[Argentinean consensus guidelines on the identification and clinical care of secondary progressive multiple sclerosis]

INTRODUCTION

The identification, diagnosis, follow-up, and treatment of patients with secondary progressive multiple sclerosis (SPMS) show significant differences between health care professionals in Argentina.

AIM

To provide consensus recommendations on the management of patients with SPMS in Argentina to optimize patient care.

DEVELOPMENT

A panel of expert neurologists from Argentina dedicated to the diagnosis and care of multiple sclerosis patients gathered during 2019 and 2020 to carry out a consensus recommendation on the diagnosis and treatment of SPMS patients in Argentina. To achieve consensus, the methodology of 'formal consensus-RAND/UCLA method' was used. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how to define SPMS and how to follow SPMS patients.

CONCLUSION

The recommendations of this consensus guidelines attempt to optimize the care of SPMS patients in Argentina.

Explaining healthcare among unaccompanied minor refugees: a realist review

Introduction

Existing research on psychosocial care of unaccompanied minor refugees (UMRs) mainly focusses on socio-epidemiological accounts and qualitative evidence from the perspective of experts in the field of psychosocial care. In contrast, knowledge concerning differing context factors as well as underlying mechanisms of current healthcare barriers, which could inform policy recommendations, are rather scant.

Methods

To synthesize scientific evidence and gray literature dealing with the field of psychosocial healthcare of UMRs, a realist review (RR) was conducted following six methodological steps of RAMESES publication standards for realist synthesis. Based on a iterative search of keywords “UMR”, “UMF”, “UMA” and “mental health care” in electronic databases PubMed, GBV and Web of Science we gained access to 974 texts from 2005 to 2019. Screend studies and reports were systematically reviewed according rigor and relevance, which included n = 53 documents for realist synthesis with theory-informed context-mechanism-outcome configurations (CMOs).

Results

UMRs have a high prevalence risk for posttraumatic stress disorders and they face manifold institutional, cultural, ethical, juridical, and language-based barriers of care. A dominant and multiple CMO highlight residence status (C1), which limits access of UMRs to healthcare (M1) and produces psychosocially related mental health outcomes (O1). Residence status (C1) may also trigger mechanisms of structural or at least perceived discrimination (M2), which mediates undersupply of UMRs (O2).

Conclusions

The inclusion of lay perspectives and an intersectional approach could inform health services research and practitioners. The reflection of UMR’s social positions between categorical constructs of resilience and vulnerability, discriminatory discourses of othering, and restrictive health policies may guide policy recommendations to potentially reduce persistent disadvantages.

Key messages

The inclusion of lay perspectives and an intersectional approach could inform UMR related health services research and practitioners. The reflection of UMR’s social positions (between categories, discourses, and health policies) may guide policy recommendations to potentially reduce persistent disadvantages.

A novel algorithm for the determination of bacterial cell volumes that is unbiased by cell morphology

The determination of cell volumes and biomass offers a means of comparing the standing stocks of auto- and heterotrophic microbes of vastly different sizes for applications including the assessment of the flux of organic carbon within aquatic ecosystems. Conclusions about the importance of particular genotypes within microbial communities (e.g., of filamentous bacteria) may strongly depend on whether their contribution to total abundance or to biomass is regarded. Fluorescence microscopy and image analysis are suitable tools for determining bacterial biomass that moreover hold the potential to replace labor-intensive manual measurements by fully automated approaches. However, the current approaches to calculate bacterial cell volumes from digital images are intrinsically biased by the models that are used to approximate the morphology of the cells. Therefore, we developed a generic contour based algorithm to reconstruct the volumes of prokaryotic cells from two-dimensional representations (i.e., microscopic images) irrespective of their shape. Geometric models of commonly encountered bacterial morphotypes were used to verify the algorithm and to compare its performance with previously described approaches. The algorithm is embedded in a freely available computer program that is able to process both raw (8-bit grayscale) and thresholded (binary) images in a fully automated manner.

