JAMA : the journal of the American Medical Association
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Twenty-four children, teenagers, and young adults (8 to 26 years old) with insulin-dependent diabetes mellitus were treated with continuous subcutaneous insulin infusion (CSII). Criteria for using CSII included persistent high glycohemoglobin (GHb) values and/or wide swings in blood glucose values despite arduous efforts to improve glycemia. Thirty percent discontinued CSII. ⋯ Electromechanical problems with the devices, patient errors, or local skin problems occurred in 50% of patients, although none produced ketoacidosis or severe hypoglycemia. Dietary noncompliance and decreased intensive home monitoring were contributory factors. Better ways to predict success or failure are needed if normalization or even near-normalization is a goal of CSII in younger patients with insulin-dependent diabetes mellitus followed up in a nonresearch setting.
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A high level of sodium (440 mg/L) in the water supply of Gila Bend, Ariz, caused concern because of apparently elevated rates of hypertension in Gila Bend Papago Indians. We surveyed 342 Gila Bend Papago Indians and 375 non-Indians from July to September 1983. ⋯ Mean blood pressures for the Gila Bend whites were lower in most age groups than in comparison US white populations. The prevalence rates of hypertension in Gila Bend were not significantly higher than national rates.
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Nine patients who have died of giant cell arteritis (GCA) are described. Two patients died of myocardial infarction caused by GCA in the coronary arteries. ⋯ None of the cases were receiving adequate corticosteroid treatment when symptoms of the ischemic catastrophies started. These cases illustrate that GCA is a generalized arteritis that can involve arteries of vital importance.