bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolation of fetal cells from transcervical samples by micromanipulation: Molecular confirmation of their fetal origin and diagnosis of fetal aneuploidy
Authors: Tutschek Boris , Sherlock Jon , Halder Ashutosh , Delhanty Joy , Rodeck Charles , Adinolfi Matteo
Published: March 2007

Transcervical cell (TCC) samples have been shown to contain fetal cells amenable to molecular analysis. However, the presence of ‘contaminating’ maternal cells limits their use for prenatal diagnoses. In this report we show that clumps of fetal cells can be isolated from transcervical samples by micromanipulation and tested by fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR). Out of 129 clumps, isolated from mucus aspirates and transcervical lavages from 29 patients, 29 clumps from 11 patients were found to be exclusively of fetal origin as judged by the detection of chromosome 21‐specific polymorphic DNA markers and Y‐derived DNA sequences by PCR and FISH. One case of a male triploid fetus, diagnosed by the analysis of TCC samples obtained by mucus aspiration and lavage, was confirmed by testing clumps of cells isolated by micromanipulation.
Uterine cavity lavage: Adding fish to conventional cytogenetics for embryonic sexing and diagnosing common chromosomal aberrations
Authors: Ishai David , Amiel Aliza , Diukman Rony , Cogan Olga , Lichtenstein Zelda , Abramovici Haim , Fejgin Moshe D.
Published: March 2007

This study was undertaken to examine the efficacy for early prenatal diagnosis of uterine cavity lavage at the level of the internal os and to assess the rate of maternal contamination. In phase I, uterine cavity lavage was performed in 38 women scheduled for pregnancy termination between 6 and 12 weeks. In addition to short‐ and long‐term cultures, one‐colour FISH (fluorescence in situ hybridization) with Y and X probes was used for fetal sexing. Two‐colour FISH was used in all known male fetuses for the assessment of maternal contamination. In phase II, lavage was performed on 16 women. Fetal sex was diagnosed with direct labelled X and Y probes and common numerical chromosomal aberration was attempted with 18 and 21 direct labelled probes. Fetal sexing was successful in all cases in phases I and II. Out of 34 patients in which tissue was obtained, only FISH was done in six. Long‐term cell cultures were successful in the other 28 cases, but complete karyotyping in 19 (56 per cent). No chromosomal aberration was found with the direct labelled probes 18 and 21 in FISH. Maternal contamination was assessed to be 5–10 per cent. This simple and easy‐to‐master technique is very effective in obtaining fetal cells early in pregnancy for genetic diagnosis, especially by FISH. However, the safety of the procedure must be tested in ongoing pregnancies.
Increased incidence of cytogenetic abnormalities in chorionic villus samples from pregnancies established by in vitro fertilization and embryo transfer (IVF–ET)
Authors: Veld P. A. In't , van Opstal D. , van den Berg C. , van Ooijen M. , Brandenburg H. , Pijpers L. , Jahoda M. G. J. , Stijnen Th. , Los F. J.
Published: March 2007

We studied 201 pregnancies that were established by in vitro fertilization and embryo transfer (IVF–ET) and compared the frequency of cytogenetic abnormalities with that found in a large control population matched for indication group (advanced maternal age) and time of sampling. A total of 252 IVF–ET fetuses were cytogenetically analysed by either chorionic villus sampling (CVS; n = 80) or amniocentesis (n = 172). Eleven chromosome abnormalities were found in the CVS group (13·8 per cent); among them, a 45, X/46, X, dic(q11)/46, X, del(Y)(q11) mosaic that was found in an IVF pregnancy established by intracytoplasmic sperm injection (ICSI), four cases of trisomy 21, and three cases of trisomy 7 confined to the placenta. The results indicate a statistically significant three‐to five‐fold increase in both confined placental abnormalities (P<0·008) and true fetal chromosome anomalies (P<0·04). In the amniocentesis group, identical rates (1·7 per cent) of chromosome abnormalities were found in the IVF–ET and control groups. It is concluded that late first trimester, but not early second trimester, IVF–ET pregnancies are characterized by an increased frequency of cytogenetic abnormalities found at prenatal diagnosis.
Infantile hypophosphatasia: Successful prenatal assessment by testing for tissue‐non‐specific alkaline phosphatase isoenzyme gene mutations
Authors: Henthorn Paula S. , Whyte Michael P.
Published: March 2007

We successfully assessed a fetus at risk for lethal infantile hypophosphatasia using amniocyte DNA and allele‐specific oligonucleotide (ASO) probes for two missense mutations in the tissue‐non‐specific alkaline phosphatase isoenzyme (TNSALP) gene. The nucleotide changes had been discovered in a sister who died at 8 months of age from this inborn error of metabolism. The mother was known to carry the 747 (cDNA) G→A transition, whereas her husband and 5‐year‐old daughter, who were also healthy, carried the 1309 A→T transversion. Amniocytes, obtained at 16 weeks' gestation, provided genomic DNA for polymerase chain reaction (PCR) amplification of the appropriate TNSALP gene exons. ASO hybridization revealed absence of the 747A mutation and presence of the 1309T base change in the fetus, indicating a carrier for hypophosphatasia. At 8 months of age, the offspring was in excellent health and without any radiological evidence of skeletal disease. His serum ALP activity and plasma pyridoxal 5′‐phosphate level were decreased and increased, respectively, at levels consistent with the prenatal assessment. The ASO studies were confirmed postnatally using peripheral blood leukocyte DNA. This is the first application of direct mutational analysis to assess a fetus at risk for hypophosphatasia.
Elevated mid‐trimester hCG and maternal lupus anticoagulant
Authors: Clark Frank , Dickinson Jan E. , Walters Barry N. J. , Marshall Lorraine R. , O'Leary Peter C.
Published: March 2007

