The pathophysiological influence of leptin and the tumor necrosis factor system on maternal insulin resistance: negative correlation with anthropometric parameters of neonates in gestational diabetes.

The contribution of the tumor necrosis factor (TNF) system and leptin was studied in insulin resistance and neonatal development during the course of normal pregnancy and gestational diabetes mellitus (GDM). Thirty patients with GDM and their neonates (n = 30), 35 healthy pregnant women (15 in the first, nine in the second and 11 in the third trimester) and their neonates (n = 20), and 25 healthy matched non-pregnant women participated in the study. Significantly elevated levels of maternal TNF-alpha, sTNF receptor (R)-1 and R-2, leptin (detected by enzyme-linked immunosorbent assay) and fasting C-peptide (measured by radioimmunossay and raised body mass index (BMI) were found in GDM patients and in the third trimester of normal pregnancies. TNF-alpha, sTNFR-2, C-peptide, leptin concentrations and BMI positively correlated with each other in GDM. An inverse relationship between the body length, head circumference and body weight of the newborns, and maternal TNF-alpha, leptin and C-peptide concentrations was shown in GDM. In healthy pregnancies the maternal serum leptin level was in a negative linear correlation with the head circumference of the newborns. In conclusion, increased TNF-alpha and leptin levels may contribute to insulin resistance in GDM and in the third trimester of normal pregnancy and may negatively influence the anthropometric parameters of the newborns.

Updated screening protocol for abortion services.

We performed 2976 first-trimester abortions at our outpatient center in 1986. In 16 cases (0.54%), products of conception could not be confirmed histologically, although history, bimanual pelvic examination, and urine pregnancy test were suggestive of pregnancy. In 1987-1988, we prospectively evaluated 6689 women presenting for first-trimester abortions. Adding sonography and a semiquantitative serum hCG test to our earlier protocol, we were able to date and locate accurately 6510 pregnancies (97.3%) at the first visit. The remaining 179 patients (2.7%) required only one follow-up visit for final evaluation. This protocol reduced the number of visits for accurate evaluation of pregnancy and eliminated the risk of unnecessary curettage and unplanned second-trimester abortions.

Early prediction of fetal macrosomia in diabetes mellitus.

We studied 374 pregnant diabetic women to determine the value of various ultrasound parameters in the prediction of fetal macrosomia. The correlation between ultrasonographic signs and maternal glycaemia in the development of fetal macrosomia was also studied. Significant correlation was observed between the accurence of hydramnios and future macrosomia during the second-trimester (p less than 0.001). Serum fructosamine levels as an index of maternal glycaemia in patients of macrosomic fetuses were significantly higher throughout the pregnancy as compared with mothers of infants with normal birth weight (p less than 0.001). These data suggest: 1. The presence of hydramnios in the second trimester is a useful predictor of macrosomia in diabetic patients (specificity: 86%, negative predictive value: 88%). 2. Maternal diabetic control during pregnancy has a significant influence on fetal growth and contributes to the development of fetal macrosomia. 3. The lack of correlation between the frequency of hydramnios and fructosamine levels suggests that a mechanism other than carbohydrate metabolism also plays an important role in the development of fetal macrosomia.

[Radiology today is no longer what it once was]. / Die Radiologie von heute ist nicht mehr, was sie einst war.

Todays radiology is totally different from that 10-15 years ago. Consequences appear for radiologists, but no less for clinicians, health officials and financing. The radiologist gives advice to the clinician on the selection of investigation and technique and the demonstration of the results. For this he needs clinical information. Todays radiology should be organized as an centralized service. Splitting into fields or disciplines is inefficient. Financial bodies must recognize the high costs also for maintainance. The only way for cost reduction is central installation and multi-shift employment. Financing must provide the money for manpower and materials. The reduction of unnecessary radiologic investigations can be achieved by radiologists only with the help of economists. Modern diagnostic radiology has a central role in the health services. The pretentiousness of clinicians, the effectiveness of the administration and economy can be seen in their relation to diagnostics as a whole and especially diagnostic radiology. Clinicians and hospitals will have the diagnostic radiology that they deserve by their own efforts (material, organizational) for modern medical imaging.