[Chronic cluster headache: course and outcome of treatment]

We analyze the results of treatment and the course of disease in 20 patients suffering from chronic cluster headache. Patients were followed for an average of 5 years. Sumatriptan provided the most effective relief of symptoms in those who used that medication. The results of surgical and medical prophylaxes were poor. The disease either remitted or changed to an episodic variety after several months or years in most patients. There is no evidence to suggest that these changes were related to any particular treatment.

A sensitive enzyme immunoassay for angiotensin II in serum

A sensitive and specific enzyme immunoassay for measuring angiotensin II (AII) has been developed as a convenient alternative to a radioimmunoassay. An antiserum to AII was prepared using AII conjugated by carbodi-imide to rabbit serum albumin, and coated on to microwell plates. The labelled antigen was prepared from AII and horseradish peroxidase using the periodate method. This enzyme immunoassay was a simple two-step procedure: 0.1 ml of AII-extracted plasma was incubated for 1 h at 37 degrees C; and 1 ml of labeled AII was incubated for 1 h at 37 degrees C. Bound horseradish peroxidase activity was then determined using o-phenylenediamine as chromogen by measuring the absorbance at 492 nm. The lower detection limit of the assay was 3.5 pmol l-1. Between- and within-assay RSD values were 8.8-18.3% and 6.9-17%, respectively, for concentrations of 10-40 pmol l-1. The accuracy of the assay, determined by recovery and linearity experiments, was 89-106% for recovery and 91-126% for parallelism. The results obtained by the present ELISA method were well correlated with those obtained by an established radioimmunoassay (n = 10, r = 0.96, intercept = 0.9 and slope = 1.02). This assay is easy to perform, rapid and does not require radioisotopes; thus it could be widely applied in clinical laboratories.

Collagenolytic activity in human pancreatic tissue with different degrees of fibrosis

The present study was designed to establish a valid method for expressing collagenolytic activity in pancreatic tissue with different degrees of fibrosis. Collagenolytic activity was measured in pancreatic tissue of control and alcoholic chronic pancreatitis (CP) patients and data were expressed as percent digestion/mg tissue or as percent digestion/mg protein obtaining different results. The values were 18.4 +/- 4.7% digestion/mg tissue in the control group, and 8.4 +/- 3.2% digestion/mg tissue in the chronic pancreatitis group (p < 0.001). When collagenolytic activity was expressed as percent digestion/mg protein, measured by the Bradford assay, the values of the control group were 190.2 +/- 69.0% digestion/mg protein, and those of chronic pancreatitis patients were 187.2 +/- 61.7% digestion/mg protein (p = ns). Protein determination in pancreatic tissue of control and CP patients was seen to be influenced by the method assayed. Protein content per mg of fresh tissue, measured by the methods of Lowry, Bradford, and Bradford-SDS, were similar and twofold higher in controls than in CP samples. However, the Kjeldahl assay showed that protein content per mg of dry tissue was the same in both groups. The high degree of fibrosis in the pancreas of CP patients (60.2 +/- 28.0%) with regard to controls (4.7 +/- 1.8%) (p < 0.001) and the low response of collagen proteins to the Lowry and Bradford assays could explain the differences observed in protein content of human samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of ovariectomy and ageing on the structure and ultrastructure of the female Syrian hamster Harderian gland: a stereological analysis

The effects of ovariectomy and ageing on the structure and ultrastructure of the Syrian hamster Harderian gland were investigated by techniques of quantitative stereology. Tissues were obtained from intact 6-month-old, sham-operated 6-month-old, ovariectomized 6-month-old, intact 18-month-old and ovariectomized 18-month-old female hamsters. Glands from both ovariectomized and aged hamsters showed comparable qualitative and quantitative characteristics. They showed histological alterations that included thinning of the tubule walls, lowering of luminal porphyrins, invasion of lumina by neutrophils and the occurrence of interstitial porphyrins. Glands from both ovariectomized and aged hamsters showed statistically significant differences from control animals in relation to numerical density and cellular size. Finally, quantitative studies with the electron microscope revealed significant decreases in the volume densities of the cytoplasmic organelles concerned with secretion. These results support the hypotheses that the secretory activity of the female hamster Harderian gland is influenced, directly or indirectly, by ovarian hormones, and that many of the age-related modifications of the Harderian gland reflect alterations in ovarian function.

