Determination of the steroidogenic capacity in premature ovarian failure

OBJECTIVE

To determine the secretion of precursors, intermediate and final products of androgen biosynthesis in women with premature ovarian failure (POF).

PATIENTS

Seven patients 20 to 34 years of age with idiopathic POF and a control group of six women 27 to 29 years of age with normal ovarian function studied during the early follicular phase were included. DESIGN, INTERVENTIONS: In all patients an adrenal stimulation test was performed as follows: a short dexamethasone (DEX) inhibition was carried out the night before the corticotropin (ACTH, 0.25 mg, Cortrosyn; Organon, Orangeburg, NY) stimulation test, obtaining blood samples in basal conditions, post-DEX inhibition as well as at 60, 120, and 180 minutes after the ACTH bolus.

MAIN OUTCOME MEASURES

Using specific RIA serum concentrations of delta 5 precursors (pregnenolone, 17-hydroxypregnenolone, DHEA), delta 4 intermediates (P, 17-hydroxyprogesterone, androstenedione) and the final products T and cortisol (F) were measured.

RESULTS

Adrenal inhibition and stimulation responses in both groups of patients showed no differences for delta 5 precursors and F. On the other hand, delta 4 intermediates and androgens exhibited significant differences at the level of response to ACTH stimulation. Patients with POF had significantly lower values than those of control group.

CONCLUSION

An important decrement in the steroidogenesis was noticed in POF, particularly in androgen synthesis, revealing the selective participation of the adrenal gland in steroid production.

Effect of prostaglandin synthesis inhibition on glomerular filtration rate in renal transplant recipients

To determine the influence of prostaglandin (PG) synthesis inhibition on the renal function in renal transplant recipients, we carried out a crossover, double-blind, placebo controlled study of 18 ambulatory patients. Glomerular filtration rate (GFR) was measured using 51-Cr EDTA, before and after indomethacin (50 mgr. three times a day for three days), and placebo. Overnight urinary PGE excretion decreased 88.9 +/- SEM 4.81% after indomethacin, but remained unchanged following placebo. GFR decreased 15.3 +/- SEM 3.94% (p = 0.0139) after indomethacin. There was no correlation between PGE urinary excretion and GFR changes. Pre-existing renal functional impairment was not a significant risk factor. Caution should be exercised when using non-steroidal anti-inflammatory drugs in renal transplant patients.

Ontogenesis of pyroglutamyl peptidase II activity in rat brain, adenohypophysis and pancreas

Pyroglutamyl peptidase II (PPII; E.C. 3.4.19.-) is a highly specific membrane-bound ectoenzyme degrading thyrotropin releasing hormone (TRH). The ontogenesis of this enzyme was measured in rat brain regions, adenohypophysis and pancreas. In hypothalamus PPII activity was maximal at day 8 postnatal, decreasing to adult values at day 45. The postnatal ontogenic patterns in posterior cerebral cortex and hypothalamus were similar. In olfactory bulb, two peaks of activity were observed (3th and 22nd day) while in adenohypophysis it appeared only at day 8, increased to day 30, decreasing thereafter to adult values.

[Diagnosis of dominant renal polycystosis in adults by analysis of DNA polymorphism]

BACKGROUND

Adult renal polycystosis (ARP) is a dominant autosomic disease. The gene responsible for this disease in most families has been located on the short arm of chromosome 16 (16 p) by restriction analysis of the DNA polymorphisms (RFLP).

METHODS

The existence of several polymorphic markers flanking this gene permits the diagnosis of any member of an affected family. A series of proximal and distal genetic markers have been used to study the segregation of the disease in a group of families with more than one affected member.

RESULTS

The clinical and genetic results obtained from a study of 10 Spanish families with ARP have been reported. A high percentage of the members under 30 years of age (40%) did not present renal cysts.

CONCLUSIONS

Restriction analysis of DNA are fundamentally for a disease in which a high percentage of carriers remain asymptomatic within the reproductive age.