An association is described between women with lupus anticoagulant and abnormal prenatal serum screening results. Three cases of positive second‐trimester serum screening for Down syndrome, with karyotypically normal fetuses, in women demonstrated to have lupus anticoagulant are presented. Serum screening positivity was principally due to a disproportionately elevated maternal serum human chorionic gonadotrophin (hCG) level. In each case, early, severe intrauterine growth restriction was documented, with only one fetus surviving the neonatal period. As maternal lupus anticoagulant may have a profoundly adverse effect on the course of pregnancy, we suggest that an elevated hCG level on prenatal screening prompt consideration of maternal lupus anticoagulant testing if ultrasonography demonstrates an otherwise normal singleton gestation and the fetal karyotype is normal.
The preserving of chorionic villi before establishing long‐term cell cultures for cytogenetic analysis
Authors: Hansson K. , Schuring‐Blom G. H. , Leschot N. J.
Published: March 2007

The possibility of preserving intact chorionic villi in culture medium for up to 7 days before establishing long‐term cultures for prenatal chromosome analysis is demonstrated. The preserving itself had no negative effect on the growth capacity of the mesenchymal cells.
Prenatal detection of limb defects after chorionic villus sampling
Authors: Sheu Bor‐Ching , Shyu Ming‐Kwang , Tseng Li‐Hui , Lin Chi‐Jen , Hsieh Fon‐Jou
Published: March 2007

Prenatal sonographic diagnoses of two cases of severe limb defects after first‐trimester chorionic villus sampling (CVS) are presented. Pathological examination after elective termination correlated well with the prenatal sonographic findings. Although the relationship between CVS and limb defects remains controversial, careful ultrasound examination for possible limb defects in cases receiving CVS is recommended.
Ultrasonography in pregnancy and fetal abnormalities: Screening or diagnostic test? IPIMC 1986–1990 register data
Authors: Baronciani Dante , Scaglia Chiara , Corchia Carlo , Torcetta Francesco , Mastroiacovo Pierpaolo
Published: March 2007

The aim of the present study was to assess the sensitivity of ultrasound diagnosis used as a screening test in detecting major congenital anomalies in the prenatal period in a large nation‐based multicentre setting. Data from the IPIMC register were collected in the period 1986–1990. One hundred and thirty‐five hospitals, located in 17 out of the 20 regions in Italy, participated in the register. Study cases were 3479 infants with major congenital anomalies diagnosed at birth or in the first week of life. Subjects with chromosomal anomalies or multiple defects were excluded. The sensitivity of ultrasound prenatal diagnosis was 49.5 per cent for central nervous system anomalies, 3.8 per cent for congenital heart diseases, 17.1 per cent for gastrointestinal tract defects, 46.6 per cent for abdominal wall defects, 74.8 per cent for urinary tract anomalies, and 22.9 per cent for skeletal abnormalities. The detection rate for diaphragmatic hernia was 24.2 per cent. Overall, only 18 per cent of the defects diagnosed in utero were detected before 24 weeks' gestation. The sensitivity of prenatal diagnosis was 30.1 and 19.0 per cent in the northern, central, and southern regions, respectively. In light of its low sensitivity, ultrasonography as a screening test in the general population should be abandoned, although some improvement in its performance should be expected following adequate training of the ultrasound staff and the use of good technical equipment.
Prevalence and clinical significance of anticardiolipin antibodies in pregnancies complicated by parvovirus B19 infection
Authors: Gratacós E. , Torres P. J. , Vidal J. , Font J. , Antolin E. , Cararach V. , Fortuny A.
Published: March 2007

Anticardiolipin antibodies were measured in 60 pregnant women with acute parvovirus B19 infection. Test results for eight (13.3 per cent) women were positive for anticardiolipin antibody. Six of these eight women became negative later, yielding a prevalence of anticardiolipin antibodies of 3.3 per cent (2/60) 6 months after acute parvovirus B19 infection. Anticardiolipin antibody positivity was not associated with an increased risk of abortion, fetal death, or maternal complications. This study suggests that there is an elevated frequency of anticardiolipin antibodies in pregnant women with acute parvovirus B19, probably representing an epiphenomenon. However, this is not associated with an adverse maternal or perinatal outcome.
Immunohistochemical characterization of cells retrieved by transcervical sampling in early pregnancy
Authors: Bulmer Judith N. , Rodeck Charles , Adinolfi Matteo
Published: March 2007

Trophoblastic cells can be retrieved from the endocervix and the lower uterine segment in early pregnancy by aspiration or lavage (Rodeck et al., 1995). The feasibility of using this technique for prenatal diagnosis depends on how frequently fetal cells can be retrieved and whether such cells can be purified from the predominant maternal cell population. In this study, specimens retrieved from the lower uterine segment prior to elective first‐trimester termination of pregnancy were examined histologically and characterized using a panel of monoclonal antibodies in an avidin‐biotin‐peroxidase technique. Lavage samples generally contained fewer cervical epithelial cells than aspirates. Syncytial fragments or cytotrophoblast were identified in 9 of 12 lavage samples but in only 4 of 10 aspirates. Trophoblast cells were reactive with various anti‐trophoblast monoclonal antibodies but the trophoblast cells present displayed considerable antigenic heterogeneity. For positive selection of trophoblast cells from these samples, it is likely that the best yield will be achieved by using a panel of carefully characterized monoclonal antibodies directed against various villous and extravillous trophoblast populations.
Renatal diagnosis of mosaic tetrasomy 12p/trisomy 12p by fluorescent in situ hybridization in amniotic fluid cells: A case report of pallister–killian syndrome
Authors: Los Frans J. , Van Opstal Diane , Schol Martin P. , Gaillard Johannes L. J. , Brandenburg Helen , Van Den Ouweland Ans M. W. , In 'T Veld Peter A.
Published: March 2007

