Is centralized hospital care necessary for all insulin-dependent pregnant diabetics?

Summary. A retrospective population study in Northern Ireland examined the benefits of centralized care in insulin-dependent diabetic pregnancies. In the 5 years 1979–1983, there were 139 250 deliveries in Northern Ireland and of these 221 pregnancies occurred in 187 insulin-dependent diabetic patients; 100 were managed entirely in peripheral maternity units, 61 were referred from a peripheral unit to the Royal Maternity Hospital, Belfast and 60 were managed entirely in this central referral hospital. The patients referred from the periphery had the worst past obstetric history with a combined perinatal mortality rate of 200 per 1000. During the study period the perinatal mortality rate was 107 for the referred pregnancies, 33 for those managed entirely in the peripheral units and 18 for those managed at the Royal Maternity Hospital. If those pregnancies terminated for fetal abnormality, and deaths beyond the perinatal period are included, the figures for total fetal loss were 15.5%, 5.5% and 7.1% respectively. Overall the major congenital malformation rate was 7.5%, and for the respective groups 6.5%, 3.0% and 13.0%. For the general population during the same period the perinatal mortality rate was 1.4% and the major congenital malformation rate was 2.5%. Thus it is suggested that only peripheral hospitals which can offer combined antenatal/endocrine care and with a neonatal intensive care unit should undertake the management of the pregnant diabetic.     

Pulmonary histiocytosis X: comparison of radiographic and CT findings

The authors retrospectively evaluated radiographs, computed tomographic (CT) scans, and results of pulmonary function tests (when available) for 17 patients with biopsy-proved pulmonary histiocytosis X. In 11 patients, high-resolution CT was used. In 12 patients, CT demonstrated cystic air spaces, usually less than 10 mm in diameter. In three of these 12, cysts were the only abnormality, but in six others, nodules (usually less than 5 mm in diameter) were also present. Two patients had only nodules and one, only emphysema. CT showed that many lesions that appeared reticular on plain radiographs were actually cysts. CT showed no central or peripheral concentration of lesions, but it did reveal that many small nodules were distributed in the centers of secondary lobules around small airways. CT findings correlated better with the diffusing capacity (rho = -0.71) than did the plain radiographic findings (rho = -0.57). Thus, CT was better than radiography at showing the morphology and distribution of lung abnormalities.     

A Survey of Stress at Work

A survey was carried out among members of the Society of OccupationalMedicine on their assessment of stress-related illness in industry.It was found that medical officers in organizations estimatedthat over 45 per cent of their managers suffered from some formof psychosocial stress (e.g anxiety, psychosomatic illness,depression), ‘to some or a ereat extent’. Professor C. L. Cooper, University of Manchester Institute of Science and Technology, P.O. Box 88, Manchester M60 1QD.     

B-cell lymphoproliferative disorders in children after bone marrow transplantation: radiologic manifestations

The radiographic findings in five pediatric patients in whom unregulated B-cell lymphoproliferative disorders developed following bone marrow transplantation are described. Four patients received T-cell-depleted bone marrow from mismatched donors and one received nondepleted marrow from a matched sibling donor. These disorders are similar to B-cell lymphoproliferative disorders that have been described in other immunosuppressed hosts. They are associated with Epstein-Barr virus and range from polyclonal proliferation without cytogenetic abnormalities to monoclonal lymphoma with clonal cytogenetic changes. Unlike other postallograft lymphoproliferative processes, B-cell lymphoproliferative disorders in these patients have not responded to antiviral therapy, immunologic therapy, or chemotherapy. The radiographic patterns of disease include diffuse or focal hepatic involvement; gallbladder wall thickening; and pulmonary, soft-tissue, and basal-ganglion masses. These radiologic findings are not specific and evaluation of tissue histology is required for diagnosis.     

New catheter design and placement technique for pulmonary arteriography

An improved catheter for pulmonary arteriography via the antecubital approach is described. The catheter has been used successfully in 56 patients.     

MR imaging of facial nerve enhancement in Bell palsy or after temporal bone surgery

The authors evaluated magnetic resonance (MR) images obtained with intravenously administered gadolinium in ten patients who had facial paralysis and no facial nerve tumor. In patients with either Bell palsy (four patients) or facial paralysis after temporal bone surgery (six patients), intratemporal facial nerve enhancement was seen. Facial nerve enhancement on MR images proved to be a nonspecific finding.     

