Hyperglycemia and other metabolic derangements resulting from absolute or functional deficiency of insulin are accompanied by typical signs and symptoms of diabetes. The clinical signs and the findings of hyperglycemia over 200 mg/dl should establish a diagnosis of diabetes mellitus. An oral glucose tolerance test (O-GTT) is rarely necessary for diagnosis of diabetes in a child. A small proportion of children, however, present less severe symptoms, and may require an O-GTT. Approximately 14% of IDDM children were in coma at diagnosis in Tokyo, and 11 onset deaths (0.94%) were observed among the 1172 newly diagnosed IDDM cases in Japan. A significant decline in the onset mortality, however, has been observed in the past 20 years in Japan in association with the improvement of early management of childhood diabetes. The clinical distinction of IDDM from NIDDM is often difficult in diabetic children of Oriental origin without obesity. Japanese IDDM can be divided into two forms, abrupt and slow onset forms, but they may be essentially the same disease. There was no difference in the frequency of being tested positive for circulating ICA between the two groups of the patients. But a difference in the frequency of HLA DR4 and DRW9 was noticed between the two groups. Clinical features of 107 children with NIDDM were studied and about 75% of these cases were obese. All of them can be detected by routine urinalysis for glucose. Diet and exercise therapy in most of the newly diagnosed patients resulted in remission but some of them may require insulin or an oral hypoglycemic agent to get better glycemic control.

Child↗

PubMedDate not supplied

Hepatic artery embolization for postoperative hemorrhage in upper abdominal surgery.

BACKGROUND: The purpose of this study was to evaluate angiographic findings and radiologic and clinical results of transcatheter arterial embolization (TAE) of the hepatic artery for hemorrhage after upper abdominal surgery. METHODS: Ten patients (nine male, one female, mean age = 63.5 years) with postoperative hemorrhage underwent emergency hepatic artery embolization. We retrospectively analyzed the angiographic findings and the effectiveness of TAE. RESULTS: Angiography demonstrated pseudoaneurysms (n = 6) and extravasation (n = 5). Portal veins were not compromised in any patient. The bleeding points were at the gastroduodenal artery (n = 3), proper hepatic artery (n = 3), right hepatic artery (n = 2), left hepatic artery (n = 1), and intrahepatic artery (n = 2). Embolization was performed at the extrahepatic site (n = 6) and intrahepatic site (n = 4). TAE was successful in eight patients. Hemostasis was achieved in eight patients. Two patients in whom TAE was not successful died of bleeding after TAE. In six patients whose collateral arteries were visualized at TAE, hypoxic hepatic failure was avoided and the patients had a favorable clinical course. CONCLUSION: TAE is a useful treatment for postoperative hemorrhage, but the presence of collateral arteries at the time of TAE can affect the patients' prognoses.

Abdomen↗

PubMedDate not supplied

[Pathological study of the transseptal puncture site of interatrial septum in catheter interventions].

Pathological changes in the transseptal puncture site of the interatrial septum were studied in seven autopsy patients in whom transseptal puncture had occurred during catheter interventions under transesophageal echocardiography monitoring. 1. In one patient with chronic renal failure who had received hemodialysis for more than 10 years, the transseptal puncture was unsuccessful. The failure is attributable to the severe calcification of the left atrial wall and interatrial septum. The autopsy showed only a small scratch on the fossa ovalis in the right atrial side. 2. The puncture hole was round in five patients and a slit in one, without tearing or extension from the puncture hole. 3. Late closure of the transseptal puncture hole was observed in two patients who died 7 and 22 days after the intervention procedures. 4. Mild infiltration of red blood cells around the transseptal puncture hole was detected in two patients. One died immediately after left atrio-arterial bypass support and another died on the 24th day after percutaneous transvenous mitral commissurotomy. Both patients showed tendency to bleeding due to heparinization and/or coagulopathy treatment during the clinical course. 5. Autopsy specimens demonstrated that the transseptal puncture was performed just on the fossa ovalis in all patients. 6. Biplanar transesophageal echocardiography is a very effective guidance method for transseptal puncture during catheter interventions.

Adult↗