Decreased skin wrinkling in diabetes mellitus

Skin wrinkling, which may be dependent on peripheral autonomic innervation, was assessed in 100 normal and 42 diabetic subjects using a temperature-controlled water bath with immersion of the hands for 30 min. Markedly decreased skin wrinkling was observed in diabetic subjects and in manual workers, but did not correlate with cardiovascular tests of autonomic function, control, type or duration of diabetes, or diabetic complications. The cause of decreased skin wrinkling in people with diabetes is unexplained.     

Paradoxical Bleeding in Intensively Transfused Hemophiliacs: Alteration of Platelet Function

Platelet function tests (bleeding time, platelet adhesiveness, platelet factor 3 release, and platelet aggregation to ADP) were done on a group of severe factor VIII deficient hemophiliacs before, during, or after transfusion therapy with cryoprecipitate or factor VIII concentrate. Mild decreased platelet function was seen in nonbleeding hemophiliacs after a single transfusion of cryoprecipitate. More severe abnormalities of platelet function were observed in a group of patients receiving factor VIII therapy for severe hemorrhages or in the postoperative period. Several of these intensively transfused patients bled when their circulating factor VIII level was normal or near normal. In one patient, who was studied repeatedly, prolongation of the thrombin time and partial thromboplastin time occurred in association with high levels of fibrinogen. Fibrin split products (fsp) were increased in most of the patients during bleeding episodes. Mixtures of cryoprecipitate or factor VIII‐concentrate with normal plasma contained increased protamine precipitable material and fibrin split products. Paradoxical bleeding can occur in intensively transfused hemophilic patients and may be related to either abnormal platelet function or increased levels of circulating fibrin monomer, fsp, or fibrinogen interfering with thrombin‐fibrinogen interaction.     

The role of calcium in insulin action. III. Calcium distribution in fat cells; its kinetics and the effects of adrenaline, insulin and procaine-HCl.

The effects of adrenaline, insulin and procaine-HCl on Ca distribution in intact fat cells and on Ca binding to fat cell ghost membranes have been investigated. 1. Fat cells incubated in 45Ca containing media till isotopic equilibrium indicated that the exchangeable Ca in these cells averages 25.7 +/-3.2nmol/mg protein, which represents approximately 9.8% of their ttotal Ca content. 2. Perifusion of 45Ca prelabelled fat cells gave washout curves whose analysis conformed with three kinetically distinct Ca pools (Fig. 1). The fast exchangeable pool (Compartment A) had an efflux rate constant of 0.193 +/-0. 013 min.-. The release of Ca from the second and thrid pools (Compartments B and C) was much slower with efflux rate constants of 0.032 +/-0.0018 min.-1 and 0.0042 +/- 0.0006 min.-1 respectively. Changing the Ca concentration in the perifusing medium modified the initial fast phase and its rate constant, while added dinitrophenol (DNP) inhibited the efflux rate from the later compartments...     

Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial

Objectives: The aim was to evaluate an Acceptance commitment therapy (ACT) intervention for people with knee or hip osteoarthritis; a related aim was to compare treatment effects from Rasch-transformed and standard scales. Methods: Participants were recruited from a research database and outpatient rheumatology and orthopaedic clinics at two hospitals. Eligible participants were randomly allocated to either intervention or usual care. Intervention comprised six-sessions of group ACT. Outcomes were assessed two and four months after randomization. Rasch-transformed and standard self-report measures were compared. Qualitative interviews also explored the acceptability of the intervention. Results: Of 87 people assessed for eligibility, 31 (36%) were randomized. The main reason for non-randomization was that participants received surgery. Of the 16 participants randomized to intervention, 64% completed ≥50% of the scheduled group sessions. Follow-up data was complete for 84% participants at two months and 68% at four months. Outcome analysis demonstrated important differences between the Rasch-transformed and standard scales. There were significant differences between the groups in pain. Qualitative interviews with seven participants suggested the intervention was acceptable. Conclusions: ACT for osteoarthritis is likely to be an acceptable treatment option for people with osteoarthritis. Progress to a definitive trial is warranted. Rasch-transformed outcome scales are preferable in clinical trials where possible.