[Frequency of lumbar spine osteopenia in an asymptomatic postmenopausal Chilean population]

The aim of this study was to assess lumbar spine bone density in a group of chilean postmenopausal females and to estimate the frequency of vertebral osteopenia in the national urban female population. A clinical assessment and lumbar spine bone density measurement were performed to 171 healthy women over 40 years of age and not receiving medications that modify bone turnover. Calcium ingestion was recalled in 77 of these. Fifty women (29.2%) had osteopenia, defined as a bone density of less than 0.92 g/cm2. Extrapolating this figure to the national urban population, an osteopenia frequency of 21.7% was estimated. Body mass index was 25.5 +/- 3.8 and 57% of the sample was overweight. Calcium ingestion was 740.3 +/- 331.7. These two parameters did not correlative with bone density. Women with osteopenia were older and had a longer postmenopausal lapse than those with normal bone density. The completion of further clinical an epidemiological studies is recommended to know the real magnitude of osteoporosis in Chile.

Reactive sacroiliitis as late sequela after severe pelvic inflammatory disease verified by laparoscopy or laparotomy

OBJECTIVE

To investigate the frequency of lumbosacral pains and sacroiliitis as late sequela of severe pelvic inflammatory disease (PID) confirmed by laparoscopy or laparotomy.

DESIGN

The sacroiliac joints were examined radiographically and scintigraphically to search for signs of reactive sacroiliitis.

SETTING

Department of Obstetrics and Gynecology, Hospital General Virgen de las Nieves, Granada, Spain.

PATIENTS

Thirty-five out of 70 women admitted with severe clinical symptoms of PID during a five-year period. PID was confirmed by laparoscopy or laparotomy.

MEASUREMENTS

The sacroiliac joints were examined radiographically, and bone scintigraphic studies of the pelvic girdle were performed with 99technetium labelled pyrophosphate.

RESULTS

Twenty out of 35 patients reported lumbosacral pain. The bone scintigraphic findings were positive for sacroiliitis in 18 out of 33 patients (54.6%), and the radiographic findings were positive in 11 women (33.3%).

CONCLUSIONS

Patients with previous severe clinical PID complaining of lumbosacral pains may be offered a bone scintigraphy, a sensitive procedure using low-dose radiation, to search for early signs of reactive sacroiliitis.

Role of zinc in the process of pancreatic fibrosis in chronic alcoholic pancreatitis

Zinc acts as a cofactor in many enzymatic processes, including collagen synthesis. The observation of increased activity of prolylhydroxylase (PHase), an enzyme that takes part in the synthesis of collagen, in zinc-depleted liver tissue suggests that zinc deficiency is associated with hepatic collagen deposition. The pancreatic zinc content in chronic alcoholic pancreatitis (CAP) is still unknown. The objectives of this study were (a) To assess zinc concentrations in the pancreatic tissue in CAP; (b) to establish a possible relation between pancreatic zinc content, fibrosis, and PHase activity; and (c) to evaluate the relation between serum and pancreatic zinc levels. Sixteen surgical specimens of pancreatic tissue from patients with CAP were analyzed; control pancreatic samples from 11 organ donors were also studied. Zinc concentration, PHase activity, and the amount of fibrous tissue were assessed in the pancreatic tissue of each individual. The amount of fiber deposited in the pancreas in CAP was 68.4 +/- 19.8%, and that of the control group, 5 +/- 2% (p < 0.001). PHase activity in CAP was 754 +/- 230 cpm/mg of protein and that of the control group was 405 +/- 151 cpm/mg of protein (p < 0.001). The amount of pancreatic zinc in the former was 15.0 +/- 9.7 micrograms/g of tissue and that of the latter was 28.1 +/- 18.1 micrograms/g of tissue (p = 0.023). Serum zinc levels were similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cluster headache with a familial presentation]

Four out of 190 patients suffering from cluster headache (CH) were of familial presentation. In three families the affected relative was either the brother or the father of the proband. In the other family the disorder affected the father, two brothers, and perhaps the grand mother of the patient. The prevalence of the disease seems to be higher among relatives of CH patients compared to general population. It is unclear whether this familial aggregation depends up on genetic factors.

[Autoimmune thyroid disease diagnosed during puerperium: evaluation 2 years later]

This is a 2 years follow-up study of seventeen women who were found to have mild goiter and post-partum thyroid disease two years earlier in order to establish if post-partum thyroid disease is a self-limited entity or the relapse of a chronic pre-existing disease. When first studied, the 17 women had thyroid dysfunction (15 with hyperthyroidism and 2 with hypothyroidism). Eight women had also elevated antimicrosomal antibodies (AMA) titers and 9 were negative for AMA. In the present study, all women were reexamined for the presence of goiter, and free thyroxine index (FT4I), TSH and AMA were determined. Mild (grade I-II, less than 30 g) goiter was found in 11 women. Six out seventeen women, still had altered functional tests (3 with hypothyroidism and 3 with hyperthyroidism). The elevated AMA titers seen in 8 patients in the first study, remained high in 6 (1:100-1:25600). None of the 9 patients who in the first study had negative AMA changed to positive titers. Results indicate that post-partum thyroid disease is not always a self-limited entity. The presence of elevated AMA titers in the initial post-partum period can express a chronic thyroid disease compromise. In these patients a longterm clinical and biochemical follow-up is recommended.