Regional distribution of pyroglutamyl peptidase II in rabbit brain, spinal cord, and organs

Pyroglutamyl peptidase II (PPII) is a narrow specificity ectoenzyme that degrades thyrotropin-releasing hormone (TRH). We detected the enzyme in the brain of various mammals, with highest specific activity in rabbit brain. In this species, activity was heterogeneously distributed in the central nervous system. There was a 28-fold difference between regions of highest and lowest PPII activity. Enzyme activity was highest in the olfactory bulb and posterior cortex. In the spinal cord, activity was low but unevenly distributed, with highest values detected in the thoracic (T) region. Segments T1 and T2 activities were particularly high. Other organs contained low or undetectable levels of activity. The levels of TRH-like immunoreactivity (TRH-LI) in spinal cord segments were greatest in T3-T4 and lumbar L2-L6. Low concentrations were found in T1 and T9-T12. There was a partial correlation between the distribution of PPII activity and TRH receptors but not with TRH-LI levels. These results demonstrate that PPII is predominantly a central nervous system enzyme, and they support the hypothesis that PPII is responsible for degrading TRH released into the synaptic cleft.

[Lack of predictive power of cerebrospinal fluid calcitonin and serotonin concentrations for the intensity of postoperative pain and the duration of analgesia after subarachnoid morphine administration]

Based on the important relationship of calcitonin and serotonin with narcotic drugs at the level of the central nervous system and with the modulating mechanisms of pain sensation, we have studied whether central baseline levels of these modulators possess a predictive value for the assessment of the intensity and duration of narcotic spinal analgesia. Therefore, intradural levels of calcitonin an serotonin were measured in 18 patients who underwent and infraumbilical laparotomy with intradural anesthesia with bupivacaine associated with 0.5 mg of morphine. There was no statistically significant correlation between the levels of calcitonin and serotonin with the age, weight, height, sex, values of analogic visual scale 2, 4, 6, 12 and 24 hours after lumbar punction, and duration of the analgesia. Even though a correlation exists in experimental models, our results indicate that baseline values of modulators calcitonin and serotonin lack of predictive value for the assessment of the degree and duration of narcotic spinal analgesia.

[Gastric metastasis of renal cell adenocarcinoma]

Gastric metastases are rare, usually discovered at autopsy. The most frequent ones are breast and bronchial cancer, as well as malignant melanoma. The case of a patient with upper gastroenterological hemorrhage due to an ulcerated metastasis from a renal cell carcinoma is presented.

Fluid intake patterns in schizophrenia and normal controls

1. Patterns of fluid intake and urine output was examined in schizophrenia and normal controls. 2. Fluid intake and urine output were significantly higher in schizophrenic patients. 3. Bouts of drinking correlated significantly with fluid intake but did not differ significantly between schizophrenic patients and normal controls. 4. Schizophrenic patients drink more per bout compared to normal controls.

Negative symptoms: psychopathological models

The psychopathological manifestations of schizophrenia have been broadly divided into positive and negative symptom groups. Even though there is no definitive consensus, psychomotor agitation, motor excitement, hallucinations, delusions and thought disorder constitute positive and psychomotor retardation, amotivation, apathy and decreased emotional expression are grouped into negative symptoms. The negative symptoms have been reported to appear late in the course of the illness and resistant to treatment with neuroleptics. While these claims have not been substantiated, the current interest on negative symptoms is related to the fact that many nonfunctioning institutionalized as well as ambulatory schizophrenics manifest negative symptoms. As chronic psychiatric beds have become scarce, many patients with negative symptoms who were harbored in the chronic mental hospitals have been released to the community care and some of these patients live on the streets. Thus their visibility has challenged psychiatry to focus its efforts on the etiology and treatment of negative symptoms.

Incidence of type 1 (insulin-dependent) diabetes mellitus in subjects 0-14 years of age in the Comunidad of Madrid, Spain

A retrospective, population-based registry was established in the Comunidad of Madrid, Spain (total population: 4,780,572; under age 15: 1,105,243) to investigate the epidemiology of Type 1 (insulin-dependent) diabetes mellitus. Included were all cases diagnosed with diabetes between 1985 and 1988, with age onset less than 15 years, and using insulin at discharge from hospital. Using the capture-recapture method employing hospital records as the primary source and membership files of the Spanish Diabetic Association as the secondary source, the ascertainment was 90%. The overall annual incidence was estimated to be 11.3/100,000 (Poison 95% confidence interval: 10.3-12.4). There was no temporal increase in incidence, nor was there a significant sex difference in incidence rates, either overall or by year. The seasonal onset pattern showed the highest incidence in winter (December-February) and lowest in summer (June-August) (r = 7.36, p less than 0.05). The age-adjusted (world standard) incidence of 10.9/100,000 was inconsistent with the hypothesis of a north-south gradient in diabetes risk.

