[Show abstract][Hide abstract] ABSTRACT: We tested the hypothesis that silent coeliac disease is more frequent than expected in both patients with Type I (insulin-dependent) diabetes mellitus and their first-degree relatives. We evaluated how the presence of other autoimmune disorders in diabetic patients and their first-degree relatives is related to silent, unrecognized coeliac disease.
Sera from 491 subjects with Type I diabetes, 824 relatives and 4,000 healthy control subjects were screened for anti-endomysial antibodies and all those subjects who tested positive for anti-endomysial antibodies underwent intestinal biopsy.
We found that the prevalence of coeliac disease was 5.7 % among the diabetic patients and 1.9 % among the relatives, values significantly higher than those found among the control subjects (p < 0.0001; p < 0.001). The prevalence of autoimmune disorders in diabetic patients with coeliac disease was significantly higher than in subjects with Type I diabetes alone (p < 0.0001). The prevalence of autoimmune disorders in the relatives with coeliac disease was significantly higher than in those who tested negative for anti-endomysial antibodies (p = 0.01).
This report provides further confirmation of the high prevalence of undiagnosed coeliac disease among diabetic patients and their relatives. This interesting new finding is the increased presence of other autoimmune diseases in these patients, as well as in their relatives with a delayed diagnosis for coeliac disease. Patients newly diagnosed with coeliac disease showed excellent compliance with the gluten-free diet. This should encourage policymakers to consider introducing an easy-to-use screening programme for diabetic patients and their relatives into everyday clinical practice, in order to prevent coeliac-associated symptoms and the onset of additional, more serious auto-immune disorders.
[Show abstract][Hide abstract] ABSTRACT: We describe 54 transient focal neurologic deficits (TFND) episodes in 44 children under 18 y observed retrospectively during a 5-y period (1991-96). Mean age and duration of insulin-dependent diabetes mellitus (IDDM) were 8.4 and 3.4 y, respectively. None of the children had a history of seizure disorder and only one had a personal history of migraine. Twenty-nine episodes were characterized by right- and 25 by left-sided hemiparesis. Three of six patients who presented more than one event had alternate episodes of right- and left-sided hemiparesis. On 8 occasions the episode was preceded by a brief convulsion, in 39 it was not witnessed, and in 7 it was certainly absent. Hypoglycaemia (< or = 2.77 mmol/l) was documented on 26 occasions. On 18 of these 26 occasions, the episodes did not resolve promptly after sugar administration. The clinical course was benign, all patients remained neurologically normal and none developed migraine at follow up. Episodes of TFND were associated with hypoglycaemia in the majority of our cases and we do not consider invasive investigations to be mandatory, since the long-term prognosis was invariably good.
[Show abstract][Hide abstract] ABSTRACT: Antibody titres (IgA and IgG) for Helicobacter pylori were assayed in 69 insulin-dependent diabetes mellitus patients (42 males, age 1-20 years) and 310 healthy controls (171 males, age 1-20 years). A positive antibody titre for Helicobacter pylori was found in 18/69 diabetic subjects compared to 17/310 controls (p < 0.001). There was no difference between Helicobacter pylori positive and negative diabetic subjects as regards age, sex, duration of diabetes, diabetic control, insulin dose and SDS for weight and height. Gastroduodenoscopy revealed presence of Helicobacter pylori and evidence of gastric inflammation in 7/8 symptomatic diabetic children. There was a significant association in the diabetic subjects between positivity for anti-cow's milk protein and anti-Helicobacter antibodies, compared to the control group. Seven of the 17 diabetics studied within 3 months of the onset of diabetes had positive antibody titres for Helicobacter. Of these seven patients, five were positive for anti-cow's milk protein antibodies. In our study the prevalence of Helicobacter pylori infection was significantly higher in diabetic subjects than in controls, but the infection was asymptomatic and there was no correlation with diabetes control. In diabetic subjects Helicobacter pylori infection was associated with a humoral response to cow's milk proteins and was often present from the onset of diabetes.
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to evaluate the impact of educative summer camp on the glycemic control in two different age-groups of young diabetic patients.
54 patients (36 M, 18 F, age 10-27 years, duration of diabetes 2-19 years), treated with 0.81 +/- 0.2 UI/kg/day of insulin and with HbA1c mean levels of 8.25 +/- 1.35 g% were followed by an equip of 8 medical doctors, 4 nurses and 1 dietician for a week during an educative summer camp.
