[Diagnosing and treating rheumatoid arthritis].

Rheumatoid arthritis (RA) is a chronic, autoimmune joint disease associated with increased risk of multiorgan involvement and comorbidities such as osteoporosis, cardiovascular disease, and infections. Therefore, doctors in other specialities should have knowledge of RA. No diagnostic criteria are available, but the classification criteria are often used as a diagnostic tool. Early initiation of effective immunosuppressive treatment is essential to improve outcome. The cornerstone of treatment is intra-articular administration of glucocorticoids in combination with methotrexate.

[Intramural duodenal haematoma after endoscopic injection therapy of a bleeding ulcer].

In this case report a 48-year-old man presented with nausea and abdominal pain. Ten days prior he had been treated with an endoscopic epinephrine/saline injection for haemostasis of a bleeding duodenal ulcer and was discharged the following day. At readmission, an abdominal CT revealed severe gastric distention and a gastroscopy showed total duodenal obstruction. Subsequent post-contrast CT revealed that a massive intramural duodenal haematoma was the cause of the total duodenal occlusion. Also, acute pancreatitis was seen. The treatment was conservative, and follow-up gastroscopy showed total resolution of the haematoma.

Parity and type 2 diabetes mellitus: a study of insulin resistance and ß-cell function in women with multiple pregnancies.

OBJECTIVE: Increasing parity may be a risk factor for the development of type 2 diabetes mellitus and the metabolic alterations during a normal pregnancy induces a prediabetic state; thus, multiple pregnancies may act as a risk factor for development of type 2 diabetes if these physiological alterations in glucose homeostasis are not reversed postpartum. We hypothesize that multiple pregnancies may lead to ß-cell exhaustion and that the insulin resistance that occurs during pregnancy may persist after multiple births. RESEARCH DESIGN AND MEASURES: A total of 28 healthy premenopausal women were recruited: 15 high parity women (≥4 children) and 13 body mass index (BMI)-matched and age-matched low parity women (1 and 2 children). The study consisted of an intravenous glucose tolerance test for assessment of ß-cell function followed by a hyperinsulinemic euglycemic clamp for assessment of insulin sensitivity. Dual-energy X-ray absorptiometry was performed to assess body composition. RESULTS: All anthropometric measures, measures of body composition and baseline blood samples were comparable between the 2 groups. Neither first phase insulin release (0-10 min, p=0.92) nor second phase insulin release (10-60 min, p=0.62), both measured as area under the curve, differed between the 2 groups. The M-value, calculated as the mean glucose infusion rate during the last 30 min of the clamp period, was 8.66 (7.70 to 9.63) mg/kg/min in the high parity group compared with 8.41 (7.43 to 9.39) mg/kg/min in the low parity group (p=0.69). CONCLUSIONS: We did not detect any effects of increasing parity on insulin sensitivity or ß-cell function.

Gestational diabetes: A clinical update.

Gestational diabetes mellitus (GDM) is increasing in prevalence in tandem with the dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Much controversy surrounds the diagnosis and management of gestational diabetes, emphasizing the importance and relevance of clarity and consensus. If newly proposed criteria are adopted universally a significantly growing number of women will be diagnosed as having GDM, implying new therapeutic challenges to avoid foetal and maternal complications related to the hyperglycemia of gestational diabetes. This review provides an overview of clinical issues related to GDM, including the challenges of screening and diagnosis, the pathophysiology behind GDM, the treatment and prevention of GDM and the long and short term consequences of gestational diabetes for both mother and offspring.