Epoetin theta: efficacy and safety of IV administration in anaemic haemodialysis patients in the maintenance phase in comparison to epoetin beta

OBJECTIVE

To compare the efficacy and safety of epoetin theta and epoetin beta in anaemic patients with chronic kidney disease, undergoing haemodialysis and previously on stable maintenance therapy with epoetin beta.

METHODS

In this multicentre, randomised, controlled, double-blind study 270 haemodialysis patients were treated intravenously (i.v.) for 24 weeks with either epoetin theta (n = 180) or epoetin beta (n = 90). The primary efficacy endpoint was the change in haemoglobin (Hb) from baseline to end of treatment (efficacy evaluation period, EEP, weeks 15-26). Hb levels, weekly doses of epoetin theta or epoetin beta required to maintain Hb levels, dose changes, safety, tolerability and immunogenicity were evaluated.

CLINICAL TRIAL REGISTRATION

EudraCT No. 2005-000143-28.

RESULTS

Mean Hb values were similar in both treatment groups at baseline and during the 24-weeks treatment period. The estimated treatment difference between epoetin theta and epoetin beta from baseline to EEP was -0.01 g/dL (95% confidence interval: -0.24, 0.21), p = 0.9021, indicating that the difference between both groups was not statistically significant. The weekly doses of epoetin theta or epoetin beta required to maintain Hb levels were nearly the same. The changes from baseline to EEP in patients who switched to treatment with epoetin theta (95.5-99.7 IU/kg(BW)) were smaller than in patients staying on their epoetin beta therapy (89.0-98.0 IU/kg(BW)). The profile and the frequency of adverse drug reactions (ADRs) were similar in both treatment groups (21.7% epoetin theta; 22.2% epoetin beta). The most common ADRs were hypertension, headache and arteriovenous fistula thrombosis. None of the patients developed anti-erythropoietin antibodies.

CONCLUSIONS

Epoetin theta (i.v.) has a similar efficacy compared to epoetin beta (i.v.) in haemodialysis patients based on Hb changes from baseline to end of treatment (non-inferiority). The safety profile was similar in both groups. Patients could be switched from maintenance treatment with epoetin beta to epoetin theta without relevant dose changes.

Automated quality assessment of autonomously acquired microscopic images of fluorescently stained bacteria

Quality assessment of autonomously acquired microscopic images is an important issue in high-throughput imaging systems. For example, the presence of low quality images (>or=10%) in a dataset significantly influences the counting precision of fluorescently stained bacterial cells. We present an approach based on an artificial neural network (ANN) to assess the quality of such images. Spatially invariant estimators were extracted as ANN input data from subdivided images by low level image processing. Different ANN designs were compared and >400 ANNs were trained and tested on a set of 25,000 manually classified images. The optimal ANN featured a correct identification rate of 94% (3% false positives, 3% false negatives) and could process about 10 images per second. We compared its performance with the image quality assessment by different humans and discuss the difficulties in assigning images to the correct quality class. The computer program and the documented source code (VB.NET) are provided under General Public Licence.

Audiovisual mirror neurons and action recognition

Many object-related actions can be recognized both by their sound and by their vision. Here we describe a population of neurons in the ventral premotor cortex of the monkey that discharge both when the animal performs a specific action and when it hears or sees the same action performed by another individual. These 'audiovisual mirror neurons' therefore represent actions independently of whether these actions are performed, heard or seen. The magnitude of auditory and visual responses did not differ significantly in half the neurons. A neurometric analysis revealed that based on the response of these neurons, two actions could be discriminated with 97% accuracy.

I know what you are doing. a neurophysiological study

In the ventral premotor cortex of the macaque monkey, there are neurons that discharge both during the execution of hand actions and during the observation of the same actions made by others (mirror neurons). In the present study, we show that a subset of mirror neurons becomes active during action presentation and also when the final part of the action, crucial in triggering the response in full vision, is hidden and can therefore only be inferred. This implies that the motor representation of an action performed by others can be internally generated in the observer's premotor cortex, even when a visual description of the action is lacking. The present findings support the hypothesis that mirror neuron activation could be at the basis of action recognition.

