Skeletal status in patients with chronic renal disease.

The bone mineral content (BMC) was measured in 17 patients with chronic renal failure. The patients as a group had a mean BMC of 89% compared with 127 normal subjects. The investigation failed to disclose any significant correlation between BMC and the stage of renal diseases.     

临床护理路径在初诊2型糖尿病患者健康教育中的应用

目的探讨临床护理路径(CNP)在初诊2型糖尿病(T2DM)患者胰岛素强化治疗中进行糖尿病教育的有效性。方法将住院初诊T2DM患者41例随机分为两组。对照组20例采用常规教育方法;观察组21例应用专家组制定的CNP进行健康教育。结果观察组住院天数、住院费用显著下降(均P0.01),健康教育达标率和护理满意度相对提高,但差异无统计学意义(均P0.05)。结论运用CNP实施糖尿病健康教育缩短了患者的住院天数,降低了住院费用,有助于提高健康教育达标率及护理工作满意度。     

Radionuclide bone scan in patients with newly diagnosed prostate cancer. Clinical aspects and cost analysis

BACKGROUND: The indication for a radionuclide bone scan in patients with newly diagnosed, untreated prostate cancer remains controversial. PATIENTS AND METHODS: In this retrospective study we examined 406 patients who had received a staging bone scan irrespective of their PSA serum level and histology. We evaluated different guidelines and recommendations with respect to their usefulness. The costs were calculated according to EBM and GOA. We evaluated the classification systems of bone metastases according to Soloway, Crawford, and Rigaud. RESULTS: The bone scan was positive in 41 (10%) of 406 patients. The EAU guidelines turned out to be useful with respect to both clinical value and cost efficiency. The Rigaud classification of bone metastases predicted outcome better than the Soloway or Crawford classification. CONCLUSIONS: The EAU guidelines from 2005 are a useful tool to decide whether to perform a bone scan in patients with newly diagnosed, untreated prostate cancer. A bone scan should be performed if PSA levels exceed 20 ng/ml in patients with a G1/G2 histology, and in patients with G3 histology and locally advanced disease irrespective of PSA level. Bone scan metastases should be classified according to Rigaud.     

The prevalence of newly diagnosed hyperlipidaemia in men with erectile dysfunction

OBJECTIVE: To determine the prevalence of newly diagnosed hypercholesterolaemia and hypertriglyceridaemia in patients presenting to an andrology clinic with erectile dysfunction (ED), and to assess the relationship between serum lipid levels and the severity of ED. PATIENTS AND METHODS: In all, 199 consecutive men attending an ED clinic were assessed for risk factors for ED; patients completed the International Index of Erectile Function (IIEF)-15 questionnaire and provided venous blood samples for assaying fasting total cholesterol and total triglyceride levels. The proportion of newly diagnosed hyperlipidaemia in patients presenting with ED was calculated and related to patient age, total IIEF score and severity of ED. RESULTS: Using a threshold of 5.0 mmol/L, there was newly diagnosed hypercholesterolaemia in 40% of the men, while there was undiagnosed hypertriglyceridaemia (>2 mmol/L) in 29% of the population. There was no clear correlation between patient age and the fasting lipid levels, and no association between total IIEF-15 score or severity of ED and serum cholesterol and triglyceride levels. CONCLUSION: This study shows the high prevalence of undiagnosed hypercholesterolaemia and hypertriglyceridaemia in men presenting with ED. The opportunity to screen for and treat these risk factors has long-term benefits in preventing cardiovascular disease in this group of patients.     