Familial hypertrophic cardiomyopathy and muscle carnitine deficiency

Five members of the same family, along three generations, presented with hypertrophic cardiomyopathy. Neurological examination, muscle strength, electromyography, and serum creatine kinase were normal. Skeletal muscle biopsy showed abnormal lipid accumulation and carnitine deficiency. In three patients the cardiac symptoms and echocardiographic findings improved after treatment with L-carnitine, 3-4 g daily, and a long-chain fatty-acid-free diet.

Nonuniform irradiation of the canine intestine. I. Effects

To investigate the effects of nonuniform irradiation on the small intestine, we prepared 24 dogs for continent isoperistaltic ileostomies under aseptic surgical conditions and general anesthesia. After a 3-week recovery period, the ileum was catheterized with a fiberoptic endoscope to observe the intestinal mucosa and to harvest mucosal biopsies. The baseline macroscopic and microscopic appearance of the intestinal mucosa was determined. Two weeks later, the ileum was catheterized with a 100-cm soft tube containing 40 groups of three thermoluminescent dosimeters placed at equally spaced intervals, and a dose of either 4.5, 8, 10, 11, or 15 Gy 60Co gamma rays was delivered to the right abdomen (nonuniform exposure). This method allowed a direct and precise assessment of the dose received at 40 sites located in the 100-cm intestinal segment. The intestinal mucosa was again evaluated 1, 4, and 6 days after irradiation. All animals exposed to 4.5 and 8 Gy survived, whereas none survived after 11 and 15 Gy. After exposure to 10 Gy, 60% of the animals died within 4-6 days and 40% survived with symptoms associated with both the intestinal and the hematopoietic syndromes. Crypt cell necrosis, blunting of villi, and reduction of the mucosal lining increased between 1 and 4 days after irradiation, and mucosal damage was correlated with intraintestinal dosimetry at Day 6. The granulocyte counts at Day 4 were significantly lower than baseline level in animals that died within 4-6 days but not in survivors. The present model appears to be realistic and clinically relevant, allowing the concurrent study of the intestinal and hematopoietic effects of high-dose nonuniform irradiation similar to that received by patients during radiation therapy as well as by radiation accident victims.

Modulation of luteinizing hormone secretion by estrogens in patients with Reifenstein's syndrome

The role of estrogens on gonadotropin secretion was assessed in two siblings with incomplete virilization syndrome type I due to partial androgen insensitivity (Reinfenstein's syndrome). Serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured before and after 100 micrograms LH-releasing hormone (RH) intravenous (IV) stimulation, as well as during long-term clomiphene citrate (CC) administration. Serum testosterone (T) and estrogens were determined before and during daily administration of human chronic gonadotropin (hCG) and also during the CC treatment. Basal levels of LH were elevated in both patients: 12.5 +/- 1.1 mIU in patient A and 19.8 +/- 1.8 mIU/ml in patient B. Conversely, FSH levels were within normal limits. Administration of LH-RH in both subjects induced a rise in LH levels, while FSH concentration showed no increase. The CC administration resulted in a significant (P less than 0.005) increment in serum LH levels without changes in FSH concentration. An important increase of serum T and estradiol (E2) levels was noted during CC administration; thus, in patient A those levels augmented from 20 to 48 ng/ml for T and from 78 to 220 pg/ml for E2; and patient B showed an increment from 20 to 35 ng/ml for T, and from 55 to 180 pg/ml for E2. The daily administration of hCG was followed by an increment in both T and E2 levels, which was of lesser degree for estrone concentration. These results suggest that endogenous estrogens, particularly E2, modulate LH secretion in patients with partial androgen insensitivity; however, it appears that estrogens had no physiologic effect on FSH secretion.

