Blood pressure measured telemetrically from home throughout pregnancy.

Sixty-eight healthy pregnant women measured their blood pressure at home for 1 day every 4 weeks from 14 weeks' gestation until delivery. Blood pressure measurements were made with the Cambridge blood pressure telemetry system, which was composed of a Dinamap 1846 monitor linked to and controlled by a dedicated microprocessor which communicated transtelephonically with a hospital-based microcomputer. On each measurement day each woman measured her blood pressure five times: on first rising and then at 10 AM, 2 PM, 6 PM and 10 PM. At each measurement session the blood pressure was automatically taken 10 times at 1-minute intervals. A total of 23,790 individual blood pressure measurements were analyzed. Systolic, diastolic, and mean arterial blood pressures were lowest at 18 weeks' gestation, rising slowly thereafter at a rate of 0.4 mm Hg systolic and 0.2 mm Hg diastolic per week. The maternal pulse rate also increased steadily after 18 weeks at a rate of 0.25 beats/min per week. There was a strong correlation between the blood pressures at 18, 26, and 38 weeks. All blood pressure parameters were significantly lower on first rising than at other times of the day, although the differences were small: 5 mm Hg for systolic, 4 mm Hg for mean arterial, and 3 mm Hg for diastolic blood pressure. After 10 AM, however, there was no significant daytime variation in any blood pressure parameter, indicating that for most purposes the time of day at which pressure measurements are made is unimportant.

GLUCOPAGE: a computer program for managing diabetic pregnancy.

The microcomputer is an invaluable aid in the management of diabetes mellitus because of its ability to manipulate, summarise, and produce graphical displays from blood glucose data in such a way that new trends, or the effects of changes in therapy, are more readily apparent to the clinician. Currently available software however, while adequate for most purposes, has not been written to cope with the unique problems presented by diabetic pregnancy in which large amounts of data are generated over short periods of time, insulin requirements may change rapidly, and blood glucose control must be extremely tight. We have produced a new program, GLUCOPAGE, specifically for use in the management of diabetic pregnancy. GLUCOPAGE operates in conjunction with the Ames Memory Glucometer, from which it can download data either directly or telemetrically via a modern into the host IBM PC or compatible microcomputer. Large amounts of data can be summarised in various tabular and graphical formats on screen or in printed form. A single A4-size printout, the Glucopage, provides tabular and graphical summaries of a full week's blood glucose data. Copies of the Glucopage may conveniently be filed in the case notes, given to the patient or distributed to other medical staff.

Computerized and telemetric management of diabetic pregnancy in Cambridge.

In order to optimize the quality of our care, we have used the Ames Memory Glucometer in our computerized management of 17 insulin-dependent diabetic pregnancies. Patients measured their own blood glucose levels on 4.5 +/- 1.2 (SD) occasions per day, and six of them transmitted their blood glucose measurements telemetrically from home into a hospital-based computer on a total of 42 occasions. We achieved near-optimal blood glucose levels and normal HbA1 levels throughout most of these 17 pregnancies. Average blood glucose levels were 6.4 +/- 0.9 mmol/l in the first, 5.9 +/- 1.2 mmol/l in the second, 5.4 +/- 1.0 mmol/l in the third trimester. Corresponding values for HbA1 were 8.0 +/- 1.5%, 6.5 +/- 0.8%, and 6.2 +/- 0.4%. Average insulin requirement doubled during pregnancy, but fell to 74% of the pre-pregnancy dosage by one week after delivery. The average gestational age at delivery was 38.9 +/- 1.3 weeks, and we had no perinatal deaths. Two of the babies were macrosomic, even though their mothers had good diabetic control. Four patients were delivered by Caesarean section. However we achieved a vaginal delivery in 93% of those in whom it was planned. Our computerized system of managing diabetic pregnancies was efficient, safe, and popular with our patients.

Cast-bracing for fractures of the femoral shaft. A biomechanical and clinical study.

A study was made of the mechanics of blood-bearing in a series of patients treated with a cast-brace for fracture of the distal femur. Knee hinges incorporating strain-gauges, a simple force-plate on the floor and a standardised weight-bearing test were used to record axial loads through the cast-brace itself and through the fracture during the phases of healing. The cast-brace carried loads of only 10 to 20 per cent of body weight and functioned mainly as an antibuckling hinged tube. Patterns of weight-bearing recovery showed that the fracture itself limited loads to safe levels. A measure of the recovery of strength at the fracture was determined and termed the "fracture load index". Graphs obtained in this way demonstrated four biomechanical phases of bony union which correlated well with the stages of clinical healing. The clinical application of these results have led to improvements in the design of braces and the use of a cylinder cast-brace for fractures of the distal half of the femoral shaft and of a new type of brace with a hinge at the hip attached to the thigh cast for fractures of the proximal shaft. A simple clinical test is described by which it is possible to monitor the healing of fractures in cast-braces.