Aspects of early social smiling by infants with Down''s syndrome

Smiling by five Down's syndrome and seven nonhandicapped infants was recorded longitudinally during face-to-face interactions with their mothers over the first 6 months of the infants' lives. Two conditions, 'mobile' (mothers were asked to talk to the baby as naturally as possible) and 'immobile' (silent and maintain an impassive face), were contrasted. Between-group comparisons confirmed previous findings of significantly delayed emergence and less frequent smiling by the infants with Down's syndrome. Their smiles were also found to be shorter, and less discriminative between the two face-to-face conditions. The non-handicapped infants showed significantly more cry/distress vocalizations in the immobile than in the mobile condition, while the reverse was found for the Down's syndrome infants. A close temporal association between smiling and eye contact with mothers was found for both groups of infants. In a free interaction condition, mothers of the Down's syndrome babies showed a stronger tendency to use kinaesthetic and tactile stimulation than mothers of the non-handicapped infants.     

Prevalence of renal artery stenosis in diabetes mellitus — an autopsy study

Abstract. The prevalence of renal artery stenosis in diabetic patients is unknown, since no noninvasive and valid screening procedures are available. We have therefore evaluated 5194 consecutive autopsy protocols from patients who died between 1980 and 1988. In addition, all available clinical records for patients with renal artery stenosis (RAS) and a random sample were evaluated. It was found that 73% of patients with RAS were hypertensive, and 53% had diabetes, all but one being Type 2 (non-insulin-dependent). Renal artery stenosis was present in 225 (4.3%) of all patients [95% confidence interval (95% CI), 3.8–4.9], and was not reported in the patients' clinical records in 93% of cases. RAS was present in 8.3 % of all diabetic patients (95% CI, 6.8–9.8 %), the odds ratio being 3.5 (95% CI, 2.6–4.6). The frequency of renal artery stenosis in diabetic patients with hypertension was 10.1 %. Bilateral renal artery stenosis was found in 43% of patients with RAS and diabetes, and in 30% of non-diabetic patients with RAS (P = 0.059). Our results indicate that renal artery stenosis often goes undetected before autopsy. The presence of non-insulin-dependent diabetes mellitus increases the risk of renal artery stenosis. The risk of bilateral renal artery stenosis is greater in diabetic patients. These results may be of significance with regard to the diagnostic evaluation and choice of antihypertensive treatment in hypertensive non-insulin-dependent diabetic patients.     

Pulsatile insulin infusion and glucose-homeostasis in well-controlled type 1 (insulin-dependent) diabetic patients

Pulsatile, intravenous insulin infusion designed to mimic the portal insulin concentrations that emerge physiologically after a meal, has been postulated to improve glucose tolerance in Type 1 (insulin-dependent) diabetic patients. We studied the effects of insulin pulsing (10 i.v. pulses of human insulin of 0.035 U kg-1 idealised body weight were given, each of 20 s duration, with intervals of 6 min, three times per day covered with adequate administration of glucose) on 2 successive days on glucose-tolerance in nine well-controlled Type 1 diabetic patients on continuous subcutaneous insulin infusion therapy (age 26 (7) years, mean (SD); duration of diabetes 10 (7) years; body mass index 23.4 (2.3) kg m-2; HbA1c 6.0 (0.6)%). On the days before and after the insulin pulsing, the patients were subjected to metabolic assessments by an oral glucose tolerance test (1 g glucose kg-1 body weight) 30 min after the subcutaneous injection of 0.15 U kg-1 body weight regular human insulin and a subsequent bicycle-ergometer test. During these metabolic assessments, plasma free insulin concentrations, plasma glucagon and the non-protein respiratory quotient remained unaffected by the insulin pulsing. However, glucose tolerance deteriorated significantly (maximal glucose concentration 120 min after glucose load was 10.0 mmol l-1 before and 13.9 mmol l-1 after insulin pulsing, P less than 0.01). In conclusion, the pattern of insulin pulsing used in this study did not ameliorate oral glucose homeostasis in well-controlled Type 1 (insulin dependent) diabetic patients.