[Surgical evaluation of a liver transplant program. Experiences with the first 45 cases]

The cumulative experience in liver transplantation since the introduction of cyclosporine A has confirmed its efficacy in the treatment of diverse liver diseases in children and adults. In the present study we review the surgical aspects of 45 transplants performed in 39 patients (17 children and 22 adults). Immunosuppressive treatment consisted of cyclosporine A, steroids and monoclonal antibodies (OKT3) in rejection unresponsive to steroids. The actuarial survival rate one year after transplantation was 74%. In the course of development of the program, the elective use of veno-venous bypass during the anhepatic phase in adults was confirmed as useful. Among pediatric transplantations there were numerous arterial malformations (31.5%) in donor organs, which, with the malformations associated in receptors, made allograft reconstruction difficult. Our results confirm those reported by other groups, as well as the importance of specialized training for this type of intervention.

Limited eye movement patterns in chronic schizophrenic patients

Eye movements of 29 chronic schizophrenic patients and 23 normal control subjects were measured by an eye mark recorder during viewing of stationary geometric figures. The results suggested that the eye movements of schizophrenic patients were more limited than those of normal control subjects and that the abnormal eye movement inspection patterns in schizophrenic patients may reflect a lack of visual investigation of novel stimuli in the environment. Our findings, together with Moriya's (1979) observation of similar eye movement pattern abnormalities in the relatives of schizophrenic patients, support the hypothesis that the limited eye movement patterns may be a biological marker for schizophrenia.

[Aspects related to extraction and preservation in 60 cases of liver transplant]

Extraction and preservation are of special interest in any liver transplant program. The viability and correct early function of the graft are determinant factors of the success or failure of the transplant. Application of a restrictive criterion in the acceptance of donor livers has allowed us to achieve an optimal viability (96.7%) in our first 60 cases of liver transplant.

Increased urinary excretion of prostaglandin E in patients with idiopathic hypercalciuria

1. Because urinary prostaglandin excretion could play a role in idiopathic hypercalciuria (IH), we studied the excretion of prostaglandin E (PGE), calcium and sodium at various urine flows in 21 patients (14 males) with urolithiasis and IH, seven stone formers (five males) with normal calciuria and 20 controls (11 males). Dietary composition was comparable and sodium intake was restricted to 100-120 mmol/day. 2. Analyses were performed on 30 min urine collections obtained after overnight water deprivation and during water diuresis. Male IH patients had increased levels of urinary PGE at all ranges of urine flow. PGE excretion correlated directly with urine flow in patients and controls, but the slope of this relationship in individual IH male patients was steeper than in controls (P less than 0.01). Calciuria correlated directly with urine output in patients with IH but not in controls. Calcium and sodium excretion were directly correlated (P less than 0.0001) in patients and controls. There were no significant differences between absorptive IH (seven patients) and renal IH (eight patients). There were no significant differences between stone formers with normocalciuria and control subjects. 3. The findings suggest that increased urinary PGE could play a role in the hypercalciuria syndrome, possibly by promoting natriuresis.

The renal functional reserve in health and renal disease in school age children

The capacity to increase the glomerular filtration rate (GFR) in response to stimuli is a characteristic of the healthy kidney. To establish normal limits of this functional reserve is of clinical relevance because its loss may be the earliest indication of renal damage. For this purpose we have used a method applicable in clinical practice: one-hour clearances of creatinine (CCr) done under water diuresis, before (unstimulated) and two hours after (stimulated) a test meat meal, taking a single postmeal blood sample. Urine collection was done by voluntary voiding under direct supervision. In studies done in 14 control subjects, inulin clearance (CIn)/CCr ratios were (mean +/- SEM) 1.04 +/- 0.05 and 0.96 +/- 0.03, in unstimulated and stimulated clearances, respectively. In studies repeated at three to nine week intervals, we found a variation coefficient (mean +/- SEM) of 24.5 +/- 3.11% and 9.25 +/- 1.43% (P less than 0.001) for the unstimulated and stimulated CCr, respectively. The corresponding values for CIn were 19.3 +/- 2.36% and 9.17 +/- 1.19% (P less than 0.001), suggesting that stimulated GFR values are more stable. Unstimulated and stimulated GFR and renal functional reserve (stimulated CCr - unstimulated CCr) were studied in 260 school aged children, ages 6 to 16 years (140 boys and 120 girls). The distribution of the renal functional reserve was approximately Gaussian but the distribution of the urinary creatinine excretion, unstimulated and stimulated GFR had considerable positive skewness.(ABSTRACT TRUNCATED AT 250 WORDS)

