bluuebunny/crossref_metadata_2025 huggingface dataset:
Chlorpropamide-induced Hyponatremia: Incidence and Risk Factors
Authors: Kadowaki Takashi , Hagura Ryoko , Kajinuma Hiroshi , Kuzuya Nobusada , Yoshida Sho
Published: March 2007

The incidence and risk factors of chlorpropamide-induced hyponatremia were assessed in diabetic outpatients. In 176 chlorpropamide-treated patients, 11 (6.3%) exhibited hyponatremia (serum sodium ≤ 129 meq/L) during the mean follow-up period of 7.4 yr. In contrast, only one (0.6%) developed hyponatremia in 162 tolbutamide or glibenclamide-treated patients (P < 0.005). Moreover, administration to elderly patients and combination with thiazide diuretics were regarded as significantly potent risk factors for the development of hyponatremia in patients receiving chlorpropamide.
Twenty-four-hour Cortisol Profiles Demonstrate Exaggerated Nocturnal Rise in Diabetic Children
Authors: Lebinger Tessa G , Saenger Paul , Fukushima David K , Kream Jacob , Wu Richard , Finkelstein Jordan W
Published: March 2007

Plasma cortisol was measured every 20 min for 24 h in 12 normal and 8 insulin-dependent, nonketotic, diabetic children treated with one daily injection of insulin. Plasma glucose was also measured every 20 min in the diabetic children. The diurnal pattern of cortisol secretion was identical. The mean 24- h plasma cortisol was similar in both groups, but significantly elevated in the diabetic children between 0200 and 0920 h. Peak cortisol levels were higher in the diabetic than in the normal children. No correlation was found between average plasma glucose and average plasma cortisol, or between the nocturnal change in plasma glucose and average nocturnal plasma cortisol in the diabetic subjects. These studies demonstrate an exaggeration of the normal nocturnal rise in plasma cortisol in diabetic children not related to the levels of plasma glucose.
Visual Evoked Potentials in Diabetic Children and Adolescents
Authors: Cirillo Dante , Gonfiantini Enrico , De Grandis Domenico , Bongiovanni Luigi , Robert Jean Jacques , Pinelli Leonardo
Published: March 2007

Visual evoked potentials were studied in 30 insulin-dependent diabetic children and adolescents. Thirty percent of the subjects had evidence of significant abnormalities. No correlation was found between visual evoked potentials and age, duration of diabetes, metabolic control, and retinopathy.
Continuous Subcutaneous Insulin Infusion (Mill-Hill Infuser) Versus Multiple Injections (Medi-Jector) in the Treatment of Insulin-dependent Diabetes Mellitus and the Effect of Metabolic Control on Microangiopathy
Authors: Chiasson J -L , Ducros F , Poliquin-Hamet M , Lopez D , Lecavalier L , Hamet P
Published: March 2007

The present study was designed to compare continuous subcutaneous insulin infusion (CSII) using the Mill-Hill Infuser (Muirhead Medical Products Ltd., London, England) with multiple injections (MI) using the Medi-Jector (Derata Corporation, Minneapolis, Minnesota)in the treatment of insulin-dependent diabetes mellitus (IDDM), and to assess the effect of glucose control on diabetes complications. Twelve diabetic subjects were treated 3 mo with CSII and 3 mo with MI (bedtime ultralente and premeal boluses of regular insulin) ina randomized fashion. Prestudy preprandial/postprandial glucose levels were 147–215 mg/dl and improved to 108–138 mg/dl during CSII, and to 115–139 mg/dl during MI with glycosylated hemoglobin of 12.9%, 9.1%, and 8.7%, respectively. This improved glucose control with either CSII or MI was associated with an increase in sural nerve conductivity from 42.9 to 45 m/s and a decrease in proteinuria from 1.9 to 0.5 g/24 h. The 24-h insulin dose consisted of 45 U before the study, 44 U during CSII, and 56 U during MI. After the study, seven patients opted to continue with the Mill-Hill Infuser, and five with the Medi-Jector. We conclude the following: (1) treatment with both the Mill-Hill Infuser and the Medi-Jectorwas well accepted by the patients and resulted in similar improvement in measured blood glucose and glycosylated hemoglobin; (2) this improved metabolic control was associated with an increased nerve conductivity and a decreased protein excretion; and (3) MI required20% more insulin than CSII to achieve similar glycemic control.
Insulin Wastage in Ambulant Practice
Authors: Berne Chiristian , Agenäs Ingegerd , Eriksson Gunnar , Wibell Lars
Published: March 2007

The total insulin consumption in 162 insulin-requiring diabetic patients was calculated from the prescriptions of purchased insulin for 1979–80. The mean daily consumption was 58.6 U, whereas the actual dose injected was 41.7 U. A mean of 1.9 doses was injected daily, which yields a loss per dose of 8.9 U (SD ± 7.9). The dose loss was independent of age and sex and only marginally dependent on insulin dose. Visual impairmentincreased the loss. From a direct study of 101 patients while drawing their usual morningdose of insulin into the syringe, the following major factors underlying insulin wastage emerged: (1) expulsion of surplus insulin into the air instead of into the vial, when adjustment of the insulin dose is made; (2) use of syringes with a separate needle instead of new low-dead-space syringes; and (3) unnecessary use of 2-ml syringes for doses of insulin ≤40 U (≤1 ml).
Decreased Serum C-Peptide/Insulin Molar Ratios After Oral Glucose Ingestion in Hyperthyroid Patients
Authors: Osei Kwame , Falko James M , O'Dorisio Thomas M , Adam David R
Published: March 2007

