Trends in mortality of childhood-onset insulin-dependent diabetes mellitus in Leicestershire: 1940-1991

The relative risk of death by calendar date of diagnosis was investigated in a population-based incident cohort of 845 (463 males:382 females) IDDM diagnosed in Leicestershire before the age of 17 years between 1940 and 1989. The mortality status of 844 (99.9%) patients was determined as of the 31 December 1991, representing 14,346 person-years of risk. Trends in relative risk of death were investigated using Cox proportional hazards modelling for within cohort comparisons and age/sex and calendar time adjusted standardized mortality ratios (SMR) using generalized linear modelling for external comparisons. Median age at diagnosis was 10 years (range 3 months to 16 years); median duration of diabetes 15 years (range 1-51 years). Forty-four patients had died (5.2%; median age at death 31 years, range 11-51 years). A further four patients died at presentation (within 24 h) from ketoacidosis and are excluded from all analyses. Calendar date of diagnosis was found to be an important predictor of mortality. Adjusting for attained age there was evidence of a decline in relative risk of death with calendar date of diagnosis of 3.4% (95% CI, 0.005-6.9%) per annum, equivalent to a 32% fall per decade (95% CI, 5-51%), or 84% (95% CI, 21-97) from 1940 to 1989. The data are consistent with a large fall in mortality between the 1940s and 1950s representing over 50% of the total reduction in mortality between 1940 and 1991. Neither sex nor age at diagnosis were significant predictors of mortality. Over the study period 1940-89 the SMR (male and female combined) fell from 981 (541-1556) to 238 (60-953) relative to the general population. This population-based study shows that the prognosis for Type 1 (insulin-dependent) diabetes mellitus has improved markedly over the period 1940-1991.     

Central alveolar hypoventilation in neurosarcoidosis

Although the lung is almost always involved in sarcoidosis and respiratory failure is not uncommonly caused by intrinsic lung disease, chronic alveolar hypoventilation on the basis of neurosarcoidosis has not been previously described. This report describes the case of a 42-year-old woman with sarcoidosis and documented involvement of the lungs, muscle, peripheral nerves, and skin. She presented with ventilatory failure and a vital capacity of 700mL and required hospitalization for intubation and mechanical ventilation. After failing ventilator weaning attempts and requiring continuous ventilatory assistance, she was extubated to continuous use of noninvasive intermittent positive pressure ventilation (IPPV). She eventually weaned to nocturnal-only use of noninvasive IPPV. However, her PaCO2 remained elevated during daytime hours despite the fact that her vital capacity had returned to 3,600mL. She was not obese, and her oxyhemoglobin saturation (SaO2) was normal on room air. Subsequent attempts to discontinue nocturnal nasal IPPV resulted in marked nocturnal decreases in SaO2 and return of symptoms. This case illustrates successful noninvasive management of an apparently unique occurrence of central alveolar hypoventilation caused by neurosarcoidosis.     

Equivalent oxygen percentage as a function of hydration in hydrogel lenses: an in vivo study

Although many investigations have examined the parameters of hydrogel lens hydration loss, the in vivo effect (in humans) on lens oxygen behavior has not been characterized previously. Human subjects wore 2 different lenses (a thin, 38% water polymacon lens and a thin, 55% water bufilcon lens) for 5-min periods under either fully hydrated (i.e., with saline regularly applied to the lens) or partially hydrated (i.e., with "normal" wear of 1 blink every 5 s) conditions. An equivalent oxygen percentage (EOP) technique and a gravimetric method were used to determine lens oxygen behavior and hydration, respectively. The hydration results demonstrate that significant lens dehydration occurs during the partially hydrated (normal blink rate) condition compared to the in situ, fully hydrated situation. A corresponding, statistically significant diminution in oxygen equivalency was also observed.     

A STUDY ON THE PERFORMANCE OF THE CATALYTIC POROUS-WALL THREE-PHASE REACTOR

A theoretical investigation of a catalytic porous-wall reactor in which gaseous and liquid reactants approach each other from opposite sides of the catalyst is undertaken. Equations for the annular liquid-channel are coupled with those for the catalytic wall and solved numerically and analytically using a simplified model. For the model reaction under study, the main design and operation parameters which affect reactor performance are the Thiele modulus, Peclet number, width of the liquid channel and the inlet concentration of the reactant in the liquid phase.