34 children, group 1 (20 M, 14 F, 10-14 years aged, mean duration of the disease 4.52 years, range 2-12 years) and 20 young adults, group 2 (16 M, 4 F, age 16-27 years, mean duration 10.21 years, range 2-19 years) were evaluated. Insulin doses and HbA1c levels were 0.82 +/- 0.21 UI/kg/day vs 0.80 +/- 0.22 U/kg/day and 9.54 +/- 1.5% vs 7.6 +/- 0.6%, p < 0.02 in group 1 and 2 respectively. Glycemic levels at 8 a.m. and 11 p.m. were significantly higher in group 1 than in group 2 (180 +/- 87 mg% vs 219 +/- 77 mg%, p < 0.05 and 164 +/- 84 mg% vs 201 +/- 81 mg%, p < 0.05). Hypoglycemic/patient/episodes were 1.82 vs 0.72, p < 0.05 in group 1 and group 2 respectively.
1. Glycemic control was unsatisfactory in both groups and it was significantly worse in the group of youngs, though in this group HbA1c level was significantly lower. 2. The risk of hypoglycemia was significantly higher in group 1, though in this group insulin doses were significantly decreased.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 01/1997; 19(6):447-9.
[Show abstract][Hide abstract] ABSTRACT: Forty-one sera of patients with IDDM (insulin-dependent diabetes mellitus) containing complement-fixing islet cell antibodies were analyzed for their ability to activate TCC (terminal complement complex). Eighteen sera were found to promote deposition of TCC on human islets of pancreatic cryostat sections with a nonhomogeneous pattern of distribution corresponding to that of insulin. Activation of TCC by IDDM serum and binding of this complex to islet cells was confirmed using purified islets. Flow cytometric analysis of islet cell treated with a TCC+ IDDM serum showed IgG binding to the cell surface. The same serum had a cytotoxic effect on islet cells in the presence of human C. These results obtained with a homologous system of C activation by IDDM sera suggest that TCC may contribute, at least in part, to the pancreatic beta cell damage.
Clinical Immunology and Immunopathology 07/1996; 79(3):217-23. DOI:10.1006/clin.1996.0071
[Show abstract][Hide abstract] ABSTRACT: Complement (C) fixing islet cell antibodies (CF-ICA) are regarded as a marker of active disease in IDDM patients, but their role in the pathogenesis of the disease has yet to be defined. We have evaluated the ability of CF-ICA to promote the assembly of the terminal C complex (TCC) and to be cytotoxic for human pancreatic islet cells. Sera were screened for ICA and CF-ICA on frozen sections of human pancreas by standard immunofluorescence (IF) and a mAb to C9 neoantigen was used to reveal bound TCC. CF-ICA were also tested by IF on islets purified from human pancreas by collagenase treatment and their cytotoxic activity was assayed on a cell suspension obtained from the islets by further trypsin digestion. The results were as follows: 1) Of 300 ICA+ sera examined, 34 were found to be CF-ICA+ and 17 of these were TCC+;2) Double IF staining showed presence of TCC only on insulin-producing cells; 3) Purified viable islets could bind TCC when treated with TCC+ sera and human C and, as a result of this, islet cells were killed. We conclude that some CF-ICA may be responsible for the β cell damage.
Pediatric Research 05/1993; 33. DOI:10.1203/00006450-199305001-00447 · 2.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: IgA and IgG antigliadin antibodies were measured in 498 patients with insulin dependent diabetes mellitus and no history of intestinal malabsorption. Thirty patients had abnormal concentrations of antigliadin antibodies; 22 of these had an intestinal biopsy carried out and 16 of the 22 had subtotal villous atrophy suggestive of coeliac disease (prevalence 3.2%). There were no significant differences between patients with coeliac disease and diabetes and diabetic patients with normal IgA antigliadin antibodies in any of the nutritional variables measured, duration of diabetes, and mean insulin requirement. The mean age of onset of diabetes and attainment of expected height for age were both significantly lower in the patients with both diseases. Typing HLA classes I and II was done in 242 patients. The incidence of HLA-B8, DR3, and DQW2, which are commonly associated with both the diseases, is increased when both are present.