Since C-peptide/immunoreactive insulin (IRI) molar ratios may reflect hepatic extraction of insulin, we measured simultaneous serum glucose, IRI, and C-peptide levels during fasting and 30, 60, 90, 120, and 180 min after 75 g of oral glucose in 10 hyperthyroid patients and 10 age- and weight-matched controls. Mean fasting serum glucose and IRI levels were significantly higher in the hyperthyroid versus control subjects (glucose: 4.9 ± 0.3 mmol/L versus 4.36 ± 0.11 mmol/L, P < 0.01; IRI: 0.10 ± 0.02 pmol/ml versus 0.05 ± 0.01 pmol/ml; P < 0.025). After glucose, mean serum glucose levels were significantly higher in the hyperthyroid versus control subjects at all times studied except for 180 min (P < 0.01). Mean IRI levels were significantly higher at all times studied including 180 min (P < 0.01). Mean fasting C-peptide levels were significantly greater in the hyperthyroid patients compared with the controls (1.2 ± 0.25 pmol/ml versus 0.62 ± 0.09 pmol/ml; P < 0.025). After oral glucose, mean C-peptide levels were significantly higher (P < 0.025) in the hyperthyroid compared with control subjects at 30–60 min but not at 90–180 min. Molar ratios of C-peptide/IRI were significantly lower (P < 0.05) in the hyperthyroid versus control subjects at all times studied except fasting. In summary, glucose intolerance and hyperinsulinism occur in hyperthyroidism. In addition, C-peptide/IRI molar ratios are reduced after oral glucose ingestion.
Bullosis Diabeticorum: A Case with Lesions Restricted to the Hands
Authors: Collet J T , Toonstra J
Published: March 2007

Bullous lesions on the extremities of people with diabetes are known as bullosis diabeticorum. A new case is described with lesions restricted to the hands, and the literature is reviewed.
Bacteremia in Diabetic Patients: Comparison of Incidence and Mortality with Nondiabetic Patients
Authors: Bryan Charles S , Reynolds Kenneth L , Metzger Wayne T
Published: March 2007

We determined the incidence of bacteremia and associated mortality in diabetic and nondiabetic patients in the four major hospitals of one metropolitan area over the 5-yr period 1977–1981. Mortality rates, based on episodes of bacteremia, were similar in diabetic and nondiabetic patients in most instances. Diabetic patients experienced lower mortality rates from Enterobacteriaceae bacteremia compared with nondiabetic patients; this finding was explained by a greater tendency for diabetic patients to have Escherichia coli bacteremia due to community-acquired urinary tract infection. However, the incidence of bacteremia due to all microorganisms was increased twofold in diabetic patients and the incidence of Enterobacteriaceae bacteremia was increased threefold. Because of their increased incidence of bacteremia, diabetic patients in this population were nearly twice as likely to die as a result of bacteremia compared with nondiabetic patients. Thus, the frequent occurrence of bacteremia among patients with diabetes mellitus represents a significant problem.
Glucose-induced Alterations in Nerve Metabolism: Current Perspective on the Pathogenesis of Diabetic Neuropathy and Future Directions for Research and Therapy
Authors: Greene Douglas A , Lattimer Sarah , Ulbrecht Jan , Carroll Patricia
Published: March 2007

Recent animal and in vitro studies have identified several interrelated metabolic abnormalities in diabetic nerve that are attributable to elevated ambient glucose concentrations. In combination, these metabolic changes may induce a variety of biochemical and biophysical alterations in peripheral nerve that are highly relevant to the pathogenesis of diabetic neuropathy. This article reviews the current status of several of these metabolic defects and describes ways in which their interaction could lead to pathogenetically important changes in nerve metabolism, function, and structure. Areas of related future research are also discussed.
Complications of Insulin Pump Therapy: The Effect of Insulin Preparation
Authors: Mecklenburg Robert S , Guinn Terin S
Published: March 2007

Complications of insulin infusion pump therapy include ketoacidosis related to interruption of insulin delivery and infected infusion sites. To determine if the type of insulin used in insulin pumps is a factor influencing these complications, we compared the occurrence of inflammation and infection at infusion sites and obstruction of infusion tubing in a 6-mo crossover study of 28 patients using two different insulin preparations. The use of buffered purified pork insulin was associated with less infusion site inflammation (P = 0.0039) and infusion set obstruction (P = 0.0215) than use of unbuffered beef-pork insulin. Infected infusion sites occurred less often with buffered pure pork insulin than with unbuffered beef-pork insulin, but the difference was not statistically significant. We conclude that the type of insulin selected for use in insulin pumps influences the occurrence of adverse reactions to insulin pump therapy: buffered purified pork insulin is associated with less infusion site inflammation and infusion set obstruction than unbuffered beef-pork insulin.
Adjuvant Therapy with Tolazamide and Insulin Improves Metabolic Control in Type I Diabetes Mellitus
Authors: Kabadi Uaya M
Published: March 2007