An improved Bradford protein assay for collagen proteins

A modification of the protein determination method of Bradford adapted for collagen-rich samples is described. The use of Coomassie-based protein determination methods is limited by the great variation in colour yield obtained for different proteins. This is especially important in samples containing significant amounts of collagen where direct application of the methods of Lowry and Bradford results in underestimated values. Addition of small amounts of sodium dodecyl sulphate (SDS) (0.0035%) to the diluted solutions of Coomassie Brilliant Blue G used as dye reagent in the Bradford colorimetric assay caused a 4-fold increase in the colour response of three collagen proteins (Col I, III and IV) and a decrease in absorbance for various non-collagen proteins. The presence of SDS in the reagent did not result in a significant metachromatic shift of the collagen-dye complexes. This simple modification in the preparation of the reagent for the Bradford assay allows similar response curves to be obtained for collagen and non-collagen proteins, making the modified assay of potential use for protein determination in collagen-rich samples such as pancreatic extracts.

[Biochemical markers of bone remodeling and bone density in healthy postmenopausal women]

The aim of this study was to study bone turnover and density in postmenopausal women. One hundred healthy postmenopausal women aged 45 to 86 years, in whom menopause occurred between 3 months and 33 years before and were not receiving medications that could alter bone metabolism, were studied. Measurements performed were serum alkaline phosphatases, urine hydroxyproline/creatinine and calcium/creatinine excretion ratios and lumbar spine and femoral bone densities. Mean urinary hydroxyproline/creatinine excretion ratio was 39.5 +/- 11.9 (over 45 in 26% of women) and calcium/creatinine ratio was 0.11 +/- 0.08 (over 0.12 in 29% of women). At least one of these measurements were increased in 39% of women and no relationship of these values with age or length of postmenopausal period was found. Alkaline phosphatases were elevated in 9.6% of women. Twenty six percent of women had lumbar spine osteopenia and 10% femoral neck osteopenia. There was an inverse relationship between the length of hypoestrogenism and bone density. It is concluded that more than one third of studied women had biochemical evidences of bone resorption and that these women had a higher frequency of osteopenia than the general population. A decrease in bone density and an increase in bone resorption indices identify women with higher risk of osteoporosis that could be benefitted with an opportune treatment.

A morphometric and fine structural study of the myoepithelial cells in the hamster harderian gland

Myoepithelial cells were structurally and morphometrically studied in the hamster Harderian gland. Myoepithelial cells appeared as irregularly shaped cells with a central body containing the nucleus and numerous long cytoplasmic processes embracing the basal surface of the secretory cells. The main identifying feature of myoepithelial cells was the numerous myofilaments that occupied much of the cytoplasm. Quantitative studies with the electron microscope revealed significant differences between male and female glands, being either volume fraction and numerical density of myoepithelial cells higher in female glands than in male glands. No evidence of cellular size variation between sexes was found. Cell number differences, rather than cell size, were responsible for the sex difference. The functional significance of this sex difference is discussed in relation to the different secretory activity of the Harderian gland in the two sexes.

Sex differences in serum hormone levels in umbilical vein blood

OBJECTIVE

To determine the serum levels of FSH, LH, PRL, estradiol, progesterone and testosterone in umbilical vein blood in a group of normal neonates.

METHOD

Umbilical vein blood was obtained for serum analyses from 52 newborns (25 females and 27 males) in the Maternity of the Hospital Regional Virgen de las Nieves, Granada (Spain) and means were compared with Student's t-test.

RESULT

Mean values of prolactin, estradiol and progesterone were similar in both sexes. The levels of gonadotropins in umbilical vein blood found were significantly higher in newborn males than in females (P < 0.001 for LH, P < 0.007 for FSH). Testosterone levels were higher in male neonates than in females (P < 0.004).

CONCLUSION

Our data reflect the dynamic state of male fetal endocrinological status in comparison to female fetuses, and strongly suggest that the mechanisms of hormonal regulation differ in the two sexes.

