Efficacy of continuous subcutaneous insulin infusion in Type 1 diabetes: a 2-year perspective using the established criteria for funding from a National Health Service.

AIM: To determine the 2-year efficacy of continuous subcutaneous insulin infusion (CSII) following the current established criteria for funding of a National Health Service. METHODS: Longitudinal, prospective, observational unicentre study. Included in the study were 153 Type 1 diabetes (T1D) subjects, previously treated with multiple daily injections (MDI) of insulin, in whom CSII was started in accordance with the criteria for reimbursement of the Catalan National Health Service. At baseline, we recorded data on age, gender, duration of the disease, body mass index (BMI), insulin dose and indications for CSII. Glycated haemoglobin (HbA(1c)) and the frequency of hypoglycaemic events were used to assess glycaemic control. Quality of life was assessed using three different self-report questionnaires. After 24 months, these same items were remeasured in all subjects. Serious adverse events and injection-site complications were also recorded. RESULTS: In 96% of subjects, CSII indication included less than optimal glycaemic control using MDI. HbA(1c) fell from 7.9 +/- 1.3 to 7.3 +/- 1.1% (P < or = 0.001) after 24 months of CSII. Insulin requirements were significantly lower at the end of follow-up (0.55 +/- 0.21 U/kg body weight) in comparison with before use of CSII (0.70 +/- 0.20, P < or = 0.001). BMI increased from 24.0 +/- 3.1 to 24.4 +/- 3.2 kg/m(2) after 24 months (P < or = 0.025). The rate of episodes of diabetic ketoacidosis per year remained unchanged. Mild and severe hypoglycaemic episodes were significantly reduced. The scores in all subsets of the Diabetes Quality-of-Life (DQoL) questionnaire significantly improved after 24 months of CSII. CONCLUSIONS: CSII, commenced according to the criteria for a nationally funded clinical programme, improves glycaemic control and quality-of-life outcomes with fewer hypoglycaemic episodes in T1D subjects previously conventionally treated with MDI.     

Posterior instability near extension is related to clinical disability in isolated posterior cruciate ligament deficient patients

The purpose of this study is to evaluate the relationship between the magnitude of knee laxity and posterior instability at different knee flexion angles and clinical disability in isolated posterior cruciate ligament (PCL) deficient patients. Knee laxity at 20° and 70° of knee flexion were evaluated using KT-2000 arthrometer, and the posterior instability at 20°, 45° and 90° of flexion were evaluated using stress radiography. We assessed the differences in the knee laxity and the tibial translation between isolated PCL deficient knees and normal knees, and between the patients with giving-way during activities of daily living (ADL) and without giving-way. There were statistical differences in the knee laxity and the tibial translation at all knee flexion angles between the PCL deficient knees and normal knees. The magnitude of the knee laxity at 20° of flexion measured with KT-2000 arthrometer was significantly larger in the patients with giving-way than those in the patients without giving-way although there was no significant difference in the tibial translation at 70° between the two groups. The tibial translation in both medial and lateral compartments at 20° and 45° measured with stress radiography were significantly larger in the patients with giving-way than those in the patients without giving-way although there was not significant difference at 90° between the two groups. These results suggested that the magnitude of the knee laxity and the posterior tibial translation at shallow knee flexion angles would be related to giving-way during ADL in isolated PCL deficient patients.     

Analysis of signal-to-noise behavior in Cartesian continuous sampling sequences: predictions and experimental validation of opportunities for improved image SNR.

Image signal-to-noise ratio (SNR) limits many MRI applications. Here we propose a method to improve SNR based on continuous sampling (CS) during each TR without significant increases in acquisition time. The general concept of CS is defined here as sampling the NMR signal immediately after slice excitation including ramp times, both the dephase and rephase lobes, the phase-encoding (PE) gradient application, and the slice refocusing gradient. This study analyzes several cases of CS and demonstrates a specific case where sampling occurs during an isolated and balanced readout gradient in order to increase SNR in a rectilinear Cartesian sequence without significantly increasing overall acquisition time. The noise correlation consequences of rectilinear CS are mathematically derived and proven through simulation. The SNR improvement of up to approximately 40% measured in both phantom and asymptomatic human volunteer images is comparable to theoretical prediction of increased SNR proportional to the increase in the square root of the sampling time.     

Continuous laser radiation effect at 1.06 microns on gastrointestinal tract

The thermal effect of 1.06 microns YAG:Nd laser irradiation at temperature conditions up to 100 degrees C without crater formation on gastrointestinal (GI) tissue samples was investigated. The theoretical and experimental data show that at an intensity of 160-400 W/cm2 laser-induced heating of the tissue with an initial temperature of 20 degrees C leads to coagulation lesions at a temperature no less than 60 degrees C and at a depth of 1.7-2.1 mm.     

Pharmacokinetics of ciprofloxacin and vancomycin in patients with acute renal failure treated by continuous haemodialysis.