新诊断糖尿病住院患者糖尿病痛苦现状及影响因素研究

目的调查新诊断糖尿病住院患者(新诊断患者)的糖尿病痛苦现状,探讨其影响因素,为开展针对性干预提供参考。方法采用领悟社会支持量表、医学应对方式问卷、中文版糖尿病痛苦量表对100例新诊断患者进行问卷调查。结果新诊断患者的糖尿病痛苦总分1.88±0.71;35.0%存在糖尿病痛苦;糖尿病痛苦总分及各维度得分与领悟社会支持总分及各维度呈负相关,与屈服、回避因子呈正相关(P<0.05,P<0.01);屈服应对方式、领悟社会支持和住院时间是患者糖尿病痛苦的影响因素(调整R2=0.414)。结论新诊断患者糖尿病痛苦发生率高,受屈服应对方式、领悟社会支持及住院时间的影响,医护人员应及时评估和引导患者积极应对,以减少其糖尿病痛苦。     

Insulin and insulin-receptor autoantibodies in children with newly diagnosed IDDM before insulin therapy

Twenty-nine children, aged 1-15 yr, with newly diagnosed insulin-dependent diabetes mellitus (IDDM) had sera taken before insulin therapy to be examined for the presence of insulin-receptor antibodies by measuring the inhibition of binding of radiolabeled insulin to IM-9 lymphocytes in both whole serum and purified IgG fractions. Groups of children with long-standing IDDM and autoimmune endocrine disease as well as a normal control group were studied. A positive result, defined as binding greater than or equal to 2 SD below the mean zero standard, was found in 3 (10.3%) of the 29 newly diagnosed diabetic patients. As a group, they showed significantly greater binding inhibition than the normal control group for both whole serum and purified IgG (one-tailed t test, P less than .05 and P less than .002, respectively). Insulin autoantibodies were also measured by a sensitive radioimmunoassay technique. A positive result, defined as binding greater than 3 SD above the normal control pooled sera, was found in 9 (37.5%) of 24 of the newly diagnosed IDDM group tested. All 3 subjects positive for insulin-receptor antibodies were also positive for insulin autoantibodies, whereas 6 of the 21 receptor-antibody-negative subjects were positive for insulin autoantibodies (Fisher's exact test, P = .0415). This suggests the possibility that the presence of insulin autoantibodies is a prerequisite for the development of insulin-receptor antibodies, i.e., as an anti-idiotypic response. Insulin-receptor antibodies and insulin autoantibodies may play a currently undefined pathophysiologic role in the development of IDDM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Skeletal status and laboratory investigations in adolescent girls with anorexia nervosa

To our knowledge anorexia nervosa (AN) adversely influences bone density, but whether qualitative characteristics of bone are also affected is not known. For this reason we investigated prospectively the changes in skeletal status in a population of 18 adolescent girls with AN aged 11.5-18.1 years (mean 15.9+/-1.9 years) using both dual-photon X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) measurements, bone turnover markers (osteocalcin, bone alkaline phosphatase - bALP, carboxy-terminal cross-linked telopeptide of type I collagen - ICTP), and laboratory investigations (serum total and ionised calcium, serum phosphate, urine calcium/creatinine ratio, luteinizing hormone - LH, follicle-stimulating hormone - FSH, estradiol). Measurements of bone mineral density at the spine (s-BMD) and total body (TB-BMD) and amplitude-dependent speed of sound (Ad-SOS) of the hand phalanges were performed at baseline, 7.8+/-2.4 and 19.4+/-5.6 months of follow-up. The mean values of TB-BMD, s-BMD and Ad-SOS measurements did not change during the period of observation. The mean Z-scores for TB-BMD and Ad-SOS were significantly lower after 19.4 months of observation vs. baseline (-1.06+/-1.00 vs. -0.67+/-0.98 vs. and -0.50+/-0.88 vs. 0.26+/-1.75, respectively). Z-scores for s-BMD decreased non-significantly (p=0.08). Among bone turnover markers, we observed a significant increase in bALP and a non-significant increase in osteocalcin serum concentrations which were below normal ranges for age, sex and Tanner stage at baseline. High baseline serum ICTP concentration decreased non-significantly, reaching normal ranges during the observation. We conclude that anorexia nervosa seriously affects skeletal status in adolescent girls. Bone turnover markers analysed together with densitometric parameters suggest that AN influences both bone formation and resorption processes. QUS measurements at hand phalanges may be an appropriate method in the evaluation of skeletal status in patients with AN.     