A prenatally detected case of a rare mosaic tetrasomy 12p/trisomy 12p is reported, presenting as the well‐known accessory isochromosome 12p and a supernumerary single 12p marker in 17/24 and 6/24 clones of cultured amniotic fluid cells, respectively. The chromosomal nature of both marker chromosomes was investigated in cultured amniotic fluid cells by fluorescent in situ hybridization with various probes: the 12‐centromeric probes pa12H8 and D12Z3, a whole chromosome 12 paint, and the chromosome 12p‐specific paint M28. DNA analysis revealed a maternal origin of the extra 12p material. After counselling, the parents requested termination of pregnancy. Inspection and autopsy of the fetus revealed many of the dysmorphisms and internal structural abnormalities of the Pallister–Killian syndrome.
Prenatal diagnosis of acute bladder distension associated with fetal sacrococcygeal teratoma—a case report
Authors: Elchalal U. , Ben‐Shachar I. , Nadjari M. , Gross E. , Appleman Z. , Caspi B.
Published: March 2007

A case report of sacrococcygeal teratoma prenatally diagnosed at 23 weeks of amenorrhea, subsequently causing dilatation of both lower and upper urinary tracts is presented. The importance of repeated ultrasonographic evaluation of fetuses with sacrococcygeal teratoma is discussed.
Paralytic ileus in a fetus–neonate after maternal intake of benzodiazepine
Authors: Haeusler Martin C. H. , Hoellwarth Michael E. , Holzer Peter
Published: March 2007

Paralytic ileus of the small bowel was diagnosed in a fetus at 32 weeks' gestation after referral because of polyhydramnios. The mother had taken clonazepam, a benzodiazepine, and carbamazepine during the entire pregnancy for epilepsy. All known causes for the ileus were ruled out and at 20 months the boy has developed normally. We conclude that maternal anticonvulsant drug intake was very likely the cause of the paralytic ileus. This side‐effect is known in experimental and clinical pharmacology but has not yet been described in human fetuses.
Prenatal diagnosis of marfan syndrome: Identification of a fibrillin‐1 mutation in chorionic villus sample
Authors: Rantamäki T. , Raghunath M. , Karttunen L. , Lönnqvist L. , Child A. , Peltonen L.
Published: March 2007

Marfan syndrome (MFS) is one of the most common heritable connective tissue disorders and is caused by mutations in a gene coding for fibrillin‐1. All but one of over 30 published mutations have been unique and specific prenatal diagnostics can only be provided to families with a previously established mutation. We have earlier identified a 366 bp deletion of fibrillin mRNA in a three‐generation British Marfan family. An affected female in the family together with her husband sought prenatal diagnosis. Chorionic villus sampling was performed at 11.5 weeks of gestation and total RNA was directly extracted from the sample. After reverse transcription and polymerase chain reaction (PCR) of the cDNA, the same deletion was identified in the chorionic villus sample (CVS) and the mother's sample in agarose gel electrophoresis. The fetal origin of the CVS was confirmed with polymorphic markers. In addition to the mutation analysis, CVS cells of the proband and a control fetus were cultured for biochemical studies of fibrillin polypeptides. The results of the biochemical investigation were in concordance with the molecular analysis.
Prenatal molecular diagnosis of gaucher disease
Authors: Zimran A. , Elstein D. , Abrahamgv A. , Kuhl W. , Brown K. H. , Beutler E.
Published: March 2007

Prenatal diagnosis of Gaucher disease, the most prevalent glycolipid storage disease, is based on a reliable enzyme assay of cells from amniocentesis or chorionic villous samples. However, this method cannot differentiate among the various forms of the disease. This report details four cases of prenatal diagnosis of Gaucher disease, three of which predate the use of molecular diagnosis. DNA mutation analysis to determine the genotype was predictive of the phenotypic status of the fetus and conformed to the genotype of an affected proband where available.
Prenatal screening for haemoglobin disorders
Authors: Petrou Mary , Modell Bernadette
Published: March 2007

The technology has been available to detect carriers of haemoglobin disorders since the late 1960s. Prenatal diagnosis has been available since 1978. First trimester diagnosis by chorionic villus sampling and DNA analysis was introduced in 1982, and subsequent simplifications in DNA technology have made screening, counselling and prenatal diagnosis cost‐effective at the community level, in countries at all levels of development.

Audit of prenatal diagnosis for haemoglobin disorders in countries which have the resources and infrastructure necessary for genetic population screening (such as the UK and other European countries), has shown that the number of prenatal diagnoses actually performed fall far short of expectation. The demonstration that this reflects failures in delivering information, screening and counselling to the populations at risk, rather than rejection of prenatal diagnosis, shows the importance of placing more emphasis on the organisational and social requirements for genetic population screening.

