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A Canadian community hospital review of women with ectopic pregnancies revealed that 7.6% had had a previous tubal sterilization. This rate was higher than reported previously.
The short-term and longterm effects of physical exercise and sports on the regulation of diabetes mellitus in children are described. The precise tuning of insulin dosage, food and sports can be achieved with self-control and self-regulation. Advisable sports activities and limitations like poor metabolic control are being discussed. Regular physical exercise for diabetic children is advised to prevent lack of movement, also for their health in older age.
Children with high normal or high BP should also be evaluated for other cardiovascular risk factors, and interventions should address overall cardiovascular risk. Nonpharmacologic interventions include weight reduction when appropriate, avoidance of dietary salt excess, and dynamic exercise. Drug treatment should be required in a minority of children with hypertension. There are concerns about the longterm effects of drug therapy on lipid and carbohydrate metabolism and on physical and cognitive growth and development. Beta adrenergic antagonists and diuretics are usually the first line drugs to be added to the nonpharmacologic therapeutic strategies for BP control in children. After a sufficient period of BP control, a stepped-down approach and discontinuation of drug therapy should be considered.
Oral antidiabetics are given for preference to adult diabetics who do not need insulin. Biguanides are particularly indicated for adipose diabetics, sulphonamides for those of normal weight. Phenformin must not be used in the presence of renal insufficiency and severe liver diseases because of the high risk of lactacidosis. Oral antidiabetics should not to be given during pregnancy. With oral treatment of diabetics under the age of 30, proteinuria, peripheral vascular diseases and disturbances of fat metabolism occure more frequently while retinopathies, coronary diseases, peripheral neuropathies or infections of the urinary tract cannot be influenced orally, nor by insulin nor by a combination of the two. The i. v. lipid tolerance test is always pathological even in apparently well-adjusted orally treated diabetics. On the other hand it is normal even in less well adjusted insulin therapy. More epidemiological investigations should be carried out in order to be able to assess clearly the longterm effects of oral antidiabetics.
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The possible vascular hazard associated with carbohydrate intolerance produced by long-term use of oral contraceptives was investigated by examining the capillary basement membrane thickness in quadriceps muscle biopsies, a highly sensitive and reliable indicator of diabetic microangiopathy. The average basement thickness of 18 long-term (4-9 years) contraceptive users with diminished carbohydrate tolerance was 1644 A, compared to normal pregnant women (1711 A) prediabetic pregnant women (1854 A), and overt diabetic women (2593 A). Contraceptive steroid-induced carbohydrate intolerance appears to carry little, if any, increased risk for the development of diabetic vascular disease, even as assessed by the sensitive electron microscopic technique.
Cells of the preadipocyte ob17 clonal line convert in culture after confluence to adipose-like cells. Longterm effects of hypolipidemic drugs on glucose and palmitate utilization by ob17 cells were investigated after chronic exposure to one anionic drug (clofenapate) and three cationic drugs (benfluorex and two of its metabolites, 422 SE and 1475 SE). The results indicate that long-term treatment of ob17 cells by clofenapate and 1475 SE enhances significantly the glucose utilization through both increased oxidation and incorporation into lipids. Compound 1475 SE enhances palmitate utilization mainly through increased oxidation. Chronic exposure to clofenapate leads to an increase in palmitate utilization through both oxidation and, as previously shown (Verrando et al., 1981), esterification. Thus, these two drugs are able on a long-term basis to induce on a single and homogeneous cell type--the adipose cell--an increase in the utilisation of two main nutrients both through more active catabolic and anabolic pathways.
About the method of central vein catheterisation in rats is reported. The catheterisation takes place after operative lay open by way of the external jugular vein. So it is possible to perform successfully an effective longterm infusion therapy in animal experiments, too.
Radiotherapy of tumors in children together with surgery and chemotherapy is an important part of therapy in the multimodal approach. Since the radiotherapy of such children requires special technical as well as psychological know-how, this should only be undertaken in larger centers. The indications for using such radiation should be very strict because of the direct and longterm effects on the growing organs, and the benefits carefully weighed against the risks. It is the function of a multidisciplinary tumor team to estimate these risks. Changes in current standard therapy, as unilateral reduction in radiotherapy, should only be undertaken in controlled randomised trials.
Current treatment for Felty's syndrome, a triad of rheumatoid arthritis, splenomegaly and neutropenia, is often unsuccessful. Felty's syndrome may be related to decreased production of hematopoietic growth factors. We treated a patient with Felty's syndrome, profound neutropenia and a history of multiple complicated hospitalization for severe infections, with granulocyte colony stimulating factor (GCSF) for 18 months. After initiation of GCSF, the patient's neutrophil count has remained in the normal range for 18 months. After 2 easily treated infections at the start of therapy, she had only one episode of cellulitis occurring after 18 months when her GCSF dose was reduced to every 3rd day. She has been infection-free since then on every other day therapy. GCSF may be a cost effective longterm therapy for selected patients with Felty's syndrome and may reduce both patients' morbidity and overall medical costs.
A consecutive series of 15 impotent men (mean age: 53 (range 18-65 years)) underwent venous surgery for abnormal drainage of the cavernous bodies. During the follow-up period (mean 19 months (range 10-34)), 11 patients became potent and sexually active. Three of the impotent men had had a primary venous leakage of the corpora cavernosum, and all these three had to be re-operated. Two achieved full potency. The three postoperative failures in the 12 patients with the secondary type of venous impotence occurred in one heavy smoker, one patient with severe arterial hypertension and one continued to be impotent until his death eight months postoperatively. It is concluded that erectile impotence due to pronounced leakage of the cavernous bodies should be treated surgically, and that the longterm effect is acceptable.
