6d 70 6c 69 63 | 61 74 69 6f 6e 73 0d 0a | Complic|ations..|
|00004bf0| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00004c00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c40| 0d 0a 49 6d 70 61 69 72 | 65 64 20 4e 65 75 72 6f |..Impair|ed Neuro|
|00004c50| 67 65 6e 69 63 20 61 6e | 64 20 45 6e 64 6f 74 68 |genic an|d Endoth|
|00004c60| 65 6c 69 75 6d 2d 4d 65 | 64 69 61 74 65 64 20 52 |elium-Me|diated R|
|00004c70| 65 6c 61 78 61 74 69 6f | 6e 20 6f 66 20 50 65 6e |elaxatio|n of Pen|
|00004c80| 69 6c 65 20 53 6d 6f 6f | 74 68 0d 0a 4d 75 73 63 |ile Smoo|th..Musc|
|00004c90| 6c 65 20 46 72 6f 6d 20 | 44 69 61 62 65 74 69 63 |le From |Diabetic|
|00004ca0| 20 4d 65 6e 20 57 69 74 | 68 20 49 6d 70 6f 74 65 | Men Wit|h Impote|
|00004cb0| 6e 63 65 0d 0a 0d 0a 53 | 61 65 6e 7a 20 64 65 20 |nce....S|aenz de |
|00004cc0| 54 65 6a 61 64 61 20 49 | 2c 20 47 6f 6c 64 73 74 |Tejada I|, Goldst|
|00004cd0| 65 69 6e 20 49 2c 20 41 | 7a 61 64 7a 6f 69 20 4b |ein I, A|zadzoi K|
|00004ce0| 2c 20 4b 72 61 6e 65 20 | 52 4a 2c 20 43 6f 68 65 |, Krane |RJ, Cohe|
|00004cf0| 6e 20 52 41 0d 0a 28 42 | 6f 73 74 6f 6e 20 55 6e |n RA..(B|oston Un|
|00004d00| 69 76 29 0d 0a 4e 20 45 | 6e 67 6c 20 4a 20 4d 65 |iv)..N E|ngl J Me|
|00004d10| 64 20 33 32 30 3a 31 30 | 32 35 2d 31 30 33 30 2c |d 320:10|25-1030,|
|00004d20| 20 41 70 72 20 32 30 2c | 20 31 39 38 39 0d 0a 2d | Apr 20,| 1989..-|
|00004d30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00004d80| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00004d90| 20 20 41 73 20 6d 61 6e | 79 20 61 73 20 68 61 6c | As man|y as hal|
|00004da0| 66 20 6f 66 20 61 6c 6c | 20 6d 65 6e 20 77 69 74 |f of all| men wit|
|00004db0| 68 20 64 69 61 62 65 74 | 65 73 20 6d 61 79 20 62 |h diabet|es may b|
|00004dc0| 65 20 69 6d 70 6f 74 65 | 6e 74 2e 20 20 41 6c 74 |e impote|nt. Alt|
|00004dd0| 68 6f 75 67 68 20 74 68 | 65 0d 0a 6e 65 75 72 6f |hough th|e..neuro|
|00004de0| 6c 6f 67 69 63 20 61 6e | 64 20 76 61 73 63 75 6c |logic an|d vascul|
|00004df0| 61 72 20 63 6f 6d 70 6c | 69 63 61 74 69 6f 6e 73 |ar compl|ications|
|00004e00| 20 6f 66 20 64 69 61 62 | 65 74 65 73 20 61 72 65 | of diab|etes are|
|00004e10| 20 70 72 65 73 75 6d 65 | 64 20 74 6f 20 63 61 75 | presume|d to cau|
|00004e20| 73 65 0d 0a 65 72 65 63 | 74 69 6c 65 20 64 79 73 |se..erec|tile dys|
|00004e30| 66 75 6e 63 74 69 6f 6e | 2c 20 74 68 65 20 6d 65 |function|, the me|
|00004e40| 63 68 61 6e 69 73 6d 73 | 20 72 65 73 70 6f 6e 73 |chanisms| respons|
|00004e50| 69 62 6c 65 20 66 6f 72 | 20 65 72 65 63 74 69 6f |ible for| erectio|
|00004e60| 6e 20 61 72 65 20 6e 6f | 74 20 66 75 6c 6c 79 0d |n are no|t fully.|
|00004e70| 0a 75 6e 64 65 72 73 74 | 6f 6f 64 2e 20 20 42 65 |.underst|ood. Be|
|00004e80| 63 61 75 73 65 20 72 65 | 6c 61 78 61 74 69 6f 6e |cause re|laxation|
|00004e90| 20 6f 66 20 74 68 65 20 | 73 6d 6f 6f 74 68 20 6d | of the |smooth m|
|00004ea0| 75 73 63 6c 65 20 6f 66 | 20 74 68 65 20 63 6f 72 |uscle of| the cor|
|00004eb0| 70 6f 72 61 20 63 61 76 | 65 72 6e 6f 73 61 0d 0a |pora cav|ernosa..|
|00004ec0| 6f 66 20 74 68 65 20 70 | 65 6e 69 73 20 69 73 20 |of the p|enis is |
|00004ed0| 72 65 71 75 69 72 65 64 | 20 66 6f 72 20 65 72 65 |required| for ere|
|00004ee0| 63 74 69 6f 6e 2c 20 63 | 6f 72 70 75 73 20 63 61 |ction, c|orpus ca|
|00004ef0| 76 65 72 6e 6f 73 75 6d | 20 74 69 73 73 75 65 20 |vernosum| tissue |
|00004f00| 77 61 73 20 65 78 61 6d | 69 6e 65 64 0d 0a 69 6e |was exam|ined..in|
|00004f10| 20 64 69 61 62 65 74 69 | 63 20 61 6e 64 20 6e 6f | diabeti|c and no|
|00004f20| 6e 64 69 61 62 65 74 69 | 63 20 6d 65 6e 20 77 69 |ndiabeti|c men wi|
|00004f30| 74 68 20 69 6d 70 6f 74 | 65 6e 63 65 2e 0d 0a 20 |th impot|ence... |
|00004f40| 20 20 20 20 53 61 6d 70 | 6c 65 73 20 6f 66 20 70 | Samp|les of p|
