Long-term follow-up of and underlying medical conditions in patients with diabetic exudative maculopathy.

Recent reports of risk factors for and survival of patients with diabetic retinopathy do not include exudative maculopathy as a separate entity. We therefore studied a group of hypertensive Type II diabetic subjects with exudative maculopathy (n = 26) compared to a carefully matched hypertensive diabetic comparison group without retinopathy (n = 26) over seven years. Diabetic maculopathy patients had higher mean diastolic blood pressure (101.

Assessment of the response to chemotherapy in oesophageal cancer.

Thirty-eight patients with localised oesophageal carcinoma have been studied by computed tomography (CT) and barium swallow before and after preoperative chemotherapy and the results correlated with the pathological findings in the resected specimen. Overall 48% of patients showed a complete or partial response to chemotherapy on CT, compared with 50% on barium and 94% on pathological examination. This study highlights deficiencies in CT scanning and barium swallow as methods of assessing the regression of tumor bulk following chemotherapy for oesophageal carcinoma.

Cefpodoxime proxetil in the treatment of lower respiratory tract infections.

Cefpodoxime proxetil is the orally absorbed ester of cefpodoxime, a new third generation cephalosporin. In the gastrointestinal tract, cefpodoxime proxetil is hydrolysed to cefpodoxime, which has potent antibacterial activity against the major bacterial pathogens involved in lower respiratory tract infections: Haemophilus influenzae, Moraxella (Branhamella) catarrhalis (including beta-lactamase-producing strains), and Streptococcus pneumoniae (including amoxicillin-resistant strains). Six randomised comparative studies in patients with lower respiratory tract infections, 5 of which were large (enrollment of more than 200 patients) and double-blind, examined the efficacy and safety of cefpodoxime proxetil.

Treatment of typhoid fever and infectious diarrhoea with ciprofloxacin.

Ciprofloxacin and other related fluorinated 4-quinolones have microbiological and pharmacokinetic properties that suggest they could be useful agents in the management of typhoid fever and bacterial gastroenteritis. Initial studies confirm that this is the case. Against fully sensitive Salmonella typhi ciprofloxacin is clinically as effective as chloramphenicol or co-trimoxazole.

Paraesthesia with lumbar epidural catheters. A comparison of air and saline in a loss-of-resistance technique.

The epidural space was located in 32 obstetric patients using loss of resistance to air, while in a further 35 saline was used. The incidence of paraesthesia was 56% in the air group and 57% in the saline group. There was no significant difference between the groups in terms of other complications or in the quality of analgesia provided.

The significance of transverse folds in the gastric antrum.

Multiple fine transverse folds in the gastric antrum were found in three patients on double contrast barium meal. These folds were constant. Endoscopy and histology demonstrated gastritis in all patients.

Life threatening Branhamella catarrhalis pneumonia in young infants.

Branhamella catarrhalis is a common nasopharyngeal commensal organism but is also a recognised pathogen. Lower respiratory tract infections caused by this organism have been reported in adults but not, to our knowledge, in otherwise healthy infants. Two infants, born prematurely, suffered near fatal pneumonia.

Restoration of forearm rotation following malunited fractures: Baldwin's operation.

The technique and results of a series of 38 Baldwin's operations (excision of the ulnar neck) are described. This is a simple and effective procedure to restore forearm rotation following malunited fractures of the distal forearm.

Silver staining of nucleolar organizer region associated proteins using polyethylene glycol as the protective colloidal developer.

A simple modification to the silver staining technique for the demonstration of nucleolar organizer region associated proteins is described. Polyethylene glycol 20,000 is used instead of gelatin as the colloidal developer. This modified technique remains a one stage procedure that is quick and easy to perform.

Oesophageal carcinoma: the view from East Birmingham.

Oesophageal carcinoma is a bad, but not a hopeless, disease. Overall survival is poor but a 5-year survival rate in the region of 30% can be obtained with surgical resection in properly selected patients. In this review we outline our overall strategy for the management of patients with both localized and advanced disease, based on more than 1500 cases treated over the past 14 years.

