Fetal growth patterns in fetuses of women with pregestational diabetes mellitus.

OBJECTIVE: To assess the effect of glucose control on the rate of growth of fetuses in women with pregestational diabetes mellitus (Types 1 and 2). METHODS: All pregestational diabetic women booked at Mater Mothers' Hospital, Brisbane, Australia, between 1 January 1994 and 31 December 2002, were included. Pregnancies with congenital fetal anomalies, multiple pregnancies, and pregnancies terminated prior to 20 weeks' gestation were excluded. Dating scans were performed before 14 weeks' gestation and serial scans were performed at 18, 24, 28, 32 and 36 weeks. Fetal parameters, including biparietal diameter, femur length and abdominal circumference, were recorded. The daily growth rates for biparietal diameter, femur length, and fetal abdominal area were calculated and compared with those in a low-risk (non-diabetic) population. The growth rates in fetuses of women with satisfactory diabetic control (HbA1c < 6.5%) and unsatisfactory control (HbA1c > or = 6.5%) in the three trimesters were compared. RESULTS: A total of 174 diabetic pregnancies were included and a total of 997 ultrasound scans were performed. The growth rates for fetuses of mothers with diabetes mellitus were significantly higher than for those in the low-risk population. The z-scores for biparietal diameter, femur length, and fetal abdominal area were 0.18, 0.59 and 1.44, respectively. Fetuses of diabetic mothers with high HbA1c in the first trimester had significantly greater fetal abdominal area growth rate than those with normal HbA1c (fetal abdominal area z-score of 1.7 vs. 0.75, P = 0.009). Although the fetal abdominal area z-scores in fetuses of diabetic mothers with high HbA1c in the second or third trimesters were also higher than those with normal HbA1c levels, the differences did not reach statistical significance. Maternal obesity did not influence the fetal growth rate. CONCLUSION: The rate of growth of fetuses of diabetic mothers differs from that of the normal population. Growth acceleration persists until the late third trimester. Moreover, periconceptional glucose control appears to have a significant effect on accelerated growth of the fetal abdominal area.     

From Braxton Hicks to preterm labour: the constitution of risk in pregnancy.

With the recent introduction of preterm birth prevention programs there has been a shift in our understanding of what the presence of contractions during pregnancy means and a reconstituting of risk in ways that position increasing numbers of women at risk for preterm birth. This paper highlights the findings of a study exploring the influences of risk discourses on women's experiences of preterm labour. The primary goals of this institutional ethnographic study were to describe the effects of societal discourses, institutional structures, and nursing work processes on the everyday lives of childbearing women experiencing preterm labour. The findings suggest that risk discourses exert social control over pregnant women and result in fear, guilt, feelings of being judged or punished, and an overwhelming sense of personal responsibility for preventing preterm birth.The study also exposes ways in which biomedical constructions of risk and preterm labour affect the organization of health services, including nursing practice.     

Immunological responses to pneumococcal vaccine in frail older people

Advanced age has been associated with a wide range of defects in both the innate and adaptive immune systems including diminished specific antibody responses that increase the risk of invasive pneumococcal disease (IPD) and limit the effectiveness of vaccines. However, the elderly are a heterogeneous group and measures of overall frailty may be a better indicator of disease susceptibility (or vaccine response) than chronological age alone.     

Influence of pain and urinary symptoms on quality of life in young men with chronic prostatitis-like symptoms