The ability to follow eye gaze and its emergence during development in macaque monkeys

The ability of monkeys to follow the gaze of other individuals is a matter of debate in many behavioral studies. Physiological studies have shown that in monkeys, as in humans, there are neural correlates of eye direction detection. There is little evidence at the behavioral level, however, of the presence and development of such abilities in monkeys. The aim of the present study was to assess in juveniles and adult pig-tailed macaques (Macaca nemestrina) the capacity to use eye cues only to follow the gaze of an experimenter. Biological stimuli (head, eye, and trunk movements) were presented by an experimenter to 2 adult monkeys with their heads restrained (Experiment 1) and to 11 monkeys of different ages, free to move in their home cages (Experiment 2). A nonbiological stimulus served as a control. Results showed that macaques can follow the gaze of the experimenter by using head/eye and eye cues alone. Trunk movements and nonbiological stimuli did not significantly elicit similar reactions. Juvenile monkeys were not able to orient their attention on the basis of eye cues alone. In general, gaze following was more frequent in adults than in juveniles. Like in humans, however, such abilities in macaques dramatically improve with age suggesting that the transition to adulthood is a crucial period in the development of gaze-following behavior.

A comparison of single fraction radiosurgery tumor control and toxicity in the treatment of basal and nonbasal meningiomas

Between July 1993 and October 1997, 107 patients with 118 meningiomas were treated with Gamma Knife radiosurgery (GKRS). The most frequent site of tumor origin was the skull base (54%). The mean tumor diameter and volume were 2.5 cm and 9.4 cm3, respectively. The mean dose to the tumor periphery was 17 Gy, prescribed to a mean iso-dose of 47%. At a mean follow-up of 28 months, tumor control for basal and nonbasal meningiomas was 80%. Deteriorating peritumoral edema associated with symptoms was observed in 1 of 49 (2%) skull-base tumors and in 4 of 39 (10%) non-basal tumors, without associated tumor growth. (p=0.l5 and 0.234 respectively, z-test). Stereotactic radiosurgery can achieve acceptable tumor control with low morbidity in the treatment of most meningiomas. However, when the tumor is nonbasal, the potential morbidity from peritumoral edema should be recognized and other treatment options considered, such as adjuvant surgery, partial fractionated irradiation or stereotactic radiotherapy.

Stereotactic radiosurgery toxicity in the treatment of intracanalicular acoustic neuromas: the Seattle Northwest gamma knife experience

Patients with acoustic neuromas have several treatment options. The appropriate individual treatment decision and expected control rates and risks for the individual techniques have been outlined in several texts [1-4, 6-8]. This article describes radiosurgery toxicity in those patients with acoustic neuromas who have intracanalicular disease. 52 patients with 54 acoustic neuromas were treated between September 1993 and April 1997. 14 tumors were intracanalicular lesions, with a mean diameter <1 cm and volume <1 cm3. Dose to the periphery of the intracanalicular lesion extension ranged from 12-18 Gy (mean 16 Gy). The margin isodose was 40-60% (mean 47%). 32 isocenters were used to treat the 14 intracanalicular tumors (mean 2.3 isocenters per patient). At a mean follow-up of 18 months (range 1-39 months), 12/12 or 100% of the intracanalicular lesions demonstrated regression or no change in size on subsequent imaging. The following acute side effects were observed posttreatment in intracanalicular tumors: diminished hearing 14%, facial neuropathy 43%, trigeminal neuropathy 21%, balance disorder 14%, dizziness 7%, and headache 7%. Facial and trigeminal neuropathy, balance disorder, dizziness, vertigo and headaches were more common in patients with intracanalicular tumors than those with an extracanalicular extension. Although it has been suggested that small acoustic neuromas (i.e. <1 cm3) tolerate doses of 18 Gy with acceptable toxicity, when the lesion is located in the auditory canal a lesser dose may be warranted to minimize potential side effects. For now, our center has established a protocol that limits radiosurgical stereotactic intracanalicular peripheral doses to 12 Gy until further toxicity studies have been collected and reviewed.

