Poor Progress in Breast Cancer Control in the Elderly in the UK

Background:In 1998 England introduced a national cancer target, to reduce cancer mortality in the under 75 year olds from 1996 to 2010 by 20%. This might potentially lead to inequalities between younger and elderly cancer patients. In this study we assessed progress in breast cancer control in the elderly in the UK by comparing cancer mortality rates in the elderly with younger age groups in the UK and by comparing the elderly in the UK with other similar countries.Material and Methods:Mortality data for the UK, USA, Northern Europe (Denmark, Finland, Iceland, Sweden and Norway) and Western Europe (Germany, Netherlands, Luxembourg, Austria, France Switzerland) was obtained from the WHO mortality database. Age specific cancer mortality rates for the age bands 55-64, 65-74, 75-84 and 85 plus were calculated for the different geographies for the three year periods 1995-97 and 2003-05. Change in the differences between the age bands was assessed as the ratio between the youngest age group 55-64, which was set to 1, and the older age groups. The number of excess deaths in the UK was calculated by applying the lowest rate observed in each age band to the UK population, assuming that the UK could achieve the same rate.Results:Compared to other countries the UK had the highest breast cancer mortality rates in all age bands in 1995-07 and 2003-05 and rates were statistically significantly higher in 2003-05 at the 95% Confidence interval limit. In the younger age groups (55-64 and 65-74) the UK had the biggest decrease from 1995-97 to 2003-05 and is decreasing the gap to the other countries. In contrast the UK was the only geography with an increase in mortality rates in the over 85 year olds and only ranked second after the USA in the 75 to 84 year olds. If the UK had the same mortality rates as the lowest observed in each age band 681 breast cancer deaths could be prevented in the 55 to 74 year olds and 1590 in the over 75 year olds each year. The UK also had the greatest increase in the ratio between the 55-64 year olds and 85plus year olds, with and increase of a 100% from 3.5 to 4.5 from 1995-97 to 2003-05. The USA had the lowest rates in each age group.Conclusion:Little progress has been made in decreasing breast cancer mortality rates in the elderly in the UK. The gap in breast cancer mortality in the elderly compared to the younger age groups as well as the other countries is increasing. The gap with other countries will be closed only if there is a marked decrease in death rates in the over 75s. Future analysis should also look at the causes of higher mortality in the UK, taking the USA as the gold standard.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2059.

Genetics of Intermediate Phenotypes in Suicidal Behavor - Focus on Aggression

Family and twin studies point towards a partial heritability of suicidal behavior. We investigated the role of a comprehensive set of genes in this behavior. Their selection was driven by results from post mortem and genetic studies. 250 suicide attempters with various psychiatric disorders were compared with 2200 volunteers which were randomly selected from the general population. All subjects were administered standard psychiatric interviews including SCID as well as self-report questionnaires for anger-related traits. Especially, aggressive-impulsive behavior has been studied and associations with these intermediate phenotypes will be presented.

Additionally a large-scale gene expression analysis using cDNA-microarrays to identify new candidate-genes for suicide was conducted. We found several genes to be differentially expressed in the orbitofrontal cortex of suicide completers. Cross-validation experiments using quantitative RT-PCR validated a few genes so far. These genes have been genotyped in our patients and controls and associations with suicidal behavior and intermediate phenotypes, like aggression and impulsivity will be presented.

Effect of 3T MRI on the function of shunt valves—Evaluation of Paedi GAV, Dual Switch and proGAV

The MR-compatibility of medical implants and devices becomes more and more important with the increasing number of high-field MR-scanners employed. Until the end of 2004, about twenty 3T MR in Germany will be in clinical practice. Patients with hydrocephalus need frequent follow-up MR-examinations to assure correct functioning of a shunt. We tested three types of gravitational valves: the Paedi GAV, the Dual Switch and as a new programmable valve the proGAV (Miethke Company, Berlin), that have not been evaluated at 3T, yet. In sum, there is strong evidence for maintenance of function of these valves after exposure to 3T. This also implies the programmable valve, as long as the brake mechanism is properly adjusted during MR-examination.

