Prothrombotic and Antithrombotic Factors are Elevated in Patients with Type 1 Diabetes Complicated by Microalbuminuria

Increased urinary albumin loss in patients with Type 1 diabetes is associated with accelerated atherosclerosis. Prothrombotic factors known to be associated with cerebrovascular and coronary artery disease in the general population, and antithrombotic factors, were studied in 52 patients with Type 1 diabetes and varying urinary albumin loss and 24 non-diabetic control subjects. Fibrinogen increased from 2.5 g I_-1 (95 % confidence interval 2.3–2.8) in control subjects and 2.8 g I_-1 (2.6–3.0) in diabetic patients without microalbuminuria to 3.1 g I_-1 (2.7–3.5) with microalbuminuria (p < 0.005 vs control; p < 0.001 vs without microalbuminuria). Factor VIIc increased from 81 % (75–86 % in non-diabetic control subjects and 84 % (78–90 %) in diabetic patients without microalbuminuria to 103 % (89–117 %) with microalbuminuria (p < 0.005 vs control; p < 0.05 vs without microalbuminuria) and 118% (86–150%) with albuminuria (p < 0.005 vs control and p < 0.001 vs without microalbuminuria). Levels of the antithrombotic factors protein C, protein S, and antithrombin III also rose in the diabetic patients with evidence of renal damage. Elevation of prothrombotic factors has been associated with increased risk of microvascular disease, whereas elevation of antithrombotic factors has no known protective effect. Therefore, this pattern of alteration of haemostatic factors in diabetic renal disease may contribute to the increased risk of vascular disease associated with both microalbuminuria and albuminuria.     

An electrophysiological and anatomical study of afferents reaching the cerebellar uvula in the rabbit

Stimulation of a medial region of the cerebellar uvula cortex produces sympathetically mediated cardiovascular effects in the decerebrate rabbit. In the present study the afferents to this cerebellar area have been determined using electrophysiological and neuroanatomical methods. Field potentials of prevalent mossy origin evoked by single-shock stimulation of different peripheral nerves have been recorded from sublobules IXa and IXb. No response to vagus and aortic nerves stimulation has been found. A modulation of Purkinje cell discharge following natural vestibular stimulation has been found. A modulation of Purkinje cell discharge following natural vestibular stimulation has been recorded from sublobules IXb and IXc. The retrograde transport of horseradish peroxidase from the uvula cortex has revealed a widespread afferent input to this cerebellar region arising from brain stem reticular and sensory nuclei. On the basis of the results obtained, together with the results of experiments performed in conscious rabbits, contained in the following paper (Bradley, Ghelarducci, La Noce & Spyer, 1990), it is suggested that the uvula participates in co-ordination of the visceral and somatic components of the alerting reaction in the rabbit.     

A clinical study of Noonan syndrome.

Clinical details are presented on 151 individuals with Noonan syndrome (83 males and 68 females, mean age 12.6 years). Polyhydramnios complicated 33% of affected pregnancies. The commonest cardiac lesions were pulmonary stenosis (62%), and hypertrophic cardiomyopathy (20%), with a normal echocardiogram present in only 12.5% of all cases. Significant feeding difficulties during infancy were present in 76% of the group. Although the children were short (50% with a height less than 3rd centile), and underweight (43% with a weight less than 3rd centile), the mean head circumference of the group was on the 50th centile. Motor milestone delay was usual, the cohort having a mean age of sitting unsupported of 10 months and walking of 21 months. Abnormal vision (94%) and hearing (40%) were frequent findings, but 89% of the group were attending normal primary or secondary schools. Other associations included undescended testicles (77%), hepatosplenomegaly (50%), and evidence of abnormal bleeding (56%). The mean age at diagnosis of Noonan syndrome in this group was 9.0 years. Earlier diagnosis of this common condition would aid both clinical management and genetic counselling.     

Role of ultrasound assessment and harness treatment in the management of developmental dysplasia of the hip.

The effect of the introduction of a programme combining clinical hip screening supplemented by limited targeted ultrasound assessment on splintage for developmental dysplasia of the hip (DDH) was evaluated over a 3-year period. The use of ultrasound is of both diagnostic and therapeutic value as it allows monitoring of the effects of splintage and decreases the total treatment time required. In all, 82 dysplastic hips were identified in 65 infants and the period of splintage averaged 6.3 weeks (range 3-12 weeks). The overall splintage rate can also be reduced as hips with only minor dysplasia can be assessed by serial scans until resolution or progression occurs rather than automatic treatment of all abnormal hips and in this series the rate was 6 per 1000 (0.6%). The Wheaton-Pavlik harness is a dynamic light-weight splint which is user friendly, easy to apply and adjust, and with no major complications being encountered in this series. Unnecessary exposure to radiation was reduced as plain radiographs were not performed before ossification of the capital epiphysis; prolonged splintage was prevented and a weaning period from the brace was not used. All children remained under follow-up for 1 year after the hips were confirmed to be clinically and radiologically normal and there were no cases of late re-dislocation or subluxation. There were no cases of avascular necrosis and a markedly reduced need for diagnostic arthrograms, with only two being performed during the 3 years. This regimen has resulted in a low rate of late presenting DDH requiring surgery of 0.28/1000, as well as a low splintage rate of 6/1000 (0.6%). Most of the improvement in the results can be attributed to the more accurate evaluation of DDH by ultrasound, but the absence of avascular necrosis and other complications is likely to be due to the shorter period of time spent in a dynamic splint without the use of excessive abduction.