|00004f50| 65 6e 69 6c 65 20 63 6f | 72 70 6f 72 61 6c 20 74 |enile co|rporal t|
|00004f60| 69 73 73 75 65 20 77 65 | 72 65 20 6f 62 74 61 69 |issue we|re obtai|
|00004f70| 6e 65 64 20 64 75 72 69 | 6e 67 20 69 6d 70 6c 61 |ned duri|ng impla|
|00004f80| 6e 74 61 74 69 6f 6e 20 | 6f 66 20 61 0d 0a 70 65 |ntation |of a..pe|
|00004f90| 6e 69 6c 65 20 70 72 6f | 73 74 68 65 73 69 73 2e |nile pro|sthesis.|
|00004fa0| 20 20 49 6e 76 65 73 74 | 69 67 61 74 6f 72 73 20 | Invest|igators |
|00004fb0| 69 6e 64 75 63 65 64 20 | 63 6f 6e 74 72 61 63 74 |induced |contract|
|00004fc0| 69 6f 6e 20 69 6e 20 69 | 73 6f 6c 61 74 65 64 20 |ion in i|solated |
|00004fd0| 73 74 72 69 70 73 20 6f | 66 0d 0a 73 6d 6f 6f 74 |strips o|f..smoot|
|00004fe0| 68 20 6d 75 73 63 6c 65 | 20 62 79 20 6e 6f 72 65 |h muscle| by nore|
|00004ff0| 70 69 6e 65 70 68 72 69 | 6e 65 2e 20 20 52 65 6c |pinephri|ne. Rel|
|00005000| 61 78 61 74 69 6f 6e 20 | 77 61 73 20 74 68 65 6e |axation |was then|
|00005010| 20 65 76 61 6c 75 61 74 | 65 64 20 62 79 20 65 6c | evaluat|ed by el|
|00005020| 65 63 74 72 69 63 61 6c | 0d 0a 73 74 69 6d 75 6c |ectrical|..stimul|
|00005030| 61 74 69 6f 6e 20 6f 66 | 20 61 75 74 6f 6e 6f 6d |ation of| autonom|
|00005040| 69 63 20 6e 65 72 76 65 | 73 20 61 6e 64 20 62 79 |ic nerve|s and by|
|00005050| 20 74 68 65 20 61 64 6d | 69 6e 69 73 74 72 61 74 | the adm|inistrat|
|00005060| 69 6f 6e 20 6f 66 20 61 | 63 65 74 79 6c 63 68 6f |ion of a|cetylcho|
|00005070| 6c 69 6e 65 2c 0d 0a 70 | 61 76 65 72 69 6e 65 2c |line,..p|averine,|
|00005080| 20 61 6e 64 20 73 6f 64 | 69 75 6d 20 6e 69 74 72 | and sod|ium nitr|
|00005090| 6f 70 72 75 73 73 69 64 | 65 2e 0d 0a 20 20 20 20 |oprussid|e... |
|000050a0| 20 53 6d 6f 6f 74 68 20 | 6d 75 73 63 6c 65 20 66 | Smooth |muscle f|
|000050b0| 72 6f 6d 20 6e 6f 6e 64 | 69 61 62 65 74 69 63 20 |rom nond|iabetic |
|000050c0| 6d 65 6e 20 68 61 64 20 | 6d 6f 72 65 20 70 72 6f |men had |more pro|
|000050d0| 6e 6f 75 6e 63 65 64 20 | 72 65 6c 61 78 61 74 69 |nounced |relaxati|
|000050e0| 6f 6e 20 77 69 74 68 0d | 0a 65 6c 65 63 74 72 69 |on with.|.electri|
|000050f0| 63 61 6c 20 73 74 69 6d | 75 6c 61 74 69 6f 6e 20 |cal stim|ulation |
|00005100| 74 68 61 6e 20 73 6d 6f | 6f 74 68 20 6d 75 73 63 |than smo|oth musc|
|00005110| 6c 65 20 66 72 6f 6d 20 | 70 65 72 73 6f 6e 73 20 |le from |persons |
|00005120| 77 69 74 68 20 64 69 61 | 62 65 74 65 73 2e 20 20 |with dia|betes. |
|00005130| 54 68 65 0d 0a 64 65 67 | 72 65 65 20 6f 66 20 69 |The..deg|ree of i|
|00005140| 6d 70 61 69 72 6d 65 6e | 74 20 63 6f 72 72 65 73 |mpairmen|t corres|
|00005150| 70 6f 6e 64 65 64 20 74 | 6f 20 74 68 65 20 64 75 |ponded t|o the du|
|00005160| 72 61 74 69 6f 6e 20 6f | 66 20 64 69 61 62 65 74 |ration o|f diabet|
|00005170| 65 73 3a 20 20 54 68 65 | 20 6c 6f 6e 67 65 72 20 |es: The| longer |
|00005180| 74 68 65 0d 0a 64 75 72 | 61 74 69 6f 6e 2c 20 74 |the..dur|ation, t|
|00005190| 68 65 20 6c 65 73 73 20 | 70 72 6f 6e 6f 75 6e 63 |he less |pronounc|
|000051a0| 65 64 20 74 68 65 20 6e | 65 75 72 6f 67 65 6e 69 |ed the n|eurogeni|
|000051b0| 63 20 72 65 6c 61 78 61 | 74 69 6f 6e 2e 20 20 4e |c relaxa|tion. N|
|000051c0| 69 74 72 6f 70 72 75 73 | 73 69 64 65 20 61 6e 64 |itroprus|side and|
|000051d0| 0d 0a 70 61 70 61 76 65 | 72 69 6e 65 20 68 61 64 |..papave|rine had|
|000051e0| 20 73 69 6d 69 6c 61 72 | 20 65 66 66 65 63 74 73 | similar| effects|
|000051f0| 20 69 6e 20 62 6f 74 68 | 20 67 72 6f 75 70 73 2c | in both| groups,|
|00005200| 20 62 75 74 20 61 63 65 | 74 79 6c 63 68 6f 6c 69 | but ace|tylcholi|
|00005210| 6e 65 20 62 72 6f 75 67 | 68 74 20 61 62 6f 75 74 |ne broug|ht about|
|00005220| 0d 0a 61 20 6c 65 73 73 | 65 72 20 64 65 67 72 65 |..a less|er degre|
|00005230| 65 20 6f 66 20 72 65 6c | 61 78 61 74 69 6f 6e 20 |e of rel|axation |