股骨柄假体表面多孔层孔隙形状改造的动物实验

目的:观察菱形孔隙及方形孔隙两种不同几何形状多孔层设计股骨柄假体的生物学固定效果,分析孔隙几何形状对假体生物学固定的影响。方法:于2003-03/2004-04在中山大学医学部动物中心完成全部实验过程。纳入24只成年杂种犬,雌雄不拘,以随机数字表法均分为2组,即菱形孔隙组及方形孔隙组,各12只。自行设计完成犬骨重建型股骨柄假体,将股骨柄假体近2/3段表层改成两种不同几何形状的粗大多孔层结构,钛丝表面假体,钛丝直径改为1.0mm,孔径加大至5.0mm,孔隙度可达80%。菱形孔隙组钛丝沿股骨假体柄呈螺旋形排列并斜形相交,方形孔隙组钛丝沿股骨假体柄纵横排列并直角相交。均将假体表面孔隙内充填自体股骨头颈骨质制成的骨泥后,行右侧人工股骨头置换术。术后6个月行X射线摄片、组织学检查及生物力学测试,以股骨近端骨吸收情况、新生骨长入深度及孔隙充满度、假体-骨界面最大剪切强度测量为评价指标,了解假体内外成骨和固定情况。结果:菱形孔隙组及方形孔隙组各12只,实验中手术不成功或术后生存不够观察时间的均予实验过程中随时补足,最终每组12只进入结果分析。①组织学观察显示菱形孔隙组多孔层孔隙内最大骨长入深度及孔隙内新生骨平均充盈率均优于方形孔隙组(3000,2450μm;96.2%,71.6%)。②菱形孔隙组假体-骨界面最大剪切强度高于方形孔隙组,差异有显著性意义[(8.57±0.51),(3.15±0.41)N/mm2,P<0.01]。③菱形孔隙组6个月标本肉眼及X射线观察股骨近端无明显骨吸收,优于方形孔隙组;所有实验犬术后伤口缝线任其自行脱落,除1只伤口感染并于术后17d死亡外,余实验犬均伤口愈合良好,未出现不良反应。结论:股骨柄假体表面不同几何形状多孔层设计能影响其生物学固定效果,菱形孔隙设计优于方形孔隙。     

骨关节炎大鼠关节软骨修复与橄榄叶提取物的干预效应

目的:观察橄榄叶提取物对白陶土及鹿角菜胶诱导的大鼠骨关节炎组织炎症的预防作用及对关节软骨的修复作用。方法:试验于2005-11/12在大连医科大学中日合作医药科学研究所进行。实验动物:选择健康雄性SD大鼠80只。实验材料:受试物橄榄叶提取物[由日本国Eisai食品与化学有限公司(日本国东京市)提供]。实验分组及给药:按体质量将大鼠随机分为5组,每组16只。模型对照组,灌胃给予蒸馏水,消炎痛组,灌胃给予消炎痛2mg/kg体质量,其余3组为橄榄叶提取物组,分别给予橄榄叶提取物(活性成分为以羟基酪醇为主的多酚)25,50,100mg/kg体质量灌胃,连续5d。第1天给药后1h,采用白陶土与鹿角菜胶诱发大鼠单发亚急性关节炎。实验评估:①诱发关节炎后1,3,5d,用容积测量法测定每组8只大鼠的左右后肢足跖体积,计算肿胀度,并同时用游标卡尺测定其胫跗骨关节最大径。②诱发关节炎后第5天,测定大鼠足跖伊文思蓝含量。每组的另8只大鼠,在诱发关节炎第5天麻醉后处死,剪下右足跖做组织病理学检查,观察橄榄叶提取物对大鼠骨关节炎中组织炎症的预防作用及对关节软骨的修复作用。结果:80只大鼠全部进入结果分析。①足跖肿胀度及胫跗骨关节径:诱发关节炎后1,3,5d,橄榄叶提取物50mg/kg组和100mg/kg组大鼠的右后足跖肿胀度均明显小于模型对照组大鼠[1d:(46.7±4.2)%,(44.8±6.8)%,(52.5±4.0)%;3d:(40.4±4.8)%,(37.4±5.7)%,(45.0±2.9)%;5d:(34.5±4.8),(31.7±5.3)%,(40.4±4.0)%,P<0.05],橄榄叶提取物25mg/kg体质量组,50mg/kg体质量组,100mg/kg体质量组大鼠的右后胫跗骨关节径与模型对照组大鼠比较差异无显著性(P>0.05)。②足跖伊文思蓝含量:诱发关节炎后第5天,橄榄叶提取物50mg/kg,100mg/kg组大鼠的右后足跖伊文思蓝含量均明显小于模型对照组大鼠(P<0.05)。③组织病理学检查及评分:组织病理学检查可见,与模型对照组比较,橄榄叶提取物50mg/kg组,100mg/kg组大鼠骨关节炎中组织炎症浸润明显减少,软骨组织无破坏,且组织病理学评分也明显小于模型对照组(P<0.05)。结论:橄榄叶提取物在50mg/kg体质量及以上剂量能有效地预防白陶土与鹿角菜胶诱发的大鼠骨关节炎中组织炎症,且对软骨有修复作用。     

