Hypothalamo-pituitary hypothyroidism detected by neonatal screening for congenital hypothyroidism using measurement of thyroid-stimulating hormone and thyroxine

The optimal strategy in neonatal screening for congenital hypothyroidism is still a subject of controversy. In Kanagawa Prefecture in Japan, simultaneous thyroid-stimulating hormone (TSH) and T4/fT4 determination has been used, while the results of our program may provide valuable information. Cumulative findings were analysed to determine the type and frequency of thyroid disorders in infants detected by simultaneous TSH and T4/fT4 determination, and the TSH and T4/fT4 screening strategy was validated. A total of 1284130 neonates were screened between October 1979 and September 1997 and infants followed because of low T4/fT4 without elevated TSH (T4 < 51.5 nmol/L or fT4 < 9 pmol/L and TSH < 15 mU/L) were retrospectively analysed. The first survey was carried out within 6 mo of birth and the second in 1998; 258 infants were diagnosed with congenital hypothyroidism at the first medical evaluation, 15 of them with hypothalamo-pituitary hypothyroidism. However, in the second survey, only 8 children were confirmed as having hypothalamo-pituitary hypothyroidism, therefore the incidence detected by the present strategy was 1/160516. Of 8 children with hypothalamo-pituitary hypothyroidism, mental retardation was prevented in 3 owing to early treatment.

CONCLUSIONS

Simultaneous measurement of TSH and T4/fT4 is a useful strategy for detecting hypothalamo-pituitary hypothyroidism, but more studies are needed to show the cost-benefits of using this strategy.

Measurements of cosmic-ray low-energy antiproton and proton spectra in a transient period of solar field reversal

The energy spectra of cosmic-ray low-energy antiprotons ( *p's) and protons ( p's) have been measured by BESS in 1999 and 2000, during a period covering reversal at the solar magnetic field. Based on these measurements, a sudden increase of the *p/p flux ratio following the solar magnetic field reversal was observed, and it generally agrees with a drift model of the solar modulation.

Pemphigus vulgaris associated with silicosis

Pemphigus vulgaris has never before been associated with silicosis, although there are many reports of silicosis accompanied by several autoimmune diseases such as progressive systemic sclerosis, systemic lupus erythematosus, dermatomyositis or rheumatoid arthritis. We observed a patient with pemphigus vulgaris accompanied with silicosis. The patient was a 75-year-old man with a 2-month history of repeated oral erosions and blisters on the back, thighs and axillas. Histological examination showed suprabasal cleavage with acantholysis. Immunoblotting analysis demonstrated binding of the patient's serum to the 130-kD pemphigus vulgaris antigen (desmoglein 3) and the 160-kD pemphigus foliaceus antigen (desmoglein 1). The patient has radiographically been diagnosed as having silicosis. An elevated serum IgG, antinuclear antibody, anti-ssDNA, antimicrosomal antibodies and a biologically false-positive reaction to the Wassermann test were also detected. Although the clinical symptoms improved after treatment with systemic steroids, the patient died due to pneumonia. This is the first reported case in which the characteristics of both pemphigus vulgaris and silicosis could be detected.

Recurrent annular erythema in a case of seronegative Sjögren's syndrome

We describe a case of Sjögren's syndrome who repeatedly developed annular erythema on her extremities. Her anti-nuclear antibody, anti-SSA/Ro antibody, and anti-SSB/La antibody were all negative. Characteristics of the annular erythema included a tendency to appear on the extremities especially in summer, spontaneous regression after 1-2 weeks, and residual slight pigmentation. The histological findings revealed dermal perivascular lymphocytic infiltration admixed with some neutrophils. Slight exsudative changes were found in the upper dermis. There were no epidermal changes. This case suggests the existence of annular erythema which may not be related to the anti-SSA/Ro or anti-SSB/La antibody. Unknown factors other than those antibodies may be involved in the pathogenesis of the annular erythema.

