Long-term exendin-4 treatment delays natural deterioration of glycaemic control in diabetic Goto-Kakizaki rats.

AIM: The glucagon-like peptide-1 (GLP-1) receptor agonist, exendin-4, has previously been shown to delay the onset of diabetes when administered to Goto-Kakizaki (GK) rats in the prediabetic period. The present study aimed to evaluate whether long-term administration of exendin-4 to GK rats in the diabetic period would improve their diabetes and how glycaemic control was affected following drug wash-out. METHODS: Glycaemic control was assessed in diabetic GK rats during 12 weeks of exendin-4 or vehicle treatment. Moreover, some animals were followed for an additional 9 weeks without treatment. RESULTS: Glycaemic control was seen to deteriorate in vehicle-treated animals, as assessed by increased glycated haemoglobin A1c (HbA1c), whereas HbA1c improved in exendin-4-treated animals. Following an additional 9 weeks without treatment, glycaemic control in exendin-4-treated animals remained below baseline value and thus remained significantly lower than that of vehicle-treated animals. Following exendin-4 administration, oral glucose tolerance tests revealed greatly reduced glucose and insulin excursions compared with vehicle-treated animals, whereas following overnight drug wash-out, only little difference was seen, suggesting that the improvement in glycaemic control may have been obtained primarily by increased postprandial control. No significant differences were observed in pancreatic islet morphology or islet hormone content. CONCLUSIONS: Exendin-4 treatment improved glycaemic control in diabetic GK rats, independent of changes in beta-cell mass. Additionally, progression of the disease seemed to be delayed because the improvement in HbA1c was still apparent 9 weeks after cessation of treatment.

[Anterior lumbar intercorporal spondylodesis. Radiological and functional therapeutic results]. / Forreste lumbal interkorporal spondylodese. Radiologisk og funktionelt behandlingsresultat.

The purpose of this investigation was to identify risk factors in relation to non-union following lumbar intercorporal spondylodesis and to correlate this result with the functional outcome as assessed by the Dallas Pain Questionnaire (DPQ). This comprises questions concerning daily activities, work-leisure activities, anxiety-depression and social interest, measured on visual analog scales. During the period 1979-87 a total of 132 patients were operated with spondylodesis, diagnosed as suffering from spondylolisthesis or disc degeneration. Minimal follow-up was one year. Radiological graft incorporation was complete in 52% of the cases, partial in 24% and lacking in 24%. The rate of functional outcome follow-up was 72%. Seventy percent claimed an improvement in three out of four categories. Thirty percent claimed no improvement or worsened condition. The DPQ showed signs of poor prognosis for age groups above 45 (p < 0.04) and those with former spine surgery (p < 0.02). The questionnaire showed significantly better results for the group with perfect or doubtful union compared to the group with non-union (p < 0.006). In conclusion this investigation demonstrates a success rate of 70% for anterior lumbar interbody fusion. There is a tendency to poorer prognosis for patients with previous spine surgery and age above 45 years. The Dallas Pain Questionnaire correlates significantly to X-ray analysis and seems to be a useful tool for the description of individual biopsychosocial changes following spine surgery.

[A comparative study of atenolol (Tenormin) and the combined preparation atenolol/chlorthalidone (Tenoretic Mite) in essential hypertension. A randomized double-blind study from general practice]. / En sammenlignende undersøgelse af atenolol (Tenormoin) og kombinationspraeparatet atenolol/klortalidon (Tenoretic Mite) ved essentiel hypertension. En randomiseret dobbeltblind undersøgelse fra almen praksis.

Two hundred and ninety-two hypertensive patients from general practice who had previously been treated with a diuretic with insufficient effect participated in a randomised trial for a period of three months. A total of 115 patients completed treatment with 50 mg atenolol (Tanormin) and 121 were treated with the combined preparation consisting of 50 mg atenolol and 12.5 mg chlothalidone (Tenoretic Mite) while 56 patients defected from the trial. In both of the groups, the average blood pressure was reduced significantly already after treatment for one month. A significantly greater number of patients receiving combined treatment achieved satisfactory diastolic blood pressures (less than 90 mmHg), the proportions being 78% and 54%, respectively. Better effects from combined treatment were found particularly in patients over 60 years of age and in females. No significant differences were observed between the side-effects of the regimes nor in the laboratory values registered during treatment.