Sulfonylurea agents have been well documented to be effective in type II diabetes mellitus by increasing insulin secretion as well as by enhancing cellular binding of endogenous insulin. We have examined in 20 type I diabetic subjects the efficacy of tolazamide, a common sulfonylurea agent, as adjuvant therapy in combination with an appropriate diet and insulin. This regimen decreased the insulin dose while continuing to maintain adequate metabolic control, as reflected by fasting plasma glucose (FPG) <150 mg/dl and HbA1 levels <9%, and reduced number of hypoglycemic episodes to almost nil in a group of subjects with adequate metabolic control before institution of combination therapy. In subjects in whom metabolic control was inadequate (FPG > 150 mg/dl and HbA1 > 9%) with insulin alone, the adjuvant therapy with tolazamide improved or normalized hyperglycemia and HbA1. In 13 subjects in whom adequate metabolic control was achieved with combination therapy, metabolic control worsened on withdrawal of tolazamide while continuing insulin in the same dosage and adequate metabolic control promptly returned on reinstitution of combination therapy with insulin and tolazamide. In the remaining seven subjects, metabolic control remained adequate with combination therapy during the 4–10-mo follow-up period. This study therefore demonstrates that combination therapy with sulfonylurea agent and insulin may be beneficial in management of type I diabetes. Furthermore, this regimen may be helpful in prevention of extreme plasma glucose excursions observed in brittle diabetic individuals. A larger, long-term clinical trial with this regimen in type I diabetic subjects must be undertaken to establish this preliminary finding.
Effect of Insulin Pump Treatment for One Year on Renal Function and Retinal Morphology in Patients with IDDM
Authors: Beck-Nielsen H , Richelsen B , Mogensen C E , Olsen T , Ehlers N , Nielsen C B , Charles P
Published: March 2007

The effect of strict metabolic control for 1 yr on renal function and retinal morphology was estimated in 24 insulin-dependent diabetic individuals (age 29 ± 8 yr, diabetes duration 10 ± 6 yr) with Albustix negative urine and minimal or no background retinopathy before the study. They were randomized to conventional insulin treatment (CIT) or continuous subcutaneous insulin infusion (CSII) with a portable pump. During CSII treatment the metabolic status was significantly improved and glomerular filtration rates (GFR) were found to decline (from 130 ± 18 to 116 ± 15 ml/min/1.73 m2, P < 0.01). The mean value of urinary albumin excretion (UAE) was not statistically significantly reduced (from 15.3 ± 24.1 to 6.8 ± 1.5 mg/24 h, P > 0.1). In the CIT group both GFR and UAE values were unchanged. In all subjects before treatment we found a positive correlation between the metabolic status, estimated by the HbA1c values, and GFR as well as UAE values, respectively (r = 0.64, P < 0.01 and r = 0.42, P < 0.05). We conclude that elevated GFR values can be reduced toward normal level by insulin pump treatment for 1 yr. Retinal morphology was found to deteriorate in four of 12 CIT subjects and in three of 12 CSII subjects. However, the progression was mild and in most individuals only due to a slight increase in the number of microaneurysms. Pump treatment did not induce proliferation and “cotton-wool” exudates were not detectable in any pump subject after 1 yr of treatment. We conclude that CSII treatment for 1 yr was unable to stop the progression of retinopathy in individuals with minimal or no retinopathy on entering the study. On the other hand, pump treatment did not induce cotton-wool exudates or proliferation in these subjects as previously reported in subjects with more severe retinopathy before CSII treatment.
Metabolic Control May Alter Antithrombin III Activity but Not Its Plasma Concentration in Diabetes: A Possible Role for Nonenzymatic Glycosylation
Authors: Ceriello Antonio , Giugliano Dario , Russo Patrizia Dello , Tirelli Angelo , Passariello Nicola , Sgambato Saverio
Published: March 2007

The effects of metabolic control on both antithrombin III (AT III) activity and AT III plasma concentration in 20 insulin-treated diabetic subjects have been evaluated. Basal AT III activity was significantly lower in diabetic subjects versus healthy controls (P < 0.001), whereas no difference was found in AT III concentration. A good correlation was found between AT III activity and AT III concentration (r = 0.81; P < 0.001) in healthy controls, but this correlation was not significant in diabetic subjects (r = 0.12; P = NS). In those subjects a linear inverse correlation was found to exist between AT III activity and level of glycosylated proteins (r = −0.43; P < 0.05). Diabetic subjects were also examined after 1 and 2 mo of restored metabolic control, obtained by human insulin (DNA-recombinant) therapy. Improved metabolic control was characterized by an increase of AT III activity (P < 0.05), a decrease of mean daily blood glucose, and stable HbA1 and glycosylated proteins (P < 0.05), while AT III concentration did not vary. On the other hand, a significant inverse correlation between AT III activity and glycosylated proteins was found during both the first and second months (r = −0.54 and r = −0.53, respectively; P < 0.01). Moreover, no correlation between AT III activity and AT III concentration was found. These data suggest that impaired metabolic control may alter the biologic activity of AT III in diabetes, but not its plasma concentration.
Metabolic Consequence of Two-Week Fructose Feeding in Diabetic Subjects
Authors: Crapo Phyllis A , Kolterman Orville G , Henry Robert R
Published: March 2007