The effect of reactor configuration is peculiar to the cylindrical geometry because the thickness and relative location of the catalytic wall as well as the selection of the liquid and gas channels can influence the reactor performance. Thin-walled catalyst tubes have larger effectiveness factors and as the tube radius approaches that of the reactor, conversion in the reactor increases especially when the liquid is saturated with the gaseous reactant. Concentration of the liquid reactant in the feed has a significant effect if the reactant is depleted at some point inside the catalyst wall. Since the reaction zone width can be adjusted by changing the feed composition, this might have important implications with respect to selectivity.     

Thermal Decomposition of Europium Hydroxide

The thermal decomposition of europium hydroxide in an air atmosphere was investigated by means of weight-loss measurements, infrared spectroscopy, X-ray diffraction analysis, and electron microscopy. These studies showed that EU(OH)° decomposed at temperatures between 225° and 300°C into EuOOH, which was stable up to about 425°C. Between 435° and 465°C this compound decomposed into cubic Eu₂O₃, which was stable until its inversion to the high-temperature monoclinic form. X-ray diffraction data were collected for Eu(OH)₃ and EuOOH and showed that the trihydroxide has a hexagonal crystal structure and the oxyhydroxide is possibly orthorhombic. The Eu(OH)₂, EuOOH, and cubic EunOa powders contained particles up to several microns in size consisting of agglomerates of crystallites in the size range 200 to 400 A. The single monoclinic Eu₂O₃ sample studied contained crystallites whose average size was greater than 2000 A.     

High-Temperature Fatigue Behavior of Polycrystalline Alumina

The strength and fatigue behavior of a 99.5% polycrystalline alumina were measured as a function of temperature. Both the strength and fatigue behavior remained essentially constant up to 500°C; from 800° to 1100°C the strength and fatigue resistance decreased markedly and at >1100°C macroscopic creep was observed. It is believed that the decrease in strength and fatigue resistance is caused by a grain-boundary glassy phase enhancing subcritical crack growth. Proof-testing at room temperature was effective in improving the strength distributions at both room temperature and 1000°C; however, at 1000°C it was not effective, due to crack growth during the proof test. The good agreement between proof-test results and fracture-mechanics theory indicates that the same flaws control the strength at room temperature and at high temperatures.     

Mechanical distraction for treatment of severe knee flexion contractures

Ten patients (14 knees) with severe knee flexion contractures were treated by gradual mechanical distraction using either the Ilizarov or Orthofix external fixator. Range of motion improved from an average flexion contracture of 60 degrees before surgery to 16 degrees at the follow-up evaluation. Range of motion results were graded good or excellent in five knees, fair in two knees, and poor in three knees. Average total arc of motion remained essentially unchanged when comparing the preoperative (59 degrees) with the follow-up results (63 degrees). However, the functional position of this arc improved significantly. Problems encountered included a "rebound" phenomena after frame removal, with loss of the temporarily increased total arc of motion. The role of hamstring tenotomy and radical posterior knee release remains unclear.     

Interpretation time of serial chest CT examinations with stacked-metaphor workstation versus film alternator

PURPOSE: Interpretation time of serial staging chest CT cases, which each contained current and previous examinations, with a simple prototype workstation called filmstack was experimentally compared with interpretation time with a film alternator. MATERIALS AND METHODS: The filmstack displayed a "stack" of sections for each examination; user controls allowed rapid selection of preset attenuation windows and both synchronized and unsynchronized scrolling. Eight radiologists were timed as they used the filmstack and the film alternator to interpret four ergonomically complex serial CT cases. RESULTS: All reports dictated on the basis of findings with filmstack and film were of acceptable clinical accuracy. The time to examine a case with filmstack was significantly faster than the time with film, including the time to load and unload the alternator (99% confidence [P = .01]). There was no statistically significant difference in interpretation time between filmstack and prehung film. CONCLUSION: Use of a low-cost stacked CT workstation with a single 1,024 x 1,024 monitor is an effective means of interpreting cases that require comparison of multiple CT examinations.     

Insights into the assessment of myocardial perfusion offered by different cardiac imaging modalities

Myocardial perfusion may be very broadly defined as the tightly regulated nutrient delivery to cardiac tissue. The different components of perfusion are myocardial blood flow, oxygen delivery, myocardial oxygen consumption, and myocardial blood volume. Historically, focus has been placed mostly on the assessment of blood flow. In many instances, knowledge of flow without information about these other aspects is inadequate. This review discusses the various cardiac imaging techniques used for the assessment of myocardial perfusion that represent diverse physiologic measures of "perfusion." Their strengths and limitations are discussed as is their relevance to specific clinicopathologic conditions. Significant work still needs to be performed before all the aspects of myocardial perfusion can be precisely measured in human beings.