Necrotizing granulomatosis of the breast

We describe a case of necrotizing granulomatosis of Wegener's type involving the breasts of a 40-year-old man. There were no signs of generalized disease. Involvement of the breast is rare in Wegener's granulomatosis (WG). To date, 17 cases have been reported, and all were women. They predominantly presented with a unilateral breast mass, and mammary malignancy was the principal concern. In the majority of cases, breast lesions of WG have been a presenting sign of, or preceded, disseminated disease. Our patient is unusual in that the necrotizing granulomas developed as an isolated finding in a site remote from those usually affected by WG, and, as far as we are aware, represents the first case of Wegener's type granulomatosis involving the male breast.

Ca2+ channel blockers modulate metabolism of collagens within the extracellular matrix

The extracellular matrix (ECM) is an intricate network composed of an array of macromolecules capable of regulating the functional responsiveness of cells. Its composition greatly varies among different types of tissue, and dysregulation of its metabolism may contribute to vascular remodeling during the pathogenesis of various diseases, including atherosclerosis. In view of their antiatherosclerotic effects, the role of Ca2+ channel blockers in the metabolism of ECM was examined. Nanomolar concentrations of the five Ca2+ channel blockers amlodipine, felodipine, manidipine, verapamil, or diltiazem significantly decreased both the constitutive and platelet-derived growth factor BB-dependent collagen deposition in the ECM formed by human vascular smooth muscle cells and fibroblasts. The drugs inhibited the expression of fibrillar collagens type I and III and of basement membrane type IV collagen. Furthermore, Ca2+ channel blockers specifically increased the proteolytic activity of the 72-kDa type IV collagenase as shown by gelatin zymography and inhibited the transcription of tissue inhibitor of metalloproteinases-2.

Plasma secretin determination as a test of gastric acid secretion: effect of a marker perfusion technique on validation

OBJECTIVE

To examine whether plasma secretin levels can be used as a diagnostic measure of gastric acid output.

METHODS

A marker perfusion technique was used to quantify gastric acid output. Blood samples were drawn for secretin radioimmunoassay at specified intervals before and after pentagastrin stimulation in six healthy volunteers and six patients suspected of having abnormal gastric acid secretion.

RESULTS

Linear relationships were found between integrated secretin response and maximal acid output as well as between peak acid output and acid output at 2 h (P < 0.01). Similar correlations were also observed with secretin levels 52, 60 and 68 min after pentagastrin stimulation. Discrimination between low, average and high gastric acid secretors was possible at 52 and 60 min after stimulation. Plasma secretin did not increase after pentagastrin stimulation in the 12 subjects when acid was continually aspirated, nor did correction for gastric acid loss improve the correlation or discrimination.

CONCLUSION

One or two measurements of plasma secretin about 1 h after pentagastrin administration may provide a useful quantitative estimate of gastric secretory capacity for epidemiological or clinical purposes.

A specific binding site for angiotensin II(3-8), angiotensin IV, in rabbit cardiac fibroblasts

This study demonstrates the existence of a high affinity binding site on rabbit cardiac fibroblasts of the hexapeptide (3-8) fragment of angiotensin II (AngIV). [125I]-AngIV binding is saturable, reversible and distinct from angiotensin II (AngII) receptors. At 37 degrees C equilibrium of [125I]-AngIV binding is reached within 2 h. AngIV displaces [125I]-AngIV bound to cultured rabbit cardiac fibroblasts whereas AngII receptor-specific ligands ([Sar1, Ile8]-AngII, Dup753, CGP42112A) do not. Scatchard plot analysis revealed that [125I]-AngIV binds to a single class of sites with Kd = 4.87 +/- 0.11 x 10(-9) mol/l, Bmax = 371 +/- 8.3 fmol/mg protein and a Hill coefficient of 0.92. In the presence of the non-hydrolyzable GTP analog GTPgammaS [125I]-AngIV binding in rabbit cardiac fibroblasts was not markedly affected, whereas binding of [125I]-(Sar1,IIe8)-AngII is reduced. The role of AngIV in the heart and in particular in cardiac fibroblasts is unknown, and the putative interaction of AngIV with AngII needs further characterization.

