Optic disk neovascularization and retinal vessel diameter in diabetic retinopathy

We measured retinal vessel diameter before and after panretinal photocoagulation in 59 eyes with diabetic retinopathy and moderate to severe optic disk neovascularization. Treatment significantly reduced mean arteriolar and venular diameter. The diameter of the retinal arterioles after treatment correlated significantly with the amount of regression in disk neovascularization. Eyes with large diameter vessels after treatment usually had little or no regression of proliferative retinopathy, whereas regression was more frequently seen in eyes with smaller diameter vessels after treatment.     

Fetal cardiac arrhythmias: Doppler assessment

Pregnancies in which fetal cardiac arrhythmias are present are associated with an elevated perinatal and neonatal mortality. In this group various major and minor fetal malformations, including heart malformations, are more common. FECG and phonocardiogram give some information on the type of arrhythmia in favorable cases. Real-time imaging detects fetal heart malformations and late signs of heart failure. Fetal echocardiogram is of great aid for the classification of the arrhythmia and for the detection of heart malformations. By applying combined real-time linear array and pulsed Doppler technique in cases of fetal cardiac arrhythmia, important information on the fetal circulatory state can be obtained. Estimations of the volume blood flow guide the clinician in the practical handling of these cases. Volume blood-flow estimations can probably detect imminent fetal heart failure. Therapeutic effects can be followed, and the timing of delivery can be optimized taking the circulatory state into account. Within the fetal heart rate range 50 to 250 beats/min adequate blood circulation is usually maintained in the fetus. The peak velocity, the acceleration, and the rising slope are all increased in the postextrasystolic beat, indicating the existence of postextrasystolic potentiation in the fetal heart. These three parameters can be related to the ventricular filling time, supporting the opinion that the fetal heart follows the rules of the Frank Starling relationship. Fetal arrhythmias constitute also an experimental model for the study of fetal cardiac physiology.     

Continuous epidural infusion of racemic methadone results in effective postoperative analgesia and low plasma concentrations

PURPOSE: To compare two protocols of epidural administration of racemic methadone for postoperative analgesia (continuous infusion and intermittent bolus), focussing on plasma concentration, analgesic efficacy and side effects. METHODS: Ninety patients undergoing abdominal or lower-limb surgery were randomly assigned to two groups in a prospective double-blind design. The continuous infusion patients (n=60) received initial doses of 3 to 6 mg followed by 6 to 12 mg by continuous infusion over 24 hr. The bolus administration patients (n=30) received repeated boluses of 3 to 6 mg of racemic methadone every eight hours. Pain intensity was assessed on a visual analog scale. Amount of supplementary analgesia was recorded, as was the incidence of side effects. Plasma methadone concentrations were determined by high performance liquid chromatography. Treatment was continued for 72 hr. RESULTS: Pain relief was good and comparable in both groups throughout the three days of treatment. No accumulation of plasma racemic methadone was observed in either group, although the concentrations were significantly higher in the bolus group. Miosis was significantly more frequent in the bolus group. CONCLUSION: Plasma methadone concentrations were significantly lower with continuous infusion. Plasma methadone accumulation, which is considered the main disadvantage for its purported influence on the incidence of side effects, did not occur at the doses used over the three days of treatment that we report.     

Prevalence of Parkinson's disease in Cantalejo, Spain: a door-to-door survey.

We assessed the prevalence of Parkinson's disease in Cantalejo, Spain. In 1994, we screened 1,579 persons (age > or = 40 years) using a high-sensitivity method. Cases fulfilling established clinical criteria were followed for a minimum of 3 years. Prevalences were compared with those from other door-to-door surveys. We detected 27 individuals with parkinsonism, 20 of whom had Parkinson's disease. The prevalence of Parkinson's disease increased with age and, when age-adjusted to European standards, was 9.01 per 1,000 (age 40 years and over; 10.78 in men and 5.23 in women). Of the 11 men, three were in Hoehn & Yahr grades III-IV, but six of the nine women were more severely affected. Overall, we found 18 newly diagnosed cases of parkinsonism, 13 of which were Parkinson's disease, and the majority of which were in men aged 80 years or older with a mean duration of illness of 5 years. Our prevalence figures are the highest reported, apparently because of the inclusion of several very elderly men. Parkinson's disease in Cantalejo is less severe in men than in women, particularly in those newly diagnosed. Despite the low numbers, the high prevalence and sex-related pattern are unexplained but they probably relate to the high sensitivity of the screening method.     

Prediction of ovulation based on the serum estradiol level and the diameter of the follicle

Experiences with the methods are summarized. Follicular growth was monitored by ultrasound folliculometry (USFM) and estimation of serum estradiol (E2 values in physiologic cycles. USFM was found to predict follicular rupture-ovulation--more precisely than E2 values. Cases of disturbed folliculogenesis (persisting and luteinized unruptured follicle, cysts) are described. The wider use of USFM in Hungary is urged, because appropriate equipment is available while the chances of continuous hormonal monitoring are rather limited.     

The role of intraoperative ultrasonic studies in abdominal surgery

Intraoperative echography is a new field of application of the ultrasound diagnostics. With a special intraoperative examination head the parenchymal abdominal organs may be examined directly in the course of the operation. The intraoperative echo-examination of the tumors and cysts of the liver and pancreas as well as of nephroliths and gallstones is routinely applied in several institutions abroad. The authors report on their initial experiences with intraoperative ultrasonography of different abdominal organs.     

Nurses' intentions to wear gloves during venipuncture procedures: a behavioral psychology perspective.

Registered nurses working at a teaching hospital in Kuwait were surveyed to assess the psychosocial variables associated with their intention to comply with glove-wearing recommendations. Perceived consequences and normative beliefs, as well as sex and years of nursing experience, significantly influenced their behavioral intentions, suggesting that improvements in intention to comply are more likely to come from practical demonstrations that show nurses the potential outcomes of both using and not using gloves.     

MRI of transplanted pancreatic islets.

A promising treatment method for type 1 diabetes mellitus is transplantation of pancreatic islets containing beta-cells. The aim of this study was to develop an MR technique to monitor the distribution and fate of transplanted pancreatic islets in an animal model. Twenty-five hundred purified and magnetically labeled islets were transplanted through the portal vein into the liver of experimental rats. The animals were scanned using a MR 4.7-T scanner. The labeled pancreatic islets were clearly visualized in the liver in both diabetic and healthy rats as hypointense areas on T2*-weighted MR images during the entire measurement period. Transmission electron microscopy confirmed the presence of iron-oxide nanoparticles inside the cells of the pancreatic islets. A significant decrease in blood glucose levels in diabetic rats was observed; normal glycemia was reached 1 week after transplantation. This study, therefore, represents a promising step toward possible clinical application in human medicine.