• Implications for Rehabilitation

• Acceptance commitment therapy (ACT) is an effective treatment for many pain conditions andcould be a useful intervention for people with osteoarthritis who have high levels of pain.

• Rasch analysis is a measurement technique that may enable greater precision in detectingmeaningful treatment effects in routine clinical outcomes.

• The ACT intervention was successful in reducing pain and sleep difficulties and there werenotable differences in effects between standard and Rasch-transformed scales.

• In a relatively small trial, ACT may to be an acceptable intervention for people with osteoarthritisand progress to a definitive trial is warranted.

     

Familial distribution of thyroid disease and diabetes: further evidence for aetiological heterogeneity of diabetes mellitus

The prevalences of thyroid disease, insulin-dependent and non-insulin-dependent diabetes were compared in first degree relatives of diabetics with and without coexisting autoimmune thyroid disease. Thyroid disease was more common in siblings of diabetics with thyroid disease than in those of diabetics without thyroid disease. Insulin-dependent diabetes was more common in siblings of diabetics with a personal or family history of thyroid disease than in those of diabetics without such a history. The prevalence of non-insulin-dependent diabetes was unrelated to that of thyroid disease but was greater in siblings of non-insulin-dependent diabetics than in those of insulin-dependent diabetics. These findings add further support to the aetiological distinction between insulin-dependent and non-insulin-dependent diabetes and suggest that further heterogeneity exists within the population of insulin-dependent diabetics based on the presence of a personal or family history of thyroid disease.     

Facial transplantation: adding to the reconstructive options after severe facial injury and disease

The ability to reconstruct complex facial injuries is still a considerable challenge despite the development of microsurgical techniques. The reconstructive options for conditions such as panfacial burns are severely limited. The result after multiple surgical procedures in this group is often poor in terms of function and cosmesis. Facial transplantation provides a potential solution, but opinion is currently divided about the extent to which the potential benefits to the quality of life can be justified when weighed against the technical, psychological and immunological risks. This paper reviews the current status of the debate and argues that a rigorous research strategy is the only logical basis for countering the ethical objections to a procedure that offers considerable benefits over existing reconstructive options.     

Safety and acceptability of implantation of internal cardioverter-defibrillators under local anesthetic and conscious sedation

BACKGROUND: Implantation and testing of implantable defibrillators (ICDs) using local anesthetic and conscious sedation is widely practiced; however, some centers still use general anesthesia. We assessed safety and patient acceptability for implantation of defibrillators using local anesthetic and conscious sedation. METHODS: The records of 500 consecutive device implants from two UK cardiac centers implanted under local anesthetic and conscious sedation from January 1996 to December 2004 were reviewed. Procedure time, left ventricular ejection fraction (LVEF) sedative dosage (midazolam), analgesic dosage (fentanyl or diamorphine), requirement for drug reversal, and respiratory support were recorded. Patient acceptability of the procedure was also assessed. RESULTS: Of 500 implants examined, 387 were ICDs, 88 were biventricular ICDs, and 25 were generator changes. Patients with biventricular-ICDs had significantly longer (mean +/- SD) procedure times 129.7 +/- 7.6 minutes versus 63.3 +/- 32.3 minutes; P < 0.0001 and lower LVEF 24.4 +/- 8.4% versus 35.7 +/- 15.4%; P < 0.0001. There were no differences in the doses (mean +/- SD) of midazolam 8.9 +/- 3.5 mg versus 8.0 +/- 3.1 mg; P = NS, diamorphine 4.3 +/- 2.0 mg versus 3.8 +/- 1.7 mg; P = NS or fentanyl 94.4 +/- 53.7 mcg versus 92.2 +/- 48.6 mcg; P = NS, between the two groups. There were no deaths or tracheal intubations in either group. Acceptability was available for 373 of 500 (75%) patients, 41 of 373 (11%) described "discomfort," but from these 41 patients only 14 of 373 (3.8%) declined a second procedure under the same conditions. CONCLUSIONS: Implantation of defibrillators under local anesthetic and sedation is safe and acceptable to patients. General anesthesia is no longer routinely required for implantation of defibrillators.