The effects of the partial beta 1-agonist xamoterol on heart rate and ventricular arrhythmias in patients with mild to moderate heart failure.

A major concern with the use of oral inotropes in chronic heart failure is their propensity to exacerbate cardiac arrhythmias. In a double-blind randomized placebo-controlled crossover study of xamoterol, a novel beta 1-partial agonist, 24 h ambulatory electrocardiograms were obtained in 26 patients prior to and at the end of 13-week treatment periods. During treatment with xamoterol there was no significant change in mean hourly number of ventricular extrasystoles compared with baseline and placebo (30 +/- 17 vs 56 +/- 42 and 18 +/- 7, respectively), or in the number of patients showing complex forms (multiform VEs, pairs, ventricular tachycardia) (20/26 vs 19/26 and 19/26, respectively), or ventricular tachycardia alone (5/26 vs 4/26 and 6/26, respectively).

Lower limb sympathectomy assessed by laser Doppler blood flow and transcutaneous oxygen measurements.

In a retrospective study of critical ischaemia of the lower limb, sympathectomy appeared to be of value in the majority of patients. We therefore assessed sympathectomy by measuring skin blood flow before and after the procedure using laser Doppler flowmetry (LDF) and transcutaneous oxygen tension (TCpO2) techniques. Twenty patients underwent chemical sympathectomy and there was one surgical procedure.

Acute bronchitis in the community: clinical features, infective factors, changes in pulmonary function and bronchial reactivity to histamine.

A descriptive study of acute bronchitis in patients without pre-existing pulmonary disease was undertaken in the community during the winter months of 1986-87. Forty-two episodes were investigated in 40 individuals. The cardinal symptom was the acute onset of cough (100%), usually productive (90%).

Measurement of cardiac reserve in cardiogenic shock: implications for prognosis and management.

The hypothesis that the prognosis of cardiogenic shock patients is primarily dependent on cardiac pumping reserve was tested in a prospective study of 28 consecutive patients clinically diagnosed to be in cardiogenic shock and treated medically. Haemodynamic function was assessed by thermodilution Swan-Ganz catheters and arterial cannulas. The cardiac pumping reserve was evaluated by the response of the failing heart to graded incremental dobutamine infusion (2.

Transfer from animal insulins to semisynthetic human insulin: a study in four centres.

The effects of transfer from animal insulin to semisynthetic human insulin on glycaemic control, insulin dose and anti-insulin antibodies were investigated in a total of 108 patients at four centres in a double-blind controlled study of eight months duration. Six months after transfer from porcine to human insulin there was a mean (+/- SE) increase in pre-breakfast blood glucose of 1.1 +/- 0.

Is candidiasis the true cause of vulvovaginal irritation in women with diabetes mellitus?

Vulvovaginitis is common in diabetic women and is often treated with antifungal agents on the assumption that the causative organism is Candida albicans. In a survey of 100 consecutive diabetic women attending a diabetes clinic 36 had complained to their general practitioner about vulvovaginal irritation during the past three years and 26 were treated with antifungal agents without a vaginal examination or swabs being taken. In a separate study 27 post-menopausal women with non-insulin dependent diabetes and symptoms of vulvovaginitis were investigated.

Hepatitis B virus infection: detection of circulating HBsAg/IgM antibody immune complexes.

Circulating hepatitis B surface antigen (HBsAg) IgM antibody complexes have been described in patients infected with hepatitis B virus (HBV). A radioimmunoassay to test for these complexes was developed and compared with a commercial kit. Complexes were demonstrated in both test systems.

Delayed rupture of the spleen in rheumatoid arthritis.

When tripping and falling patients with rheumatoid arthritis may adopt the 'fetal tuck' position to protect their painful deformed hands. There is then a risk of splenic injury by the left elbow, which may not be immediately apparent.