We studied the metabolic effects of 2-wk fructose feeding as the sweetener in the diet of seven noninsulin- dependent diabetic individuals. The data demonstrated reduced postprandial hyperglycemia to an oral glucose challenge after 14 days without a significant difference in insulin response. There was no change in the markedly blunted glucose response to a fructose challenge but a significantly lower insulin response (area under the 3-h curve) was observed after 14 days of fructose feeding. There was reduced postprandial hyperglycemia after 14 days of fructose feeding with test meals as compared with baseline, without significant differences in insulin response. We also found no significant difference in free fatty acids, cholesterol, high-density lipoprotein (HDL) cholesterol, pyruvate, lactate, or uric acid after fructose feedings. There was a 13% increase in triglyceride levels after 14 days in 5 subjects with initial fasting hypertriglyceridemia (>150 mg/dl). Insulin receptor binding to isolated adipocytes did not change after 14 days of fructose feeding.
Insulinoma in a 94-year-old Woman: Long-term Therapy with Verapamil
Authors: Ulbrecht Jan S , Schmeltz Ralph , Aarons Jerome H , Greene Douglas A
Published: March 2007

Several drugs can be used to control hypoglycemia caused by insulin-secreting pancreatic tumors but none are reliably efficacious or free of side effects. We report the case of a woman with an insulinoma who refused surgical intervention and was successfully treated with the Ca2+-channel blocker verapamil.
Ketonuria in Hospitalized Patients With Non-Insului-Dependent Diabetes Mellitus
Authors: Papadakis M , Grunfeld C
Published: March 2007

Physicians routinely order urinary ketone testing for most patients with diabetes mellitus upon hospitalization, even in the absence of a history of diabetic ketoacidosis. To determine whether testing for urinary ketones is clinically useful in patients with non-insulin-dependent diabetes mellitus (NIDDM), a retrospective review was undertaken of 152 charts of patients admitted to the hospital during a 6-mo period with the diagnosis of diabetes mellitus. Of the 135 patients with NIDDM, 96% had routine testing performed for urinary ketones. Surprisingly, 26% of the patients with NIDDM had positive urine ketones at some time during hospitalization, and the degree of ketonuria was markedly greater than that of control NIDDM outpatients and nondiabetic hospitalized patients. However, ketonuria did not reflect diabetic ketoacidosis. Ketonuria was accompanied by significant hyperglycemia and most likely reflects relative insulinopenia. Only 23% of the episodes of ketonuria were acknowledged in the progress notes. Although NIDDM patients who had ketonuria in the hospital were more likely to be transiently treated with insulin than patients without ketonuria, in no instance did the progress notes state that a diagnostic test or change in therapy was ordered because of the presence of a positive test for urinary ketones. The primary goal for therapy of patients with NIDDM should remain good control of blood glucose. In the hospitalized patient in whom frequent blood glucose determinations are made, it is not clear that urinary ketone testing needs to be routinely done.
Comparison of Insulin Levels After Injection by Jet Stream and Disposable Insulin Syringe
Authors: Malone J I , Lowitt S , Grove N P , Shah S C
Published: March 2007

Intermediate-acting biosynthetic human (NPH) insulin was administered by disposable insulin syringe into the right upper thigh of nine insulin-dependent diabetic youths. Seven days later, the same amount and type of NPH insulin was given in the same anatomic site with a Medi-Jector II, which delivers insulin as a jet stream. Blood was collected before insulin injection and at hourly intervals subsequently for the measurement of glucose and insulin. The total serum insulin measured before the first morningdose with the needle and syringe and the Medi-Jector II was 41.2 ± 10.7 μU/ml and 46.2 ± 10.7 μU/ml, respectively. During the next 9 h, the areas under the respective total insulin curves were not different, but the area under the free-insulin curve after jet injection was greater than the free-insulin area after needle injection (P < .01). The ratio of free/total serum insulin was 0.31 ± 0.02 after needle injection and 0.40 ± 0.03 after jet injection (P < .0025). The peak of total insulin concentration occurred 4.2 h after jet injection of NPH: 1 h earlier than the peak after needle injection. The plasma glucose at time zero was 197 ± 15 mg/dl before needle injection and 242 ± 19 mg/dl before jet injection. Although the diet consumed by each subject on the 2nd study day was identical to that of the 1st day, the mean glucose increase was greater after needle-injected insulin than after jet-spray injection. This indicates that the greater amount of free insulin observed after jet-injected insulin had a direct effect in lowering the plasma glucose. Jet injection may reduce insulin requirements by increasing the availability of free insulin.
The Science of Diabetic Snack Bars: A Review
Authors: Rafkin-Mervis Lisa E. , Marks Jennifer B.
Published: March 2007

In Brief

Diabetic snack bars are formulated to either prevent hypoglycemia or reduce postprandial hyperglycemia. This article reviews this new product category and the evidence-based claims associated with specific products. Diabetes health care providers and their patients should be aware of how products differ based on ingredient formulations and intended uses.
Recent Developments in the Pharmacological Reduction of Blood Glucose in Patients With Type 2 Diabetes
Authors: White John R. , Campbell R. Keith
Published: March 2007

IN BRIEF

The pharmacological management of type 2 diabetes has changed dramatically in the past few years with the introduction of many new medications, including α-glucosidase inhibitors, a biguanide, the thiazolidinediones, insulin analogs, meglitinides, and d-phenylalanine derivatives. These new agents have dramatically increased the number of options available to providers and patients. Combination therapy has become commonplace for the management of hyperglycemia in patients with type 2 diabetes. This article briefly reviews some of the more recent pharmacological advances in diabetes care.
Hypoglycemia: An Excuse for Poor Glycemic Control?
Authors: Saleh Mohammad , Grunberger George
Published: March 2007

