The need for special dietary products marketed for use by individuals with diabetes mellitus and the safety and efficacy of certain nutritive sweetener substitutes for sucrose are reviewed. Special foods for individuals with diabetes mellitus are not necessary to achieve the dietary objectives recommended by leading United States and European authorities. They can be achieved conveniently and at minimum expense through enlightened choices of commonly available food items. At present, specific and unique characteristics of food products with special therapeutic properties for diets of diabetic individuals cannot be delineated or defined on rational nutritional grounds. Such terms as "diet", "dietetic", and "diabetic" on food labels have no uniform meaning for consumers, and diabetologists have observed that patients tend to consume such foods without regard to their energy content. Some consumers regard the reduced-calorie and low-calorie prepared food products as convenient in diets for weight reduction and diabetes although their use in dietary management of diabetes has no therapeutic basis other than weight reduction and maintenance. When fed as pure substances to fasted subjects, the nonglucose carbohydrate nutritive sweeteners, fructose, xylitol, and sorbitol, are absorbed relatively slowly and produce less postprandial hyperglycemia and insulin response than sucrose or glucose. Adequate studies of their long-term effectiveness when ingested as part of mixed meals have not been conducted. Although these sucrose substitutes are generally considered safe, the significance of recent information on possible carcinogenicity of oral xylitol in long-term feeding studies has not been fully evaluated. In view of the lack of certain essential information on the long-term effectiveness of various diets in preventing or mitigating the chronic debilitating complication of diabetes, suggestions for future research are included.

Blood Glucose↗

PubMedDate not supplied

Bony abnormalities of the paranasal sinuses in patients with Wegener's granulomatosis.

Wegener's granulomatosis is a systemic vasculitis that can affect any organ system, but primarily involves the upper and lower respiratory tracts and the kidneys. Chronic sinusitis is a well-known clinical feature of the disease. Mucosal abnormalities of the nose and paranasal sinuses have been well-characterized and range from granulomatous lesions to diffuse mucosal thickening. In contrast, abnormalities of the underlying bone of the paranasal sinuses in this disease have not been well-described, and reports have been limited. To characterize bony abnormalities of the nose and paranasal sinuses in patients with Wegener's granulomatosis, we performed a retrospective review of all patients with Wegener's granulomatosis who underwent a sinus CT scan at our institution between 1989 and 1999. Nine patients were identified. A total of 22 distinct bony abnormalities were identified in 5 patients. Specific bony findings included bony erosion and destruction of the septum and turbinates; erosion of the ethmoid sinuses; neo-osteogenesis of the maxillary, frontal, and sphenoid sinuses; and complete bony obliteration of the maxillary, frontal, and sphenoid sinuses. Although these findings are suggestive of Wegener's granulomatosis, they are not pathognomonic. Bony changes on sinus CT scan may provide radiologic evidence of underlying Wegener's granulomatosis when clinical suspicion is high.

Adult↗

PubMedDate not supplied

Concerns of young otolaryngologists. Postresidency education: concerns of a new specialist.

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Certification↗

PubMedDate not supplied

Ethnic influence on health and dependency of elderly inner city residents.

The objectives of the study were to assess and compare the social characteristics, prevalence of disease, health needs, dependency and use of health services by elderly people in the different ethnic groups living in an inner city. A prevalence study was conducted using a questionnaire administered to people aged 65 years and over living at home, selected from the registers of inner city general practices in West Birmingham. Contact was made with 736 individuals from the original sample of 1,450 names, and completed questionnaires were obtained from 669 individuals (297 men, 372 women). Respondents were divided by place of birth into four groups: UK, Asia, West Indies, and 'Other'. Outcome measures were demographic data, language, household composition, prevalence of disease and health problems, help with activities of daily living, and contact with and knowledge of community health services. We found that those born in the UK were likely to be older, female, unmarried and living alone. In the Asian group, only 15% spoke English and 59% lived in a household with more than three other people compared with 4% in both the UK and West Indian groups. Hypertension was more common in West Indians, arthritis in Asians and diabetes mellitus more common in both groups than in the UK group. Asians were more likely to complain of poor vision. The level of dependency was similar in all groups despite age differences. Contact with community health services was low among Asians who also had a low awareness of the availability of these services. The conclusions from the study were that the average age of elderly individuals in ethnic minority groups is less than that of the indigenous population, making direct comparison difficult. Nevertheless, they have a higher prevalence of age-related disease and a similar level of dependency. They are less well served by, and have little knowledge of the existence of, community health services. For older Asians, difficulty in communicating with English-speaking health personnel is a major barrier to effective health care. Access to health care by older people from ethnic minorities needs to be improved, and services developed in a more culturally sensitive manner.

Activities of Daily Living↗