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The aim of this study was to evaluate the incidence of metabolic syndrome (MetS) during long-term follow-up of women with gestational diabetes (GDM). Furthermore, we evaluated the glycemic measures from an oral glucose tolerance test (OGTT) during pregnancy as predictors of incident MetS. Women diagnosed with GDM were divided into two groups according to the results of OGTT: one abnormal value = GDM1 (n = 338) and two abnormal values = GDM2 (n = 151), while women with normal glucose tolerance (n = 385) served as controls. MetS and its components were evaluated in a follow-up study (mean follow-up time 7.3 ± 5.1 years) according to the International Diabetes Federation (IDF) criteria. Fasting plasma glucose in OGTT was the best predictor of incident MetS in ROC (area under the curve) analysis. The incidence of MetS during a <5-year follow-up was 22.2% in controls, 39.3% in GDM1 and 60.4% in GDM2; and >10-year follow-up 24.2%, 46.2% and 62.5%, respectively. In controls and GDM2, the incidence of MetS remained nearly constant during the follow-up, whereas in GDM1 it increased. In conclusion, already mild gestational glucose intolerance may progress to MetS and therefore merits intervention measures to prevent future cardiovascular disease.

The aim of this study was to evaluate the glycemic measures from an oral glucose tolerance test (OGTT) during pregnancy as predictors of incident type 2 diabetes mellitus (T2DM). Patients diagnosed with gestational diabetes mellitus (GDM) were divided into two groups according to the results of OGTT: one abnormal value = GDM1 (n = 338) and two abnormal values = GDM2 (n = 151), while women with normal glucose tolerance served as controls (n = 385). Glucose tolerance was re-evaluated with an OGTT in a follow-up study (average follow-up time 7.3 ± 5.1 years). The incidence of T2DM after 10 years follow-up increased progressively by the degree of the glycemic abnormality during pregnancy: 0.8% in controls, 3.8% in GDM1 (adjusted HR 17.6, 95% CI 1.9-162.3) and 25.0% in GDM2 (adjusted HR 72.9, 95% CI 9.6-553.7), respectively (p = <0.0001). The risk of T2DM is significantly increased in women with two or more abnormal values in OGTT during pregnancy. Post-challenge glucose levels in OGTT were the best predictors of the incident T2DM in ROC analysis and they therefore identify the greatest risk group for targeted prevention of T2DM after GDM.

Background: In recent decades the treatment of childhood acute bone and joint infections has shifted towards shorter antibiotic courses and rapid transition to oral therapy., Methods: We prospectively collected 265 culture-positive cases of non-neonatal bone and joint infections in Finnish children during 1983-2005. The duration of antimicrobial treatment and the extent of surgery were defined in the study protocol, but for ethical reasons, the liaison clinician determined the time of discharge using normalization of the serum C-reactive protein (CRP) level as a yardstick. We examined changes during the study in the distribution of causative organisms, severity of disease, and length of hospital stay., Results: Staphylococcus aureus was overwhelmingly the most common causative agent throughout the study, whereas Haemophilus influenzae type b was eliminated soon after the introduction of vaccination. The mean time from initial symptoms to presentation remained the same at 4 days, and no significant change was observed in the severity of disease, CRP, or the rate of sequelae. The mean duration of intravenous antibiotic administration was only 4 days. The average hospital stay shortened significantly from 13 days to 9 days (p = 0.0001)., Conclusions: The shortened hospital stay was not due to a change in the anatomical site of these infections, but to simplified treatment. Considerable savings in hospital stay, and thus costs, are feasible in osteoarticular infections of childhood by using CRP in monitoring the disease and shortening intravenous treatment by a swift move to per oral administration.

Fifty patients who had undergone partial gastrectomy for benign ulcer disease 3-4 years previously were examined. Blood haemoglobin, serum iron, calcium, and phosphorus, alkaline phosphatase, urine excretion of calcium and phosphorus, faecal fat, body weight, and bone mineral density by 241Am gamma ray attenuation were determined preoperatively and at the follow-up investigation. Radiocalcium (47Ca) absorption was measured at the follow-up and compared with that of controls. An increase was found in serum alkaline phosphatase and a decrease in serum inorganic phosphorus and urinary calcium excretion. The other biochemical data did not change significantly. The bone mineral density of the gastrectomized patients did not differ from that of the controls in either sex. The intestinal 47Ca absorption showed no significant difference between the patients and controls.