Atypical hepatic tuberculosis presenting as obstructive jaundice

A 78-yr-old female with a short history of malaise, anorexia, mild pyrexia, and obstructive jaundice is presented. A diagnosis of tuberculosis of the liver and gallbladder was established at laparotomy. In spite of anti-tuberculous therapy, the patient died on the 5th postoperative day. Widespread miliary tuberculosis affecting the lung, kidneys, spleen, and mesenteric lymph nodes was observed in postmortem studies, with strikingly severe involvement of the intrahepatic bile ducts. Saccular dilatation of the bile ducts alternating with areas of stenosis and narrowed intrahepatic bile ducts was seen. A correlation of the radiological and hepatic postmortem findings is discussed. The atypical presentation of tuberculosis in present times and the causes of jaundice in atypical cases of hepatic tuberculosis are discussed. The rarity of gallbladder tuberculosis is pointed out.

Urinary prostaglandin E and kallikrein activity in glomerular hyperfiltration induced by a meat meal in man

Because renal vasodilator systems may be involved in the physiologic response to a protein meal, we studied the relationship of prostaglandin E (PGE) and kallikrein (KE) activity to the renal hemodynamic changes induced by a meat meal. Ten normal subjects on a maintenance diet providing 1 g protein per kg and 100 mmol Na daily were studied before and after a meal of 86 g of meat protein, once without medication, and again after treatment with indomethacin (150 mg daily for 3 days before and 50 mg the morning of the test). A carbohydrate meal of similar caloric, Na and K content was used in control studies. Glomerular filtration rate (GFR, inulin clearance), renal blood flow (RBF, para-aminohippurate [PAH] clearance), PGE and kallikrein urinary excretion were determined. All studies were performed during water diuresis to avoid bladder catheterization. The protein load induced an increase in GFR (ml/min, mean +/- s.e.m.: baseline 107.2 +/- 6.05, peak postmeal 146.4 +/- 6.79, p less than 0.01) and RBF (baseline 529.7 +/- 42.9, postmeal 678.9 +/- 61.9, p less than 0.05). Renal hemodynamic changes were unrelated to changes in urinary PGE and KE excretion. Indomethacin treatment inhibited PGE excretion by 73% during the test meal but did not modify the protein-induced hyperfiltration. Our results suggest that these renal vasodilator systems are not primarily responsible for the hyperfiltration response. In addition, the data show that inhibition of prostaglandin synthesis is not a practical approach to prevent glomerular hyperfiltration in clinical practice.

Exacerbation of psychosis after discontinuation of carbamazepine treatment

Carbamazepine alone or carbamazepine plus neuroleptic was administered to 20 chronic schizophrenic patients. Upon abrupt discontinuation two of the 20 patients had exacerbations of their psychoses characterized by paranoia, hostility, and agitation. The authors discuss the possibility of a carbamazepine withdrawal syndrome.

A carbamazepine trial in chronic, treatment-refractory schizophrenia

Carbamazepine was given to 12 chronic, treatment-refractory schizophrenic patients for 5 weeks. No overall change was found, but four patients significantly improved while eight worsened. Given the paucity of successful treatments for refractory schizophrenia, further study of carbamazepine appears warranted.

Neuroleptic-induced hypothermia associated with amelioration of psychosis in schizophrenia

Body temperature is a regulatory function of the hypothalamus. Recently, DeMet et al. (Society for Neuroscience Abstracts Vol 12, 1986) reported that apomorphine stimulation of dopamine autoreceptors caused a significant decrease in metabolic rate in the posterior heat-conserving area of the hypothalamus. The logical hypothesis to follow is that apomorphine administration should induce a decrement in body temperature; this in fact was demonstrated by Cutler et al. (Commun Psychopharmacol 3:375-382, 1979) in humans. It is well known that neuroleptics also disrupt thermoregulation (Clark: Neurosci Biobehav Rev 3:179-231, 1979) and affect dopamine autoreceptors. Therefore, eight chronic treatment-resistant schizophrenics underwent a 6-week single-blind trial of haloperidol and then a subsequent 6-week double-blind trial of clozapine. Both haloperidol and clozapine significantly lowered oral body temperatures relative to baseline washout temperatures. More interestingly, clozapine relative to haloperidol was found to induce a greater decrement in body temperature and was associated with greater clinical improvement. Possible confounding variables are discussed, as is the possible neurochemical basis for the amelioration of psychosis associated with hypothermia.