家兔失神经支配腓肠肌肌纤维退行性变与修复性再生的超微结构观察

目的:观察家兔腓肠肌失神经支配后肌纤维在退行性变与修复性再生过程中超微结构的变化,探讨失神经支配骨骼肌修复性再生障碍的机制。方法:实验于2005-04/2006-04在南方医科大学中心实验室完成。选择成年新西兰大白兔20只,切断一侧胫神经腓肠肌肌支,术后1,4,8,12,16周分别采用耳缘静脉注射空气处死4只。取实验侧和对照侧腓肠肌内侧头肌组织少许,用于制备超薄切片标本,透射电镜观察各时间点兔失神经腓肠肌肌纤维形态。结果:纳入动物20只,均进入结果分析。①正常家兔腓肠肌肌原纤维排列整齐,肌小节和Z线清晰,线粒体均匀分布在肌原纤维之间,排列规则,细胞核位于质膜周边,未见溶酶体。②失神经支配1周,肌原纤维排列基本整齐,线粒体增多,无明显肿胀。③失神经支配4周,线粒体明显增多肿胀,部分线粒体空泡样变,溶酶体增多,Z线模糊,肌原纤维间隙增大。④失神经支配8周,肌纤维明显萎缩退行性变,大部分肌原纤维消失,残留的肌原纤维变得模糊,间隙增大,肌小结丧失正常的结构,胞浆内含有大量空泡变性的细胞器,可发现畸形核,染色质浓缩、边集,肌细胞膜极度皱缩。镜下发现较多的位于基膜下活化的肌卫星细胞,细胞内含有发达的粗面内质网和丰富的胞浆。一些肌卫星细胞直接与肌纤维融合。同时在间质中可发现一些形态上很象成纤维细胞的细胞,不过这些细胞含有大量的粗面内质网,胞浆内有颗粒和微丝,少量的圆形的线粒体。在退行性变的肌纤维基膜下也可发现肌管样结构的再生肌细胞,在这些肌管内一些肌丝在一起聚集成束,没有组装成肌原纤维,没有正常的肌小结结构。在它们周围有细小的空肌管样结构,可能是以往再生的肌细胞退行性变后的残余体。在间质中可发现一些细小的肌纤维。⑤失神经支配12周,大部分肌纤维萎缩退行性变,但是仍可发现没有萎缩的肌纤维,这些肌纤维细胞核位于周边,有良好的收缩系统,纤维排列规则,Z线清晰,有完整的肌膜。⑥失神经支配16周,肌卫星细胞的数量明显减少,并可发现大量细小的肌纤维,多分布在较大的肌纤维附近,肌膜完整平滑,无皱褶。可发现核位于中央的肌纤维,胞浆内肌原纤维结构清楚,但是肌原纤维的排列远不如核位于周边的肌纤维整齐,说明其收缩系统发育不良。结论:失神经支配后肌细胞退行性变和修复性再生同时存在,再生的肌细胞不能,化发育为成熟的肌纤维,进而发生退行性变。长时间失神经支配,肌卫星细胞的耗竭是失神经支配骨骼肌晚期的主要超微结构变化。