Eighty consecutive patients with endoscopically proven gastric ulcer were randomly assigned to treatment with sucralfate, 1 g four times daily, or cimetidine, 200 mg three times daily and 400 mg at night. The patients were endoscoped after four and eight weeks by an examiner who was unaware of the treatment in use. Of the 40 patients assigned to each treatment group, 2 in the sucralfate and 4 in the cimetidine group were withdrawn due to the finding of gastric cancer in the biopsies. Two patients in the sucralfate and 3 patients in the cimetidine group interrupted treatment. Complete ulcer healing was found after four weeks of treatment in 17 of the 36 patients (47%) in the sucralfate and in 16 of the 33 patients (48%) in the cimetidine group. The cumulative healing rate after 8 weeks of treatment was 80% in the sucralfate group and 73% in the cimetidine group. There were no serious side effects, but it was necessary to discontinue treatment with cimetidine in two subjects because of rash in one and dizziness in the other. The results suggest that sucralfate is an effective and safe drug for the treatment of gastric ulcer and that its efficacy is equivalent to that of cimetidine.

One hundred and forty-nine patients with endoscopically documented duodenal or prepyloric ulcer were randomly allocated to treatment with ranitidine, 150 mg twice daily (75 patients), or glycopyrrobromide, 2 mg three times daily, and antacid suspension, 60 ml/day, with a buffering capacity of 480 mmol/day (74 patients). The patients underwent a thorough prestudy symptom analysis, and endoscopy was performed by an observer who was unaware of the treatment in use. After 4- and 8-week courses of treatment the patients were re-evaluated. Sixty-nine patients in the ranitidine group and 66 in the anticholinergic/antacid group completed the trial. Complete ulcer healing was obtained in 60 of the 69 patients (87%) in the ranitidine group and in 50 of the 66 patients (76%) in the anticholinergic/antacid group after 4 weeks of treatment and in 65 (94%) and in 61 (92%), respectively, after 8 weeks of treatment. Forty-three patients had troublesome side effects of either anticholinergic or antacid treatment, and three patients had to interrupt the treatment. There were no serious side effects of ranitidine. This study suggests that ranitidine causes faster ulcer healing than the combination of anticholinergic and antacid. The results show that ranitidine is an effective and safe drug for duodenal ulcer healing, with no troublesome side effects.

The efficacy of sucralfate and of an alginate/antacid compound was compared in a randomized, double-blind 6-week trial in patients with symptomatic, endoscopically confirmed macroscopic reflux esophagitis. Of the 68 patients who completed the study, 36 received sucralfate and 32 alginate/antacid. Significant symptomatic improvement occurred in both treatment groups: almost 70% of the patients became symptom-free or improved. Esophagitis healed completely in 53% of the patients receiving sucralfate and in 34% of the alginate/antacid patients, as measured with endoscopic criteria (p greater than 0.05). Our results indicate that sucralfate seems to be at least as effective as alginate/antacid in relieving symptoms and in healing macroscopic lesions. As a safe, locally active mucosal protecting agent, sucralfate is a promising new drug for the treatment of reflux esophagitis and deserves further trials over longer periods.

Of 35 patients operated upon for peptic ulcer and subjected to absorption tests before operation, 26 could be followed up with absorption tests for 1, 6, and 10 years after operation. The following operations had been performed on the latter: antrectomy with gastroduodenostomy in 10, antrectomy with selective vagotomy and gastroduodenostomy in 9, and other operations in 7. None had recurrence of the ulcer or disturbing abdominal complaints during the follow-up period. Ten years after operation there was an increase in the mean value of the Schilling test, and all patients had a normal serum B12 vitamin level. On the other hand, a decrease was noticed in the mean value of the d-xylose test and an increase in that of faecal dry-weight fat content. At the time of the 10th year follow-up examination, 6 patients had an impaired d-xylose absorption and 7 an impaired fat absorption. According to the increase in the mean body weight and the serum protein and haemoglobin concentration, the nutritional status had not worsened.