|00005240| 69 6e 20 64 69 61 62 65 | 74 69 63 20 6d 65 6e 2e |in diabe|tic men.|
|00005250| 20 20 49 6e 73 75 6c 69 | 6e 20 74 72 65 61 74 6d | Insuli|n treatm|
|00005260| 65 6e 74 20 64 69 64 20 | 6e 6f 74 0d 0a 61 66 66 |ent did |not..aff|
|00005270| 65 63 74 20 6e 65 75 72 | 6f 67 65 6e 69 63 20 72 |ect neur|ogenic r|
|00005280| 65 6c 61 78 61 74 69 6f | 6e 2c 20 6e 6f 72 20 64 |elaxatio|n, nor d|
|00005290| 69 64 20 68 79 70 65 72 | 74 65 6e 73 69 6f 6e 20 |id hyper|tension |
|000052a0| 6f 72 20 73 6d 6f 6b 69 | 6e 67 2e 0d 0a 20 20 20 |or smoki|ng... |
|000052b0| 20 20 49 6e 20 64 69 61 | 62 65 74 69 63 20 6d 65 | In dia|betic me|
|000052c0| 6e 20 74 68 65 72 65 20 | 69 73 20 61 6e 20 61 70 |n there |is an ap|
|000052d0| 70 61 72 65 6e 74 20 69 | 6d 62 61 6c 61 6e 63 65 |parent i|mbalance|
|000052e0| 20 74 6f 77 61 72 64 20 | 76 61 73 6f 63 6f 6e 73 | toward |vasocons|
|000052f0| 74 72 69 63 74 6f 72 0d | 0a 6d 65 63 68 61 6e 69 |trictor.|.mechani|
|00005300| 73 6d 73 20 74 68 61 74 | 20 6d 61 79 20 70 72 6f |sms that| may pro|
|00005310| 6d 6f 74 65 20 64 65 74 | 75 6d 65 73 63 65 6e 63 |mote det|umescenc|
|00005320| 65 2e 20 20 42 6f 74 68 | 20 74 68 65 20 61 75 74 |e. Both| the aut|
|00005330| 6f 6e 6f 6d 69 63 20 61 | 6e 64 0d 0a 65 6e 64 6f |onomic a|nd..endo|
|00005340| 74 68 65 6c 69 75 6d 2d | 64 65 70 65 6e 64 65 6e |thelium-|dependen|
|00005350| 74 20 6d 65 63 68 61 6e | 69 73 6d 73 20 74 68 61 |t mechan|isms tha|
|00005360| 74 20 6d 65 64 69 61 74 | 65 20 74 68 65 20 72 65 |t mediat|e the re|
|00005370| 6c 61 78 61 74 69 6f 6e | 20 6f 66 20 73 6d 6f 6f |laxation| of smoo|
|00005380| 74 68 20 6d 75 73 63 6c | 65 0d 0a 6f 66 20 74 68 |th muscl|e..of th|
|00005390| 65 20 63 6f 72 70 6f 72 | 61 20 63 61 76 65 72 6e |e corpor|a cavern|
|000053a0| 6f 73 61 20 61 72 65 20 | 69 6d 70 61 69 72 65 64 |osa are |impaired|
|000053b0| 2e 20 20 49 6e 74 72 61 | 63 61 76 65 72 6e 6f 73 |. Intra|cavernos|
|000053c0| 61 6c 20 69 6e 6a 65 63 | 74 69 6f 6e 20 6f 66 0d |al injec|tion of.|
|000053d0| 0a 76 61 73 6f 64 69 6c | 61 74 6f 72 73 2c 20 62 |.vasodil|ators, b|
|000053e0| 79 20 69 6e 64 75 63 69 | 6e 67 20 65 6e 64 6f 74 |y induci|ng endot|
|000053f0| 68 65 6c 69 75 6d 2d 69 | 6e 64 65 70 65 6e 64 65 |helium-i|ndepende|
|00005400| 6e 74 20 72 65 6c 61 78 | 61 74 69 6f 6e 20 6f 66 |nt relax|ation of|
|00005410| 20 74 68 65 20 73 6d 6f | 6f 74 68 0d 0a 6d 75 73 | the smo|oth..mus|
|00005420| 63 6c 65 2c 20 6d 61 79 | 20 62 65 20 68 65 6c 70 |cle, may| be help|
|00005430| 66 75 6c 20 69 6e 20 74 | 68 65 20 74 72 65 61 74 |ful in t|he treat|
|00005440| 6d 65 6e 74 20 6f 66 20 | 64 69 61 62 65 74 69 63 |ment of |diabetic|
|00005450| 20 6d 65 6e 20 77 69 74 | 68 20 69 6d 70 6f 74 65 | men wit|h impote|
|00005460| 6e 63 65 2e 0d 0a 0d 0a | 50 6f 73 74 2d 43 6f 6d |nce.....|Post-Com|
|00005470| 6d 65 6e 74 0d 0a 0d 0a | 20 20 20 20 20 55 6e 74 |ment....| Unt|
|00005480| 69 6c 20 72 65 63 65 6e | 74 6c 79 2c 20 77 65 20 |il recen|tly, we |
|00005490| 68 61 64 20 6c 69 74 74 | 6c 65 20 74 6f 20 6f 66 |had litt|le to of|
|000054a0| 66 65 72 20 28 6f 74 68 | 65 72 20 74 68 61 6e 20 |fer (oth|er than |
|000054b0| 70 65 6e 69 6c 65 20 70 | 72 6f 73 74 68 65 73 65 |penile p|rosthese|
|000054c0| 73 29 20 66 6f 72 0d 0a | 64 69 61 62 65 74 69 63 |s) for..|diabetic|
|000054d0| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 69 | patient|s with i|
|000054e0| 6d 70 6f 74 65 6e 63 65 | 2e 20 20 54 68 69 73 20 |mpotence|. This |
|000054f0| 68 61 73 20 63 68 61 6e | 67 65 64 20 77 69 74 68 |has chan|ged with|
|00005500| 20 74 68 65 20 69 6e 74 | 72 6f 64 75 63 74 69 6f | the int|roductio|
|00005510| 6e 20 6f 66 0d 0a 73 65 | 6c 66 2d 61 64 6d 69 6e |n of..se|lf-admin|
|00005520| 69 73 74 65 72 65 64 20 | 69 6e 74 72 61 63 61 76 |istered |intracav|