Special operative events in the first case of liver grafting after heart transplantation

Combined heart-liver transplantation is the only therapeutic possibility for patients with familial hypercholesterolemia IIa. A 12-year-old boy with this metabolopathy underwent a double transplant in two steps (different donors). This original alternative was chosen to assure a safer procedure in this critical situation. Details of intraoperative events are described. Cholesterol and LDL decreased to physiologic levels after liver transplantation. The child's condition is optimal 1.5 years after surgery.

Relationship between glomerular filtration rate and renal blood flow at different levels of protein-induced hyperfiltration in man

1. We studied the relationship between changes in glomerular filtration rate (GFR) determined as inulin clearance (CIn), and changes in renal blood flow (RBF), determined as p-aminohippurate clearance (CPAH), after the ingestion of a large (1.35 +/- SEM 0.04 g/kg, n = 9), moderate (1.08 +/- 0.03 g/kg, n = 10) or mild (0.55 +/- 0.02 g/kg, n = 8) protein load given as a meat meal. Control subjects (n = 10) received a carbohydrate meal. 2. CIn and CPAH increased after a protein meal. Two hours after eating the test meal, GFR levels were (mean +/- SEM) 160.0 +/- 13.8 (P less than 0.05), 141 +/- 7.69 and 127.8 +/- 9.07 ml/min in the groups that received a large, moderate and mild protein load, respectively. Peak CIn values after the meal were 211.6 +/- SEM 14.92 (P less than 0.001), 177.5 +/- 10.88 (P less than 0.01) and 129.0 +/- 8.72 ml/min after a large, moderate and mild protein load, respectively. 3. At peak GFR levels after the meal, filtration fraction (FF) (CIn X 100/CPAH) increased significantly (P less than 0.02) with the large and with the moderate protein load, but not with the mild protein load. 4. There was a significant (P less than 0.001) positive relationship between increments of FF and increments of CIn, but not CPAH, whether the values were expressed as post-meal/pre-meal ratios or as absolute changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Violent and nonviolent schizophrenic patients clinical and developmental characteristics

The purpose of the present study was to examine clinical and developmental indices of violent and nonviolent schizophrenic patients. Included in the study were 20 treatment-resistant male schizophrenic patients on fixed doses of neuroleptics; treatment-resistance was determined on the basis of documented failure to respond adequately to treatment with at least three drugs from two different neuroleptic classes. Comparisons of t tests yielded significant differences between the violent and nonviolent patients on the Lion's Violence subscales. Significant differences were also found on the Brief Psychiatric Rating Subscale: violent patients presented more pathologic clinical pictures, were rated higher on physical and motor manifestations of tension, reported more subjective stress, and appeared more hostile and belligerent. Analysis of the WAIS—R data showed that violent patients scored consistently higher on all performance subscales. Violent patients also had fewer prior hospitalizations and a more intact late adolescence. Research is needed to understand better the development and clinical course of violence in schizophrenic patients.

Correlation study between prolactin and androgens in male patients with systemic lupus erythematosus

The hypothalamic-pituitary-gonadal axis was studied in 8 male patients with systemic lupus erythematosus (SLE), both before and after intravenous administration of luteinizing hormone-releasing hormone (LH-RH). We provide evidence herein that resting serum levels of estrone are increased and that resting serum testosterone (T) and dihydrotestosterone (DHT) levels are decreased in male patients with SLE. The decreased serum T levels were observed even after the IV administration of 25 micrograms of LH-RH. The high basal serum prolactin (PRL) levels observed in these patients with SLE is a novel finding not previously reported that could explain why serum T and DHT levels are low in this syndrome. We observed a decrease in the pituitary response to LH-RH stimulation; this low response could also be a hormonal manifestation of hyperprolactinemia. Furthermore, it has been suggested that PRL plays a role in immunocompetence, and therefore it could have influence either directly or indirectly in the altered immunoregulation observed in SLE.

