Foot pathology in insulin dependent diabetes

OBJECTIVES--Foot pathology is a major source of morbidity in adults with diabetes. The aim of this study was to determine if children with insulin dependent diabetes have an increased incidence of foot pathology compared with non-diabetic children. DESIGN--Questionnaire, clinical examination, and biomechanical assessment. SUBJECTS--67 diabetic children and a comparison group matched for age, sex, and social class. RESULTS--We found significantly more foot pathology in the children with diabetes (52 children) than the comparison group (28 children); with more biomechanical anomalies (58 children with diabetes, 34 comparison group); and a higher incidence of abnormal skin conditions (53 children with diabetes, 27 comparison group). Forty two children with diabetes had received foot health education compared with 27 in the comparison group, but the study revealed ignorance and misconceptions among the diabetic group, and previous contact with a podiatrist was minimal. CONCLUSIONS--The survey suggests that children with diabetes have an increased incidence of foot pathology justifying greater input of podiatric care in the hope of preventing later problems.     

The role of radiation therapy in Gravesophthalmopathy ‘

Gravesophthalmopathy ‘ can occur in 25–30% of patients with hyperthyroidism. This condition can result in serious visual disturbance and disfigurement. The treatment options for symptomatic disease are oral corticosteroids or orbital irradiation. Ten patients with Gravesophthalmopathy ‘ were treated with external beam radiotherapy at Saint Lukes Hospital from March 1991 to February 1994. Eight of these patients had excellent response with minimal morbidity. We believe that orbital radiotherapy is effective and well tolerated, and should replace corticosteroid therapy as the initial treatment modality in these patients.     

Cerebral blood flow velocity in term newborns following intrapartum fetal asphyxia

Twenty-six term newborns with intrapartum fetal asphyxia, determined biochemically (umbilical artery base deficit < 12mmol/1), were compared with 59 normal newborns to determine the effect of intrapartum fetal asphyxia on newborn blood pressure and cerebral blood flow velocity following delivery. Cerebral blood flow velocity observations with concurrent measures of blood pressure and heart rate were obtained during the 24 h after delivery and after 24 h. After delivery, diastolic blood pressure in the newborns of the asphyxia group was significantly greater than that of the newborns of the normal group and this difference persisted after 24 h. Cerebral blood flow velocity in the newborns of the asphyxia group was of the same order as that of the newborns of the normal group during the 24 h after delivery. However, there was a significant increase in both peak systolic and end-diastolic blood flow velocity after 24 h. The duration of metabolic acidosis may be a factor in the occurrence of this delayed cerebral blood flow velocity response. Observations of cerebral blood flow velocity should be continued for more than 24 h following delivery to determine the effect of intrapartum fetal asphyxia.     

Review of neuropsychological functioning in treated phenylketonuria: an information processing approach

Phenylketonuria is no longer associated with mental retardation and other devastating neurological effects. Nonetheless, learning disabilities and IQ loss are common, even in early-treated individuals. Until recently, IQ was used as the sole measure of mental functioning in this population. As specific academic deficits were recognized and as greater variety of tests became available, evaluation of children with phenylketonuria has included neuropsychological testing. A review of the 21 published reports highlights the areas of consensus and the need for additional well designed studies in the future. Problem solving, particularly abstract reasoning and executive functions, appears to be impaired in children with phenylketonuria. Reaction time, or speed of mental processing, appears to be the other important area affected in PKU. An information processing model is presented as paradigm for further research and development of remedial strategies for children with phenylketonuria.     

Alternative treatment to corticosteroids in steroid sensitive idiopathic nephrotic syndrome

A review was undertaken of the use of alternative immunosuppressive treatment in addition to corticosteroids in a cohort of 429 children with steroid sensitive nephrotic syndrome (SSNS) treated between 1980 and 1994. Two hundred and twenty two children (52%) received at least one course of alternative treatment, 98 (23%) two, and 43 (10%) three. Cyclophosphamide was administered to 196 children (46%); in 181 it was the first course of alternative treatment and in 104 (57%) of those it was also the last ('final course'). Levamisole was given to 56 children (13%) and cyclosporin to 53 (12%). Fifteen children in whom cyclosporin failed were treated with chlorambucil. A few patients received azathioprine or vincristine. Ten children developed secondary steroid resistance, of whom five progressed to chronic renal failure. Acute complications included reversible renal failure, septicaemia, peritonitis, convulsions, and cerebral thrombosis. There were three deaths. It is concluded that half of the referred children with SSNS were deemed to require at least one course of alternative immunosuppressive treatment, and that side effects of the treatment and complications of SSNS are infrequent but occasionally fatal.     

Hysteroscopic Metroplasty

EDITORIAL COMMENT: Septate uterus is a common obstetric problem often first diagnosed during pregnancy when oblique fetal lie with breech presentation is noted in an asymmetrical heart-shaped uterus in the early third trimester. The diagnosis may also be made by hysterosalpingography in patients with habitual abortion, by early second trimester ultrasonography (although sometimes the ultrasonographer cannot identify the septum), or at the time of manual removal of a retained placenta. Most obstetricians have treated many patients with a septate uterus conservatively since the majority reproduce successfully. The question of metroplasty only arises when habitual abortion occurs. The remarkably few published series of metroplasties performed abdominally indicate that the operation is seldom performed. Hysteroscopic metroplasty seems so simple and effective that it appears reasonable to recommend it in any patient who has had 2 or more spontaneous miscarriages, especially if these occurred in the second trimester and resulted in the loss of a normally formed fetus. It is unlikely that a controlled trial on patients with a uterine septum and a history of spontaneous abortion will be performed to determine the extent to which metroplasty improves reproductive performance. In the case reported here readers may question whether the blighted ovum at 9 weeks' gestation, and spontaneous abortion at 9 weeks, were related to the uterine septum. The need for laparoscopy at the time of hysteroscopic metroplasty merits emphasis.     

Neonatal fat embolism and agglutination of intralipid

Pulmonary fat embolism in a preterm infant receiving Intralipid intravenously is described. Serum obtained at the time of clinical deterioration agglutinated Intralipid. This coincided with the onset of septicaemia and with a raised serum C reactive protein concentration. Subsequent clinical improvement was associated with reduction in the C reactive protein concentration and nonagglutination of Intralipid.