Archives of Disease in Childhood 05/1991; 66(4):491-4. DOI:10.1136/adc.66.4.491 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A controlled trial was carried out on type I diabetic children to evaluate and to compare the clinical effects of two different kinds of immunotherapy: high doses intravenous gammaglobulin (IVIgG) and cyclosporine A (CyA). 30 newly diagnosed patients were admitted to the trial, 10 of whom served as controls (group A), 10 received 400 mg/kg b.w. of IVIgG on 5 consecutive alternate days and subsequently after 15 days and monthly thereafter for up to six months (group B), 10 patients received CyA 5-10/kg b.w. by mouth in two daily doses for a period comprised between 6 and 18 months (group C). Serum post-prandial C-peptide level was significantly higher after 6 months in group B and C than in group A; after 12 months, only group C showed significantly higher values. This difference was no longer significative at 18 and 24 months. Insulin requirement in the treated groups was significantly lower than in control group at 6 months, this difference was no longer significative at 12 months. We didn't find any difference concerning insulin requirement during the study comparing the two groups treated with the two different immunosuppressive therapies. In 3 patients in group B and in 3 patients in group C we didn't observe any appreciable response to immunosuppressive therapy (defined as insulin requirement greater than 0.5 UI/kg b.w. at 6 months and/or greater than 0.8 UI/kg b.w. at 12 months). We couldn't find any significant difference between responders and not responders to the immunosuppressive therapies regarding age, symptoms lasting before the diagnosis, weight loss, ketoacidosis intensity and serum post-prandial C-peptide level at the onset.(ABSTRACT TRUNCATED AT 250 WORDS)
La Pediatria medica e chirurgica: Medical and surgical pediatrics 01/1991; 13(4):355-8.
[Show abstract][Hide abstract] ABSTRACT: Computer-assisted tomography (CT) with 2 mm axial sections and reconstructions was carried out in 31 children affected by GH deficiency (GHD): 18 with idiopathic complete isolated GHD, 3 with idiopathic partial isolated GHD, 2 with idiopathic panhypopituitarism, 4 with isolated acquired GHD and 4 with acquired panhypopituitarism. Density in the intrasellar area on CT corresponded to that of cerebrospinal fluid in 13/20 cases with idiopathic hypopituitarism and in 2/8 cases with acquired hypopituitarism. The overall incidence of primary empty sella syndrome (PESS) in the GH deficient patients studied was thus over 48%, while in children without endocrine dysfunction, it was only 5/213 (2.4%). It is concluded that PESS is more frequent in childhood than assumed until now and that it is frequently associated with GHD.
[Show abstract][Hide abstract] ABSTRACT: Computer-assisted tomography (CT) with 2mm axial sections and reconstructions was carried out in 31 children with GHD. Group 1 included 18 pts (11m, 7f, age 2-12yrs, height -3.3 ± 0.8 SD) with idiopathic complete isolated GHD (peak GH on provocative stimuli below 4 ng/ml, otherwise normal pituitary function), group 2 3 pts (2m, 1f, age 6-14yrs, height -1.8 to 2.2 SD) with idiopathic partial isolated GHD (peak GH above 4 and below 7 ng/ml), group 3 2 girls (age 2 and 17 yrs, height -2.0 and -3.1 SD) with idiopathic panhypopituitarism, and group 4 8 pts (6m, 2f, age 7-12yrs, height -2.6 ± 0.9 SD) with acquired hypopituitarism: 4 with isolated hypopituitarism (3 post-radiation, 1 craniopharyngioma), 4 with panhypopituitarism (2 craniopharyngioma, 1 glioma, 1 histiocytosis X). Density in the intrasellar area on CT corresponded to that of cerebrospinal fluid in 12 of 18 pts (group 1), 0/3 (group 2), 1/2 (group 3), and 2/8 (group 4, both postradiation). The overall incidence of PESS in the GHD pts studied was thus over 48%, while in children without endocrine dysfunction, it was only 5/213. It is concluded that PESS is more frequent than was assumed until now and that is most frequently associated with GHD.
Pediatric Research 10/1988; 24(4). DOI:10.1203/00006450-198810000-00093 · 2.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pseudotumor cerebri is a condition that produces symptoms and signs of brain tumor; the increased intracranial pressure is caused by diffuse cerebral edema. The authors describe a case of 12 years boy, with adrenal hyperplasia, treated by DOCA, presenting recurrent episodes of hyponatremia, headache, nausea and papilledema, cured definitively after correction of natremia and after institution 9-alpha-fluorohydrocortisone therapy.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 05/1988; 10(3):323-6.
[Show abstract][Hide abstract] ABSTRACT: Immunological markers including ICA-IgG, CF-ICA, other non organ specific autoantibodies, circulating immune complexes (CIC), IgG, IgA, IgM, C3, C4 and lymphocyte subpopulations (OKT3, OKT4, OKT8) were studied at onset in 32 insulin dependent diabetic patients (16 males, 16 females, aged 1-21 yr.). Other non organ specific autoantibodies, CIC, IgG, IgA, IgM, C3, C4 and OKT3, OKT4, OKT8 were also studied after a 6-12 months follow-up in the same group of patients. ICA-IgG and CF-ICA were also studied in a control group of 19 insulin dependent diabetic patients with an over 3 year history of diabetes. ICA IgC, CF-ICA, other autoantibodies and CIC were detected at diagnosis in 65%, 19%, 33%, and 50% of patients respectively. ICA-IgG and FC-ICA were detected respectively in 15% and zero of the control group of 19 long standing diabetes. No alterations in IgG, C3 and C4 levels and in T cells subsets have been found at onset. C4 levels significantly decreased at the successive observation. A significant elevation of IgG levels and helper/suppressor ratio were also observed at follow-up. Autoantibodies and CIC positive sera at diagnosis support the concept that a previous autoimmune disorder exists before clinical manifestations of diabetes. Other immunological abnormalities including relative hypogammaglobulinemie, lower C4 and higher helper/suppressor ratio, observed by other authors (Kanakoudi 1984, Vergani 1985, Lernmark 1985) represent an aspecific alteration due to metabolic imbalance or to an earlier immunological disorder.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 01/1988; 10(5):481-5.