A comparison of practice issues among occupational therapists in the rural Northwest and the Rocky Mountain regions

The purpose of this study was to investigate factors that affected occupational therapy practice in the rural regions of the Rocky Mountains. It compared data from the Rocky Mountain region (Wyoming, Colorado, New Mexico, Utah, and Arizona) to a previous study of the Northwest region of Alaska, Idaho, Montana, and Washington and expanded on the Northwest study. Results indicated that the two areas were similar in their demographics and problems, including need for more occupational therapists. The results also have implications regarding specialized preservice training for rural-based occupational therapists, other professions' availability of continuing education, and other support systems. The authors provide recommendations based on the results, other literature, and conjectures, for recruitment, training, and ongoing support of rural occupational therapists through cooperative consortiums and distance learning.

A component of the interphase cytoskeleton is cyclically recruited into spindle poles during mitosis

During the transition from interphase to mitosis, proteins are recruited into forming spindle poles [Leslie, Cell Motil. Cytoskeleton 16:225-228, 1990]. Antibodies which recognize these recruited components clearly label spindle poles during mitosis but the location and character of such proteins during interphase remain a mystery. Competition assays using an antibody to a recruited spindle pole protein show that in its disperse form the spindle pole protein is a highly insoluble component of the cytoskeleton which is dispersed to such an extent during interphase that it is difficult to identify by immunolocalization. The function of recruited spindle pole proteins is unknown but the aggregation/dispersion cycle and the antigen are highly conserved, appearing in sea urchin embryos and tissue culture cells.

Utilization of D-beta-hydroxybutyrate and oleate as alternate energy fuels in brain cell cultures of newborn mice after hypoxia at different glucose concentrations

In dissociated whole brain cell cultures from newborn mice, we have previously shown that during glucose deprivation under normoxia, D-beta-hydroxybutyrate and oleic acid are increasingly used for energy production. We now asked whether this glucose dependency of the utilization of D-beta-hydroxybutyrate and oleic acid as alternate energy fuels is also present after a hypoxic phase. 3-Hydroxy[3-14C]butyrate or [U-14C]oleic acid were added to 7- and 14-d-old cultures and 14CO2-production compared after hypoxia in normal and glucose-deprived conditions. After hypoxia, the ability of the cells 7 d in culture to increase D-beta-hydroxybutyrate consumption in response to glucose deprivation is diminished, 14-d-old cells lose this ability. In contrast, after hypoxia, both 7- and 14-d-old cultures maintain or even improve the ability to increase oleate consumption, when glucose is lacking.

A modification of the Brown-Roberts-Wells stereotactic frame for implantation of ventricular access reservoirs

A ventricular catheter and connected subcutaneous reservoir (ventricular access reservoir) allows easy, repeated access to the cerebrospinal fluid for a multitude of purposes. In situations in which the ventricles are small or displaced, insertion of a ventricular catheter may be difficult. Multiple passes to cannulate the ventricle may damage the brain and manipulation of the catheter and reservoir may cause migration of the catheter, possibly compromising its function. A stereotactic method for insertion of ventricular access reservoirs using a device that attaches to the Brown-Roberts-Wells stereotactic system has been developed. With this device the catheter and reservoir are guided into place as a single unit, utilizing a guide attached to the Brown-Roberts-Wells frame. This technique has been useful in inserting ventricular access reservoirs into patients with small ventricles or in whom there is some abnormality of the brain or skull that renders classical landmarks for ventricular cannulation useless.

