EFFECTS OF DEPRESSION, ANXIETY, OR LOW SELF-ESTEEM UPON GLYCEMIC VARIABILITY, IN DIABETIC PREGNANT VERSUS NON-PREGNANT PATIENTS.

Objective: We analyzed the correlation between glycemic variability and psychological problems such as depression, anxiety disorder, and low self-esteem in pregnant and non-pregnant (excluding gestational diabetes) patients with diabetes. Besides its originality, this study might contribute to better / earlier diagnosis of these psychological conditions, with a special interest in pregnant diabetic women. Better management and cost reduction of care could be a consequence. Methods: We compared diabetic pregnant and non-pregnant women from the perspective of the glycemic variability (for a period of 15 days prior inclusion in the study) and their results on the standardized questionnaires: Beck depression inventory, Hamilton anxiety scale - HRSA, Rosenberg self-esteem test. Results and Conclusions: A statistically significant correlation was identified in both groups between the glycemic oscillation and depression, anxiety, and low self-esteem. Diabetic pregnant women had a higher statistical significance for the correlation between the glycemic oscillation and depression, as well as between the glycemic oscillation and anxiety than non-pregnant diabetic patients. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients.

THE RELATIONSHIP BETWEEN DEPRESSION, ANXIETY DISORDER AND LOW SELF-ESTEEM IN REGARD TO GLYCEMIC VARIABILITY IN DIABETIC PATIENTS.

Objective: We analyzed the possible correlation between glycemic variability and psychological disorders such as depression, anxiety disorder, and low self-esteem, in diabetic patients. These correlations are relevant, as they consume a large number of resources. Their better understanding can increase the effectiveness of incident reduction techniques and could provide better management and cost reduction of care. Methods: We compared the relationships between the glycemic variability (for a period of 10 days prior to completing the depression questionnaire) and the results of two standardized questionnaires: Hamilton anxiety scale - HRSA (group 1: 500 patients), Rosenberg self-esteem test (group 2: 490 patients) and Beck depression inventory (both groups). Results: A statistically significant correlation was identified between the glycemic oscillation and depression as well as both anxiety and low self-esteem. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients. In conclusion, psychometric tests could be an important instrument in the management of diabetic patients.

Microcoil embolization for ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy.

BACKGROUND: Percutaneous transcatheter occlusion with ethanol injection of septal arteries is an efficient treatment procedure of hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study is to evaluate the feasibility and efficiency of septal artery embolization with microcoils. METHODS: The microcoils were delivered through the guide-wire lumen of a 2mm-diameter coaxial balloon positioned inside the target vessel as distally as possible. One or more 0.018"-straight microcoils (Hilal straight coils, Cook, USA) were used for each target vessel until complete flow obstruction was noted. The intraventricular pressure gradient was measured before, during and after the procedure. Septal branch occlusion was finally documented by coronary angiography. RESULTS: We treated 7 patients (pts) (male: 5 pts; mean age: 48 (10 years). All patients were symptomatic (NYHA class 3 or 4). The target vessels were successfully occluded in all patients, without complications. Moderate pain was recorded during and after the procedure and the CK level increased five- to ten-fold. The pressure gradient diminished during the procedure from 72 +/- 21 mm Hg to 30 +/- 15 mm Hg. The number of coils delivered ranged from 3 to 7 / patient. The embolized septal branches: 1 vessel in 5 patients; 2 vessels in 1 patient; 3 vessels in 1 case. After the procedure the pressure gradient, evaluated by transthoracic echocardiography, was 34 +/- 16 mm Hg and 42 +/- 12 mm Hg at 3 month-follow-up. Clinical improvement was recorded in all patients after the procedure (NYHA class 1 or 2). Temporary pacing was necessary in 3 patients during and immediately after the procedure but no patient needed permanent pacing. CONCLUSIONS: Microcoil embolization is an efficient and safe approach for transcatheter ablation of septal hypertrophy in HOCM. This technique induced myocardial necrosis without the toxic effects of alcohol, reducing the risk of complications (permanent pace-maker implantation, ethanol flow to other myocardial regions).

Methods of active immunotherapy and viral oncolysis in some forms of cancer.

In some cancers with a high antigenicity (gastric, intestinal, mammary, laryngeal, etc.) the authors associated to the classical treatment an autovaccine prepared by combining the tumoral extract (obtained by trituration, sonication and centrifugation, and stored at -80 degrees C) with some mitogens (phytohemagglutinin) and adjuvants (ovalbumin, tuberculin, lymphocyte promotion factor, etc.) obtaining a greater survival (4-6 years). The association of viruses with an oncolytic action (mumps virus) to the active unspecific immunotherapy in some cancerous structures (peritoneal, pleuropulmonary and synovial malignant mesothelioma, malignant cholangioma of the liver, hepatic metastases of some adenocarcinomas of the colon, gastric cirrhous, clearly differentiated macrocellular carcinomas of the lung, pulmonary mucoid adenocarcinomas, traditional recurrent carcinomas of the urinary bladder), in which all other oncotherapeutic resources have been exhausted, induced slow involution up to disappearance of the tumor and a favourable evolution of the patients without signs-of recurrence after 5-7 years in 73% of cases. To obtain the expected results it is mandatory to comply strictly with certain principles, established by the authors for each of the two original methods, expounded in detail in the text.

[Original technic for conservative treatment of "lateral" duodenal fistulas]. / Tehnica originala privind tratamentul conservator al fistulelor duodenale "laterale"

An original technique is presented, resulting in the spectacular recovery in only 3-7 days of "lateral" duodenal fistulae by their transformation from the "alkaline" to the "acidic" type. The author achieved this by administration, either by mouth or by intra-duodenal route, with the aid of the Eihorn tube, in continuous perfusion, of a lactic acid solution concentrated at 6 g%--not exceeding 3.000 ml over a 24 hours period, partially eliminated through the fistulous traject which is cured in the process. The condition to obtain the recovery is to provide continuous lactic acid perfusion. The patient should not receive any food by mouth but the feeding will be provided by direct jejunal infusion and parenterally, until the complete closure of the fistula. The author describes in detail several conditions which are considered as of prime importance for the resolution of any type of duodenal fistula and also suggests some new formula for jejunal alimentation and for the protection of the teguments around the fistula.