BACKGROUND: Our aims in the present study were to estimate the influences of pain and urinary symptoms on quality of life, and to determine which of these two variables has the most predictive power with respect to quality of life in young men with chronic prostatitis-like symptoms. METHODS: Chronic prostatitis-like symptoms were measured by the National Institutes of Health-Chronic Prostatitis Symptom Index. Of the 28,841 men aged 20 years who lived in the study community, 18,495 men (a response rate 64.1%) agreed to participate in the study. A total of 1057 men who complained of symptoms indicative of chronic prostatitis were included in the study. The influences of pain and urinary symptoms on quality of life were determined using logistic regression analysis. The receiver operating characteristic (ROC) curve was used to estimate the predictive ability of each of these variables with respect to quality of life. RESULTS: Results from multivariate analysis showed that both pain and urinary symptoms were associated with an increased likelihood of impaired quality of life, although pain contributed more to a reduced quality of life than urinary symptoms. Relative to men who experienced mild pain, men who experienced moderate pain had a 3.9-fold risk of poor quality of life (odds ratio [OR], 3.87; 95% confidence interval [CI], 2.86-5.23; P < 0.001) and those who experienced severe pain had a 15.7-fold risk of reduced quality of life (OR, 15.68; 95% CI, 6.59-37.35; P < 0.001). Moderate urinary symptoms were associated with a 1.4-fold risk of bother (OR, 1.41; 95% CI, 1.01-1.99; P < 0.001) and severe urinary symptoms were associated with 2.4-fold risk (OR, 2.39; 95% CI, 1.37-4.12; P < 0.001), relative to mild urinary symptoms. Comparison of the effects of pain and urinary symptoms showed that pain severity had the most predictive power for bother, quality of life, and quality-of-life impact. The areas under the ROC curves for bother, quality of life, and quality-of-life impact were 71.3%, 69.3% and 72.5%, respectively. CONCLUSION: Urinary symptoms and pain might be associated with an increased likelihood of impaired quality of life in young men with chronic prostatitis-like symptoms. In addition, our findings suggest that pain severity is the most influential variable for determining quality of life in this population.     

Radiation-induced prostatic sarcoma: a case report

A 64-year-old man had a prostatic sarcoma 8 years after transurethral prostatectomy and radical bilateral pelvic lymph node dissection with insertion of 125iodine implants for stage B1N carcinoma of the prostate. Therapy for the sarcoma consisted of isolated pelvic perfusion and then pelvic exenteration with creation of an ileal conduit and colostomy. The pathology report showed well encapsulated grade 2 spindle cell sarcoma of the prostate. Multiple small metallic particles were embedded in the tumor specimen.     

Legionella pneumophila serogroup 1 population in Italy by monoclonal subtyping

The Oxford panel of monoclonal antibodies was used to subtype 83 strains of Legionella pneumophila serogroup 1 of human and environmental origin. The International panel was also used to subtype 50 of them. All the 18 patients' isolates were of the Pontiac subgroup, and 40/43 of the environmental strains of the Pontiac subgroup were associated with human infection. The remaining environmental strains were subgroups Olda (15 strains), Camperdown (5 strains), and Bellingham (2 strains). The Philadelphia subgroup was the commonest among the environmental strains tested with the international MABs panel. This study confirms previous findings that L. pneumophila serogroup 1 isolates with the Pontiac (Oxford panel) or MAB-2 (international panel) reacting antigen marker seem to be more virulent than the other subgroups.     

Prospective survey of investigations in outpatients referred with iron deficiency anaemia.

Recent evidence has suggested that colonic neoplasm may be missed in patients presenting with iron deficiency anaemia unless colonic investigations are performed on all patients even when an alternative cause has been found. This study prospectively surveyed 114 consecutive patients referred from family practitioners to an outpatient clinic for the investigation of iron deficiency anaemia to determine the diagnoses contributing to the anaemia, the usefulness of certain clinical features, and the role of colonic and other investigations in obtaining the diagnosis. Upper gastrointestinal lesions contributing to anaemia were identified in 45 patients while colonic lesions were found in 18. Twenty three patients had a non-gastrointestinal cause for anaemia and in 12 patients no cause was found. Only two patients were identified as having colonic neoplasia (a small adenomatous polyp in each case) coexisting with upper gastrointestinal lesions. Symptoms and signs had a sensitivity and specificity of upper gastrointestinal disease of 50% and 83% respectively, and 44% and 80% for colonic disease. Endoscopy had a high yield (42%) and duodenal biopsy identified coeliac disease in three patients (two were aged > 70 years) each of whom had normal folate values. Barium enema had a yield of 13%. All colonic carcinomas occurred in patients > 65 years. The coexistence of colonic cancer or large polyps with an upper gastrointestinal lesion identified at endoscopy was rare in outpatients referred from family practitioners. Clinical symptoms and signs were poor indicators of the investigations that will detect a cause for the anaemia.(ABSTRACT TRUNCATED AT 250 WORDS)