To determine appropriate doses of ciprofloxacin and vancomycin for septic patients with acute renal failure (ARF) treated by continuous arteriovenous and venovenous haemodialysis, (CAVHD/CVVHD), we performed pharmacokinetic studies in patients receiving these antibiotics. All patients were treated by CAVHD/CVVHD using Hospal AN69S 0.43 m2 filters and Fresenius 1.5% peritoneal dialysis fluid at dialysate flow rates (Qd) of 1 and 2 l/h. Patients received ciprofloxacin 200 mg i.v. 12-hourly (n = 6) or 8-hourly (n = 5); vancomycin 1 g i.v. was administered to 10 patients approximately every 48 h to maintain therapeutic plasma levels. For ciprofloxacin, volume of distribution (Vdarea) was 136.5 +/- 9.81, terminal elimination half-life (t1/2) 6.4 +/- 0.8 h, and total body clearance (TBC) 264.3 +/- 22.9 ml/min (mean +/- SEM). Mean sieving coefficient (S/C) was 0.76 +/- 0.05 and filter clearances at Qd 1 and 2 l/h were 16.2 +/- 1.9 and 19.9 +/- 1.1 ml/min respectively. For vancomycin, Vdarea was 60.7 +/- 5.11, t1/2 24.7 +/- 2.6 h and TBC 31.0 +/- 4.6 ml/min. Mean S/C was 0.66 +/- 0.08 and filter clearances at Qd 1 and 2 l/h 12.1 +/- 2.0 and 16.6 +/- 2.0 ml/min. These data suggest that patients with ARF treated by CAVHD/CVVHD should be given ciprofloxacin 200 mg i.v. 8-12-hourly and vancomycin every 48 h.     

Haemodynamic changes during spinal anaesthesia with slow continuous infusion or single dose of plain bupivacaine

Forty elderly patients, scheduled for orthopaedic surgery of the hip or knee were studied. Twenty patients received a single-dose spinal anaesthesia with 3 ml of plain 0.5% bupivacaine (SDSA group). Twenty patients received continuous spinal anaesthesia using a 32- or 22-gauge catheter. A bolus of 1.0 ml of plain 0.5% bupivacaine was given to ten patients and 0.5 ml to another ten, continued by an infusion at a rate of 2 ml/h. The spread of analgesia and haemodynamic changes (central venous pressure, arterial pressures, need for sympathomimetic medication) were registered. The mean dose of bupivacaine was 2.9 ml (range 1.5-5 ml) in the CSA group (3.0 ml in the SDSA group). Eight patients in the CSA group needed medication for pain during surgery compared to five patients in the SDSA group (n.s.). The median level of pinprick analgesia at 60 min was T11 in the CSA and T6.5 in the SDSA group (P less than 0.01). The mean maximum decreases in CVP and MAP were quite similar in the CSA and SDSA group (2.1 vs 2.8 mmHg (0.3 vs 0.4 kPa) and 17 vs 21 mmHg (2.3 vs 2.8 kPa), respectively) (n.s.). Six patients in the SDSA group and four patients in the CSA group needed sympathomimetic medication. It is concluded that titration of bupivacaine for spinal anaesthesia caused only minor haemodynamic changes which were similar to those after single-dose spinal bupivacaine.     

后房型人工晶体植入术后早期并发症临床分析及处理

报告468例500眼后房型人工晶体植入术后2周内出现的并发症发生率,其中角膜水肿73.6％,色素膜炎症反应88.4％,瞳孔变形12.8％,人工晶体表面渗出膜3.8％,后囊混浊13.8％,短暂性高眼压5.2％,晶体皮质残留5.8％,人工晶体偏位2.6％,前房出血3％。提高术后视力的关键是提高手术技巧以减少并发症的发生。     

Bilateral complete discoid medial meniscus combined with posterior cyst formation

Bilateral discoid medial menisci is an extremely rare condition of the knee and it can be associated to other pathological findings, including anterior portion cyst formation. We report on the clinical features, radiographic findings, treatment and results of one patient who presented a bilateral medial discoid meniscus combined with posterior portion cyst of the left knee. To the best of the author’s knowledge, this is the first case of bilateral medial discoid meniscus associated with posterior portion cyst formation.     

环孢霉素A致可逆性后部白质脑病综合征的MRI表现

目的探讨环孢霉素A诱发可逆性后部白质脑病综合征(PRLS)的MRI表现。资料与方法回顾性分析1例PRLS的临床资料和MRI表现并复习文献。结果MRI显示PRLS以顶枕叶为主的皮层及皮层下白质病变,病变多呈双侧对称性分布,偶可累及双侧颞叶后部及额叶,T2WI和液体衰减翻转恢复序列(FLAIR)对病变的显示有独特的作用,扩散加权成像(DWI)能够确定PRLS的临床分期。结论PRLS在MRI上具有特征性。MRI表现结合临床资料,对PRLS多能作出正确的诊断。