Factors predisposing to and outcome of gestational diabetes.

Two hundred thirteen women with abnormal glucose tolerance tests (GTTs) were diagnosed over 9 years by a screening program involving the total antenatal population. Each subject was matched for age, parity, and ethnic group with a control. The gestational diabetics were subdivided into classes A1 or A2 based on the fasting plasma glucose value of their GTT: A1 when below 6.0 mmol/L (108 mg/dL) and A2 when 6.0 mmol/L (108 mg/dL) or higher. All received treatment with dietary advice and some with insulin. Birth weight was not related to maternal age or severity of diabetes, but was related to maternal obesity. However, neonatal morbidity indices such as admission to the special care baby unit for longer than 48 hours and polycythemia (hematocrit above 65%) were related significantly to the severity of the diabetes and not to maternal age or obesity.

Aluminium release from the Sorbsystem D-3160 and D-3260 cartridges.

Recent clinical information indicates that the aluminium level of patients' serum can rise while they are being treated with the Sorbsystem haemodialysis system. Further evidence suggests that the quality of aluminium removed from the dialysing fluid by the sorbent cartridge utilized in this equipment is time-dependent. Evaluation of the sorbent cartridges D-3160 and D-3260 has shown that ultimately aluminium is satisfactorily removed from the dialysing fluid. However, the time taken to achieve the safe condition of less than 30 micrograms/litre of aluminium is dependent on the quantity of aluminium washed out from a new cartridge before being reabsorbed, and the highly variable quantity contained in the diluting water. The results have also shown that the level of aluminium recommended by the DHSS in April 1982 (30 micrograms/litre) is not reliably attained following the manufacturer's recommended pretreatment, and a further 60 min of operation in the 'dialyse' mode is necessary. It should be noted that, as a result of evaluation of the Sorbsystem, the DHSS have issued guidelines on the use of this equipment.

Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases.

Two hundred and sixty-three women with ultrasound-diagnosed polycystic ovary syndrome were studied of whom 91 (35%) were obese (BMI greater than 25 kg/m2). Obese women with PCOS had a greater prevalence of hirsutism (73% compared with 56%) and menstrual disorders than non-obese subjects. Total testosterone and androstenedione concentrations in serum were similar in the two subgroups but SHBG concentrations were significantly lower, and free testosterone levels higher, in obese compared with lean subjects. In addition, concentrations of androsterone glucuronide, a marker of peripheral 5 alpha-reductase activity, were higher in obese than in non-obese women with PCOS. There were no significant correlations of either SHBG or free testosterone with androsterone glucuronide suggesting that obesity has independent effects on transport and on metabolism of androgen. There were no significant differences between the subgroups in either baseline gonadotrophin concentrations or the pulsatile pattern of LH and FSH secretion studied over an 8-h period. There was, however, an inverse correlation of FSH with BMI, but only in the obese subgroup. In conclusion, the increased frequency of hirsutism in obese compared with lean women with PCOS is associated with increased bio-availability of androgens to peripheral tissues and enhanced activity of 5 alpha-reductase in obese subjects. The mechanism underlying the higher prevalence of anovulation in obese women remains unexplained.