An electron microscopic study of the harderian gland of the Syrian hamster with particular reference to the processes of formation and discharge of the secretory vacuoles

The lipid-secreting cells of the Harderian gland of the Syrian hamster were studied using light, transmission, and scanning electron microscopy. Three morphologically different secretory cell types are identified in the gland: type I and II cells of the male gland and, distinct from either, the female gland cell. In all secretory cell types, lipid droplets in the cytoplasm were surrounded by unit membranes. Ultrastructural evidence of the involvement of the Golgi apparatus in the formation of the secretory vacuoles was obtained. The process of secretion involved the fusion of the boundary unit membrane of the vacuole with the plasma membrane and the release of the vacuolar content alone into the lumen. No evidence of holocrine processes was observed in this study. In addition to lipids, vacuoles contained materials whose solubility properties clearly differed from those of lipids. There appear to be variations in the ultrastructural characteristics of the vacuole content of the different types of secretory cell.

[Changes in the clinical presentation of primary hyperparathyroidism. Analysis of 84 cases]

During the last two decades, the clinical presentation of primary hyperparathyroidism (PHP) has changed due to the routine use of multiphasic biochemical screening tests. We assessed 84 patients with PHP treated in our service between 1977 and 1991. The yearly incidence increased from 1.6 to 7.6 patients/year with the introduction of multiphasic biochemical testing in our hospital in 1982; likewise the proportion of asymptomatic patients increased from 12.5 to 40.7%. The most frequent presenting symptoms were bone pain and renal colic. Nineteen percent of patients were over 70 years old and this age group had distinct clinical features. The plasma chlorine/phosphorus ratio was abnormal in 95% of cases; on the contrary only 7 of 18 patients had a urinary calcium excretion over 300 mg/day. Cervical ultrasound, performed in 45 patients had a positive predictive value of 78% to localize the lesion. Bone density was below fracture threshold in 50% of studied patients. The principal surgical finding was the presence of adenoma. Twenty one percent of patients had symptomatic hypocalcemia during the first week after surgery; however, only 2.5% of patients continued to have hypocalcemia one month after surgery. One patient had an inferior laryngeal nerve damage and two a cervical hematoma. It is concluded that the introduction of massive calcium measurements has allowed an early diagnosis of asymptomatic PHP, specially in elderly people.

Changes in hypothalamic met-enkephalin levels of rats induced by painful stimulation and morphine treatment

The possible influence of painful stimulation and morphine analgesia on hypothalamic met-enkephalin levels, and the possible correlation between this biochemical parameter and animal behaviour was studied. The results indicate that both painful stimulation and morphine treatment induce an increase in hypothalamic metenkephalin. On the other hand, naloxone did not cause any variation. In animals submitted to painful stimulus, morphine treatment induced a decrease in hypothalamic met-enkephalin levels. Finally, when both morphine and naloxone were administrated before nociceptive stimulation, much higher levels were measured. There was no correlation between the level of hypothalamic met-enkephalin and the pain rating.

Changes in arterial blood pressure induced by percutaneous thermocoagulation of the trigeminal ganglion and rootlets

The changes in arterial blood pressure which occur during the different steps of thermocoagulation of the trigeminal ganglion and rootlets are reported. The arterial blood pressure of 54 patients with trigeminal neuralgia was recorded continuously by catheterization of the radial artery. The maximal values were recorded (a) during the analgesic-sedation stage; (b) when the electrode came into contact with the base of the cranium during movement of the needle towards the foramen ovale; (c) during insertion of the electrode into the foramen ovale, and (d) during the thermocoagulation. One-way analysis of variance and Student's t test were used for analysis of the data. There was a significant increase of arterial blood pressure during the various stages of thermocoagulation.

[3 beta-hydroxysteroid dehydrogenase defect: frequency of presentation in a sample of Chilean hirsute women]

The defect of 3 beta hydroxysteroid dehydrogenase (3 beta HSD) is frequent among hirsute women and clearly dependent on the ethnic composition of the studied population. Our aim was to study the frequency of 3 beta HSD deficit in a group of Chilean hirsute women. Basal and post ACTH concentrations of cortisol, 17 hydroxyprogesterone and 17 hydroxypregnenolone were measured by RIA in 40 hirsute post puberal women and in 15 normal age matched female volunteers. Criteria for considering a 3 beta HDS deficit were 17 hydroxypregnenolone values and 17 hydroxypregnenolone/17 hydroxyprogesterone and 17 hydroxypregnenolone/cortisol ratios after ACTH stimulation over the 95% confidence intervals of normal women. Basal dehydroepiandrosterone sulphate and testosterone levels were also measured in hirsute women. All samples were obtained during the follicular phase of the menstrual cycle. ACTH stimulated hormone values and ratios were diagnostic for 3 beta HDS deficit in 7.5% of hirsute women. Basal testosterone was over 80 ng/dl in 47.5% and dehydroepiandrosterone sulphate over 3.9 micrograms/ml in 52.5% of these women. There was no correlation between dehydroepiandrosterone or testosterone values and ACTH stimulated hormone values. It is concluded that 3 beta HSD is frequent in hirsute women and that its diagnosis requires the determination of ACTH stimulated 17 hydroxypregnenolone values and 17 hydroxypregnenolone/17 hydroxyprogesterone ratio.

