Gastrointestinal problems in diabetes

Gastrointestinal symptoms are often encountered in patients with diabetes mellitus. Symptoms may arise in any region of the alimentary tract; common symptoms are heartburn, nausea, vomiting, diarrhea, constipation, fecal incontinence, and abdominal pain. This article reviews practical approaches to the identification of the pathophysiologic mechanisms involved in diabetic enteropathies and their complications and briefly outlines strategies to treat these symptoms. Particular emphasis is placed on applied physiologic tests and the choice of pharmacotherapy (e.g., cisapride, erythromycin, or octeotide). The current role of pancreatic transplantations also is briefly reviewed.     

Polymeric prodrugs of mitomycin C designed for tumour tropism and sustained activation

Prodrugs of mitomycin C (MMC) based on soluble poly-[N-(2-hydroxyethyl)-L-glutamine] (pHEG) polymers have been evaluated as tumour-targeted drugs. These materials are designed to exploit the enhanced permeability of tumour vasculature, combining a passive tumour tropism with decreased systemic liberation of free MMC. A tri- or tetrapeptide linkage (e.g. Gly-Phe-Ala-Leu) between pHEG and the aziridine nitrogen of MMC can combine good hydrolytic stability with rapid cleavage by lysosomal enzymes, releasing free MMC. The conjugates showed decreased systemic toxicity and could be administered to mice at a total MMC dose of 15 mg/kg i.v., compared with just 6 mg/kg for free MMC. Conjugates also showed better activity against animal models of established tumours, achieving up to 77% increased life span (ILS) against solid P388 leukaemia, compared with only 23% for free MMC, and up to 121% ILS against solid C26 colorectal carcinoma, compared with no activity for the free drug. Improving the therapeutic index of anticancer drugs by combining tumour tropism with decreased systemic toxicity is a versatile approach that should produce a new generation of improved anticancer agents.     

Impact of crosstalk in an arrayed-waveguide multiplexer onN×N optical interconnection

The impact of crosstalk in an arrayed-waveguide N×N wavelength multiplexer is investigated precisely in relation to its application to wavelength-routing N×N all optical networks. In such systems multiple crosstalk light which has the same wavelength as the signal results in signal-crosstalk beat noise. We confirm that the noise is Gaussian and obtain the relation between crosstalk and power penalty. It is shown that the crosstalk must be less than -38 dB for a 16×16 system to keep the power penalty below 1 dB at a bit error rate of 10^-9     

Complications of chronic otitis media

In summary, recent literature indicates that the complications of chronic otitis media have been decreasing. However, even with the advent of modern and more powerful antimicrobials and aggressive surgical eradication of disease, the morbidity and mortality are still high. Some complications may initially be quite obvious and some complications may be quite subtle. Therefore, the most important tools in making early diagnosis are careful history and physical examination, and a high index of suspicion for impending complications.     

Importance of proximal femoral fractures in elderly patients. Results of a prospective study of 61 patients

In a prospective study we found good results concerning postoperative complications (21%), perioperative lethality (3.2%) and lethality during hospital stay (6.5%) after implantation of dynamic hip screws (DHS) in patients with per- and subtrochanteric fractures of the femur. The ability to walk, as well as housing and social care postoperatively and follow-up for at least six months after dismissal demonstrates the importance of these fractures for the elderly. One of three patients needs professional care, 21% at home, 13% in nursing homes. Six months after operation the lethality is nearly 20%, i.e. three times higher than in hospital. These are the essential data for all techniques of osteosynthesis used in patients with these fractures, which could only be documented in prospective studies.     

Mental health and support of women treated for breast cancer

This article presents the results of a pilot-study conducted on a small sample of women with breast cancer and the members of their social support system. The purpose was to determine the potential link between the mental health of the breast cancer patient and their support system. Mental health was assessed with the SCL-90-R (Derogatis, 1977), a self-report scale composed of 90 items divided into nine categories, offering three global indicators of distress: the Global Severity Index (GSI); the Positive Symptom Distress Index (PSDI), and the Positive Symptom Total (PST). The SCL-90-R was distributed to a sample of 14 subjects: seven women treated for breast cancer and seven significant others (social support). The results led to the definition of symptoms such as hostility, phobic anxiety and psychosis specific to either the woman or the support system.