Ouabain as a mammalian hormone

Endogenous ouabain changes rapidly in humans and dogs upon physical exercise and is under the control of epinephrine and angiotensin II. Hence, the steroid acts as a rapidly acting hormone. A search for a specific binding globulin for cardiac glycosides in bovine plasma resulted in the identification of the d allotype of the micro chain of IgM whose hydrophobic surfaces interact with cardiotonic steroids and cholesterol. Such IgM complexes might be involved in the hepatic elimination of cardiotonic steroids. Thus, differences in the signaling cascade starting at Na(+),K(+)-ATPase must explain any differences in the action of ouabain and digoxin in the genesis of arterial hypertension.

An example on the value of non-randomisation in clinical trials in complementary medicine

BACKGROUND

Randomised clinical trials may in principle show a small external validity. Non-randomised clinical trials therefore are sometimes regarded as an appropriate alternative when complementary and conventional treatments are compared.

OBJECTIVES

To assess the value of advanced statistical methods in the process of estimating differences between a complementary and a conventional treatment of acute sinusitis in a non-randomised clinical trial.

METHODS

Multicentre, non-randomised, controlled clinical trial comparing 2 complementary and 3 conventional ENT centres. Patients were free to choose the physician (and hence the therapy). Treatment differences were estimated by controlling for confounders in analyses of covariance or by propensity score techniques.

RESULTS

Most potential confounders (sex, age, life-style parameters) did not have significant effects on the choice of therapy. Disease severity and previous ENT surgery were the main confounding factors. At study onset they almost cause a defined separation of both treatment groups. As a result estimated treatment differences vary substantially depending on the chosen statistical model.

CONCLUSIONS

When comparing complementary and conventional treatments, non-randomised clinical trials may be misleading. Results may be strongly biased even when advanced statistical methods are used. Trials of complex statistical designs are needed to give valid results.

A non-randomised pilot study to compare complementary and conventional treatments of acute sinusitis

BACKGROUND

It is still under discussion whether antibiotics are effective in the treatment of acute sinusitis. Moreover, they are known to have considerable side-effects. In contrast, complementary approaches are reported to have little side-effects and an equivalent efficiency.

OBJECTIVES

To assess the success of conventional and complementary treatments of acute sinusitis and to estimate the patient numbers needed to confirm therapeutic equivalence. Treatment success was measured by three different scores, assessed by both patients and physicians.

METHODS

Multicentre (2 complementary and 3 conventional ENT centres), non-randomised, controlled clinical trial with 63 patients (complementary group 30, conventional group 33 patients). To control for confounders treatment differences were estimated by propensity score techniques.

TREATMENTS

The choice of medication was entirely left to the physician. We recommended to use antibiotics, secretolytics and symptomimetics in the conventional group and a combination of the herbal remedy Sinupret((R)) and the homeopathic remedy Cinnabaris 3X in the complementary group.

RESULTS

Treatment differences varied substantially depending on the outcome measure, but they were always not clinically relevant. Conventional treatment was slightly better when the outcome was assessed by the physicians (1.8 score points) but slightly worse when it was assessed by patients (0.2 score points) or in terms of the HCG-5 quality of life score (0.8 score points). p values were always > 0.3.

CONCLUSIONS

Both treatments appear to be equally effective (or ineffective). Results might be biased because both treatment groups differed substantially. Randomised trials including at least 400 patients are needed to produce valid results.

Physical fitness influences water turnover and body water changes during trekking

PURPOSE

This study was performed to assess water turnover and changes of body water during a trekking tour at moderate altitude.

METHODS

Fifteen healthy normally trained adults participated in a 7-d backpack trek tour in the Swiss Alps (total walking distance: 120.5 km; cumulated altitude difference: 6990 m (uphill) and 7550 m downhill; lowest point: 1285 m; highest point: 3317 m). Total body water and water turnover were measured using deuterium dilution and elimination (oral load of 0.33 g 99.8% D2O per kg body weight, overnight equilibration period, pre- and postdose saliva samples immediately before and after sleep, analysis of D2O concentrations in saliva using Fourier-transform infrared spectroscopy, CV < 1%). Physical training state was assessed after the tour using the lactate-exercise intensity relationship obtained by performing 50-W increments every 3 min on a cycle ergometer.

RESULTS

Body water decreased from the evening of day 0 to the evening of day 4 (from 45.3 +/- 7.3 L to 43.4 +/- 7.6 L, P < 0.05), and did not significantly decrease (43.5 +/- 7.9 L) until the evening of day 5 (maximum of trekking exercise intensity). Mean daily water turnover was 5.7 +/- 1.8 L x d(-1) corresponding to 78.7 +/- 17.5 mL x kg(-1) x d(-1). Body water changes and water turnover were significantly related to the exercise intensity obtained at the lactate threshold as well as at the level of 4 mM lactate.

