Influences of thyroid diseases in diabetic pregnant women

Matrilysin is believed to play important roles in tumor progression and metastasis. In the present study, we analyzed matrilysin-producing cells in various human cancer tissues by immunohistochemistry and in situ hybridization. Tumor cells in colorectal carcinomas, pancreatic carcinomas, transitional-cell carcinomas of the kidney and small-cell lung carcinomas were frequently positive for matrilysin. In addition, we found that endothelial cells of arterioles and venules adjacent to matrilysin-positive tumors expressed matrilysin mRNA and protein. The endothelial cells adjacent to matrilysin-negative tumors and those in normal tissues were negative for matrilysin. Furthermore, analyses by casein zymography, Western blotting and RT-PCR showed that matrilysin was weakly expressed by cultured human umbilical vein endothelial cells. Our results suggest that the expression of matrilysin in vascular endothelial cells and in tumor cells may be regulated by common soluble factors, and that endothelial cell-derived matrilysin may contribute to tumor angiogenesis and tumor metastasis.     

Intensive care of myelotoxic agranulocytosis using nonselective plasmapheresis

Plasmapheresis had a marked therapeutic effect in 14 cancer patients with grave myelotoxic complications of antitumor therapy: 13 of these patients survived, felt better, isosensitization to drugs and blood preparations was eliminated, the efficacy of common detoxifying and blood-substituting therapy improved. The therapeutic effect of the procedure was obvious even in the patient who died: the anuretic stage of acute renal failure changed for the polyuretic one. Plasmapheresis caused the most pronounced shifts in the system of homeostasis maintenance. The activation of the organism's autocleansing was attended by positive laboratory and clinical shifts.     

Intensive care for patients with the human immunodeficiency virus]

RATIONALE AND OBJECTIVES: The authors evaluate a new flat-panel x-ray detector (FD) with respect to foreign body detection and reduction of radiation dose compared with screen-film radiography. METHODS: Flat-panel x-ray detector is based on amorphous silicon technology and uses a 1 k x 1 k photo-detector matrix with a pixel size of 143 x 143 microns and 12-bit digital output. A thallium-dotted cesium iodide scintillation layer converts x-rays into light. An ex vivo experimental model was used to determine the detectability of foreign bodies. Foreign bodies with varying sizes were examined: glass with and without addition of lead, bone, aluminium, iron, copper, gravel fragments, and graphite. Four hundred observation fields were examined using conventional radiography (speed, 400; system dose: 2.5 microGy) as well as FD with a simulated speed of 400, 800, 1200, and 1600, corresponding to a detector dose of 2.5 microGy, 1.25 microGy, 0.87 microGy, and 0.625 microGy, respectively. Four independent radiologists performed receiver operating characteristic analysis of 8000 observations. RESULTS: Flat-panel x-ray detector with a simulated speed of 400 was significantly superior (P = 0.012) to screen-film radiography (speed, 400). At a simulated speed of 800 and 1200 FD yielded results equivalent to screen-film radiography. Flat-panel x-ray detector was significantly inferior to screen-film radiography at a simulated speed of 1600 (P = 0.012). CONCLUSIONS: Flat-panel x-ray detector technology allows significant reduction in radiation dose compared with screen-film radiography without loss of diagnostic accuracy.     

Intensive care for people with serious mental illness

This article describes the development of a psychiatric 'intensive care' service for men and women with serious or enduring forms of psychotic disorder. The authors suggest that such a residential therapeutic service may be an essential part of the development of community care for the most vulnerable people served by mental health services.     