IN BRIEF

Although long-term maintenance of normoglycemia can prevent the onset and delay the progression of the microvascular complications in diabetes, a large percentage of diabetic patients continue to have poorly controlled glucose levels. The risk of hypoglycemia is a real obstacle to achieving glucose targets in type 1 diabetes. However, risk of severe hypoglycemia in type 2 diabetes is minimal and should not be used as an excuse for failing to achieve glycemic goals. This article reviews the incidence of severe hypoglycemia in the major diabetes trials, the results of attempts to optimize glycemia to date, and the ways to ameliorate severe hypoglycemia in the treatment of both type 1 and type 2 diabetes.
Amylin Replacement With Pramlintide in Type 1 and Type 2 Diabetes: A Physiological Approach to Overcome Barriers With Insulin Therapy
Authors: Buse John B. , Weyer Christian , Maggs David G.
Published: March 2007

In Brief

Many insulin-treated diabetic patients still fail to achieve optimal glycemic control and continue to experience problems with hypoglycemia, weight gain, and postprandial hyperglycemia. Adjunctive therapy with pramlintide, a synthetic analog of the human amylin hormone, facilitates a significant improvement of postprandial and overall glycemic control in patients with either type 1 or type 2 diabetes without an increased risk of hypoglycemia or weight gain.
Diabetic Kidney Disease: Preventing Dialysis and Transplantation
Authors: Loon Nicholas Robert
Published: March 2007

In Brief

Diabetic nephropathy, characterized by proteinuria and progressive kidney failure, occurs more frequently when uncontrolled hyperglycemia and hypertension are present. Exaggerated cardiovascular risk is present in these patients, and early detection and treatment are imperative. Successful prevention and treatment are available, primarily based on aggressive blood glucose and blood pressure control.
Gestational Diabetes Mellitus
Authors: Setji Tracy L. , Brown Ann J. , Feinglos Mark N.
Published: March 2007

IN BRIEF

Gestational diabetes mellitus (GDM) is a common condition affecting ∼7%of all pregnancies. The detection of GDM is important because of its associated maternal and fetal complications. Treatment with medical nutrition therapy, close monitoring of glucose levels, and insulin therapy if glucose levels are above goal can help to reduce these complications.
Diabetes and Periodontal Infection: Making the Connection
Authors: Southerland Janet H. , Taylor George W. , Offenbacher Steven
Published: March 2007

IN BRIEF

This review focuses on the relationship between diabetes and periodontal infection and potential mechanisms involved in local and systemic disease progression. In addition, various oral complications of diabetes are discussed, along with recommendations for management, treatment, and proper referral.
Type 2 Diabetes in Children and Adolescents: Risk Factors, Diagnosis, and Treatment
Authors: Copeland Kenneth C. , Becker Dorothy , Gottschalk Michael , Hale Daniel
Published: March 2007

IN BRIEF

Along with the epidemic of obesity among children and adolescents in the United States, additional risk factors for type 2 diabetes among these age groups are becoming increasingly apparent. This article discusses the case of a young adolescent with multiple risk factors for type 2 diabetes. Issues relevant to the diagnosis and classification of diabetes in many young patients are explored, along with the importance of initiating therapy that will allow rapid attainment of glycemic control.
Innervation and nerve injections of the lumbar spine of the horse: a cadaveric study
Authors: VANDEWEERD J. ‐M. , DESBROSSE F. , CLEGG P. , HOUGARDY V. , BROCK L. , WELCH A. , CRIPPS P.
Published: March 2007

Reasons for performing study: The distal limb innervation of the horse has been studied extensively to allow use of local anaesthetic techniques to detect the origin of pain in lameness. However, the innervation of the lumbar spine has so far been poorly described and a more precise description may assist clinicians to localise back pain in the horse.

Objectives: To gain better knowledge of the innervation of the lumbar spine and identify salient anatomical features that might be used for diagnostic and therapeutic ultrasound guided injections.

Methods: The spines of 8 mature horses were dissected. Branches of the dorsal rami were followed and their anatomical relationship, with articular facets, interspinous structures and muscles, noted. The spines of 3 other horses were sectioned transversely and dissected to identify ultrasonographic landmarks of the nerves. Six other spines were used to assess the accuracy of ultrasound guided injections of the nerves with blue dye.

Results: Gross dissections confirmed the dual segmental innervation of the articular facets. Each lumbar articular facet of 2 lumbar vertebrae was innervated by the medial branch of the dorsal ramus exiting from the intervertebral foramen between those vertebrae, but also by the branch originating of the dorsal ramus cranial to it. The medial branch divided into 2 nerves before exiting the intertransverse space and has salient anatomical landmarks which could be identified ultrasonographically. The ultrasound guided injection technique appeared to be of an accuracy that would be clinically useful.

Conclusion: The results identified that the salient anatomical features of the medial branch of the dorsal ramus, as described in the present study, can be used as landmarks for reliable ultrasound‐guided injection.

Potential relevance: This study has a clear clinical relevance for development of diagnostic and therapeutic injection techniques of the lumbar spine in the horse.
Racing performance after arthroscopic removal of apical sesamoid fracture fragments in Thoroughbred horses age <2 years: 151 cases (1989–2002)
Authors: SCHNABEL L. V. , BRAMLAGE L. R. , MOHAMMED H. O. , EMBERTSON R. M. , RUGGLES A. J. , HOPPER S. A.
Published: March 2007

Reasons for performing study: Studies on arthroscopic removal of apical proximal sesamoid fracture fragments in Thoroughbred (TB) horses age ≥2 years have reported a high success rate. However, there are no reports documenting the racing prognosis of TB horses that undergo such surgery as weanlings or yearlings.

