Robert Lindsay – författare

Diabetes is one of the most common medical conditions to complicate pregnancy. Gestational diabetes (diabetes with onset or first recognition in pregnancy) may complicate between 2 and 20% of pregnancies depending on the criteria used. Type 1 or Type 2 diabetes complicates over 1 in 300 pregnancies, and both have major implications for mother and child.The management of diabetes during pregnancy has seen a number of major innovations in recent years. Insulin analogues have been introduced, and technical innovations include improvements in insulin pumps and the development of continuous glucose monitoring devices. The evidence base for the management of gestational diabetes has improved markedly, and the investigations based around the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study promise to revolutionise our understanding of therisks of adverse outcomes in pregnancy. The Australian Carbohydrate Intolerance Study (ACHOIS) has demonstrated that identification and glycaemic management of gestational diabetes leads to reduction in birth weight, macrosomia and adverse pregnancy outcomes. Finally, recent randomised controltrials have explored use of oral hypoglycaemics (metformin, glibenclamide) in pregnancy.Part of the Oxford Diabetes Library series, ''Diabetes in Pregnancy'' summarizes the key aspects of the medical management of diabetes during pregnancy with an emphasis on clinical management. The volume is designed for all members of the multidisciplinary team and will act as a practical introduction particularly for obstetricians and endocrinologists in training.

Diabetes is one of the most common medical conditions to complicate pregnancy. Gestational diabetes (diabetes with onset or first recognition in pregnancy) may complicate between 2 and 20% of pregnancies depending on the criteria used. Type 1 or Type 2 diabetes complicates over 1 in 300 pregnancies, and both have major implications for mother and child. The management of diabetes during pregnancy has seen a number of major innovations in recent years. Insulin analogues have been introduced, and technical innovations include improvements in insulin pumps and the development of continuous glucose monitoring devices. The evidence base for the management of gestational diabetes has improved markedly, and the investigations based around the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study promise to revolutionise our understanding of the risks of adverse outcomes in pregnancy. The Australian Carbohydrate Intolerance Study (ACHOIS) has demonstrated that identification and glycaemic management of gestational diabetes leads to reduction in birth weight, macrosomia and adverse pregnancy outcomes. Finally, recent randomised control trials have explored use of oral hypoglycaemics (metformin, glibenclamide) in pregnancy. Part of the Oxford Diabetes Library series, 'Diabetes in Pregnancy' summarizes the key aspects of the medical management of diabetes during pregnancy with an emphasis on clinical management. The volume is designed for all members of the multidisciplinary team and will act as a practical introduction particularly for obstetricians and endocrinologists in training.

When I was a young intern in internal medicine,osteoporosis was defined mainly as a fracture occurring in elderly people. However,although plain X-ray examination was recognized as an insensitive way to detect osteoporosis, hypodense bone was already considered as the reflection of the disease. Over the past 20 years, con­ siderable progress has been accomplished. In terms of prevalence, incidence, risk factors, and the burden of osteoporosis and low-energy fracture, we can appreciate the magnitude of the problem and its impact on quality oflife. Weare wellaware that vertebral fracture, which can be acutely associated with a low clinical expression, leads to significant long-term impairments. The costs for the individual and for the health budget, Le. society,are estimated better. Wenow have a clear definition of the disease, such as low bone mass and architectural defects, resulting in increased fragility. For the former part of the definition, the clinician can use accurate and pre­ cise tools allowing them to distinguish how their patient''s bone mineral content differs from that of a young healthy population in which fracture occurs very rarely. For the second series of fragility determinants, i. e. structure, methods are in rapid progress and will provide information to clinicians on these variables in the near future. Basicand clinical research have allowed major improvements in the understand­ ing of the pathophysiology of the disease. Newgenes implicated in lowand/or high bone mass have been characterized.

It seems particularly appropriate that this pioneering collection of papers should be dedicated to Donald Sholl since those of us who count, measure, and reconstruct elements of the neural en~emble are all very much in his debt. Sholl was certainly not the first to attempt quantification of certain aspects of brain structure. No computers were available to him for the kind of answers he sought, and some of his answers - or rather his interpretations - may not stand the test of time. But we remember him because of the questions he asked and for the reasons he asked them. At a time when the entire family of Golgi techniques was in almost total eclipse, he had the judgment to rely on them. And in a period when the canonical neuron was a perfect sphere (the enormous dendritic superstructure being almost forgotten), he was one of a very few who looked to dendrite extension and pattern as a prime clue to the overall problem of neuronal connectivity.

It seems particularly appropriate that this pioneering collection of papers should be dedicated to Donald Sholl since those of us who count, measure, and reconstruct elements of the neural en~emble are all very much in his debt. Sholl was certainly not the first to attempt quantification of certain aspects of brain structure. No computers were available to him for the kind of answers he sought, and some of his answers - or rather his interpretations - may not stand the test of time. But we remember him because of the questions he asked and for the reasons he asked them. At a time when the entire family of Golgi techniques was in almost total eclipse, he had the judgment to rely on them. And in a period when the canonical neuron was a perfect sphere (the enormous dendritic superstructure being almost forgotten), he was one of a very few who looked to dendrite extension and pattern as a prime clue to the overall problem of neuronal connectivity.

When I was a young intern in internal medicine,osteoporosis was defined mainly as a fracture occurring in elderly people. However,although plain X-ray examination was recognized as an insensitive way to detect osteoporosis, hypodense bone was already considered as the reflection of the disease. Over the past 20 years, con­ siderable progress has been accomplished. In terms of prevalence, incidence, risk factors, and the burden of osteoporosis and low-energy fracture, we can appreciate the magnitude of the problem and its impact on quality oflife. Weare wellaware that vertebral fracture, which can be acutely associated with a low clinical expression, leads to significant long-term impairments. The costs for the individual and for the health budget, Le. society,are estimated better. Wenow have a clear definition of the disease, such as low bone mass and architectural defects, resulting in increased fragility. For the former part of the definition, the clinician can use accurate and pre­ cise tools allowing them to distinguish how their patient's bone mineral content differs from that of a young healthy population in which fracture occurs very rarely. For the second series of fragility determinants, i. e. structure, methods are in rapid progress and will provide information to clinicians on these variables in the near future. Basicand clinical research have allowed major improvements in the understand­ ing of the pathophysiology of the disease. Newgenes implicated in lowand/or high bone mass have been characterized.