An ultrastructural study of myoepithelium maturation during postnatal development of the hamster Harderian gland

This study reports the ultrastructural cell modifications in the myoepithelium of the Harderian gland during the postnatal development of the Syrian hamster. Tissues were obtained from male and female hamsters at days 1, 3, 5, 7, 10, 12, 15, 17, 20, 27, 37, 46 and 90 after birth, and processed for transmission electron microscopy. Electron microscopy was coupled with point counting methods to quantitate changes in several subcellular organelles during the course of myoepithelial cell maturation. The myoepithelial cells in this gland remained immature at birth. The earliest age of development when organized bundles of microfilaments were observed was 7 days. By the 12th day, the myoepithelial cells had developed most of their specific characteristics and resembled the mature form. Myoepithelial cells mature synchronously with each other and with the secretory cells. No undifferentiated myoepithelial and myoepithelial cells, the secretory endpieces of the adult hamster Harderian gland contain a third cell type which resembles the myoepithelial cell in shape and has an extremely electron-lucent cytoplasm lacking microfilament bundles.

Postnatal development of the harderian gland in the Syrian golden hamster (Mesocricetus auratus): a light and electron microscopic study

The main objective of the present investigation was to study the morphological and chronological aspects of the development of the Harderian gland in the Syrian golden hamster. Tissues were obtained from male and female hamsters at days 1,3,5,7,10,12,15,17,20,27,37,46, and 90 after birth and processed for light and transmission electron microscopy. The present observations indicate that a well-defined temporal sequence in microscopic and ultrastructural modification is recognizable in the development of the hamster Harderian gland. Four stages of development were proposed. Between days 1-5 (first stage), the gland shows characteristics of an immature structure. The glandular cells contain many free ribosomes, few and small organelles, and large irregular-shape nuclei. Between days 7-17 (second stage), there is a marked increase of organelles involved in synthesis and secretion. The gland begins the secretion of lipids and porphyrins, but no morphological differences between male and female glands are observed. Between days 20-36 (third stage), the morphological differences between the two sexes appear and progressively develop. In 45-day-old hamsters, the Harderian gland possesses the structural characteristics of adult glands, and further developmental changes are essentially quantitative in nature (fourth stage). At all stages of development, the population of secretory cells has a uniform appearance. The morphological results are discussed as well as the possible relationship of this temporal sequence with hormonal changes.

[Comparison of homologous and heterologous standard curves using TR-FIA for the determination of total T4 in the rat]

A homologous standard curve for rat T4 measurement has been compared to heterologous standard curves, by a time resolved fluoroimmunoassay (TR-FIA). Homologous standard curves have been carried out starting from rat serum in the absence of thyroid hormone by using Samuel's technique. The security criteria (sensitivity, inter and intraassay precision, and accuracy), were measured and compared between the homologous and heterologous test. Analysis of variance and slopes between homologous and heterologous standard curves showed homogeneous variances, the differences in the slopes being not significant.

[Asymptomatic primary hyperparathyroidism: evaluation of bone mass using dual-photon bone densitometry]

Dual-photon bone densitometry of the lumbar spine and hips was performed in 11 patients (9 females) with asymptomatic primary hyperparathyroidism and in 11 control subjects. The age was 54.7 +/- 14.8 years. The asymptomatic state of the disease was established by the absence of clinical or radiologic evidence of renal, digestive or bone involvement. 10 of 11 patients had histologic confirmation of the disorder, in addition to the biochemical and RIA findings which were present in all. Serum calcium ranged from 10.6 to 11.8 mg/dl, and P levels were decreased in 7 subjects. Alkaline phosphatase levels were elevated in 7 patients. Urinary calcium output was 341 +/- 216 mg/24 h. Bone density was 16% lower at the lumbar spine and 20% lower at the hip in patients compared to controls. In 5 patients bone density was lower than the level associated to increased risk for fractures (compared to 2 controls). No correlation existed between bone density and biochemical indices of hyperparathyroidism. Thus, decreased bone density and increased risk of fracture may exist in patients with hyperparathyroidism even at the asymptomatic stage.