[Difference of blood cell counts with reference blood cell counters in different makers: Part II]

This is the second report of evaluation on the difference of blood cell counting among different automated blood cell counters in Japan. We tested reference blood cell counters of 6 different companies: Coulter, Sysmex, Bayer-Sankyo, Nihon Kohden, Horiba and Dainabot. Forty ml of whole blood were taken from 3 healthy persons and EDTA-2K anticoagulated blood samples (Sample 1, 2 and 3) were sent to each company to determine blood cell counts with a reference automated counter. As a result, the following items showed more than 10% difference among makers: RBC between Dainabot and Horiba in Sample 3, hematocrit values between Coulter and Dainabot in Sample 2, WBC between Nihon Kohden and each of three makers (Sysmex, Horiba and Dainabot) in all 3 samples and that between Bayer-Sankyo and each of two makers (Sysmex and Horiba) in Sample 3 and platelet count between Dainabot and each of 3 makers (Bayer-Sankyo, Nihon Kohden and Horiba) in all 3 samples. The following items showed difference between 5 and 10%: MCV between Coulter and each of two makers (Bayer-Sankyo and Horiba), WBC between each of two makers (Coulter and Nihon Kohden) and each of other 4 makers, and platelet count between each of two makers (Nihon Kohden and Horiba) and each of 3 makers (Coulter, Sysmex and Bayer-Sankyo). Recently Japanese Committee for Clinical Laboratory Standards proposed minimum clinical allowance of blood cell count as follows: hemoglobin 3%, RBC 4%, MCV 4%, WBC 7% and platelet count 10%. It is suggested that all of the items showing the difference more than above allowance among makers should be improved for clinical use to have good external quality control in blood cell counting by automated instruments.

Chromosomal studies on 934 induced abortuses of middle-aged pregnant women

A total of 934 induced abortuses of middle-aged pregnant women (35-48 years old) were chromosomally surveyed. The mean gestational age was 7.6 +/- 2.0 (S.D.) weeks after the first day of the last menstrual period, and the mean maternal age was 39.6 +/- 2.7 (S.D.) years. There was a high incidence of chromosomally abnormal fetuses in induced abortions, which markedly increased with the advancing age of the women: 9.6% (40/418) for the 35-39-year-old age group, 20.7% (100/484) for the 40-44-year-old age group, and 43.8% (14/32) for the 45-48-year-old age group, averaging 16.5%.

Mineral contents in model diet samples for different age groups

Model diet samples of eight groups (3, 16, 40, and 70 years old for both sexes), were analyzed for sodium, potassium, phosphorus, calcium, magnesium, iron, zinc, manganese, aluminum, copper, barium, nickel and molybdenum by using inductively-coupled plasma atomic-emission spectrometry (ICP-AES). Mineral intakes for 3 year olds were lower than those of other age groups because total food consumption was less. The intake of major elements, Na, K, P, Ca, and Mg, varied within about 20% of each other. The intake of other elements except aluminum fluctuated within 30% or more of each other. For most of the elements studied, the mineral intakes of 40-year-old males agreed within 16% with results previously obtained by a duplicated portion study.

Effect of an aldose reductase inhibitor, CT-112, on healing of the corneal epithelium in galactose-fed rats

The effect of an aldose reductase inhibitor, CT-112 (5-(3-ethoxy-4-pentyloxyphenyl)2,4-thiazolidinedione), ophthalmic solution on wound healing in the corneal epithelium of rats fed on 50% galactose diet was investigated in correlation with CT-112 concentration. Rats were divided into 6 groups and those in 5 groups were fed on 50% galactose diet and 10 microliter of 0.1, 0.25, 0.5 and 1% CT-112 ophthalmic solutions or of their vehicle were instilled into both eyes 4 times a day. The animals in the remaining one group were fed on the regular diet and no treatment was given. After 18 days, the whole corneal epithelium was scraped off and the rate of reepithelialization was investigated over a 4-day period. Reepithelialization was delayed in galactosemic rats, but the instillation of CT-112 ophthalmic solutions improved the wound healing, although no differences in efficacy was found at the concentrations used. Moreover, the appearances of the cornea at 4 days after epithelial scraping were improved dose-dependently by the instillation of CT-112.

Enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone in dried blood spotted on filter paper

In this rapid, cost-effective, enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone (17-OHP) eluted from dried blood spotted on filter paper, second antibody is coated onto the microwell plate and horseradish peroxidase (EC 1.11.1.7) is the label enzyme. Antiserum to 17-OHP was prepared by using 4-(2-carboxymethylthio)-17-OHP-bovine serum albumin conjugate as immunogen. Enzyme conjugate was prepared from 4-(2-carboxymethylthio)-17-OHP and peroxidase. The blood spots are assayed in the microwells without extraction or centrifugation steps. The detection limit of the assay is 1 microgram/L, equivalent to 3.5 pg (10.6 fmol) per disc. Intra- and interassay CVs at two steroid concentrations (7.38 and 22.79 micrograms/L) ranged from 3.74 to 11.90% (n = 5), and 9.49 and 9.83% (n = 5), respectively. Results correlated well (r = 0.91) with those of a fluorescence enzyme immunoassay. The sensitivity, specificity, and precision of this method make it potentially useful in the mass screening of neonates for congenital adrenal hyperplasia.

Enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone in dried blood spotted on filter paper

In this rapid, cost-effective, enzyme-linked immunosorbent assay for 17 alpha-hydroxyprogesterone (17-OHP) eluted from dried blood spotted on filter paper, second antibody is coated onto the microwell plate and horseradish peroxidase (EC 1.11.1.7) is the label enzyme. Antiserum to 17-OHP was prepared by using 4-(2-carboxymethylthio)-17-OHP-bovine serum albumin conjugate as immunogen. Enzyme conjugate was prepared from 4-(2-carboxymethylthio)-17-OHP and peroxidase. The blood spots are assayed in the microwells without extraction or centrifugation steps. The detection limit of the assay is 1 microgram/L, equivalent to 3.5 pg (10.6 fmol) per disc. Intra- and interassay CVs at two steroid concentrations (7.38 and 22.79 micrograms/L) ranged from 3.74 to 11.90% (n = 5), and 9.49 and 9.83% (n = 5), respectively. Results correlated well (r = 0.91) with those of a fluorescence enzyme immunoassay. The sensitivity, specificity, and precision of this method make it potentially useful in the mass screening of neonates for congenital adrenal hyperplasia.

[2 cases simulating Tolosa-Hunt syndrome]

The Tolosa-Hunt syndrome is characterized by recurrent unilateral painful ophthalmoplegia which responds to systemic steroid therapy dramatically. The etiology appears to be a non-specific inflammation in the cavernous sinus and the superior orbital fissure. Two interesting cases similar to this syndrome are described. One is a 54-year-old man with moderate left exophthalmos who had no complaint of retro-orbital pain. CT scan demonstrated the left orbital tumor, and the orbital decompression surgery was performed. The white-yellowish tumor was found extending the orbit through the superior orbital fissure into the cavernous sinus. Histological examination revealed non-specific inflammatory granuloma. Despite the unusual clinical symptoms, the etiology of this case appeared to be identical with the Tolosa-Hunt syndrome. The other case is a 16-year-old girl who had a 2 years' history of recurrent left retro-orbital pain and the complete IIIrd nerve palsy. CT scan demonstrated a small enhancing lesion in the cavernous sinus. Corticosteroid treatment improved her IIIrd nerve palsy within 2 days, however the CT scan after the treatment revealed no change of the lesion size. Left frontotemporal craniotomy was performed and the whitish tumor in the cavernous sinus was partially removed. Histological examination revealed that the tumor was typical meningioma with whorl-formation. The anatomical structure of the cavernous sinus is so complicated that the diseases arising from this area show quite different appearances. For the differential diagnosis of these lesions, the carotid angiography and the cavernous sinus venography were said to be useful.(ABSTRACT TRUNCATED AT 250 WORDS)