In some countries current attitudes towards abortion exclude provision of prenatal diagnosis within the health service, but in many such cases it has been set up in the private sector. It is also being introduced through combined private and charitable efforts in an increasing number of developing countries, including some with extremely limited health resources: such centres are likely to act as nuclei for emergence of genetics services in these communities. A particularly notable recent achievement is the introduction of prenatal diagnosis in Nigeria, where 1–2% of all children born suffer from sickling disorders.
Recurrent “cold abscesses” due to mycobacterium chelonei in a diabetic child
Authors: Mucklow E S
Published: March 2007

The case is reported of a 13 year old diabetic girl with recurrent “cold abscess” at the site of insulin injections in the thighs, from which Mycobacterium chelonei was grown. The possibility of contamination of injection sites from the skin is discussed, but the evidence is inconclusive.

Although it is uncommon, the possibility of infection by atypical Mycobacterium should be kept in mind in patients who have repeated abscesses or suppurating glands, from which cultures for pyogenic organisms are sterile. The difficulty of growing such a fastidious micro‐organism is stressed, so that in many cases direct confirmation of the infection by culture is impossible, in which case indirect evidence from a PPD

Obranoble from Mycobacrerid Reference Loborarory, Cardiff.

skin test may be helpful.
King's fund centre award for non‐medical health professionals. for the best essay to be submitted to practical diabetes
Authors: Cannon W G
Published: March 2007

The Trustees of the King Edward's Hospital Fund for London are making an Award of £350 for the best essay relating to diabetes, by a non‐medical health professional, to be submitted to Practical Diabetes.

The judges will be nominated jointly by the King's Fund and the Editorial Board of Practical Diabetes. The Award will be made in November 1985 and the winning essay will be published in the January 1986 issue of Practical Diabetes.

In choosing the winning essay, particular emphasis will be placed by the judges on originality of subject and treatment, as well as the feasibility and significance for patient care of the contents.
Successful long‐term weight loss in Type II diabetics
Authors: Phillips Patricia , Park R , Slater S D
Published: March 2007

Weight changes were examined in 200 Type II diabetics who had had the disorder for an average of 10 years and were on conventional carbohydrate restricted diets. At diagnosis, 30.5% were overweight, 49% of average weight, 6.5% at ideal weight and 14% were underweight. The corresponding figures at review were 14%, 56.5%, 9% and 20.5% respectively. Nearly all (88%) of the overweight patients lost weight, amounting to 10% or more of their original weight in 43% of them. Conventional dietary advice may be more effective in achieving long‐term weight loss than is generally believed.
What is happening to our diabetic patients? An audit of care in general practice
Authors: Fleming P Clare
Published: March 2007

Forty‐two diabetic patients from a group practice were studied. Information relevant to their diabetes was extracted from the medical records, a questionnaire interview was conducted and glycosylated haemoglobin measured. Diabetics were frequent attenders at the surgery but their follow‐up was haphazard and incomplete. Although patients had a generally poor understanding of diabetes, they were keen to learn more. Regular follow‐up by general practitioner would be preferred to hospital care, by three out of four patients. To provide this care, we need to combine a systematic approach with the long‐term encouragement of the diabetic person to play an active part in his own management.
A consumer‐orientated survey of long‐term home blood glucose monitoring
Authors: Scobie I N , Tey Beng Hey , Bowden Vivien K , Judd Sue L , Lowy Clara , Sönksen P H
Published: March 2007

Fifty‐five patients who self‐monitored with Dextrostix/Glucochek, on average for 2 years, were studied. Their Glucocheks were tested against an Eyetone and a laboratory glucose‐oxidase method. A detailed questionnaire was completed. On formal testing, the patients' meters proved to be consistently accurate when compared to the Eyetone or laboratory, even after this long use. After 2 years of self‐monitoring, 62% still checked blood glucose at least twice‐daily. Mild hypoglycaemia, although still common, was no more frequent than before the introduction of self‐monitoring and no suggestion existed of an increased frequency of severe hypoglycaemia. On some occasions, the majority (82%) had experienced nocturnal hypoglycaemia.

No patient thought the investment not worthwhile. No complications of fingerpricking were encountered, in more than 76,000 finger pricks. The large majority (87%) thought blood glucose monitoring with Dextrostix/Glucochek made having diabetes easier. Long‐term self‐monitoring of blood glucose is highly acceptable to patients, is safe and leads to better understanding and care of diabetes. The long‐term precision of Glucochek is confirmed.
Acceptability and effectiveness of self‐administered intramuscular insulin in juvenile‐onset diabetes
Authors: Wynne H A , Brown P M , Sönksen P H
Published: March 2007

Four juvenile‐onset diabetic patients, poorly controlled on subcutaneous insulin, received twice‐daily, self‐administered intramuscular insulin, using a 25g 1 needle. All patients reported the intramuscular route to be as acceptable as the subcutaneous route. In one patient, the intramuscular route produced a marked improvement in diabetic control.
Mauriac's Syndrome in a 12‐year old diabetic girl. Associated with lipoatrophy, hyperprebetalipoproteinaemia and iron deficiency anaemia
Authors: Mucklow E S
Published: March 2007

A 12 year old diabetic girl is described who presented at the age of 10 months and was later found to be ESN with microcephaly, hepatomegaly and short stature. She subsequently developed marked generalised lipoatrophy with type V hyperprebetalipoproteinaemia, and later acanthosis nigricans and iron deficiency anaemia. The significance of the clinical findings and investigations is discussed, together with the problems encountered in treating her.
Continuous subcutaneous infusion of insulin (CSII) during pregnancy and fetal size
Authors: Dandona P , Besterman H S , Freedman Danielle B , Boag Fiona , Beckett A Gordon
Published: March 2007