|00005530| 65 72 6e 6f 73 61 6c 20 | 69 6e 6a 65 63 74 69 6f |ernosal |injectio|
|00005540| 6e 73 20 6f 66 20 76 61 | 73 6f 64 69 6c 61 74 6f |ns of va|sodilato|
|00005550| 72 73 20 73 75 63 68 20 | 61 73 0d 0a 70 61 70 61 |rs such |as..papa|
|00005560| 76 65 72 69 6e 65 2e 20 | 20 54 68 65 20 6d 61 6a |verine. | The maj|
|00005570| 6f 72 69 74 79 20 6f 66 | 20 70 61 74 69 65 6e 74 |ority of| patient|
|00005580| 73 20 62 65 6e 65 66 69 | 74 20 66 72 6f 6d 20 74 |s benefi|t from t|
|00005590| 68 69 73 20 74 68 65 72 | 61 70 65 75 74 69 63 20 |his ther|apeutic |
|000055a0| 61 70 70 72 6f 61 63 68 | 0d 0a 69 6e 20 73 70 69 |approach|..in spi|
|000055b0| 74 65 20 6f 66 20 74 68 | 65 20 70 72 65 73 65 6e |te of th|e presen|
|000055c0| 63 65 20 6f 66 20 73 65 | 76 65 72 65 20 61 75 74 |ce of se|vere aut|
|000055d0| 6f 6e 6f 6d 69 63 20 64 | 79 73 66 75 6e 63 74 69 |onomic d|ysfuncti|
|000055e0| 6f 6e 2e 20 20 54 68 65 | 20 63 75 72 72 65 6e 74 |on. The| current|
|000055f0| 20 72 65 70 6f 72 74 0d | 0a 68 65 6c 70 73 20 74 | report.|.helps t|
|00005600| 6f 20 65 78 70 6c 61 69 | 6e 20 77 68 79 20 6c 6f |o explai|n why lo|
|00005610| 63 61 6c 20 76 61 73 6f | 64 69 6c 61 74 6f 72 20 |cal vaso|dilator |
|00005620| 74 68 65 72 61 70 79 20 | 77 69 74 68 20 70 61 70 |therapy |with pap|
|00005630| 61 76 65 72 69 6e 65 20 | 68 61 73 20 62 65 65 6e |averine |has been|
|00005640| 0d 0a 73 75 63 63 65 73 | 73 66 75 6c 2e 20 20 4e |..succes|sful. N|
|00005650| 6f 72 6d 61 6c 20 65 72 | 65 63 74 69 6f 6e 73 20 |ormal er|ections |
|00005660| 61 72 65 20 64 65 70 65 | 6e 64 65 6e 74 20 6f 6e |are depe|ndent on|
|00005670| 20 72 65 6c 61 78 61 74 | 69 6f 6e 20 6f 66 20 74 | relaxat|ion of t|
|00005680| 68 65 20 73 6d 6f 6f 74 | 68 20 6d 75 73 63 6c 65 |he smoot|h muscle|
|00005690| 0d 0a 6f 66 20 74 68 65 | 20 63 6f 72 70 6f 72 61 |..of the| corpora|
|000056a0| 20 63 61 76 65 72 6e 6f | 73 61 2e 20 20 54 68 69 | caverno|sa. Thi|
|000056b0| 73 20 70 72 6f 63 65 73 | 73 20 69 73 20 63 6f 6e |s proces|s is con|
|000056c0| 74 72 6f 6c 6c 65 64 20 | 6c 6f 63 61 6c 6c 79 20 |trolled |locally |
|000056d0| 62 79 20 6e 65 72 76 65 | 73 20 74 68 61 74 0d 0a |by nerve|s that..|
|000056e0| 72 65 6c 65 61 73 65 20 | 63 68 6f 6c 69 6e 65 72 |release |choliner|
|000056f0| 67 69 63 20 61 6e 64 20 | 6e 6f 6e 61 64 72 65 6e |gic and |nonadren|
|00005700| 65 72 67 69 63 20 6e 65 | 75 72 6f 74 72 61 6e 73 |ergic ne|urotrans|
|00005710| 6d 69 74 74 65 72 73 20 | 61 6e 64 20 62 79 20 74 |mitters |and by t|
|00005720| 68 65 20 6c 6f 63 61 6c | 0d 0a 72 65 6c 65 61 73 |he local|..releas|
|00005730| 65 20 6f 66 20 76 61 73 | 6f 64 69 6c 61 74 6f 72 |e of vas|odilator|
|00005740| 79 20 66 61 63 74 6f 72 | 73 20 64 65 72 69 76 65 |y factor|s derive|
|00005750| 64 20 66 72 6f 6d 20 65 | 6e 64 6f 74 68 65 6c 69 |d from e|ndotheli|
|00005760| 61 6c 20 63 65 6c 6c 73 | 2e 20 20 42 6f 74 68 20 |al cells|. Both |
|00005770| 6f 66 20 74 68 65 73 65 | 0d 0a 6d 65 64 69 61 74 |of these|..mediat|
|00005780| 6f 72 73 20 6f 66 20 63 | 6f 72 70 6f 72 61 20 73 |ors of c|orpora s|
|00005790| 6d 6f 6f 74 68 20 6d 75 | 73 63 6c 65 20 72 65 6c |mooth mu|scle rel|
|000057a0| 61 78 61 74 69 6f 6e 2c | 20 68 6f 77 65 76 65 72 |axation,| however|
|000057b0| 2c 20 66 61 69 6c 20 74 | 6f 20 61 63 74 0d 0a 61 |, fail t|o act..a|
|000057c0| 70 70 72 6f 70 72 69 61 | 74 65 6c 79 20 6f 6e 20 |ppropria|tely on |
|000057d0| 74 69 73 73 75 65 20 74 | 61 6b 65 6e 20 66 72 6f |tissue t|aken fro|
|000057e0| 6d 20 64 69 61 62 65 74 | 69 63 20 70 61 74 69 65 |m diabet|ic patie|
|000057f0| 6e 74 73 20 77 69 74 68 | 20 69 6d 70 6f 74 65 6e |nts with| impoten|
|00005800| 63 65 2e 20 20 49 6e 0d | 0a 73 74 72 69 6b 69 6e |ce. In.|.strikin|
|00005810| 67 20 63 6f 6e 74 72 61 | 73 74 2c 20 74 68 65 20 |g contra|st, the |