[Show abstract][Hide abstract] ABSTRACT: A controlled trial was carried out on type I diabetic children in order to evaluate the clinical effect of high doses intravenous gammaglobulins (i.v. IgG). Twenty newly diagnosed patients were admitted to the trial, ten of whom received 400 mg/kg body weight of i.v. IgG on 5 consecutive alternate days and subsequently after 15 days and monthly thereafter for up to six months, while ten patients served as controls. Insulin requirement in the treated and untreated groups was essentially similar at the start of the trial (0.94 +/- 0.47 vs 1.11 +/- 0.28) but showed a statistically significant difference at 3 (0.40 +/- 0.28 vs 0.66 +/- 0.26), 6 (0.36 +/- 0.19 vs 0.63 +/- 0.27) and 9 (0.38 +/- 0.20 vs 0.62 +/- 0.25) months. The difference was still evident at 12 months but no longer reached statistical significance. The reduced requirement of insulin was accompanied by a parallel increase in the C-peptide serum levels. Lymphocyte subpopulations, C3 and C4 and immune-complex levels did not show any significant modification after i.v. IgG administration.
[Show abstract][Hide abstract] ABSTRACT: This study was designed to assess the accuracy of self fasting blood sugar (FBG) estimation in young patients with IDOM, and to determine whether intensive self monitoring of FBG would improve the accuracy of blood sugar estimation. 37 subjects (11-19 years old, diabetics from 1 to 12 years) were studied during a 9 days educative diabetic camp. Patients were asked to guess their FBG immediately before it was analyzed with a Glucometer. The correlation between actual and estimated glycemia was 0.625 (p less than 0.01). The percent-error of estimation actual FBG--estimated FBG/actual FBG x 100 was within 30% in 55% of determination (523). There was a significant positive correlation between the absolute error of estimation and the duration of IDDM (r = -0.29; p less than 0.026) and the day of measurements (r = -0.27; p less than 0.05), but not the age of children, HbAlc levels and the hour of determination. The absolute error progressively reduced during the camp: the mean value was 62.50 +/- 55.37 mg% (n = 34) in the first day, 26.52 +/- 17.99 (n = 24) (t = 2.82; p less than 0.01) in the last day. 4 patients, in 5 estimations failed to discriminate hyperglycemia (estimated FBG less than 50 mg% versus actual FBG greater than 100 mg%) and 6 patients in 17 estimations failed to discriminate hypoglycemia (estimated FBG greater than 100 mg% versus actual FBG less than 50 mg%). Conclusions: in our study diabetic patients are accurate in guessing their FBG. They nearly always identified hyperglycemia but not always hypoglycemia. An intensive self monitoring of FBG improves the accuracy of FBG self estimation.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 01/1987; 9(6):699-701.
[Show abstract][Hide abstract] ABSTRACT: The present study was undertaken to determine the clinical usefulness of fructosamine estimations in monitoring the short term changing in metabolic control in 5 newly diagnosed type 1 diabetic children (3 boys, 2 girls, aged 3-13 years). Mean glycaemic values, HbAlc (normal range: 4.77 +/- 0.67%), fructosamine (normal range: 2.65 +/- 0.65 mmol/l) were determined at the admission and after 1, 2, 3, 4 weeks. Normoglycaemia was achieved within 1 week (mean values: 232 +/- 107 mg% at admission; 98 +/- 39 mg% after 1 week of insulin therapy), HbAlc slightly decreased from 12 +/- 0.71 at admission to 9.90 +/- 1.81 after 4 weeks, but not reached normal values. Fructosamine decreased from 5.49 mmol/l to near normal values (3.02 +/- 0.67) after 4 weeks. The validity of the method was confirmed by the comparison of HbAlc and fructosamine in 22 stable long-standing diabetic children (r = 0.77, p less than 0.01). Compared with HbAlc, fructosamine appeared more useful in monitoring short term (3 weeks) changes in metabolic control. Additional advantages were lower cost and technical simplicity of measurement.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 01/1987; 9(5):583-4.