The outcome of eight pregnancies in diabetic patients managed with continuous subcutaneous infusion of insulin (CSII) during the latter two trimesters of pregnancy was compared with that of twelve pregnancies managed with conventional insulin therapy (CIT). CSII‐controlled women had fasting mean blood glucose concentrations ranging between 3.8–5.8 mmol/l and HbA1 between 6.6–8.2% (upper limit of normal: 8.5%). Conventionally treated patients had HbA1 levels ranging between 7.2–10.5%. The mean gestational age at delivery was 38.8 weeks in the CSII group and 38 weeks in the CIT group; the caesarian section rate in the two groups was 3/8 and 3/12. Three babies in the CSII group were macrosomic with a birth weight at 90th centile or greater, whereas one was macrosomic in the CIT group. The incidence of neonatal hypoglycaemia, hypocalcaemia and respiratory distress was similar in both groups.

We conclude that the use of CSII and the institution of near‐perfect diabetic control during the latter two trimesters of pregnancy does not significantly alter the outcome of pregnancy, when compared with pregnancies reasonably well‐controlled with CIT. Prevention of macrosomia and other complications of the diabetic pregnancy must be attempted by instituting near‐perfect control of diabetes prior to conception and throughout pregnancy.
Brain damage following hypoglycaemia in alcoholic diabetics
Authors: Khaw Kok‐Tee , Cassar J
Published: March 2007

Hypoglycaemic coma is a common and usually rapidly reversible complication of treatment for diabetes mellitus. Long‐term neurological effects are not well‐documented, but it is known that permanent brain damage may result from severe hypoglycaemic coma (Ref 1). We report here the cases of three diabetics who presented over a period of eighteen months. In all three, an alcoholic binge was followed by prolonged coma which was difficult to reverse, with evidence of persisting neurological deficit after recovery.
The “insulin pen”: Comparison with multiple injection treatment with syringe
Authors: Dahl‐Jorgensen K , Hanssen Kf , Mosand R , Sandvik L
Published: March 2007

A new insulin “fountain‐pen” injection device (NovoPenTM) was tested in 10 insulin‐dependent diabetic patients, aged 21–34 years, who had used multiple injection therapy with syringe‐injections for more than one year previously. The patients had strict pre‐study blood glucose control; HbA1 8.8% ± 1.9. They used NovoPen for 6–9 months (mean 8 months). HbA1 increased slightly during pen treatment to 9.3% ± 1.8 (p < 0.01), probably due to insufficient insulin delivery. All but one patient experienced technical problems with the devices. They all wanted to continue using it, because of the simplicity of injections and the increased daily life flexibility. Since the patients have no direct control over the amount of insulin injected, caution is needed when introducing insulin pen injections.
Recurrent insulin injection site abscesses due to Streptococcus milleri
Authors: Stutchfield P R , Hart A , Smith C S
Published: March 2007

A case is reported of recurrent insulin injection‐site infections in an 11 year‐old diabetic girl, due to Streptococcus milleri. This is a commensal organism which has been reported to cause extensive asbcesses in many organ systems, rarely the skin. It is microaerophilic, capable of surviving deep in the tissues and known to cause recurrent infections. A prolonged antibiotic course is therefore recommended.
Successful pregnancy in an insulin‐dependent diabetic with incapacitating ‘brittle’ diabetes
Authors: Jacyna M R , Patel N , Alberti K G M M , Borsey D Q , Newton R W
Published: March 2007

Incapacitating brittle diabetes is a well‐recognised phenomenon occurring in a small number of insulin‐dependent diabetics (Refs 1, 2). Young adult females are most commonly affected and successful outcome of pregnancy in these patients is unusual. We report the successful completion of pregnancy in a diabetic with excessive degradation of subcutaneous injected insulin and who, in a previous concealed pregnancy, had become severely systemically insulin‐resistant.
Measurement of hypoglycaemia by Reflocheck
Authors: Southgate H J , Marks V
Published: March 2007

The ability of the Boehringer Mannheim Reflocheck® glucose monitor to measure blood glucose concentration precisely and accurately over the whole of the clinically relevant range was examined. Data obtained in the plasma glucose range (4–10 mmol/l) confirm the previously reported good performance of the instrument. However, in the low normal and hypoglycaemic range it consistently overestimated plasma glucose levels by a variable amount, making it unsuitable, except as a screening instrument, for the investigation of spontaneous hypoglycaemia. Analysis of paired estimations on the same blood sample showed that the readings obtained were reproducible and not therefore due to sampling error.
Seasonal variation in incidence rates of juvenile‐onset, insulin‐dependent diabetes, and the relationship to a family history of diabetes
Authors: Drury Roisin M , Drury M I
Published: March 2007

Seven hundred and thirty‐six cases of juvenile‐onset, insulin‐dependent diabetes mellitus were studied, to investigate a possible relationship between seasonal incidence rates and a family history of diabetes mellitus of either type. Seasonal incidence was significantly affected by the presence or absence of a family history of diabetes of either type. Seasonal variation was present to a significant degree (p<0.001) only in those in whom there was no family history of diabetes, and was related to age at onset of diabetes. These differences may reflect different aetiological mechanisms related to differences in genetic susceptibility.
Which pump?
Authors: Sleightholm M A , Roberts M , Kohner Eva M
Published: March 2007

