A prospective and randomized clinical trial of an inception cohort of diabetic kidney recipients to test the hypothesis that maximized metabolic control of diabetes prevents or delays diabetic nephropathy in the renal allografts was initiated approximately three years ago. Notwithstanding the fact that all our diabetic patients were on prednisone and therefore metabolically unstable, we achieved and maintained a clear difference between the standard control (group A) and the maximized control patients (group B). At 13 months of study, the mean fasting blood glucose mg% (A: 242 +/- 22, B: 130 +/- 9, p less than 0.001), nonfasting blood glucose (A: 276 +/- 40, B: 135 +/- 10, p less than 0.001), 24 hour urine glucose (A: 85 +/- 16, B: 5 +/- 1, p less than 0.001), and glycosylated hemoglobin % (A: 13 +/- 0.9, B: 10 +/- 0.8, p less than 0.01) were all clearly and statistically significantly higher for the group A patients. These results show the feasibility of such a trial using the tools available today to treat diabetes.

Aftercare↗

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Spontaneous rupture of the hepatic artery in a patient with type 1 neurofibromatosis treated by embolization: a case report.

We report the case of a 48-year-old man with neurofibromatosis presenting with sudden-onset abdominal pain, profound hypotension, and a drop in hemoglobin. CT scan demonstrated a massive hematoma within the right lobe of the liver with rupture into the peritoneal cavity. Angiography demonstrated diffuse abnormalities of the hepatic circulation with fusifom, ectatic, and stenotic segments. Acute extravasation from a peripheral branch of the right hepatic artery was identified and successfully embolized with subsequent hemodynamic stabilization of the patient. To the best of our knowledge this is the first case report of this kind in a patient with type I neurofibromatosis.

Abdominal Pain↗

PubMedDate not supplied

Role of rice and cereal products in dietary cadmium and lead intake among different socio-economic groups in south India.

A study was conducted to evaluate the concentration of cadmium and lead in rice and cereal products commonly consumed in South India. Samples from retail outlets were purchased and analysed for cadmium and lead using graphite tube atomic absorption spectrophotometry. The results indicated varying concentrations of these metals in different rice and cereal products. The daily dietary intake of cadmium and lead varied among different socio-economic groups, based on occupation, and choice of consumption. The findings suggest that rice is the major source of cadmium and lead among the rural population and economically-deprived class. The source of intake of toxic metals appears to be more diverse in the case of the urban middle class and the economically privileged class of South India.

Cadmium↗

PubMedDate not supplied

The marriage squeeze and the rise in informal marriage in Brazil.

Around the world, populations have experienced shortages of one sex or the other at marriageable ages, as a result of mortality declines. The solutions to this problem vary with the cultural context. Declines in the spousal age difference and increases in dowry payments (India) and polygamy (Africa) are two adjustments to a disequilibrium in the marriage market. We hypothesize that in Brazil the marriage market finds its balance by "recycling" men through highly unstable informal unions. Using census and 1984 survey data, we establish the relationship between a marriage squeeze and the increase in informal marriage. Census data and a competing-risks analysis of marriage choice provide evidence that a marriage squeeze has affected both the chances of marrying at all and the type of marriage entered.

Adolescent↗

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Current options for mechanical heart technology.

Heart transplantation remains the treatment of choice for end-stage heart failure despite limited donor availability and allograft durability. Artificial heart technology was initially developed as a replacement for transplantation but the initial experience with these technologies was disappointing. The quest for a total artificial heart has largely been abandoned in favor of ventricular assist devices (VADs). VADs have gained widespread acceptance as bridge to transplant and bridge to recovery therapy. After more than a decade of clinical use, several FDA approved device designs have proved effective in treating patients with various causes of heart failure. This review describes the current, clinically available ventricular replacement and assist devices and defines the adult patient populations in which they are useful. The next generation of these devices will soon become available and their clinical utility will likely shape the future direction of heart failure therapy. Ultimately the concept of a long-term total artificial heart may be revisited.

Device Approval↗

PubMedDate not supplied

Neuropsychiatric sequelae of traumatic brain injury.

The authors review the psychiatric disturbances associated with traumatic brain injury. They highlight the close link between traumatic brain injury and psychiatry and provide an overview of the epidemiology, risk factors, classification, and mechanisms of traumatic brain injury. They describe various neuropsychiatric sequelae, and the respective treatments are outlined with emphasis on a multidisciplinary approach.

Brain Injuries↗