初诊糖尿病患者高同型半胱氨酸血症与慢性肾脏病相关性研究

目的 探讨初诊糖尿病患者高同型半胱氨酸血症(HHcy)患病情况及其与慢性肾脏病(CKD)的相关性.方法 对来本院健康体检的成年人进行横断面研究,收集体检者临床资料包括年龄、性别、吸烟史等,进行人体测量(身高、体重、血压等),空腹8～10 h测定血糖、血脂、血肌酐、血尿酸、糖化血红蛋白等生化指标检测.初诊糖尿病定义为空腹血糖＞ 7.0 mmol/L和或糖化血红蛋白＞6.5％并排除既往诊断糖尿病及服用降糖药物者.HHcy定义为Hcy≥15μmol/L.CKD定义为肾功能下降[估测的肾小球滤过率(eGFR) ＜60 mL·(min·1.73m2)-1]或蛋白尿[尿常规蛋白≥1+].应用多因素logistic回归模型探讨HHcy与CKD的相关性.结果 共有1801例初诊成年糖尿病患者纳入该研究,年龄(61.3±10.1)岁,男性占83.9％,eG-FR(119.2±30.9)(范围36.4～155.9)mL· (min· 1.73m2)-1,HHcy的患病率高达28.0％.肾功能下降、蛋白尿及CKD的患病率分别为2.3％、8.1％及10.0％.其中Hcy最高四分位数组年龄、男性比例、高血压、肾功能下降及CKD患病明显大于其他三组(P＜O.001).多因素Logistic回归分析显示,HHcy与肾功能下降及CKD正相关,测定OR值分别为3.32(95％ CI:1.63～6.78)及1.45(95％ CI:1.01 ～2.08).在771例无高血压的亚组人群中分析,同样显示HHcy与CKD正相关,OR值为2.34(95％ CI:1.18 ～4.61).结论 初诊糖尿病患者HHcy患病率较高,且HHcy与CKD正相关,应在初诊糖尿病患者尤其是合并HHcy患者中加强CKD的筛查.     

Skeletal malformations associated with esophageal atresia: clinical and experimental studies.

BACKGROUND/PURPOSE: Patients with esophageal atresia (EA) often have skeletal malformations. The purpose of this study is to examine if similar defects occur in rat fetuses prenatally exposed to Adriamycin, a chemical capable of causing EA in these animals. METHODS: The charts of 443 babies with EA were reviewed to assess the incidence and nature of these defects in them. Time-mated female rats were given either 2 mg/kg intraperitoneal Adriamycin (experimental group, n = 16) or no treatment (control group, n = 4) on gestational days 8 and 9, and the fetuses were removed near term. Skeletal anatomy was studied after alcian blue and alizarin red staining. RESULTS: A total of 528 skeletal malformations, mainly abnormal segmentation and vertebral identity (extra or defective bodies or ribs), mishaped vertebral bodies, and limb malformations like radial aplasia or hypoplasia were found in 245 babies (55%). Costal fusion and sternal anomalies were present in 17 and 4 babies, respectively. In the animal study, all control fetuses were normal, whereas 83 of 134 experimental fetuses (62%) had EA accompanied by other malformations. No segmentation or vertebral identity anomalies were seen, but butterfly, wedged, and asymmetric vertebral bodies were found at various levels in all animals with EA and in about half of those without it. Three fetuses had rib anomalies, and 3 more had sternal malformations. Ossification of limbs was delayed in treated fetuses and short, thick, and crooked bones were seen in 4 of 31 fetuses with EA and in none of the Adriamycin-exposed ones without EA. CONCLUSIONS: Adriamycin exposure induces in fetal rats, in addition to esophageal, duodenal, and anorectal atresias, high proportions of vertebral malformations and some limb defects of nature not identical but quite similar to that of babies with EA. This further validates this model for investigating the nature of the processes leading to EA and its associated malformations.     