[Bromocriptine for macroprolactinomas. Discussion of 3 cases treated successfully]

Bromocriptine was used to treat 3 patients with prolactin secreting pituitary adenoma. Diagnosis was based on the presence of a sellar tumor over 1 cm in size at CT scanning and a serum prolactin concentration above 150 ng/ml. All patients were symptomatic from pituitary hypofunction or from tumor compression of neighboring areas. Bromocriptine was given at increasing doses up to 10 mg/day. Prolactin reached normal levels 1 to 7 months later, tumor reduction was confirmed by high resolution scanning. The mechanism of bromocriptine effect on these tumors is discussed.

[Resistance of Streptococcus pneumoniae in Galicia]

We studied the antibiotic sensitivity of 130 Streptococcus pneumonia strains isolated from respiratory samples (96 cases), blood (13 cases), CSF (6 cases), ocular secretions (5 cases) and other origins (10 cases). High-level penicillin-resistance was found in 13.08% of strains, and intermediate-level penicillin resistance was also found in 22.3% of strains. A multiple-antibiotic resistance pattern was shown by 80.44% of all penicillin-resistant strains. Resistance rates found against antibiotics were as follows: tetracycline, 41.53%; chloramphenicol 17.69%; cotrimoxazole, 16.92% and erythromycin 6.92%. All isolated strains were sensitive to rifampin and vancomycin.

[Cushing's syndrome due to bilateral adrenal macronodular hyperplasia. From ACTH-dependent hypercortisolism to ACTH-independent hypercortisolism]

A 35 year old female with Cushing's syndrome and bilateral adrenal macronodular hyperplasia, in whom a change from ACTH dependency to autonomy was observed, is presented. The diagnosis of Cushing's syndrome was based on the failure of suppression of urinary ketogenic steroids (17 KCS) and free cortisol (uF) with the administration of 2 mg of dexamethasone daily for 2 days. CT scan of the abdomen showed adrenal bilateral multinodular hyperplasia and the sellar CT scan was normal. Initially 8 mg for 2 days of dexamethasone suppressed 17 KCS and uF; however, a few months later this effect was lost as well as the effect of endogenous ACTH on cortisol. Bilateral adrenalectomy was carried out, prior to attainment of normal cortisol levels with Ketoconazole. The adrenal glands has multiple nodules and they weighed 10 and 21 grams. Her postoperative plasmatic cortisol levels were imperceptible. Physiopathologic mechanisms involved in bilateral macronodular adrenal hyperplasia are reviewed.

[Biphoton bone densitometry in hyperthyroidism caused by Basedow's disease]

Bone mass and bone exchange were studied in 10 post menopausal females (age 36 +/- 9) with hyperthyroidism due to Graves disease dating from over 6 months. Biphoton osteodensitometry of the lumbar spine and hips, calcium intake, hematocrit, hemoglobin and 24 hr urinary calcium excretion were determined in each patient and compared to a control group. Hyperthyroid patients had a lower calcium intake, and evidence of higher bone turnover. However, bone density was not different from control. There was a strong correlation of bone density with serum calcium (r 0.72) and T3 levels (r 0.68). Thus, untreated hyperthyroidism associated to Graves disease does not lead to decreased bone mass in a 6 month period.

A prepubertal surge of thyrotropin precedes an increase in thyroxine and 3,5,3'-triiodothyronine in normal children

The variations in plasma levels of TSH, T4, T3, and rT3, during the pubertal period, were studied in 647 school students from the urban area of Santiago in Chile (47% males and 53% females) with ages ranging between 7.5 and 15 yr. The subjects were grouped by age in consecutive intervals of 6 months each, and pubertal development was determined in every subject. TSH showed a significant increase, reaching a peak in the 9- to 9.5-yr interval. The same was found for T3 and T4, which reached a peak by 10 and 11 yr. The T4/T3 ratio did not show any significant variation with age. After 9.5 yr, a decrease in rT3 and increase in the T4/rT3 ratio was found. The TSH peak preceded the onset of clinical pubertal development, while the T3 and T4 peaks coincided with this onset. The variations in rT3 suggest an increase of peripheral conversion of T4 to T3. These transient events, not described until now, could be termed thyroidarche and could have a significant effect on pubertal growth and development.