Evaluation of antihypertensive efficacy of lisinopril compared to metoprolol in moderate to severe hypertension

A double-blind controlled, randomized, parallel, multicenter 12-week study was conducted to compare the antihypertensive efficacy of lisinopril with that of metoprolol in treatment of moderate to severe hypertension. Initially, 118 patients were recruited on lisinopril and 61 on metoprolol; and for the purpose of efficacy analysis at week 8, 115 patients on lisinopril and 60 on metoprolol were included. The doses of lisinopril or metoprolol were 40-80 mg/day and 100-200 mg/day, respectively. At week 4, the pretreatment diastolic blood pressure of 111 mm Hg was decreased to 97 mm Hg (p less than 0.01) with lisinopril: metoprolol decreased the diastolic blood pressure from 110 to 99 mm Hg (p less than 0.01). Similar decreases were noted at week 8; however, the drop in blood pressure with lisinopril was not significantly different from that with metoprolol. Systolic blood pressure also demonstrated a decrease of about 18 mm Hg with lisinopril and 12 mm Hg with metoprolol (p less than 0.01). This larger decrease in systolic blood pressure with lisinopril was statistically significant at week 4 (p less than 0.05). These decreases in systolic blood pressures were maintained at week 8, again with statistical significance (p less than 0.01). Of the 118 lisinopril-treated patients, four were discontinued from lisinopril therapy because of headache, dizziness, rash, flushing, or lymphadenopathy. Four patients out of 61 (9.8%) were discontinued from metoprolol therapy because of fatigue, somnolence, asthenia, weight gain, flatulence, tremor, or bronchospasm. In conclusion, lisinopril 40-80 mg once daily is as effective as metoprolol 100-200 mg once daily in reducing diastolic blood pressure in patients with moderate to severe hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous attributions of heavy drinking by men and women who drink frequently or infrequently

This study compared spontaneous attributions of 38 frequent and 42 infrequent drinkers regarding the causes of alcohol abuse. Attributions of women involved fewer past events and more positive affect than men to explain why people drank excessively. Similar differences were found in the attributional patterns of frequent men and women drinkers. The results were discussed first in relation to previous attributional research in which a forced-choice format had been employed to infer causal ascriptions of problem drinking. The importance of differences in attributions in understanding the etiology of problem drinking in men and women was also discussed.

Normal ovarian function in a mild form of late-onset 3 beta-hydroxysteroid dehydrogenase deficiency

Late-onset 3 beta-hydroxysteroid dehydrogenase (HSD) deficiency was diagnosed in a 30-year-old woman with hirsutism and normal menstrual cycles. No genital abnormalities were present. Elevated basal serum levels of delta 5-3 beta-hydroxysteroids were demonstrated. Serum pregnenolone (P5) was 3.0 ng/ml, and dehydroepiandrosterone sulphate (DHEA-S) 3245 ng/ml. Basal serum levels of delta 4 steroids were low or within normal limits. Serum progesterone (P) was 0.5 ng/ml, 17 alpha-hydroxyprogesterone (17-OHP) 0.2 ng/ml, androstenedione (delta 4A) 0.4 ng/ml, and testosterone (T) 0.1 ng/ml. All delta 5/delta 4 steroid ratios were elevated. Dexamethasone (DEX) administration normalized the elevated levels of delta 5-3 beta-hydroxysteroids, whereas delta 4-3-ketometabolites exhibited only minor modifications. The DHEA-S/delta 4A ratio increased more than five times over the basal ratio, and P5/P and 17 alpha-hydroxypregnenolone (17-OHP5)/17-OHP ratios did not increase after adrenocorticotrophic hormone ACTH stimulation. Studies of basal ovarian function revealed 17 beta-estradiol (E2) and gonadotropins within normal limits according to the menstrual cycle. In the follicular phase, follicle-stimulating hormone (FSH) was 101.3 ng/ml, luteinizing hormone (LH) 46.0 ng/ml, and E2 49.7 pg/ml; in the luteal phase, FSH was 180.0 ng/ml, LH 69.3 ng/ml, and E2 50.1 pg/ml. The presence of ovulatory cycles was documented on the basis of the biphasic pattern of the basal body temperature cycles and the increment in P levels. This case demonstrates the existence of normal ovulatory function in a woman with late-onset of a mild form of HSD.