High blood pressure and hypertension in children with newly diagnosed acute leukemia and lymphoma

Little has been published on the rate of prehypertension (HBP) and hypertension (HTN) in children with hematologic malignancies. This study was preformed to determine the prevalence and predictors of HBP and HTN in newly diagnosed acute leukemia and lymphoma patients. Retrospectively, blood pressure (BP) values were followed from admission until normalization in 102 children. HBP and HTN were defined as either a systolic or diastolic value ≥ the 90th and 95th percentile BP measurement, respectively. HBP and HTN were identified in 68.6% and 52.9% of children prior to chemotherapy and 78.4% and 67.3% postchemotherapy, respectively. Mean time to BP normalization was 54days. Only ten children (15% of HTN patients) received antihypertensive therapy. Logistic regression determined that the only predictor for HBP and HTN was the estimated glomerular filtration rate (eGFR) at the time of admission—every 10ml/min per 1.73m² increase led to a 16% and 14% decrease in the odds of postchemotherapy HBP (p = 0.02) and HTN (p = 0.03), respectively. A surprisingly high prevalence of BP abnormalities was identified and lower eGFR predicted HBP and HTN in children with newly diagnosed hematologic malignancies. Better recognition and serious consideration for treatment should be given to this cardiovascular abnormality. This study was submitted in abstract form and presented as a poster presentation at the American Society of Nephrology Meeting in St. Louis, Mo, USA, in 2004 (abstract number F-PO630).     

Double-blind controlled trial of azathioprine in children with newly diagnosed type I diabetes

A double-blind controlled trial of azathioprine (2 mg.kg-1.day-1) was conducted with 49 patients aged 2-20 yr (mean 10.8 yr) who had newly diagnosed type I (insulin-dependent) diabetes. Patients were randomly assigned to receive either azathioprine (n = 24) or placebo (n = 25) for 12 mo, beginning within the 20-day period after diagnosis. Baseline clinical and metabolic characteristics did not differ between the two groups. No patient experienced complete remission, defined as restoration of normal carbohydrate tolerance without other treatment. Partial remission, defined as good metabolic control (hemoglobin A1c less than or equal to 7.9%, preprandial blood glucose less than or equal to 8 mM with an insulin dose of less than 0.5 U.kg-1.day-1), occurred in 10 placebo (40%) and 7 azathioprine (29%) patients at 6 mo and in 4 placebo (16%) and 4 azathioprine (17%) patients at 12 mo (differences not significant). Fasting plasma C-peptide was significantly greater in the azathioprine-treated group at 3 and 6 mo, but this difference was not sustained. C-peptide responses to a standard meal and the frequency of islet cell and insulin antibodies did not differ between the two groups over the 12-mo period. Azathioprine caused no significant side effects. We conclude that in the dosage used, and despite early effects on endogenous insulin secretion, azathioprine alone does not influence the remission phase in children with newly diagnosed type I diabetes.     

The prevalence and predictors of erectile dysfunction in men with newly diagnosed with type 2 diabetes mellitus

OBJECTIVE: To determine the prevalence of and risk factors for erectile dysfunction (ED) in men newly diagnosed with type 2 diabetes mellitus (DM). PATIENTS AND METHODS: All consecutive samples of men newly diagnosed with type 2 DM attending the diabetes centre in the capital of Kuwait were included in the study. Face-to-face interviews with the men were conducted using the International Index of Erectile Function (IIEF)-5 questionnaire. A threshold IIEF-5 score of <21 was used to identify men with ED. Pertinent clinical and laboratory characteristics were collected. RESULTS: Of 323 men with newly diagnosed type 2 DM, 31% had ED; comparing potent men and men with ED, there were statistically significant differences for smoking, duration of smoking, hypertension, education level, body mass index and serum glycosylated haemoglobin level. Among these, age was the most important risk factor identified by multivariate logistic regression. CONCLUSION: About a third of men with newly diagnosed type 2 DM had ED; this was associated with many variables, but most notably with age at presentation.