|00005820| 72 65 73 70 6f 6e 73 65 | 20 74 6f 20 70 61 70 61 |response| to papa|
|00005830| 76 65 72 69 6e 65 20 69 | 73 20 70 72 65 73 65 72 |verine i|s preser|
|00005840| 76 65 64 20 61 6e 64 20 | 64 6f 65 73 20 6e 6f 74 |ved and |does not|
|00005850| 20 64 69 66 66 65 72 0d | 0a 66 72 6f 6d 20 74 68 | differ.|.from th|
|00005860| 61 74 20 73 65 65 6e 20 | 69 6e 20 74 69 73 73 75 |at seen |in tissu|
|00005870| 65 20 66 72 6f 6d 20 6e | 6f 72 6d 61 6c 20 73 75 |e from n|ormal su|
|00005880| 62 6a 65 63 74 73 2e 20 | 20 54 68 65 20 63 6c 69 |bjects. | The cli|
|00005890| 6e 69 63 61 6c 20 72 65 | 73 70 6f 6e 73 65 20 74 |nical re|sponse t|
|000058a0| 6f 0d 0a 70 61 70 61 76 | 65 72 69 6e 65 20 69 6e |o..papav|erine in|
|000058b0| 6a 65 63 74 69 6f 6e 73 | 20 6d 69 72 72 6f 72 73 |jections| mirrors|
|000058c0| 20 74 68 65 73 65 20 69 | 6e 20 76 69 74 72 6f 20 | these i|n vitro |
|000058d0| 66 69 6e 64 69 6e 67 73 | 2e 2d 2d 52 2e 53 2e 20 |findings|.--R.S. |
|000058e0| 53 68 65 72 77 69 6e 2c | 20 4d 2e 44 2e 0d 0a 24 |Sherwin,| M.D...$|
|000058f0| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 31 33 31 |Unique_I|D{YRB131|
|00005900| 30 35 7d 0d 0a 24 54 69 | 74 6c 65 7b 41 20 43 6f |05}..$Ti|tle{A Co|
|00005910| 6d 70 61 72 69 73 6f 6e | 20 6f 66 20 74 68 65 20 |mparison| of the |
|00005920| 45 66 66 65 63 74 73 20 | 6f 66 20 48 79 64 72 6f |Effects |of Hydro|
|00005930| 63 68 6c 6f 72 6f 74 68 | 69 61 7a 69 64 65 20 61 |chloroth|iazide a|
|00005940| 6e 64 20 43 61 70 74 6f | 70 72 69 6c 20 6f 6e 20 |nd Capto|pril on |
|00005950| 47 6c 75 63 6f 73 65 20 | 61 6e 64 20 4c 69 70 69 |Glucose |and Lipi|
|00005960| 64 20 4d 65 74 61 62 6f | 6c 69 73 6d 20 69 6e 20 |d Metabo|lism in |
|00005970| 50 61 74 69 65 6e 74 73 | 20 57 69 74 68 20 48 79 |Patients| With Hy|
|00005980| 70 65 72 74 65 6e 73 69 | 6f 6e 7d 0d 0a 24 41 75 |pertensi|on}..$Au|
|00005990| 74 68 6f 72 7b 50 6f 6c | 6c 61 72 65 2c 20 54 0d |thor{Pol|lare, T.|
|000059a0| 0a 4c 69 74 68 65 6c 6c | 2c 20 48 0d 0a 42 65 72 |.Lithell|, H..Ber|
|000059b0| 6e 65 2c 20 43 7d 0d 0a | 24 41 66 66 69 6c 69 61 |ne, C}..|$Affilia|
|000059c0| 74 69 6f 6e 7b 55 70 70 | 73 61 6c 61 20 55 6e 69 |tion{Upp|sala Uni|
|000059d0| 76 2c 20 53 77 65 64 65 | 6e 7d 0d 0a 24 4a 6f 75 |v, Swede|n}..$Jou|
|000059e0| 72 6e 61 6c 7b 4e 20 45 | 6e 67 6c 20 4a 20 4d 65 |rnal{N E|ngl J Me|
|000059f0| 64 7d 0d 0a 24 56 6f 6c | 75 6d 65 7b 33 32 31 7d |d}..$Vol|ume{321}|
|00005a00| 0d 0a 24 50 61 67 65 7b | 38 36 38 2d 38 37 33 7d |..$Page{|868-873}|
|00005a10| 0d 0a 24 44 61 74 65 7b | 53 65 70 74 20 32 38 2c |..$Date{|Sept 28,|
|00005a20| 20 31 39 38 39 7d 0d 0a | 24 59 42 56 6f 6c 7b 31 | 1989}..|$YBVol{1|
|00005a30| 39 39 30 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |990 Year| Book of|
|00005a40| 20 45 6e 64 6f 63 72 69 | 6e 6f 6c 6f 67 79 7d 0d | Endocri|nology}.|
|00005a50| 0a 24 43 68 61 70 74 65 | 72 7b 31 31 2d 31 7d 0d |.$Chapte|r{11-1}.|
|00005a60| 0a 24 59 42 45 64 69 74 | 6f 72 7b 4a 6f 68 6e 20 |.$YBEdit|or{John |
|00005a70| 44 2e 20 42 61 67 64 61 | 64 65 2c 20 4d 2e 44 2e |D. Bagda|de, M.D.|
|00005a80| 7d 0d 0a 24 54 61 62 6c | 65 7b 54 61 62 6c 65 20 |}..$Tabl|e{Table |
|00005a90| 4f 6d 69 74 74 65 64 7d | 0d 0a 24 43 6f 6d 6d 65 |Omitted}|..$Comme|
|00005aa0| 6e 74 61 74 6f 72 7b 4a | 2e 44 2e 20 42 61 67 64 |ntator{J|.D. Bagd|
|00005ab0| 61 64 65 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |ade, M.D|.}....Co|
|00005ac0| 70 79 72 69 67 68 74 20 | 28 63 29 20 59 65 61 72 |pyright |(c) Year|
|00005ad0| 62 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |book Med|ical Pub|
|00005ae0| 6c 69 73 68 65 72 73 2c | 20 49 6e 63 2e 2c 20 31 |lishers,| Inc., 1|
|00005af0| 39 39 30 0d 0a 0d 0a 31 | 39 39 30 20 59 65 61 72 |990....1|990 Year|
|00005b00| 20 42 6f 6f 6b 20 6f 66 | 20 45 6e 64 6f 63 72 69 | Book of| Endocri|