Homology of the HSV-2 "a-sequence" to cellular sequences

Bgl-II fragments of the genome of Herpes simplex virus type 2 (HSV-2) HG-52 were cloned into the vector p-Neo and were used to screen the complete HSV-2 genome for regions cross-hybridizing with the genome of HEL cells. Most extensive cross-hybridizing activity was observed with a 530 bp SstII subfragment of the viral BamHI G DNA-fragment (contained in Bgl II F), which spans the joint and the viral a-sequence. From a lambda-L47 library, a cellular 15 kb HindIII DNA fragment was subcloned in pBR 322 which contained a 1920 bp SstII subfragment having strong cross-hybridizing activity with the 530 bp Sst II fragment of HSV-2 BamHI G. Within this 1920 bp Sst II fragment the cross-hybridizing activity was confined to a 230 bp Bgl I/Hpa II subfragment. This 230 bp fragment (including the flanking sequences) was analyzed in comparison to the viral a-sequence. Sequence data revealed a (G + C) content of 66% in the cellular and 81% in the viral DNA fragment, which is mainly determined by an extremely (G + C) rich 16-fold direct repeat (DR2) at the 5'-end. The homology between both DNA-fragments varies between 56% and 79% within the L-S inversion region. Both sequences, furthermore, show homology to the human c-myc protooncogene.

A developmentally staged curriculum for teaching self-care to the child with insulin-dependent diabetes mellitus

A developmentally staged curriculum has been designed to teach children with insulin-dependent diabetes mellitus about their disorder and its care within an organized program of ongoing ambulatory medical care. A preliminary evaluation of the teaching program based on this curriculum indicates that self-care skills are mastered but that the implementation of self-monitoring aspects decreases during adolescence. A survey of a sampling of participants indicates that interest in the program also declines with adolescence. However, the majority had positive responses at all ages and all children and adolescents had positive responses to the experience of being with diabetic peers. The curriculum is presented to help organize the appropriate teaching of diabetes care to children and adolescents.

Biotin-responsive in vivo carboxylase deficiency in two siblings with secretory diarrhea receiving total parenteral nutrition

Two siblings with a congenital syndrome of secretory diarrhea and seizures developed progressive skin rash, alopecia, and mucocutaneous candidiasis while receiving biotin-free total parenteral nutrition. Abnormally low urinary biotin excretion was associated with these clinical findings, but the serum concentration of biotin was within the normal range. There was also increased urinary excretion of lactic acid, 3-hydroxyisovaleric acid, 3-hydroxypropionic acid, and 3-methylcrotonylglycine. The younger of the two children subsequently died with severe metabolic acidosis. In the oder sibling, intravenous treatment with biotin (200 micrograms/day) resulted in resolution of the organic aciduria. A larger dose (10 mg/day) appeared to be required for rapid improvement in the skin lesions. These cases suggest that clinically significant biotin deficiency can occur in patients with chronic diarrhea receiving biotin-free total parenteral nutrition.

Plasma acidic glycohydrolases in insulin-dependent diabetes mellitus

We assayed plasma activities of beta-galactosidase, beta-hexosaminidase, alpha-fucosidase and alpha-galactosidase involved in degradation of the glycoprotein molecule in 110 insulin-dependent diabetics aged 3-1/2 to 19 years and compared them to a group of normal youngsters. We correlated the plasma enzyme activities with the duration, control and sequelae of insulin-dependent diabetes. Insulin-dependent diabetics had a significantly higher plasma activity of beta-hexosaminidase and alpha-mannosidase (p less than 0.01) and a significantly lower plasma activity of alpha-fucosidase and alpha-galactosidase (p less than 0.01). Of the 5 enzymes studied, only plasma beta-hexosaminidase correlated with fasting and postprandial blood sugar (p less than 0.01), cholesterol and triglycerides (p less than 0.05). Additionally, poor control of diabetes was also associated with a significantly higher plasma beta-hexosaminidase activity (p less than 0.01). Proteinuria or an abnormal Addis count suggestive of renal involvement was associated with various changes in plasma acidic hydrolases. These changes may be related to insulin deficiency rather than hyperglycemia and may be genetically determined.