Insulin infusion pumps for ambulatory subcutaneous insulin infusion are widely used in research and management of patients with diabetes. It is therefore important to evaluate the pumps that are available. Of the eleven pumps offered for assessment, we judged the best to be the Betatron II but considered that it was too expensive to buy and run and that, overall, the Graseby MS‐36 was the best buy in terms of specification and value for money.
Tales from the diabetic clinic' or ‘Why some patients do not bring a record book to the clinic’
Authors: Bodansky H J
Published: March 2007

Most patients monitor their control of diabetes by home urine or blood glucose tests. Assessment of the results provides a basis for changes in management. A survey of 100 consecutive diabetic out‐patients was conducted to see how many produced a record of their home tests at the clinic. Fifty‐nine patients did not produce a book (40% of insulin‐treated and 78% of non‐insulin‐treated patients). The reasons provided by patients without a book fell into three broad categories on analysis: lack of sufficient diabetes education; inability to meet the target of self‐monitoring suggested by physicians; and the indifferent attitude of a minority of poorly‐compliant patients.
Gliquidone‐induced hypoglycaemic coma
Authors: Hamilton D A , Campbell I W
Published: March 2007

Treatment with any of the sulphonylurea group of oral hypoglycaemic agents may cause hypoglycaemia, usually in situations where there may be restriction of carbohydrate intake at times of anorexia and where a potentiating drug such as salicylates, warfarin or co‐trimoxazole is given (Ref 1). There is particular risk of this occurring in the elderly and in those with impaired renal function, as many of the commonly used sulphonylureas (tolbutamide, chlorpropamide, acetohexamide, tolazamide, glibenclamide, glipizide and glibornuride) are primarily excreted by the kidney. Gliquidone is a recently introduced sulphonylurea to the UK, with a short plasma half‐life of 1.4h and which is excreted in the bile and does not accumulate with renal impairment. We describe a case of gliquidone‐induced hypoglycaemia occurring in a female diabetic with chronic renal failure.
Diabetes and injection site infections in children
Authors: Stutchfield P R , Meade H , Brown B , Hart A , Smith C S
Published: March 2007

Injection site infections in a paediatric diabetic population are reviewed and possible aetiological factors examined. The incidence of infection was found to be significantly higher (5%) than that reported from adult clinics. Adolescent girls are particularly at risk.
Metabolic control and patient acceptability of multiple insulin injections using NovoPen cartridge‐packed insulin
Authors: Jensen T , Moller Lise , Andersen O Ortved
Published: March 2007

A packed syringe ‘NovoPen’™ loaded with a prefilled cartridge containing soluble insulin (Actrapid HM), was evaluated in a multiple‐dose injection regimen by 20 patients with insulin‐dependent diabetes mellitus (IDD). Following an induction period of 8 weeks with self‐monitoring of blood glucose, the patients changed for the next 24 weeks to three preprandial soluble insulin injections per day using a NovoPen with an evening injection of human protaphane insulin. A questionnaire completed before the study revealed that a rigorous daily schedule for meals and activity was the single most important disadvantage of the diabetic life (47% of the patients). At the end of the study, only 21% and 10% respectively still considered these problems to be inconvenient. All patients showed greater ability to vary the time of meals, and all but one wanted to continue multiple injections with NovoPen.

Blood glucose and HbAlc did not improve in the multiple injection period, whereas blood glucose oscillations fell from 3.0 mmol/1 (1.0–6.0) to 1.7 mmol/1 (0.9–4.6) (p < 0.01), and the frequency of subjective hypoglycaemia was reduced from 1.2 attacks/patient/week (0–5.5) to 0.3 attacks/patient/week (0–2.1) (p < 0.01). There were no technical problems with insulin administration with NovoPen and no complications (serious hypoglycaemia, ketoacidosis or local reactions at injection sites). Thus, multiple insulin injections with NovoPen were well accepted by the patients and resulted in improvement of some parameters of glycaemic control.
A quality assurance programme for blood glucose measuring meters used in clinical areas
Authors: Thaker P , Cradock Sue , Cowan M E , Shaw K M
Published: March 2007

A quality assurance programme for blood glucose measuring meters is described. The need for careful quality control of blood sugar measurement became apparent after several discrepancies had occurred between results of tests carried out in clinical areas and those undertaken in the laboratory. This programme comprises a quality control scheme organised by the Chief MLSO, Department of Biochemistry, regular training sessions conducted by the Diabetic Specialist Nurse and a monitoring system for electro‐mechanical defects. Following the introduction of this quality control scheme, a gradual improvement in the accuracy of results obtained has been demonstrated over a twelve‐month period.
The relationship between glycosylated haemoglobin and verified self‐monitored blood glucose among pregnant and non‐pregnant women with diabetes
Authors: Langer O , Mazze R S
Published: March 2007