|00005b10| 6e 6f 6c 6f 67 79 20 28 | 52 29 0d 0a 0d 0a 43 68 |nology (|R)....Ch|
|00005b20| 61 70 74 65 72 20 31 31 | 2d 2d 4c 69 70 6f 70 72 |apter 11|--Lipopr|
|00005b30| 6f 74 65 69 6e 73 20 61 | 6e 64 20 41 74 68 65 72 |oteins a|nd Ather|
|00005b40| 6f 73 63 6c 65 72 6f 73 | 69 73 0d 0a 0d 0a 47 65 |oscleros|is....Ge|
|00005b50| 6e 65 72 61 6c 20 49 6e | 74 65 72 65 73 74 0d 0a |neral In|terest..|
|00005b60| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00005b70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005b80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005b90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ba0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005bb0| 0d 0a 41 20 43 6f 6d 70 | 61 72 69 73 6f 6e 20 6f |..A Comp|arison o|
|00005bc0| 66 20 74 68 65 20 45 66 | 66 65 63 74 73 20 6f 66 |f the Ef|fects of|
|00005bd0| 20 48 79 64 72 6f 63 68 | 6c 6f 72 6f 74 68 69 61 | Hydroch|lorothia|
|00005be0| 7a 69 64 65 20 61 6e 64 | 20 43 61 70 74 6f 70 72 |zide and| Captopr|
|00005bf0| 69 6c 20 6f 6e 20 47 6c | 75 63 6f 73 65 0d 0a 61 |il on Gl|ucose..a|
|00005c00| 6e 64 20 4c 69 70 69 64 | 20 4d 65 74 61 62 6f 6c |nd Lipid| Metabol|
|00005c10| 69 73 6d 20 69 6e 20 50 | 61 74 69 65 6e 74 73 20 |ism in P|atients |
|00005c20| 57 69 74 68 20 48 79 70 | 65 72 74 65 6e 73 69 6f |With Hyp|ertensio|
|00005c30| 6e 0d 0a 0d 0a 50 6f 6c | 6c 61 72 65 20 54 2c 20 |n....Pol|lare T, |
|00005c40| 4c 69 74 68 65 6c 6c 20 | 48 2c 20 42 65 72 6e 65 |Lithell |H, Berne|
|00005c50| 20 43 0d 0a 28 55 70 70 | 73 61 6c 61 20 55 6e 69 | C..(Upp|sala Uni|
|00005c60| 76 2c 20 53 77 65 64 65 | 6e 29 0d 0a 4e 20 45 6e |v, Swede|n)..N En|
|00005c70| 67 6c 20 4a 20 4d 65 64 | 20 33 32 31 3a 38 36 38 |gl J Med| 321:868|
|00005c80| 2d 38 37 33 2c 20 53 65 | 70 74 20 32 38 2c 20 31 |-873, Se|pt 28, 1|
|00005c90| 39 38 39 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |989..---|--------|
|00005ca0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005cb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005cc0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005cd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ce0| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00005cf0| 0a 0d 0a 20 20 20 20 20 | 41 6c 74 68 6f 75 67 68 |... |Although|
|00005d00| 20 61 6e 74 69 68 79 70 | 65 72 74 65 6e 73 69 76 | antihyp|ertensiv|
|00005d10| 65 20 64 72 75 67 73 20 | 72 65 64 75 63 65 20 74 |e drugs |reduce t|
|00005d20| 68 65 20 69 6e 63 69 64 | 65 6e 63 65 20 6f 66 20 |he incid|ence of |
|00005d30| 73 74 72 6f 6b 65 2c 0d | 0a 63 6f 6e 67 65 73 74 |stroke,.|.congest|
|00005d40| 69 76 65 20 68 65 61 72 | 74 20 66 61 69 6c 75 72 |ive hear|t failur|
|00005d50| 65 2c 20 61 6e 64 20 72 | 65 6e 61 6c 20 66 61 69 |e, and r|enal fai|
|00005d60| 6c 75 72 65 2c 20 74 72 | 69 61 6c 73 20 68 61 76 |lure, tr|ials hav|
|00005d70| 65 20 73 68 6f 77 6e 20 | 74 68 61 74 20 74 68 65 |e shown |that the|
|00005d80| 73 65 0d 0a 61 67 65 6e | 74 73 20 64 6f 20 6e 6f |se..agen|ts do no|
|00005d90| 74 20 73 69 67 6e 69 66 | 69 63 61 6e 74 6c 79 20 |t signif|icantly |
|00005da0| 6c 6f 77 65 72 20 74 68 | 65 20 72 61 74 65 20 6f |lower th|e rate o|
|00005db0| 66 20 6d 79 6f 63 61 72 | 64 69 61 6c 20 69 6e 66 |f myocar|dial inf|
|00005dc0| 61 72 63 74 69 6f 6e 2e | 20 20 53 6f 6d 65 0d 0a |arction.| Some..|
|00005dd0| 73 74 75 64 69 65 73 20 | 68 61 76 65 20 73 75 67 |studies |have sug|
|00005de0| 67 65 73 74 65 64 20 74 | 68 61 74 20 61 6e 74 69 |gested t|hat anti|
|00005df0| 68 79 70 65 72 74 65 6e | 73 69 76 65 20 64 72 75 |hyperten|sive dru|
|00005e00| 67 73 20 63 61 75 73 65 | 20 6d 65 74 61 62 6f 6c |gs cause| metabol|
|00005e10| 69 63 20 63 68 61 6e 67 | 65 73 0d 0a 74 68 61 74 |ic chang|es..that|
|00005e20| 20 69 6e 63 72 65 61 73 | 65 20 74 68 65 20 72 69 | increas|e the ri|
