ConclusionFrom the figures alone we cannot be encouraged in the hope that the large psychiatric hospitals will readily be emptied of their long-stay populations, by whatever means. In Salford, at least, it is a population ever longer-staying, not by any means al old, increasingly difficult to discharge, and dying only slowly. And we replenish it year by year with new patients. We must examine the people concerned to discover what the "need" really is and to make rational provision, but the hospital and social services must work closely together to achieve this.A further paper uses these and other data to estimate future demand for beds (Fryers, 1973 Summary A prospective study has been carried out of placental lactogen levels in pregnancy complicated by diabetes mellitus. The levels were higher than those in normal pregnant subjects; the higher levels were related to increased placental and fetal weight but more closely to the former; and lower levels were found when there was clinical evidence of placental dysfunction. Those patients requiring the largest insulin increment for the control of their diabetes in the pregnancy have placental lactogen levels in the higher range.
Summary
Plasma human placental lactogen (HPL) concentrations have been measured at frequent intervals over 24 hours in 24 normal women, 13 chemical and 13 insulin dependent diabetic patients during the third trimester of pregnancy. Most of the women studied displayed variation in HPL levels during the day, but there was no evidence of a diurnal rhythm, nor significant changes following meals or during the nocturnal fast. The mean plasma HPL concentrations over 24 hours in the chemical and insulin dependent diabetic patients (5·9±SD 1·3 and 5·9±l·7 μg/ml respectively) were greater than those in normal women (5·1·1·2 μg/ml) but this difference was not significant. No significant change in plasma HPL concentrations was observed during a five‐hour oral glucose tolerance test in either the normal or chemical diabetic group. It is suggested that in normal pregnant women HPL does not itself contribute to glucose homeostasis but acts as a ‘regulator’ which alters the actions of certain maternal hormones to achieve a favourable environment for fetal growth.
Summary
The lecithin : sphingomyelin area ratio (LSAR) was measured in 108 samples of amniotic fluid obtained after 32 weeks' gestation from 66 pregnant diabetics and in 34 samples from 27 women with latent diabetes during pregnancy. A previously reported finding that the normal terminal rise in the ratio did not occur in approximately one‐third of such patients was confirmed. The clinical value of this test, in timing delivery to minimize the risk of neonatal respiratory distress, is discussed; its routine use in pregnancies complicated by established or latent diabetes is advocated.
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