The Charnley total hip arthroplasty in juvenile rheumatoid arthritis patients.

A follow up of 27 consecutive total hip arthroplasties in 16 patients with juvenile rheumatoid arthritis was performed. The mean age at surgery was 18 years, and the average follow-up period was 64 months. No serious early complications were recorded, but three deep infections developed from 6 to 18 months after the arthroplasty, all requiring revision. The clinical results were good at follow up, as 20 hips were free of pain and 7 had only slight pain. Most of the patients had improved their walking ability and the range of motion in the hip as well. A poor correlation was, however, shown between the clinical and the roentgenographical results, as there was one femoral implant that was definitely loose and four more hips that had components which were probably loose. The frequency of infections might have been reduced by using antibiotic prophylaxis during surgery in all the cases; the frequency of aseptic loosening might also have been reduced by improved cementing techniques. Because of high loosening rate without clinical symptoms, it is recommended to follow the patients roentgenographically to make revision surgery possible while the bone stock still is sufficient.

Sinus tarsi syndrome: presentation of seven cases and review of the literature.

Seven cases with sinus tarsi syndrome are presented. The literature about the sinus tarsi syndrome is reviewed. A relationship between subtalar joint instability following lesion to the ligamentous structures in the sinus and canalis tarsi, and the sinus tarsi syndrome is discussed.

Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip.

A follow-up study was made on 129 consecutive Charnley arthroplasties in osteoarthritis secondary to congenital dislocation of the hip. The acetabular component was placed as far distal as possible using a standard technique. Bone grafting was not performed. The survival of the prostheses was assessed by the survivorship method. The cumulative survival rate of the prostheses was 93% after five years, 89% after ten years, and 80% after 15 years. In 77% of the cases the acetabular component had been placed in the true acetabulum or levels the rate of mechanical loosening of the acetabular levels the rate of mechanical loosening of the acetabular component (revisions and acetabular components showing a radiolucent line of increasing width) was 13% compared with 42% in the group where the acetabular component was placed proximal to the roof of the true acetabulum (p less than 0.005).

Prevention of sciatic nerve entrapment in trochanteric wiring following total hip arthroplasty.

Sciatic nerve entrapment secondary to trochanteric wiring is a rare but serious complication following total hip arthroplasty (THA) in which the transtrochanteric approach has been used. To eliminate this risk, the authors modified the Charnley drill-and-wire-guide forceps for the femur, an instrument that facilitates both the drilling of an anteroposterior hole through the femur in the intertrochanteric region and the insertion of the horizontal wire. Transformation of the slot on the lower branch of the forceps into a loop that engages the posterior end of the wire, thereby advancing it automatically when the instrument is retracted, effectively prevents entrapment of both the sciatic nerve and the soft tissues. The modified instrument also saves time, and in more than 3000 THAs in which it has been used, no case of sciatic nerve entrapment has been observed.

Prophylaxis against febrile convulsions with phenobarbital. A 3-year prospective investigation.

An unselected patient material of 182 children admitted consecutively with febrile convulsions during a period of two years was classified into five risk-groups. Continuous phenobarbital therapy for two years was recommended for 113 children (Groups I--IV). These children were followed-up as out-patients for at least one year after admission. In children receiving phenobarbital therapy, serum concentrations were controlled every third month. A total of 59 children completed the treatment according to the directives given and seven of these (12%) developed renewed febrile convulsions despite serum phenobarbital concentrations within the therapeutic range (70--120 mumol/l). No particular characteristics for these children could be established on the basis of the parameters registered. The therapeutic model established was found to be suitable for distinguishing between children with massive risk for renewed convulsions (Group I--IV) compared with children for whom treatment was not recommended (Group V).