|00005e30| 73 6b 20 6f 66 20 63 61 | 72 64 69 6f 76 61 73 63 |sk of ca|rdiovasc|
|00005e40| 75 6c 61 72 20 64 69 73 | 65 61 73 65 2e 20 20 54 |ular dis|ease. T|
|00005e50| 68 65 20 65 66 66 65 63 | 74 73 20 6f 66 0d 0a 68 |he effec|ts of..h|
|00005e60| 79 64 72 6f 63 68 6c 6f | 72 6f 74 68 69 61 7a 69 |ydrochlo|rothiazi|
|00005e70| 64 65 20 61 6e 64 20 63 | 61 70 74 6f 70 72 69 6c |de and c|aptopril|
|00005e80| 20 6f 6e 20 61 20 76 61 | 72 69 65 74 79 20 6f 66 | on a va|riety of|
|00005e90| 20 6d 65 74 61 62 6f 6c | 69 63 20 70 61 72 61 6d | metabol|ic param|
|00005ea0| 65 74 65 72 73 20 77 65 | 72 65 0d 0a 65 76 61 6c |eters we|re..eval|
|00005eb0| 75 61 74 65 64 20 69 6e | 20 61 20 72 61 6e 64 6f |uated in| a rando|
|00005ec0| 6d 69 7a 65 64 2c 20 64 | 6f 75 62 6c 65 2d 62 6c |mized, d|ouble-bl|
|00005ed0| 69 6e 64 2c 20 63 72 6f | 73 73 6f 76 65 72 20 73 |ind, cro|ssover s|
|00005ee0| 74 75 64 79 20 6f 66 20 | 35 30 20 70 61 74 69 65 |tudy of |50 patie|
|00005ef0| 6e 74 73 2e 0d 0a 20 20 | 20 20 20 42 6f 74 68 20 |nts... | Both |
|00005f00| 68 79 64 72 6f 63 68 6c | 6f 72 6f 74 68 69 61 7a |hydrochl|orothiaz|
|00005f10| 69 64 65 20 61 6e 64 20 | 63 61 70 74 6f 70 72 69 |ide and |captopri|
|00005f20| 6c 20 73 69 67 6e 69 66 | 69 63 61 6e 74 6c 79 20 |l signif|icantly |
|00005f30| 72 65 64 75 63 65 64 20 | 6d 65 61 6e 20 73 75 70 |reduced |mean sup|
|00005f40| 69 6e 65 0d 0a 62 6c 6f | 6f 64 20 70 72 65 73 73 |ine..blo|od press|
|00005f50| 75 72 65 20 61 73 20 63 | 6f 6d 70 61 72 65 64 20 |ure as c|ompared |
|00005f60| 77 69 74 68 20 70 6c 61 | 63 65 62 6f 2e 20 20 49 |with pla|cebo. I|
|00005f70| 6e 73 75 6c 69 6e 20 73 | 65 6e 73 69 74 69 76 69 |nsulin s|ensitivi|
|00005f80| 74 79 20 69 6e 63 72 65 | 61 73 65 64 20 64 75 72 |ty incre|ased dur|
|00005f90| 69 6e 67 0d 0a 74 72 65 | 61 74 6d 65 6e 74 20 77 |ing..tre|atment w|
|00005fa0| 69 74 68 20 63 61 70 74 | 6f 70 72 69 6c 20 61 6e |ith capt|opril an|
|00005fb0| 64 20 64 65 63 72 65 61 | 73 65 64 20 64 75 72 69 |d decrea|sed duri|
|00005fc0| 6e 67 20 74 72 65 61 74 | 6d 65 6e 74 20 77 69 74 |ng treat|ment wit|
|00005fd0| 68 0d 0a 68 79 64 72 6f | 63 68 6c 6f 72 6f 74 68 |h..hydro|chloroth|
|00005fe0| 69 61 7a 69 64 65 2e 20 | 20 54 68 65 20 62 61 73 |iazide. | The bas|
|00005ff0| 61 6c 20 63 6f 6e 63 65 | 6e 74 72 61 74 69 6f 6e |al conce|ntration|
|00006000| 20 6f 66 20 69 6e 73 75 | 6c 69 6e 20 77 61 73 20 | of insu|lin was |
|00006010| 75 6e 63 68 61 6e 67 65 | 64 20 77 69 74 68 0d 0a |unchange|d with..|
|00006020| 63 61 70 74 6f 70 72 69 | 6c 2c 20 62 75 74 20 69 |captopri|l, but i|
|00006030| 74 20 77 61 73 20 69 6e | 63 72 65 61 73 65 64 20 |t was in|creased |
|00006040| 62 79 20 68 79 64 72 6f | 63 68 6c 6f 72 6f 74 68 |by hydro|chloroth|
|00006050| 69 61 7a 69 64 65 2e 20 | 20 54 68 65 20 73 65 72 |iazide. | The ser|
|00006060| 75 6d 0d 0a 63 6f 6e 63 | 65 6e 74 72 61 74 69 6f |um..conc|entratio|
|00006070| 6e 20 6f 66 20 6c 69 70 | 69 64 73 20 61 6e 64 20 |n of lip|ids and |
|00006080| 6c 69 70 6f 70 72 6f 74 | 65 69 6e 73 20 77 65 72 |lipoprot|eins wer|
|00006090| 65 20 75 6e 61 66 66 65 | 63 74 65 64 20 62 79 20 |e unaffe|cted by |
|000060a0| 63 61 70 74 6f 70 72 69 | 6c 2c 20 77 68 65 72 65 |captopri|l, where|
|000060b0| 61 73 0d 0a 68 79 64 72 | 6f 63 68 6c 6f 72 6f 74 |as..hydr|ochlorot|
|000060c0| 68 69 61 7a 69 64 65 20 | 73 69 67 6e 69 66 69 63 |hiazide |signific|
|000060d0| 61 6e 74 6c 79 20 69 6e | 63 72 65 61 73 65 64 20 |antly in|creased |
|000060e0| 73 65 72 75 6d 20 6c 65 | 76 65 6c 73 20 6f 66 20 |serum le|vels of |
|000060f0| 74 72 69 67 6c 79 63 65 | 72 69 64 65 0d 0a 28 31 |triglyce|ride..(1|
|00006100| 35 25 29 2c 20 63 68 6f | 6c 65 73 74 65 72 6f 6c |5%), cho|lesterol|
|00006110| 20 28 35 25 29 2c 20 61 | 6e 64 20 4c 44 4c 2d 43 | (5%), a|nd LDL-C|
