Relation between insulin-like growth factor-I, body mass index, and clinical status in cystic fibrosis

OBJECTIVES: Despite improved nutrition and intensive treatment, subjects with cystic fibrosis have difficulty in maintaining anabolism during intercurrent infections, which can result in reduced body mass index and impaired skeletal growth. Insulin-like growth factor-I (IGF-I) and its binding protein IGFBP3 are sensitive to changes in nutritional status. The aim of this study was to determine the relation between circulating concentrations of these peptides, body mass index, and clinical status in cystic fibrosis. METHODS: Serum concentrations of IGF-I and IGFBP3 were measured in 197 subjects (108 males, 89 females; mean age 9.69 years, range 0.41-17.9 years) and these data were analysed with respect to body mass index, pubertal stage, and clinical status as assessed by Shwachman score and forced expiratory volume in one second (FEV1). RESULTS: The mean height SD score of the children studied was -0.2 (SD 1.14) and the body mass index SD score -0.26 (1.4). The body mass index SD score declined with increasing age (r = -0.18) and paralleled changes in IGF-I concentrations, which also declined. The IGF-I SD score (calculated from control data) correlated with age (r = -0.53). The abnormalities were most obvious during late puberty, when IGF-I and IGFBP3 concentrations were significantly reduced compared with those in control subjects matched for pubertal stage. The IGF-I SD score correlated with height SD score (r = 0.14) and the decline in IGF-I concentrations with the fall in body mass index SD score (r = 0.42). IGF-I SD scores also correlated with the Shwachman score (r = 0.33) and FEV1 (r = 0.17). CONCLUSIONS: The close relation between declining IGF-I and IGFBP3 concentrations and body mass index in patients with cystic fibrosis may simply reflect poor nutritional status and insulin hyposecretion. Nevertheless, IGF-I deficiency could also contribute towards the catabolism observed in these patients, and IGF-I SD scores correlated with other measures of clinical status such as the Shwachman score and FEV1.     

Management of genital burns: A review

We review the etiology and the management strategy of genital burns. The incidence of genital burns ranges from 2.8 to 13%. Most are part of larger injuries. Scald burns are typical for children, whereas flame and chemical burns happen more often in adults. For first and second‐degree genital burns, a conservative approach with physiological dressings and topical antimicrobials is advised. Only third degree burns need to be treated with removal of necrotic tissue and grafting. Indwelling catheters or suprapubic drainage systems must be avoided whenever possible.     

Communication between physicians and with patients suffering from breast cancer

BACKGROUND: The communication between GP and specialists is vital for the patient suffering from breast cancer. OBJECTIVES: The aim of this study was to investigate (i) the speed and type of communication between GPs, specialists and patients with breast cancer, and (ii) the problems that GPs encounter in the communication with specialists concerning these patients. METHOD: In April 1995, 246 Dutch GPs from the Zwolle region (600 000 inhabitants) were invited to complete a questionnaire, using the information from the medical record and focusing on the last patient consulted with a confirmed diagnosis of breast cancer. RESULTS: Valid replies were received from 150 (61 %) GPs. The median period between initial referral date and receipt of the definite diagnosis from the surgeon was 4 weeks. After the patient's first appointment with the surgeon, the GPs received reports for 24% of the patients within 3 days; for 31% within 3-7 days; and for 16% of the patients after more than 2 weeks. After the first consultation between patient and surgeon, 68 (45%) of the 150 GPs reported that the patient contacted them; at this stage only 30 (20%) of these GPs had received a report from the surgeon. Thirty-one (21%) GPs did not contact the patient after receival of the definite diagnosis. GPs stated that the communication on patients with breast cancer is too slow (49%), or not frequent enough (25%); 25% of GPs found that the distribution of tasks between them and the specialists are not well described. CONCLUSION: In the diagnostic stage of breast cancer the communication between GPs, specialists and patients varies widely, is too slow and is incomplete. An effect of this unsatisfactory communication is that the patient herself is the messenger of the bad news.      

Automatic implantable cardioverter-defibrillator: radiographic appearance

The automatic implantable cardioverter-defibrillator is used in patients with ventricular tachyarrhythmias resistant to medical or surgical therapy. The device, which has a unique radiographic appearance, senses ventricular tachycardia or fibrillation and automatically delivers a cardioverting or/defibrillating electric shock.