Assessment of metabolic control during pregnancy complicated by diabetes is an important element of management. Glycosylated haemoglobin (HbA1) represents an independently verifiable means of assessing average glycaemic control over a period of time (up to 6 weeks). This study, utilizing reflectance meters with onboard memories, evaluated the relationship between HbA1 determinations and self‐monitored blood glucose data at various stages of pregnancy, and compared these findings with the same tests for age‐matched women with Type I diabetes who were not pregnant. Forty‐six women with diabetes during pregnancy (15 pre‐gestational and 31 gestational diabetics) and 16 non‐pregnant women (Type I diabetes) participated in the study. As determined by verified self‐monitored blood glucose data, the patients' mean glucose values remained stable throughout the study, with pregnant patients averaging 107 ± 36 mg/dl and non‐pregnant patients averaging 208 ± 56 mg/dl. A correlation coefficient of r = 0.55 (p = 0.0071) was calculated for HbA1 and mean blood glucose values for the non‐pregnant group. A similar correlation was calculated for the pregnant group and proved stronger in pre‐gestational diabetes (r = 0.60, p = 0.03) than in gestational diabetes (r = 0.33, NS). Evaluation of fasting, pre‐prandial, post‐prandial and bedtime mean values indicated that correlations with HbA1 were inconsistent, ranging from no relationship to r = 0.83.
Part 1 of a new educational series on research (a) improvement in NIDD patients poorly controlled on oral hypoglycaemic agents following transfer to insulin
Authors: Robertson Dorothy , Fitzgerald M G , Wright A D , Nattrass M
Published: March 2007

Forty‐five patients with non‐insulin‐dependent diabetes which was poorly controlled on oral hypoglycaemic agents were studied before and six months after transfer to insulin. Diabetic control had significantly improved at six months in 38 patients (84%). Mean (SD) glycosylated haemoglobin concentration fell from 13.7 (2.7)% to 11.3 (2.6)% (p < 0.001) and blood glucose concentration from 18.7 (5.4) to 11.4 (5.6) mmol/l (p < 0.001). Improvement in control was associated with a significant increase in ideal body weight from 113 (20.0)% to 119 (19.4)% (p < 0.001). Daily insulin dose at six months was 38 (17.8) units. Diabetic control improved in patients who were > 120% ideal body weight and insulin dose for these was not significantly different from the remaining patients. Patients who had symptoms of hyperglycaemia and other medical problems did not respond as well as patients with symptomatic hyperglycaemia only.
Ketoacidosis in pregnancy
Authors: Blyth J , Beer S F
Published: March 2007

Ketoacidosis in pregnancy is uncommon and potentially fatal to both mother and fetus. Fetal mortality rates of 90% have been reported (Ref 1). We present a‐case in which a fetus survived two distinct episodes of ketoacidosis which were complicated by pre‐eclampsia.
Understanding of diabetes mellitus in non‐diabetic adults
Authors: Hoghton M R , Philipp R , Harvey K , Hughes A O , Fletcher G M , Cox C J Burns
Published: March 2007

What non‐diabetic adults know about diabetes does not seem to have been previously quantified in the UK. This information would be helpful in planning the education of newly diagnosed diabetics, their families and the public.

Five hundred self‐administered questionnaires were completed by employed people in different parts of Avon County, England. Of these questionnaires, 436 were suitable for analysis. Total knowledge scores were greater for respondents in Social Classes 1, 2 and 3 non‐manual, compared with other social classes, and for respondents with diabetics amongst their family or friends, compared with persons not familiar with diabetics.

At least 60% of respondents knew that diabetes was not an infectious disease, that the disease can be helped with treatment and that it is treated with diet and injections. Less than 30% of the respondents knew that diabetes may affect the feet, that it may affect the bowels, that some diabetics are not able to join the police force, or do shift work, that smoking is more dangerous for diabetics and that adults can lessen their chances of developing diabetes. Eighteen per cent thought that diabetes need not be managed by either a general practitioner or hospital. The correct first aid management of unconscious diabetic patients was also not widely appreciated.

These findings show that diabetes is poorly understood in the community. For the newly diagnosed diabetic and for the public, background knowledge, expectations and misconceptions about the disease still need to be identified and corrected.
Type 1 DM after non‐A, non‐B hepatitis
Authors: Gomis R , Recasens A , Valles M E , Bruguera M
Published: March 2007

An 11 year‐old girl who developed concurrent diabetes mellitus Type 1 and Addison's disease is described. The hypothesis that this was caused by a preceding viral hepatitis is explored.
Psychological issues in diabetes management: (I) blood glucose monitoring and learned helplessness
Authors: Dunn Stewart M
Published: March 2007

Learned helplessness refers to the psychological state of motivational loss, emotional disturbance, and cognitive impairment, which is induced in any person exposed repeatedly to an uncontrollable and unpleasant situation. Diabetes poses many such situations, and self‐monitoring of blood glucose (SMBG) is a common example which can be linked to the onset and maintenance of learned helplessness. This article describes the essential features of learned helplessness as identified in psychological research, and indicates how it may be inadvertently induced through SMBG. Practical recommendations are offered for the treatment and prevention of SMBG‐induced learned helplessness.
Diabetic ketoacidosis and pulmonary mucormycosis
Authors: Esack A , Thompson G S , Whittaker J S
Published: March 2007

Patients with poorly controlled diabetes and diabetic ketoacidosis are more prone to develop mucormycosis, an uncommon but important opportunistic fungal infection often diagnosed only at post mortem. Ante mortem it is considered less often because of the rapidity of the illness, rarity of the infection and the need for a tissue sample to establish the diagnosis. A fatal case of pulmonary mucormycosis in a young patient with diabetic ketoacidosis is described.
Bulimia, diabetes and the role of counselling: A case report
Authors: Brown Florence J
Published: March 2007

Recent reports suggest that eating disorders including bulimia may be more common in patients with diabetes (Ref 1). Bulimia has been recognised as a separate phenomenon from the bingeing and vomiting episodes that some patients with anorexia nervosa experience (Ref 2). This case report demonstrates how the counselling process helped an insulin‐dependent diabetic with bulimia to free herself from a potentially life threatening situation (Refs 3 and 4).
The effect of different beers on blood glucose concentrations in insulin‐dependent diabetes
Authors: Henderson B , Atkin G E , Henderson E , Rawson D R W , Connor H
Published: March 2007