|00006120| 20 28 36 37 25 29 20 77 | 69 74 68 6f 75 74 20 63 | (67%) w|ithout c|
|00006130| 68 61 6e 67 69 6e 67 20 | 74 68 65 20 48 44 4c 2d |hanging |the HDL-|
|00006140| 43 20 6c 65 76 65 6c 0d | 0a 28 74 61 62 6c 65 29 |C level.|.(table)|
|00006150| 2e 0d 0a 20 20 20 20 20 | 50 61 74 69 65 6e 74 73 |... |Patients|
|00006160| 20 77 69 74 68 20 68 79 | 70 65 72 74 65 6e 73 69 | with hy|pertensi|
|00006170| 6f 6e 20 77 68 6f 20 6d | 61 79 20 68 61 76 65 20 |on who m|ay have |
|00006180| 61 20 70 72 65 65 78 69 | 73 74 69 6e 67 20 64 65 |a preexi|sting de|
|00006190| 63 72 65 61 73 65 20 69 | 6e 20 69 6e 73 75 6c 69 |crease i|n insuli|
|000061a0| 6e 0d 0a 73 65 6e 73 69 | 74 69 76 69 74 79 20 6d |n..sensi|tivity m|
|000061b0| 61 79 20 62 65 20 61 74 | 20 69 6e 63 72 65 61 73 |ay be at| increas|
|000061c0| 65 64 20 72 69 73 6b 20 | 66 6f 72 20 6d 61 6e 69 |ed risk |for mani|
|000061d0| 66 65 73 74 69 6e 67 20 | 6f 76 65 72 74 20 64 69 |festing |overt di|
|000061e0| 61 62 65 74 65 73 20 69 | 66 20 74 72 65 61 74 65 |abetes i|f treate|
|000061f0| 64 0d 0a 77 69 74 68 20 | 61 6e 20 61 6e 74 69 68 |d..with |an antih|
|00006200| 79 70 65 72 74 65 6e 73 | 69 76 65 20 61 67 65 6e |ypertens|ive agen|
|00006210| 74 20 74 68 61 74 20 66 | 75 72 74 68 65 72 20 72 |t that f|urther r|
|00006220| 65 64 75 63 65 73 20 69 | 6e 73 75 6c 69 6e 20 73 |educes i|nsulin s|
|00006230| 65 6e 73 69 74 69 76 69 | 74 79 2e 20 20 54 68 65 |ensitivi|ty. The|
|00006240| 0d 0a 61 64 76 65 72 73 | 65 20 65 66 66 65 63 74 |..advers|e effect|
|00006250| 73 20 6f 66 20 68 79 64 | 72 6f 63 68 6c 6f 72 6f |s of hyd|rochloro|
|00006260| 74 68 69 61 7a 69 64 65 | 20 6f 6e 20 67 6c 75 63 |thiazide| on gluc|
|00006270| 6f 73 65 20 61 6e 64 20 | 6c 69 70 69 64 20 6d 65 |ose and |lipid me|
|00006280| 74 61 62 6f 6c 69 73 6d | 20 63 6f 75 6c 64 0d 0a |tabolism| could..|
|00006290| 63 6f 6e 74 72 69 62 75 | 74 65 20 74 6f 20 74 68 |contribu|te to th|
|000062a0| 65 20 72 69 73 6b 20 66 | 6f 72 20 64 69 61 62 65 |e risk f|or diabe|
|000062b0| 74 65 73 20 6d 65 6c 6c | 69 74 75 73 20 61 6e 64 |tes mell|itus and|
|000062c0| 20 63 6f 72 6f 6e 61 72 | 79 20 68 65 61 72 74 20 | coronar|y heart |
|000062d0| 64 69 73 65 61 73 65 2e | 0d 0a 43 61 70 74 6f 70 |disease.|..Captop|
|000062e0| 72 69 6c 20 6c 6f 77 65 | 72 73 20 62 6c 6f 6f 64 |ril lowe|rs blood|
|000062f0| 20 70 72 65 73 73 75 72 | 65 2c 20 69 6d 70 72 6f | pressur|e, impro|
|00006300| 76 65 73 20 73 65 76 65 | 72 61 6c 20 61 73 70 65 |ves seve|ral aspe|
|00006310| 63 74 73 20 6f 66 20 63 | 61 72 62 6f 68 79 64 72 |cts of c|arbohydr|
|00006320| 61 74 65 0d 0a 6d 65 74 | 61 62 6f 6c 69 73 6d 2c |ate..met|abolism,|
|00006330| 20 61 6e 64 20 69 73 20 | 6c 69 70 69 64 20 6e 65 | and is |lipid ne|
|00006340| 75 74 72 61 6c 2e 0d 0a | 0d 0a 50 6f 73 74 2d 43 |utral...|..Post-C|
|00006350| 6f 6d 6d 65 6e 74 0d 0a | 0d 0a 20 20 20 20 20 57 |omment..|.. W|
|00006360| 68 79 20 74 68 69 61 7a | 69 64 65 73 20 66 61 69 |hy thiaz|ides fai|
|00006370| 6c 20 74 6f 20 72 65 64 | 75 63 65 20 63 6f 72 6f |l to red|uce coro|
|00006380| 6e 61 72 79 20 72 69 73 | 6b 20 61 6e 64 20 61 74 |nary ris|k and at|
|00006390| 20 74 68 65 20 73 61 6d | 65 20 74 69 6d 65 20 62 | the sam|e time b|
|000063a0| 65 6e 65 66 69 74 0d 0a | 74 68 65 20 63 65 72 65 |enefit..|the cere|
|000063b0| 62 72 61 6c 20 61 6e 64 | 20 72 65 6e 61 6c 20 76 |bral and| renal v|
|000063c0| 61 73 63 75 6c 61 74 75 | 72 65 20 68 61 73 20 61 |asculatu|re has a|
|000063d0| 6c 77 61 79 73 20 62 65 | 65 6e 20 61 6e 20 65 6e |lways be|en an en|
|000063e0| 69 67 6d 61 2e 20 20 54 | 68 65 72 65 20 6d 61 79 |igma. T|here may|
|000063f0| 20 62 65 20 61 0d 0a 72 | 6f 75 67 68 20 61 6e 61 | be a..r|ough ana|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.