Effects of high-carbohydrate or high-fat diet on carbohydrate metabolism and insulin secretion in the normal rat

The effects of changes in the content of dietary carbohydrate, protein and fat on glucose metabolism and insulin secretion were examined in normal male rats. The animals were fed for 10 days with three types of diet: (a) standard diet, (b) glucose diet and (c) high fat/protein diet. The weight of the rats fed with the glucose diet decreased when compared to the standard diet fed rats. The glucose diet decreased insulin secretion in response to glucose in vivo and in vitro and slightly improved glucose tolerance. The hepatic glycogen content was approximately three times higher in animals fed with the glucose diet than in the control group. When compared to the standard diet, the high fat/protein diet induced an increase of the weight gain. This type of diet caused an increase of the fasting plasma glucose, a decrease of hepatic glycogen and a marked glucose intolerance to an intravenous load as demonstrated by lower rates of glucose disappearance. Plasma insulin levels were increased both in basal and glucose stimulated states. These results indicate that the glucose diet leads to an enhanced insulin sensitivity of the target tissues. By contrast, the high fat/protein diet induces an obesity-like state and an in vivo insulin resistance.

Ultrastructural study of lamellar and nucleolus-like bodies in the harderian gland during postnatal development of the hamster (Mesocricetus auratus)

Membranous structures identified as lamellar bodies (LBs) and dense intracytoplasmic bodies referred to as nucleolus-like bodies (NLBs) have been found in the hamster Harderian gland during neonatal stages. Both structures appear between 8 and 12 postnatal days, coinciding with the beginning of secretory activity. LBs in males and NLBs in both sexes gradually decrease in number with further differentiation of the glandular cells. The morphological features of these cytoplasmic structures are described, and their origin as well as their possible functional significance are discussed.

Circadian changes in synaptic ribbons and spherules in pinealocytes of the Syrian hamster (Mesocricetus auratus)

In the present study, "synaptic" ribbons were studied morphologically and quantitatively in hamster pineal gland. The number of ribbons and spherules of hamster pinealocytes was counted over a 24-h period. The 24-h variations in the quantity of "synaptic" ribbons were found to parallel fluctuations in pineal melatonin concentrations. No significant circadian changes were observed for "synaptic" spherules, indicating different roles for these two structures.

[Cushing's syndrome: the diagnostic and treatment problems in 27 cases]

Problems of diagnosis and treatment were analyzed in 27 patients with Cushing syndrome (25 confirmed by anatomic findings) followed for a mean of 50 months. The etiology was Cushing disease in 14 (52%), suprarenal tumor in 9 (33%) and ectopic secretion of ACTH in 4 (15%). Determination of plasma cortisol levels at 4 PM or 11 PM was a highly sensitive test for the presence of this syndrome (100%). High resolution computed tomography was considerably more effective than conventional X ray studies of the sella in patients with Cushing disease (42 vs 20%). Treatment has been totally effective in all patients with benign suprarenal lesions. Cure was obtained in 64% of patients with pituitary lesions and 0% of patients with Cushing syndrome associated to malignancy.

Adrenal macrotumors diagnosed by computed tomography

Adrenal tumors larger than 6 cm are unusual but show a greater incidence of malignant etiologies than smaller adrenal tumors. The scarce information about adrenal macrotumors (AMT) induced us to study prospectively all patients who were seen in our clinic during the period 1984-1988 and were diagnosed by computed tomography (CT) to have an adrenal mass greater than or equal to 6 cm. The clinical characteristics, including the main complaint, tumoral secretory activity, CT findings and histologic diagnosis from 18 patients are described; they represented a 0.3% of the total amount of abdominal CT studies performed. Seventy-two % of AMT resulted to be non cortisol or catecholamines secreting masses, and from them, a 38% corresponded to malignant etiologies characterized by marked and rapid weight loss. Four out of five hormone secreting AMT corresponded to pheochromocytomas, while the fifth one resulted to be a bilateral macronodular hyperplasia secreting cortisol. In two cases AMT did not correspond to a genuine adrenal mass, resulting to be a malignant histocytoma in one case and a hydatidic cyst in other one. When performed in two occasions, a percutaneous needle biopsy was a valuable diagnostic tool, permitting to diagnose a lymphoma and a tuberculoma.

IN CONCLUSION

1) AMT correspond mainly to non cortisol or catecholamines secreting tumors, often malignant; 2) not all AMT diagnosed by CT correspond to true adrenal masses; 3) percutaneous needle biopsy can be a helpful procedure for diagnosing nonfunctioning solid AMT.

Dominant macular colobomata

Hereditary bilateral macular colobomata are not a consequence of an anomalous closure of the fetal fissure. Their extreme rarity, their lack of embryological explanation, and their morphologic similarity to postinflammatory congenital macular scars called the hereditary-malformative etiology of this entity in question. The authors describe a four generation family with seven affected members with isolated autosomal dominant bilateral macular colobomata.

