The JEVIN trial: a population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990

Since 1990 in most Eastern European countries health care systems have been decentralized or are undergoing the processes of decentralization. Increasingly, diabetic patients are no longer treated by diabetologists but by non-specialized physicians. During the same period structured treatment and teaching programmes have been introduced and health care is increasingly influenced by the St. Vincent declaration. To show the effect of these changes on the quality of diabetes care 90% (n = 244) of all insulin-treated diabetic patients aged 16 to 60 years and living in the city of Jena (100247 inhabitants) were studied in 1994/1995. The results were compared with the baseline examination of 1989/1990 (n = 190). HbA1c (HbA1c/mean normal) in IDDM patients under specialized care was similar in 1994/1995 (1.54 +/- 0.27, n = 47) to 1989/1990 (1.52 +/- 0.31, n = 131, p = 0.0018), but higher under non-specialized care (1.71 +/- 0.38, n = 80, p = 0.0087). In the total group of NIDDM patients there was no significant change in HbA1c (1994/1995: 1.75 +/- 0.4, n = 117, vs 1989/1990: 1.78 +/- 0.4, n = 59, p = 0.67), but with a tendency to higher HbA1c under non-specialized (1.81 +/- 0.4, n = 79) compared to specialized care (1.66 +/- 0.39, n = 38, p = 0.06). Incidence of severe hypoglycaemia (IDDM 0.13; NIDDM 0.04), ketoacidosis (0.02; 0.01) and the prevalence of nephropathy (21%; 35%) and neuropathy (24%; 38%) remained unchanged in comparison to 1989/1990, whereas there was an increase in the prevalence of diabetic retinopathy. Specialized care is mandatory for patients with IDDM.     

Expression pattern and cellular distribution of the murine homologue of AF10

The microbiologists use the term corynebacteria to describe aerobically growing, asporogenous, irregularly sharped gram-positive rods. They comprise strictly aerobic bacteria isolated from environment as well as preferentially anaerobic bacteria found in clinical specimens. A large part of these bacteria is considered as commensal of skin and mucous membranes. This group of organisms has recently been subjected to considerable taxonomic revisions, which have resulted in the proposal of several new species, many of them representing previous Centers for Diseases Control coryneform groups. Moreover, recent investigations demonstrated the existence of a pathogenic role for some of them. These bacteria comprise well-known pathogens such as C. diphtheriae responsible for diphtheria, Actinomyces spp. responsible for actinomycosis and Arcanobacterium haemolyticum recovered from pharyngitis, but other corynebacteria were related to particular infections. For example, the lipophilic and antibiotics multiresistant species Corynebacterium urealyticum and C. jeikeium were found to be responsible for urinary tract infections and septicemias, respectively. The recently described species Turicella otitidis was found to be implicated in otitis media and C. seminale were recovered from genital specimens of male patients. Implantation of material devices, use of broad-spectrum antibiotics led to an increase of sepsis due to the species C. jeikeium and C. amycolatum. Many of the new Actinomyces species grow well under aerobic conditions and are often implicated in various abscesses. Moreover an increase of immunocompromised patients led to the development of infections due to the aerobic actinomycete Rhodococcus equi. The association of some corynebacteria with particular diseases should prompt the microbiologist to identify these bacteria when they are encountered in a pathogenic situation. Identification of the major part of corynebacteria isolated from clinical specimens can now be achieved by using recent schemes.     

Molecular dynamics of annexin I in normal and infected cells

Annexins are a family of proteins present within the tissues of all multicellular organisms, mammalian erythrocytes excepted. The property shared by all annexins is the calcium and membrane binding. Annexins are constituted of two domains. The N-terminal domain gives the molecule its specificity and the C-terminal domain, highly conserved, containing 4 repetitions of 70 amino-acids, gives the common properties. Although numerous important works were performed, the exact function of annexins is not unraveled. They participate to many cellular processes as for instance exocytosis, endocytosis or phagosome maturation. Many hypotheses, supported by experimental results, have been proposed. In this review, we propose a summary of the principal characteristics of annexins and we discuss the main hypotheses proposed for their functions.     

A strong prognostic variable in endometrial carcinoma: flow cytometric S-phase fraction

BACKGROUND: The purpose of this study was to determine the role of flow cytometric S-phase fraction as a prognostic factor in patients with endometrial adenocarcinoma. METHODS: The study included 80 patients with endometrial adenocarcinoma of endometrioid type who were followed regularly between 1984-1995 in the Department of Obstetrics and Gynecology at Cerrahpasa Faculty of Medicine in Istanbul, Turkey. The method employed for the flow cytometric analysis was modified from Hedley et al. RESULTS: The S-phase fraction was identified as the most significant variable associated with death from endometrial carcinoma of endometrioid type by the Cox proportional hazards model. The risk of death was significantly higher in patients with S-phase values greater than 20%. Aneuploidy and DNA indexes were also significant prognostic variables. CONCLUSIONS: The S-phase fraction is considered to be a significant prognostic variable in identifying those patients with endometrial carcinoma who have a poor prognosis. The authors believe that S-phase fraction distinguishes those patients who may benefit from additional treatment approaches.     

Determination of dehydroepiandrosterone sulfate in human plasma by gas chromatography/mass spectrometry using a deuterated internal standard: a method suitable for routine clinical use

A capillary gas chromatographic-mass spectrometric method for the determination of dehydroepiandrosterone sulfate (DHEA-S) in human plasma is described. [7,7-2H2]DHEA-S is used as internal standard. After desulfation by methanolysis, heptafluorobutyryl derivatives are prepared, and selected ion monitoring of characteristic fragment ions--m/z 270 for DHEA and m/z 272 for [7,7-2H2]DHEA--carried out. Requiring small amounts of plasma, the rapid, convenient work-up and the application of bench-top GC/MS instrumentation proved our method to be suited for routine clinical use in adults and children. The method needs no complex corrections for isotope contributions and provides good accuracy and precision. Comparative values of samples assayed by our GC/MS procedure and by a direct RIA indicated that the RIA overestimates the true concentration.     

Effect of high ambient temperature on cell division rate of fertilized ova in heat-acclimatized rats

A study of 88 patients showed a reduction in the estimated hepatic blood flow (EHBF), as measured by a colloidal gold technique, to 88% and 84% of its initial value during ether and halothane anesthesia, respectively. During the operative procedure itself, there was a further fall in the EHBF. In patients undergoing herniorrhaphy or excision of a breast tumor, the EHBF decreased to 82% and 76%, while in patients undergoing partial gastrectomy or cholecystectomy, the EHBF fell to 48% and 42% of its initial value during operations under ether and halothane anesthesia, respectively. The surgical trauma itself would appear to be the main determinant of the alteration in the liver circulation during the operation.