The influence of pregnancy on progression of diabetic retinopathy

PURPOSE: Pregnancy is considered an important risk factor of the development and progression of diabetic retinopathy (DR). The aim of the study was to assess whether retinal changes tend to progress during pregnancy in women with type 1 diabetes. MATERIAL AND METHODS: 136 women with type 1 diabetes were enrolled to this 3 years prospective study. The patients were divided according to White's scale into the following classes: B (n=76), C (n=34), D (n=24), R (n=2). Before conception and during pregnancy the patients were treated with intensive insulin therapy to achieve optimal metabolic control. Ophthalmic examination was performed before planned conception, in each trimester of the pregnancy and after delivery. RESULTS: No pathologies were discovered with fundoscopy in all the women belonging to class B, in 22 women from class C and in 4 women from class D. No progression of diabetic retinopathy was observed during the entire period of observation in 12 women from class C and in 20 from class D with nonproliferative DR in the first examination. In 3 women from class C progression of DR were observed in the second trimester with partial improvement after delivery. Visual acuity in these patients also deteriorated. Proliferative DR diagnosed in 2 patients from class R at the beginning of the observation, progressed during the pregnancy to diminish after delivery. CONCLUSIONS: Pregnancy does not influence significantly the progression of pre-existing diabetic retinopathy, provided that proper metabolic control is achieved and patients are subject to systematic ophthalmological control.     

Experience and design recommendations for picture archiving and communication systems in the surgical setting

An analysis of the efficacy of a picture archiving and communication system (PACS) in the surgical domain was undertaken at the Baltimore Veterans Affairs Medical Center. Interviews with surgeons and staff were conducted and supplemented by direct radiologist observation in the operating room (OR) and surgical outpatient clinic to determine patterns of routine clinical PACS use, levels of satisfaction both within and outside of the OR, and perceptions of the relative efficacy of the system in comparison to film. These data as well as suggestions from the surgical staff members were used to make recommendations for specific modifications in PACS design and operation to improve the current system and to help prescribe design improvements for future PAC systems. A high level of satisfaction with the system was found and the use of PACS was favored over film by a majority of surgeons and their staff. Findings of this study suggest that the design of a hospital-wide PAC system must have the flexibility to accommodate the specific requirements of a wide variety of end-users in their unique hospital environments.     

Systolic functional response of normal older and younger adult left ventricles to beta-blockade during exercise

Summary There is controversy over the effects of beta-blockade on the left ventricular systolic response of the heart of the elderly to stress. In this study we compared the effects of acute beta-blockade in normal older and younger adult left ventricles during exercise. The study population consisted of 17 healthy elderly people, 67±3 years old, while 18 young normal subjects, 31±4 years old, served as controls. A symptom-limited exercise treadmill test was performed before and 15 minutes after intravenous administration of 0.12 mg propranolol/kg. M-mode echocardiographic studies were performed before and immediately after each test. Intravenous propranolol at rest decreased heart rate by 14±7 beats/min in the elderly and by 7.5±8 beats/min in the young (p=0.02), decreased the double product by 2500±1200 mmHg/min and 1830±970 mmHg/min (p=0.05), respectively; changed the left ventricular end-systolic dimension by +0.21±0.36 cm and +0.03±0.24 cm (p=0.09), respectively; and changed the end-diastolic dimension by +0.22±0.46 cm in the elderly and by –0.02±0.32 cm in the young (p=0.08). The change in fractional shortening was –1.22±4.17% in the elderly and –0.78±4.05% in the young (p>0.05), and the decrease in the systolic blood pressure/end-systolic dimension ratio was 5.9±7 mmHg/cm and 4.3±3.8 mmHg/cm, respectively (p>0.05). During exercise, however, propranolol had the same effects in the two groups. These results indicate that beta-blockade has the same effects on normal older and younger adult left ventricles during exercise and is well tolerated by the elderly.     

Hunger Modulates the Responses to Gustatory Stimuli of Single Neurons in the Caudolateral Orbitofrontal Cortex of the Macaque Monkey

1. In order to determine whether the responsiveness of neurons in the caudolateral orbitofrontal cortex (a secondary cortical gustatory area) is influenced by hunger, the activity evoked by prototypical taste stimuli (glucose, NaCl, HCl, and quinine hydrochloride) and fruit juice was recorded in single neurons in this cortical area before, while, and after cynomolgous macaque monkeys were fed to satiety with glucose or fruit juice. 2. It was found that the responses of the neurons to the taste of the glucose decreased to zero while the monkey ate it to satiety during the course of which his behaviour turned from avid acceptance to active rejection. 3. This modulation of responsiveness of the gustatory responses of the neurons to satiety was not due to peripheral adaptation in the gustatory system or to altered efficacy of gustatory stimulation after satiety was reached, because modulation of neuronal responsiveness by satiety was not seen at earlier stages of the gustatory system, including the nucleus of the solitary tract, the frontal opercular taste cortex, and the insular taste cortex. 4. The decreases in the responsiveness of the neurons were relatively specific to the food with which the monkey had been fed to satiety. For example, in seven experiments in which the monkey was fed glucose solution, neuronal responsiveness decreased to the taste of the glucose but not to the taste of blackcurrant juice. Conversely, in two experiments in which the monkey was fed to satiety with fruit juice, the responses of the neurons decreased to fruit juice but not to glucose. 5. These and earlier findings lead to a proposed neurophysiological mechanism for sensory-specific satiety in which the information coded by single neurons in the gustatory system becomes more specific through the processing stages consisting of the nucleus of the solitary tract, the taste thalamus, and the frontal opercular and insular taste primary taste cortices, until neuronal responses become relatively specific for the food tasted in the caudolateral orbitofrontal cortex (secondary) taste area. Then sensory-specific satiety occurs because in this caudolateral orbitofrontal cortex taste area (but not earlier in the taste system) it is a property of the synapses that repeated stimulation results in a decreased neuronal response. 6. Evidence was obtained that gustatory processing involved in thirst also becomes interfaced to motivation in the caudolateral orbitofrontal cortex taste projection area, in that neuronal responses here to water were decreased to zero while water was drunk until satiety was produced.     

Color Doppler ultrasonography in diagnosis of post-traumatic optic neuropathy]

PURPOSE: To evaluate the parameters of blood flow in orbital arteries of patients with traumatic optic neuropathy. MATERIAL AND METHODS: Colour Doppler imaging of the ophthalmic artery, central retinal artery and posterior ciliary arteries was carried out in 13 patients with traumatic injury of the optic nerve. The peak-systolic, end-diastolic flow velocities and resistance index were measured. RESULTS: In 4 patients, whose vision was intact immediately after the injury and later deteriorated, the parameters of blood flow in the central retinal artery (CRA) were normal. Also in 3 patients with loss of vision to 1/50-3/50 after the injury the parameters of blood flow in the CRA were in the normal limit. In 3 other patients, who had only light perception after injury, there was decreased peak systolic blood flow and only trace or no flow was demonstrated in the CRA during the diastolic phase. In the remaining 3 patients, who displayed no light perception after the injury, no flow was observed in the CRA with Colour Doppler method. CONCLUSION: Colour Doppler ultrasonography is a useful supplementary method in diagnostics of traumatic optic neuropathy. The Colour Doppler findings seem to correlate well with clinical pathologies of the optic nerve after its traumatic injury.     

Hirnelektrische Studien über Pharmako-Logische Lokalisation im Gehirn

Ohne ZusammenfassungHerrn ProfessorPierre Rijlant möchten wir hier unseren herzlichsten Dank aussprechen für die großzügige Unterstützung unserer Forschungen.