Does the Prepubertal Duration of Diabetes Influence the Onset of Microvascular Complications?

This study investigated the relationship between the development of diabetic retinopathy and pubertal status at onset of diabetes in 521 Type 1 diabetic patients diagnosed between 1950 and 1985. Pubertal status was based on age at onset (girls ≧ 11 years and boys ≧ 12 years). Retinopathy (all forms) developed in 112 patients (21.5%; 65 background and 47 proliferative retinopathy). For subjects diagnosed in either the prepubertal or postpuberal period, a similar proportion survived without developing retinopathy for any given duration of diabetes (X² = 0.3822, p = 0.54). However, if only the postpubertal duration of diabetes is considered, then the proportion of patients surviving without retinopathy was significantly less for those diagnosed in the prepubertal period (X² = 14.2, p = 0.002). This study suggests that the prepubertal duration of diabetes is an important phase and that the years prior to puberty do contribute to the risk of developing microvascular injury.     

An analytical framework of physician productivity and variation in utilization.

The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework. Great uncertainty about patient flows is one reason for the average lower and varying doctor productivity in lower level health facilities. Until uncertainty can be reduced, more flexibility is needed at the lower level to cope with changing utilization patterns and patient characteristics. The management by doctors of non-patient care activities (preventive programmes, medical research, teaching, and administration) is crucial to any approach to using doctor resources more effectively and efficiently.     

Urological use of a disposable bipolar diathermy probe: An experimental in vivo study

The effects of monopolar and bipolar diathermy systems were studied in 12 male Sprague-Dawley rats. Fulguration was achieved by application of a standard current (13 W for 1 s) on the foreskin. Tissue damage was assessed by light microscopy. Results suggest that bipolar probe causes less tissue damage than its monopolar counterpart. It has proved to be of value in plastic and paediatric procedures and is recommended for the urologist's armamentarium.     

Results of surgery in 144 cases for aneurysms of the infra-renal abdominal aorta in patients over 75 years of age

114 patients aged over 75 underwent surgery for aneurysm of the infra-renal abdominal aorta in the University Teaching Hospitals in Nantes and Angers between 1979 and 1988. A retrospective study of these patients was performed to evaluate the immediate and long-term results. The mean age of the patients was 79 (+/- 4) years, the oldest being 94. 70% were men. Half of the patients underwent emergency or semi-emergency surgery (52 cases). Cardiovascular factors (in particular coronary insufficiency in 17% of cases) were the most common risk factors. In all cases grafting after laying open the aneurysm was performed, with an aorto-aortic graft in 32% of patients, an aorto-iliac graft in 37% or an aorto-bifemoral graft in 27% of patients. Combined intestinal revascularisation was performed in 10% of case either involving the inferior mesenteric artery or at least one internal iliac artery; renal revascularisation was performed in 3.5% of cases. 75% of patients underwent simple grafting. The mean duration of hospitalisation was 14 days (+/- 6), including a mean period of 7 days in ICU. 36 patients (31%) died in the first post-operative month. The mortality rate in patients who underwent emergency surgery for a complication of the aneurysm (essentially rupture) was 61% versus 6' for elective surgery. 96% of the patients who survived the first post-operative month were independent at the end of the study or at the time of their death.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rigid contact lens decentration: a risk factor for corneal warpage

Clinically significant contact lens induced corneal warpage is seen in a small proportion of soft and rigid contact lens wearers. Previous studies using the keratometer have found no correlation between the fit of the lens and the induced topographic changes. In this study, using computer-assisted topographic analysis, seven eyes (four patients) with rigid contact lens-induced corneal warpage were noted to have topographic abnormalities that correlated with the decentered resting position of the contact lens on the cornea. The warpage topography for each of these corneas was characterized by a relative flattening of the cornea underlying the resting position of the contact lens. Lenses that rode high, for example, produced flattening superiorly and resulted in a relatively steeper contour inferiorly that simulated the topography of early keratoconus patients who had not worn contact lenses. After discontinuing contact lenses the corneal topography returned to a normal pattern in five eyes. Two eyes retained asymmetry that is not characteristic of normal corneas. Up to 6 months was required for the corneas to return to a stable topography after contact lens wear was discontinued.     

Local anesthetics in the aqueous humor in local anesthesia of the eye

Local anesthetics injected retrobulbarly are detectable in the aqueous humor. From 40 patients who received a total dose of 140 mg lidocaine, 15 mg bupivacaine, and 30 mg etidocaine, samples of aqueous humor were taken between 30 and 90 minutes after administration (average 57 minutes). The mean lidocaine concentration was 1.02 micrograms/ml, that of bupivacaine 0.075 micrograms/ml. Etidocaine, used only for facial nerve block in front of the ear, could not be detected in the aqueous humor. All three substances were found in the central venous blood. It therefore appears unlikely that any of them are transported via the blood-aqueous barrier, whether actively or passively. Local anesthetics can inhibit corneal cell proliferation and result in lens opacification when administered into the conjunctival sac. It may be that local anesthetics detected in the aqueous humor have similar effects resulting from contact with the cornea and lens.     

The main features of central 5-HT1 receptors

The 5-HT1 receptor family comprises five different pharmacologic subtypes, designated 5-HT1A, 5-HT1B, 5-HT1C, 5-HT1D, and 5-HT1E, whose common property is to bind 5-HT with nanomolar affinity. Recent investigations with molecular biology approaches led to the cloning and sequencing of 5-HT1A receptors in the rat and in the human, and of the 5-HT1C receptor in the rat. Although the 5-HT1A and 5-HT1C protein binding subunits exhibit the same structure with seven hydrophobic transmembrane domains, an extracellular N terminal and an intracellular C tail, their respective amino-acid sequences are markedly different. Indeed, a higher degree of sequence homology is found between the 5-HT1C and 5-HT2 receptors than between the former and 5-HT1A receptors, suggesting that the 5-HT1C subtype in fact belongs to the 5-HT2 class of central 5-HT receptors. All other 5-HT1 receptor subtypes are negatively coupled to adenylyl cyclase, whereas the 5-HT1C subtype, like 5-HT2 receptors, is positively coupled to phospholipase C. The respective regional distributions and regulatory properties, as well as pending questions regarding the ultrastructural localization, synthesis, mutual interactions, and axonal flow of 5-HT1 receptor subtypes, are also discussed.     

Basic ophthalmic assessment and care workshops for rural health workers

The inequitable distribution of medical services in Australia means that many rural dwellers do not have easy access to ophthalmic care. In regions with no medical personnel, appropriately trained rural health workers may provide ophthalmic assessment, primary treatment, and, in some circumstances, definitive care. In areas with overburdened services, these rural health workers may augment facilities already established. In an attempt to improve the accessibility and quality of ophthalmic services available to presently disadvantaged rural inhabitants, the aims, curriculum, and structure of a 'Basic Ophthalmic Assessment and Care Workshop', for the transfer of knowledge and skills to such rural health workers, is presented.