Changes in blood glucose concentrations following consumption of four different beers (carbohydrate content 1.4‐12.1g per half pint; alcohol concentration 3.3‐5.5% v/v) were examined in seven insulin‐dependent men (age 21‐41 years; duration of diabetes 5‐27 years), who were studied on four evenings, on each occasion drinking a different beer but eating an identical meal. Blood samples were taken before drinking began, at half to one hour intervals during the evening and before breakfast the next morning. The peak increment in blood glucose concentration was linearly related to the carbohydrate content of the beer (r = 0.95,p<0.01), though there were no statistically significant differences between individual beers. Pre‐breakfast blood glucose concentrations of <3.5 mmol/l occurred on six out of 14 occasions after the two low carbohydrate beers but on only two out of 14 occasions after the two higher carbohydrate beers (p=0.09). If patients follow the advice given by the BDA on alcohol consumption we suggest that they choose beers and lagers with a carbohydrate content of 3‐7g per half pint (275 ml) and an alcohol concentration equal to or less than five per cent.
Dietary pattern during Ramadan fasting and its effect on the metabolic control of diabetes
Authors: Chandalia H B , Bhargav A , Kataria V
Published: March 2007

The dietary pattern of thirteen non‐insulin‐dependent diabetics during the Ramadan fast and the effect of Ramadan fasting on the metabolic control of these diabetics was studied. The dosage of oral hypoglycaemic drugs and insulin (in insulin‐requring patients) was left unaltered during the fasting period. Patients ingested significantly less calories (p<0.05), more carbohydrates (p<0.05) and less fats (p<0.05) during the fasting as compared to pre‐fasting period. The metabolic control, as judged by blood glucose values and glycosylated haemoglobin, remained unchanged at the end of the fasting period. This study demonstrates the safety of Ramadan fasting at 7pm, 10pm and 4am in non‐insulin‐dependent diabetics.
Does strict metabolic control prevent long‐term diabetic complications?
Authors: Johansen K
Published: March 2007

Although insulin has been in use for 65 years, it is still not kn„n whether strict metabolic control can prevent long‐term diabetic complications. There are two major reasons for this: conventional insulin treatment is unable to normalise or near‐normalise blood glucose levels; and until recently there were no methods for long‐term monitoring of blood glucose. During the last decade infusion pumps and pens have been marketed which enable us to simulate the endogenous insulin secretion and thereby normalise or near‐normalise blood glucose levels and home blood glucose monitoring methods are widely available. Therefore, it should n„ be possible to test the hypothesis that strict metabolic control prevents long‐term diabetic complications. This paper reviews the results of six prospective, controlled, randomised, clinical trials which have been published. The consensus is that near‐normalisation of blood glucose levels is able to retard or arrest the progression of long‐term diabetic complications.
Placebo‐controlled trial of guar in poorly controlled Type II diabetes
Authors: Baker Paul
Published: March 2007

This study assessed the acceptability and efficacy of guar mini‐tablets in poorly controlled Type II diabetes. Thirty patients were allocated in a random and single‐blind manner to two months of treatment with placebo or guar, 5 gms three times daily. No patient found guar unpalatable or difficult to take. Gastrointestinal side effects were more frequent in the guar group and were minor and temporary apart from in two patients who had to withdraw from the trial. Fasting plasma glucose and glycosylated haemoglobin (HbA1) were measured and glycosuria assessed semi‐quantitatively by urine testing strips. No significant difference was found between guar and placebo groups, although there was a trend for patients treated with diet alone to improve glycaemic control better than patients taking oral hypoglycaemic drugs in addition. The evidence of this and other trials is discussed.
Diabetic camps for children — effects on control and hypoglycaemia
Authors: Kerr David , Kerr Sara
Published: March 2007

Educational holidays provide an opportunity to assess the advice given to parents and diabetic children and provide insight into the difficulties that they face in everyday life. We describe our experience of camping with 43 diabetic children for two weeks. Hypoglycaemia was common but severe nocturnal episodes may be avoided by assessing the blood glucose in the evening and providing extra carbohydrate if the glucose value is less than 4.5 mmol/l at that time. Children describe hypoglycaemic symptoms which may differ from those described in standard textbooks and are predominantly neuroglycopaenic. It was impossible to improve diabetic control using only twice daily blood glucose monitoring. In conclusion, children should be encouraged to increase the frequency of daily blood glucose testing and parents should be provided with alternative methods of assessing diabetic control such as the results of glycosylated haemoglobin measurements.
Clinic screening for peripheral vascular disease in diabetes mellitus: Reliability of history, palpation of pulses and doppler ultrasound examination
Authors: Duarte P M , Young R J , Clarke B F
Published: March 2007

A sample of 142 (60 male, 82 female) randomly selected outpatients (94 non‐insulin‐dependent diabetics, 48 insulin‐dependent diabetics) routinely attending a diabetic clinic were carefully assessed for evidence of peripheral vascular disease by history of intermittent claudication, palpation of lower limb arterial pulses and Doppler ultrasound examination of the posterior tibial artery. Palpation of the pulses was as reliable (92.5%) as Doppler examination (90.6%) in establishing the diagnosis. A history of intermittent claudication was found in only 60.4% of patients with clear clinical evidence of peripheral vascular disease. Palpation of foot pulses may be the most efficient way of screening for peripheral vascular disease in the busy diabetic clinic.