Baby food exchanges and feeding the diabetic infant

Because of the dangers of hypoglycemia to the developing brain, the need to develop a lifelong positive attitude toward an eating pattern, the inherent communication difficulties, and the spontaneity of the very young, the diabetic infant presents a particular challenge to medical personnel. Baby and toddler foods in jar measurements and formula have been translated into the American Diabetes Association exchanges to help in teaching families with diabetic infants the effects of various foods on the infant's diabetes. The exchanges are taught as tools in maintaining metabolic balance rather than as a fixed diet. Caloric level is planned on the basis of diet history and the infant's current growth status. Flexibility of pattern and attitude is emphasized to minimize conflict over eating and to allow normal spontaneous activity without jeopardizing health.

Urinary acidic glycohydrolases as an index of kidney damage in juvenile diabetes mellitus

Two lysosomal glycohydrolases, beta-galactosidase and beta-N-hexosaminidase which have been associated with kidney disease were measured in the urine of 110 youngsters with juvenile diabetes mellitus. The mean enzyme excretions in the diabetic group were intermediate between those of normal youngsters and those with active renal disease. Three youngsters with known kidney disease had elevations comparable to others in the diabetic group but no direct correlation could be shown between enzyme elevations and proteinuria or Addis count abnormalities. Positive correlations were seen between enzyme levels and indices of metabolic balance including blood sugar, cholesterol and triglycerides but not with urine sugar or ketones. Duration and estimated stage and control of diabetes also correlated with the urinary enzymes. These preliminary studies are consistent with the possibility that the excretion of these enzymes reflects the ongoing renal damage which occurs in most juvenile diabetics.

[A system for "intermitten mandatory ventilation" (IMV) using the engström respspirators ER 200/300 (author's transl)]

At low financial and material costs conventional Engström-respirators (Types ER 200, 300) can be converted to make Intermittent Mandatory Ventilation (IMV) possible. These so converted respirators were examined when a group of patients in a surgical intensive care unit who had undergone mechanical ventilation for a longer period of time was weaned from the respirator. It could be shown that during the step-by-step weaning of these patients no significant changes appeared in the results of the blood gas analyses, which means that the patients' pulmonary function took over again gradually. Doubtlessly, the convertability of the Engström-respirator for IMV will help promote the weaning of patients with respiratory complications by this method.

Diabetic day. Setting goals for a child-directed ambulatory program

The techniques of management by objective have been used to coordinate and evaluate the activities of a non-traditional program for the medical care and education of children with juvenile diabetes mellitus. "Diabetic Day" is an ambulatory child-directed clinic program in which health professionals work together to improve the child's ability to cope with diabetes.

Policy statement on materials for testing glucose in the urine. The Committee on Materials and Therapeutic Agents, American Diabetes Association

Semiquantitative methods for measurement of glucose in the urine are useful for monitoring glucose homeostasis in subjects with diabetes mellitus where quantitative blood and urine glucose measurements are not available. The use of a "plus" scale for glucose measurement is confusing because the same plus values are assigned to different quantities of glucose with different methods. The two-drop Clinitest method is the most quantifiable and readable test for urine sugar, particularly if there is high sugar spill. Therefore, it is the most useful method for monitoring insulin-dependent juvenile diabetes. Its major disadvantages are its potential toxicity, the cumbersome methodology, the cost, and the possibility of interference from other reducing substances. The enzyme "dipstick" methods are most sensitive for detecting the presence of glucose. Among the available "dipstick" methods, Diastix is the most quantifiable and readable. These methods are inhibited by the presence of ketones and a number of other substances. Tes-Tape is the least expensive and, where there are inhibiting substances, the most useful, because it can be read at the liquid front where the glucose reaction is chromatographically separated. Clinistix and Chemstrip are essentially screening methods for the presence of glucose and not useful for quantification. Basing therapy on these and other plus values is irrational and should be discontinued.

[Results and advantages of simultaneously measured peroperative arterial and central venous pressure]

Central venous pressure and intravasal arterial pressure have been followed up during different operations in 80 patients of different age and sex. At the same time we have determined an exact fluid balance and blood gas analysis pre-, intra- and postoperatively. These examinations had some interesting results. In our view the most important result is that the anesthetist gets more suitable informations about intraoperative blood volume therapy by continuous measuring of central venous pressure than by the continuous following up of intravasal arterial pressure which is practised very often to-day.