Autoimmune thyroid disease in the puerperium. Predictive value of thyroid enlargement and related hormonal changes occurring during pregnancy

The incidence of goiter detected during pregnancy and its significance as an indicator of autoimmune thyroid disease after delivery was investigated in a sample of 707 pregnant women (81% in their 2nd trimester of gestation). Goiter was detected in 106 subjects (15%). Blood T4, T3, TSH, free T4 index (FT4I), antimicrosomal antibodies (AMA) and urinary iodine excretion were measured in these women and in a control group of gravidas without goiter. These measurements were repeated at 1 and 3 months after delivery. Compared with controls during pregnancy, subjects with goiter had lower FT4I values (11.0 +/- 2.8 vs 9.0 +/- 1.8; p less than 0.01) and higher TSH values (2.9 +/- 0.6 microU/ml vs 4.2 +/- 2.1 microU/ml; p less than 0.01). In contrast, T4, T3, AMA and urinary iodine excretion values were similar in both groups. In subjects with goiter FT4I values increased over pregnancy levels at 1 month (11.2 +/- 2.0; p less than 0.05) and 3 months (14.0 +/- 3.0; p less than 0.05) after delivery; in 29% a biochemical hyperthyroidism (FT4I greater than 13.5) was detected. During the same period TSH values decreased significantly (1 month: 1.9 +/- 0.7 microU/ml; p less than 0.05; 3 months: 2.7 +/- 3.0 microU/ml; p less than 0.05). Frequency of positive AMA increased from 8.6% during pregnancy up to 32.1% in the post-delivery period (p less than 0.01). In the control group no variation in the FT4I, TSH or AMA were observed after delivery. These results indicate that goiter during pregnancy is common in Chilean gravidas and that it has predictive value for the appearance of autoimmune thyroid disease after delivery.

[Unilateral adrenalectomy for cortisol producing adenoma: prolonged suppression of the hypothalamus-pituitary-adrenal axis]

Hypercortisolism induces a functional suppression of the hypothalamus-pituitary-adrenal axis which is expected to subside within a year following either the removal of the cortisol producing adrenal adenoma or the withdrawal of glucocorticoid therapy. We report 3 women (35, 40 and 43 years old) with Cushing's syndrome due to cortisol producing adrenal adenoma. All had typical clinical and biochemical features of the syndrome dating from up to 4 years before surgery. Cortisol supplementation was given during the postoperative period (20 mg/day po at 9 AM, reduced to 10 mg/day after 6 months). Cortisol was withdrawn 16, 20 and 39 months after surgery, when 9 AM plasma concentration raised over 10 ug/dl [corrected]. An ACTH stimulatory test was performed until a normal response was obtained. Patients showed and abnormal response up to 16, 17 and 30 months after surgery, respectively. Complete recovery took place at 21, 36, and 55 months after the operation. We concluded that risk of hypocortisolism may persist up to 30 months after surgery for cortisol producing adenomas, due to complete or partial suppression of the hypothalamus-pituitary-adrenal axis.

[Primary hyperparathyroidism: usefulness of high resolution echography in local diagnosis]

Recent reports show a better surgical outcome in primary hyperparathyroidism when an accurate preoperative localization of the lesion in available. We performed high resolution sonography in 23 consecutive patients (20 women) with biochemically proven hyperparathyroidism. Twenty two of them were operated on and their sonographic reports were compared to the surgical and pathological findings (20 adenomas, 1 carcinoma and 1 hyperplasia). One patient did not have surgery but the sonogram was compared to a Tl 201-Tc99 scintigram that suggested an adenoma. Sonography showed a single parathyroid tumor in 17 patients and failed to demonstrate a lesion in six. There were two false positives and 6 false negatives. The sensitivity was 71.5% and the positive predictive value was 88%. Three out of 6 patients with a negative sonography had an adenoma located out of reach for the method. Our results show that the high resolution sonography is a useful, non invasive method to localize abnormally enlarged parathyroid glands in hyperparathyroidism and we think it should be performed in every patient with a biochemical diagnosis of this disease.

Morphometry of the pyramidal tract in the spinal cord of normal rats

A morphometric study of the pyramidal tract at the spinal cord level in the normal albino rat is reported. The area, perimeter, axonal and glial cell count, and axonal concentration were determined at the seventh cervical, second thoracic, and third lumbar spinal cord levels. The results show consistent diminishing values of the area, axonal and glial cell count, and axonal concentration with the tract descent in the spinal cord.