Phospholipid concentrations in amniotic fluid from diabetic pregnant women

Epithelioma adenoides cysticum (EAC) is a well-known genodermatosis which follows an autosomal dominant mode of inheritance. Questions still remain, however, concerning an apparent excess of females with EAC. An analysis of nineteen previously published pedigrees and one newly ascertained pedigree, which in the aggregate included over 175 cases of EAC, induced no excess of affected females, but rather, a marked deficit males. This deficiency was not the consequence of sex linkage or decreased viability, and was most evident in large pedigrees and sibships, sibships not including the probands, and late birth orders. In these situations, the penetrance of EAC in male gene carriers was only 50%, but was close to 100% in female gene carries. Under maximum detection conditions, i.e. small pedigrees, small sibships, sibships containing the proband, and early birth orders, the penetrance in males increased to 85% and was again close to 100% in females. These findings suggested that the deficit of affected males was best explained by a comination of lessened expressivity and penetrance, effects which were magnified under situations of poor detection. A review of familial cases of EAC indicated no consistent associated anomalies such as those that characterize the naevoid basal cell carcinoma syndrome.     

Special health care needs of homeless pregnant women

As women and families join the ranks of the homeless in increasing numbers, many women find themselves confronting both pregnancy and homelessness. When pregnancy accompanies the precarious state of homelessness, the need for adequate shelter is not being met during one of the most critical periods of a woman's life. This article focuses on the unique health needs of homeless pregnant women. Detailed accounts of the daily life experiences of African American, Anglo, and Latina homeless pregnant women were derived from an ethnographic study conducted in a large metropolitan area in southern California. Their pregnancies were difficult because normal physiological changes of pregnancy often became pathological, signs of potential complications went unnoticed or unattended, and minor discomforts of pregnancy were exacerbated by the women's environment. Nursing therapeutics that support health maintenance and coping strategies of the women while on the streets or in shelters were explicated.     

Changing patterns of care of pregnant women: the independent midwife

Forty-eight pink teeth from eight male cadavers, all dying from unnatural causes were studied for the pink tooth phenomenon. Perfusion with whole and lysed blood, at different temperatures was carried out, followed by longitudinal sectioning for histological observation. Another 30 unblemished human teeth were used to reproduce the phenomenon in vitro to help clarify its pathogenesis.     

Preventing diabetic nephropathy: the role of primary care

Diabetic nephropathy is the leading cause of end-stage renal disease in the United States and is associated with significant human and economic cost. It is recognized that care of the person with diabetes should be focused on the prevention of the many devastating long-term complications of the disease. The primary care provider is in a key position to implement good preventive care. Monitoring for microalbuminuria is the accepted method for identifying early nephropathy. Individual providers need to be aware of current guidelines for performing screening exams. Once early nephropathy is detected, prudent care with tight glycemic control, angiotension-converting enzyme therapy, control of hypertension, and lifestyle risk-factor modification are warranted. Currently, there is strong indication that the progression of renal disease can be slowed with appropriate early interventions. Positive outcomes are dependent on timely detection of microalbuminuria.     

Intensive care, old age, and the problem of death in America

This article, part of a larger anthropological investigation of how death occurs in the hospital, explores the relationship of elderly deaths in the intensive care unit to the cultural conversation about the desire for "death with dignity." Based on participant observation, it provides three case studies that focus on the unfolding of events surrounding patient treatment, decision making, and family involvement. The cases are interpreted in the context of four sources of the culturally defined "problem" of death: (a) how medicine operates as the dominant conceptual framework for understanding both old age and death; (b) the power of the technological imperative to determine events; (c) ambivalence regarding end-of-life goals; and (d) the incommensurability of lay and medical knowledge.     

When do pregnant women attend for antenatal care?

The case records of a representative sample of 313 women from four health districts in the North-east Thames Health Region were reviewed to determine the stage of pregnancy at which they contact antenatal services. Patients seeking care (when a blood specimen was obtained) after 20 weeks' gestation ranged from 6% to 26%. These women were more likely to be of higher parity and immigrants. Appreciable delays in obtaining an early blood specimen, or in referral to a hospital antenatal clinic, were due to delay by hospitals in giving appointments and, to a lesser extent, to slowness of general practitioners in referring patients or taking blood.