Objectives: To describe the incidence of apical proximal sesamoid fractures in immature TB horses, age <2 years and determine probability and quality of racing performance after arthroscopic removal of such fractures in 151 TB weanlings and yearlings.

Methods: The medical records of TB horses age <2 years that underwent arthroscopic surgery for removal of apical proximal sesamoid fracture fragments were reviewed. Follow‐up information was obtained from race records. Student'sttests were used to compare performance variables of operated racehorses to that of their maternal siblings.

Results: Ninety‐two percent (139/151) of fractures occurred in the hindlimbs and 8% (11/151) in the forelimbs (fracture of both fore‐ and hindlimb, n = 1). Horses with forelimb fractures had a greatly reduced probability of racing (55%) compared to those with hindlimb fractures (86%). Overall, 84% of the horses raced post operatively and had performance records similar to that of their maternal siblings, 78% (787/1006) of which raced.

Conclusions: Arthroscopic removal of apical proximal sesamoid fracture fragments in TB weanlings and yearlings carries an excellent prognosis for racing in horses with hindlimb fractures and a reduced prognosis in those with forelimb fractures. Medial fractures of the forelimb carry the worst prognosis.

Potential relevance: The determination of prognosis increases knowledge on apical sesamoid bone fractures and potential for arthroscopic restoration of the ability to race; and enables the value of yearlings for subsequent sale to be established.
Bacteraemia in neonatal foals: clinicopathological differences between Gram‐positive and Gram‐negative infections, and single organism and mixed infections
Authors: CORLEY K. T. T. , PEARCE G. , MAGDESIAN K. G. , WILSON W. D.
Published: March 2007

Reasons for performing study: Treatment for bacteraemia in foals must be started before the identity of the causative organism is known. Information aiding selection of effective antimicrobials should improve outcome.

Objectives: To describe differences in clinical and clinicopathological data and outcome in foals with bacteraemia due to different classes of bacteria.

Methods: Records of foals with a positive blood culture, age <10 days and presenting to a university hospital 1995–2004, were reviewed. Bacterial culture results, subject details, historical information, physical examination findings at admission and clinicopathological data generated during the first 48 h of hospitalisation were analysed. Results from foals with Gram‐positive or Gram‐negative organisms, single or mixed organism bacteraemias, and with bacteraemia due to 3 commonly isolated organisms were compared.

Results: Eighty‐five foals met the inclusion criteria. Gram‐negative organisms (n = 59) Gram‐positive organisms (n = 13) or multiple organisms (n = 19) were cultured from individual foals. Foals with Gram‐negative bacteraemia had lower total white blood cell and lymphocyte counts at admission than did those from which only Gram‐positive bacteria were cultured. Mixed organism bacteraemia was associated with tachycardia, increased serum concentrations of sodium, chloride and urea nitrogen, acidosis, respiratory distress, recumbency on admission and nonsurvival.Actinobacillusspp. infections were associated with leucopenia, neutropenia, lymphopenia and depression on hospital admission.

Conclusions and potential relevance: Recognising particular patterns of clinical and clinicopathological findings associated with infection with specific groups of bacteria may, in the future, aid antimicrobial selection and influence prognosis in bacteraemic foals.
Instability of bounded gas‐particle fluidized beds
Authors: Liu Xue , Glasser Benjamin J. , Howley Maureen A.
Published: March 2007

Steady flows of gas and particles in unbounded‐fluidized beds have been shown to lose stability to localized voidage disturbances. An insight is provided into the linear stability of bounded gas‐particle flows using a kinetic theory approach. The stability analysis is carried out for two illustrative sets corresponding to fluidized systems having walls acting as sinks and sources of fluctuation energy. Instabilities are characterized by computing leading eigenvalue profiles and dominant eigenfunction contour maps. Results show two types of dominant instability patterns (symmetric and antisymmetric) for flow in a vertical duct, both of which propagate through the bed in the form of traveling waves at speeds comparable to that of the solid phase. Moreover, model predictions show that increasing solids fraction and decreasing particle inelasticity will suppress the wavy disturbance. The physical mechanism of instability formation is further investigated using a term‐by‐term method of analysis. Results show that instability modes can be suppressed if solid phase inertia or inelastic particle collisions are eliminated from the momentum and pseudo‐thermal energy balance equations. Finally, the symmetric instabilities were shown to develop into bubble‐like structures while the antisymmetric instabilities develop into streamer‐like structures. © 2007 American Institute of Chemical Engineers AIChE J, 2007
The evaluation of low dose pre-operative X-ray therapy in the management of operable rectal cancer; results of a randomly controlled trial
Authors:   Second Report of an MRC Working Party, Duncan W , Smith A N , Freedman L S , Alderson M R , Arnott S J , Bleehen N M , Bond W H , Crowther D , Deeley T J , Duthie H L , Dykes P W , Fielding L P , Flatman G E , Goligher J C , Hawley P R , Hughes L E , Joslin C A F , Koriech O M , Morson B C , Oates G D , Peckham M J , Sandland M R , Schofield P F , Slack W , Slaney G , Smith J A R , Scott J Stewart , Whitehouse J M A , Wrigley P F M , York-Mason A
Published: March 2007

824 patients with operable rectal carcinoma were randomly allocated to be treated by surgery alone, 2000 rad in 10 daily fractions and 500 rad as a single fraction. No difference has been demonstrated in the actuarial survival rates to 5 years. The local recurrence-free and metastasis-free rates are similar in all groups. There is also no evidence that the pre-operative radiotherapy benefited patients in subgroups by Dukes' stage. The complication rates were also similar in the three treatment groups.
Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids
Authors: Read N W , Bartolo D C C , Read M G
Published: March 2007