OBJECTIVE: To report the short and longterm effect of intravenous immunoglobulin (IVIG) in patients with systemic onset juvenile rheumatoid arthritis (SOJRA). METHODS: A retrospective chart review of 27 patients with SOJRA treated with IVIG and followed for 37.1 +/- 18.2 months was undertaken. Indications for treatment were fever, arthritis, or steroid dependency. RESULTS: We treated 27 patients with SOJRA with IVIG monthly for 3-54 months. Six months after IVIG therapy, 20 patients had a least a 50% decrease in at least one of the following: the number of days of fever; prednisone dose; or the number of active joints. Five patients failed to respond to IVIG, and 2 dropped out after 3 and 4 months. At last followup visit (mean 37.6 +/- 18 months), 11 of the initial 20 responder group patients were in remission, while 3 had significantly improved but still had active arthritis, and 6 were now unresponsive. Of the initial 5 patients in the nonresponder group, 4 had nonresponsive arthritis and 1 had improved at last followup. Three patients in the responder group subsequently developed other diseases. CONCLUSION: The main benefit of IVIG therapy to most of our patients was a significant improvement in the systemic features, with resolution of fever and a significant reduction in the steroid dose. The efficacy of IVIG in altering the course of arthritis was less predictable. We suggest that IVIG has a role in the management of SOJRA, but it should be limited to patients with severe SOJRA in whom prolonged unresponsiveness to standard therapy is present.
The parotid flow rate, buffering capacity and inorganic components in saliva from 17 children with juvenile recurrent parotitis (JRP) in periods free of symptoms and in healthy controls of the same number, sex and age were analysed after gustatory stimulation with 1%, 2% and 6% citric acid. There was a great individual variation in all analysed variables in the JRPs, as well as in the controls. The flow rate, the buffering capacity of saliva and the ion concentration of phosphate were significantly lower for the JRP-children than for the controls, while the concentration of chloride, sodium and copper were raised (p < 0.01-0.001). No statistical differences were found for the pH, the calcium, the potassium, the magnesium and the zinc concentrations. The results suggest a longterm effect on the parotid saliva in the JRP-cases due to the disease.
OBJECTIVE: We conducted an open observational study to assess the short and longterm effect of single local glucocorticosteroid injection for trochanteric bursitis. METHODS: 75 patient diagnosed with trochanteric bursitis based on clinical criteria were injected; 20, 32, and 22 patients each received 6, 12, and 24 mg betamethasone, respectively, mixed with 4 cm3 of 1% lidocaine. A standardized baseline questionnaire was administered to assess the severity and functional limitation due to trochanteric pain, including the visual analog scale for pain. Patients were followed at Weeks 1, 6, and 26 to determine their response to treatment. RESULTS: 77.1, 68.8, 61.3% of responding patients reported improvement in pain at Week 1, 6, and 26, respectively. Patients receiving higher doses of betamethasone were more likely to experience pain relief (p < 0.0123). CONCLUSION: Corticosteroid and lidocaine injection for trochanteric bursitis is an effective therapy with prolonged benefit.
An overview is given of diagnostic determinations to be carried out on ascites fluid, and on the medical therapy as based on our knowledge of the pathophysiology. Paracentesis has become more frequently used. It is slightly more effective than therapy with high doses of diuretics and carries less side effects. Longterm studies are needed to investigate whether albumin can be safely substituted by dextran-70 or haemaccel.
The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. The state of the art is based on recent meta-analyses and the understanding of the pathophysiology of discal hernia which includes inflammation. Contemporary concepts and data from recent reviews are summarized to elucidate current recommendations and suggestions for the management of patients with acute sciatica. The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.
OBJECTIVE: To investigate the initial longterm effect of inhaled NO on hypoxemia in ARDS patients. DESIGN: Retrospective study. PATIENTS: Nine hypoxemic patients with ARDS (Murray Lung Injury Score, LIS, 2.8 +/- 0.3), treated with conventional mechanical ventilation. INTERVENTIONS: Continuous NO inhalation was started after a test of inhaled NO efficacy on gas exchange and hemodynamics. Long term effects of inhaled NO were evaluated daily in terms of arterial oxygenation and methemoglobin formation. RESULTS: The initial NO inhalation increased the PaO2/FiO2 from 141 +/- 64 mmHg to 216 +/- 70 mmHg (p < 0.0001) and decreased the mean pulmonary pressure from 38 +/- 7 mmHg to 32 +/- 5 mmHg (p < 0.01), the pulmonary venous admixture from 29 +/- 10% to 20 +/- 8% (p < 0.01) and the pulmonary vascular resistance from 325 +/- 97 dyne.s.cm-5 to 238 +/- 48 dyne.s.cm-5 (p < 0.01). Daily withdrawal of inhaled NO, which was administered for 14 +/- 16 days at 8 +/- 2 ppm, was associated with a decrease in PaO2/FiO2 by 61 +/- 32 mmHg (p < 0.0001). During prolonged NO inhalation the FiO2 was decreased, on average, by 0.34 +/- 0.19 (p < 0.01), the positive end-expiratory pressure by 4 +/- 2 cmH2O (p < 0.01) and the peak inspiratory pressure by 7 +/- 4 cmH2O (p < 0.01). Three patients died during the ICU stay. CONCLUSIONS: Our results confirm the interest for inhaled NO as an additional approach for the treatment of hypoxemia in ARDS. Inhaled NO seems to allow for a better control of gas exchange, rather than for a rapid reduction of the ventilatory support.