Manometric radiological and neurophysiological measurements of the anal sphincter were carried out in 19 female patients who were incontinent to liquid faeces only, 15 female patients who exhibited incontinence to solid and liquid faeces and 18 normal female controls. Both groups of patients had abnormally obtuse anorectal angulation and perineal descent, a weak and easily inhibited sphincter tone and similar degrees of neuropathy during electromyography. However, patients who were incontinent to solids and liquids exhibited lower squeeze pressures during standard manometry and lower peak pressures during saline infusion than patients who were only incontinent to liquids. These findings suggest that it is the additional weakness of the external sphincter that renders patients incontinent to solids as well as liquids.
Recurrent rectal carcinoma after anterior resection and rectal stapling
Authors: Anderberg B , Enblad P , Sjödahl R , Wetterfors J
Published: March 2007

Nine local recurrences have been diagnosed in 38 patients with carcinoma of the rectum operated on with anterior resection using the EEA-stapling instrument. The characteristics of these recurrences have been compared with those of other authors, currently a total of 27 recurrences. The presence of a locally advanced growth with extramural spread, a distal location and a short margin of clearance seems to increase the risk of local recurrence, with often distressing symptoms. It is proposed that even if the EEA-stapler offers technical possibilities for anterior resection in these growths, this operation should be restricted to less advanced tumours.
Calcitonin and carcino-embryonic antigen in the follow-up of patients with medullary carcinoma of the thyroid
Authors: Palmer B V , Harmer C L , Shaw H J
Published: March 2007

Nineteen patients who have had medullary carcinomas of the thyroid have been followed up at the Royal Marsden Hospital. All had nodal involvement. Postoperative unprovoked serum calcitonin assays have been performed.

Four patients had incomplete excisions of their tumours and these had the highest postoperative levels. Two died within 3 years, one has stable disease 8 years later and one remains well 13 years later.

Four patients had postoperative calcitonin assays of over 100 ng/ml but had no clinical evidence of remaining disease. Only one has died (7 years later), the others remaining well 10, 10 and 3 years later.

Four patients died of their disease and all had assays of over 200 ng/ml, before death.

Slightly raised postoperative assays were found in all the other patients, but these have not significantly altered. These patients had good prognoses.

Three patients also had regular carcino-embryonic antigen (CEA) assays and the value of this is discussed.
Percutaneous drainage of pancreatic pseudocysts
Authors: Colhoun E , Murphy J J , MacErlean D P
Published: March 2007

Ultrasonography was used to diagnose, localize and direct the percutaneous transabdominal needle aspiration of 10 pancreatic pseudocysts in 9 patients. Thirty-four aspirations were performed without complication. In 9 pseudocysts no other treatment was necessary, and in all patients relief of pain or obstructive symptoms when present was obtained. None of the cysts have recurred with a mean follow-up of 26 months.
Haemorrhage from the pancreatic duct: A rare form of upper gastrointestinal bleeding
Authors: van Rooyen W , van Blankenstein M , Schattenkerk M Eeftinck , de Vries J E , Obertop H , Bruining H A , van Houten H
Published: March 2007

Recurrent upper gastrointestinal haemorrhage arising from the pancreatic duct presents diagnostic difficulties. Bleeding can be secondary to pancreatic disease (pancreatitis, pseudocysts) or vascular disorders (aneurysms of the splanchic arteries). Of the 5 cases reported here, 3 involved a ruptured aneurysm of the splenic artery and 2 chronic pancreatitis. Attacks of colicky pain in the left epigastric region associated with haematemesis and/or melaena were characteristic symptoms. Pancreatectomy controlled the bleeding in 4 and ligation of the splenic artery and the pancreatic duct in one. Fifty-five patients with similar pathology have been previously reported, suggesting that this syndrome should be borne in mind when gastrointestinal haemorrhage of obscure origin is encountered.

If routine endoscopy does not reveal the site of the haemorrhage and there are no signs of cholestasis, endoscopic retrograde pancreatography (ERP) and selective coeliac arteriography should be performed to evaluate the possibility of haemorrhage from the pancreatic duct. Surgical management depends on the site of the causative lesion.
Treatment of sputum retention by minitracheotomy
Authors: Matthews H R , Hopkinson R B
Published: March 2007

Retention of sputum is a major cause of morbidity and mortality following thoracic surgery and regular access to the trachea for suction can only be obtained either by tracheostomy or endotracheal intubation, both of which have significant disadvantages. A simple method of percutaneous tracheal cannulation for suction has therefore been developed in which a 4 mm Portex paediatric endotracheal tube is inserted through a 1 cm incision in the cricothyroid membrane, using a guarded knife and an introducer. The procedure can be performed in the ward or theatre, using local or general anaesthesia. Twenty-four patients have been treated between October 1981 and June 1982. Ages ranged from 19–80 years and the duration of cannulation from 1–45 days. No patient subsequently required any further treatment for sputum retention. Twenty-one patients made an uneventful recovery and 3 died from unrelated causes. Following decannulation healing occurred within 6 days and there were no late sequelae. The method is much simpler and less invasive than existing alternatives and can therefore be used at an early stage and before the consequences of sputum retention become irreversible.
Radical cure of pilonidal sinus by a transposition rhomboid flap
Authors: Azab A S G , Kamal M S , Saad R A , Abou Al Atta K A , Ali N A
Published: March 2007

A new operation for pilonidal sinus is described. This utilizes a rhomboid transposition flap to cover the defect left after radical excision. The results show healing by first intention in 29 out of 30 patients. No patient remained in hospital for more than ten days. Minor infection took place in five cases and major infection in one case. Patients have been followed for up to three years. No recurrence has yet been encountered. The reasons for the success of this operation are discussed.
The resistance of a lymph node to lymph flow
Authors: Browse N L , Doig R L , Sizeland D
Published: March 2007

The relationship between lymph flow, lymph node arterial and venous perfusion pressure and lymph node resistance have been studied in an in vivo isolated canine iliac lymph node perfused through an afferent lymphatic with heparinized canine plasma. The relationship between the rate of perfusion and perfusion pressure across the node was linear but the calculated resistance of the node decreased as the rate of perfusion increased. In nine dogs the mean resistance to lymph flows less than 0.1 ml/min was 180 mmHg/ml min, but 68 mmHg/ml min to rates of perfusion above 1.0 ml/min. An increase of venous pressure in the veins draining the node increased the node's resistance by 8.6 mmHg/ml min for each 10 mmHg increase of venous pressure. The effect on node resistance of an increase of venous pressure was greater at low rates of perfusion. A decrease of arterial pressure in the arteries supplying the node reduced the node's resistance by 2 mmHg/ml min for each 10 mmHg decrease of arterial pressure. Increases of arterial pressure had an opposite effect of a similar magnitude. The effect on node resistance of a change of arterial pressure in either direction was greater at low rates of perfusion.
Sites of recurrent tumour after ‘curative’ colorectal surgery: Implications for adjuvant therapy
Authors: Gilbert J M , Jeffrey I , Evans M , Kark A E
Published: March 2007

The pattern of recurrent tumour following ‘curative’ colorectal surgery was examined in a necropsy series and a prospective clinical series. In the necropsy series the commonest pattern of recurrence was disseminated disease (73 per cent) and recurrence in a single site was much less common (27 per cent). In the clinical series recurrence in a single site was commoner (55 per cent). The difference between the two series is statistically significant (P = 0.02, χ2), and is probably due to under-diagnosis of disseminated recurrence in the clinical series. In both series local recurrence and hepatic metastases occurred almost equally but usually as part of disseminated disease.

We conclude that after ‘curative’ surgery for colorectal cancer, recurrence is usually disseminated (73 per cent) and therefore therapy adjuvant to surgery should be active systemically. Adjuvant therapy directed at a single site (e.g. radiotherapy or intrahepatic chemotherapy) should be combined with a systemic therapy.
Pre-operative carcino-embryonic antigen and survival in patients with colorectal cancer
Authors: Lewi H , Blumgart L H , Carter D C , Gillis C R , Hole D , Ratcliffe J G , Wood C B , McArdle Mr C S
Published: March 2007

The relationship between pre-operative levels of carcino-embryonic antigen (CEA), resectability of the primary tumour, the extent of tumour spread and subsequent survival was studied in 333 patients with colorectal cancer. Twenty-five per cent of patients undergoing ‘curative’ resection had elevated CEA levels compared with fifty-six per cent of patients receiving palliative treatment. Twenty-five per cent of patients with Dukes B or C tumours had elevated pre-operative CEA levels compared with seventy per cent of patients with stage D disease. In patients undergoing ‘curative’ resection there was no correlation between pre-operative CEA levels and subsequent survival. In patients undergoing palliative resection, elevated pre-operative CEA levels were associated with poor survival. Although pre-operative levels of CEA reflect the extent of the underlying disease process, estimations of pre-operative CEA levels are of limited value in predicting patients with a poor prognosis following curative resection for colorectal carcinoma.
Surgical aspects of continuous ambulatory peritoneal dialysis — 3 years experience
Authors: Francis D M A , Donnelly P K , Veitch P S , Proud G , Taylor R M R , Ramos J M , Ward M K , Wilkinson R , Elliott R W , Kerr D N S
Published: March 2007

Since January 1979, 122 patients (mean age 38.5 years, range 5–72 years) with chronic renal failure have been treated with continuous ambulatory peritoneal dialysis (CAPD). Peritoneal access was achieved by inserting silicone rubber Tenckhoff peritoneal dialysis catheters (Quinton, Seattle, Washington) by an open (76 per cent) or closed technique. Actuarial analysis showed a patient survival of 98 and 94 per cent and a success rate of 88 and 64 per cent at 1 and 2 years, respectively. Currently, 74 patients are using CAPD and 8 have been treated for 30–36 months. Thirty-five patients (29 per cent) required two or more peritoneal catheters and 69 per cent of these patients are still on CAPD. Catheter-related peritonitis was the most frequent complication (233 separate episodes in 94 patients) and necessitated catheter removal in 16 per cent of episodes, although 37 per cent of patients from whom catheters were removed because of peritonitis later resumed CAPD. Extravasation of dialysate from the peritoneal cavity (31 episodes) and catheter obstruction (31 episodes) required surgical replacement of catheters in 8 and 23 cases, respectively. Twenty patients (16 per cent) developed 24 abdominal hernias, only one of which caused failure of CAPD. Infective and mechanical complications of CAPD frequently require surgical intervention but only occasionally result in failure of the technique, and even multiple catheter replacements are compatible with successful long term CAPD.