CONCLUSIONS

This correlation may be in part explained by differing glycogen content of muscle tissue.

Evaluation of myelination and myelination disorders with turbo inversion recovery magnetic resonance imaging

The aim of our work was to determine the efficacy of turbo inversion recovery spin echo (TIRSE) pulse sequences in differentiating patients with normal and abnormal myelination. Twenty neurological normal children (aged 5 months to 12 years) as well as 65 children presenting clinically with neurologic developmental deficits (aged 2 months to 10 years) were examined using TIRSE, T1-weighted SE, and T2-weighted turbo SE pulse sequences. Contrast-to-noise-ratio (CNR) between myelinated white and gray matter was compared for the different pulse sequences. In addition, two readers analyzed all images qualitatively by consensus. The CNR values were significantly higher on TIRSE images as compared with conventional images (p < 0. 05). Forty-two neurologically abnormal patients displayed a normal myelination on all sequences, whereas 23 showed an abnormal myelination. The TIRSE sequence provided a sensitive and specific depiction of an abnormal myelination in all of these patients. The TIRSE sequence provided additional information to conventional pulse sequences in determining myelination disorders in children, especially in children older than 2 years.

[Homeopathic treatment of adenoid vegetations. Results of a prospective, randomized double-blind study]

In a monocenter prospective randomized double-blind clinical trial the efficacy of homeopathic treatment was investigated on children with adenoid vegetations justifying an operation. Patients were treated with either homeopathic remedies such as Nux vomica D200, Okoubaka D3, Tuberculinum D200, Barium jodatum D4 and Barium jodatum D6 or with placebo. The duration of the study for each patient was 3 months. Examination of the ears using a microscope, rhinoscopy, stomatoscopy and pharyngoscopy, as well as tympanometry and audiometry were performed after 4, 8 and 12 weeks. Out of a total of 97 children studied between the ages of 4 to 10 years 82 could be analyzed. At the end of the study no operation was required in 70.7% of the placebo-treated children and in 78.1% of the children treated with homeopathic preparations. These results show no statistical significance.

The homoeopathic treatment of otitis media in children--comparisons with conventional therapy

In a prospective observational study carried out by 1 homoeopathic and 4 conventional ENT practitioners, the 2 methods of treating acute pediatric otitis media were compared. Group A received treatment with homoeopathic single remedies (Aconitum napellus, Apis mellifica, Belladonna, Capsicum, Chamomilla, Kalium bichromicum, Lachesis, Lycopodium, Mercurius solubilis, Okoubaka, Pulsatilla, Silicea), whereas group B received nasal drops, antibiotics, secretolytics and/or antipyretics. The main outcome measures were duration of pain, duration of fever, and the number of recurrences after 1 year, whereby alpha < 0.05 was taken as significance level. The secondary measures were improvement after 3 hours, results of audiometry and tympanometry, and necessity for additional therapy. These parameters were only considered descriptively. The study involved 103 children in group A and 28 children in group B, aged between 6 months and 11 years in both groups. For duration of pain, the median was 2 days in group A and 3 days in group B. For duration of therapy, the median was 4 days in group A and 10 days in group B: this is due to the fact that antibiotics are usually administered over a period of 8-10 days, whereas homoeopathics can be discontinued at an earlier stage once healing has started. Of the children treated, 70.7% were free of recurrence within a year in group A and 29.3% were found to have a maximum of 3 recurrences. In group B, 56.5% were free of recurrence, and 43.5% had a maximum of 6 recurrences. Out of the 103 children in group A, 5 subsequently received antibiotics, though homoeopathic treatment was carried through to the healing stage in the remaining 98. No permanent sequels were observed in either group.

[Acute otitis media in children. Comparison between conventional and homeopathic therapy]

Within a prospective group study of five practicing otorhinolaryngologists, conventional therapy of acute otitis media in children was compared with homeopathic treatments. Group A (103 children) was primarily treated with homeopathic single remedies (Aconitum napellus, Apis mellifica, Belladonna, Capsicum, Chamomilla, Kalium bichromicum, Lachesis, Lycopodium, Mercurius solubilis, Okoubaka, Pulsatilla, Silicea). Group B (28 children) was treated by decongestant nose-drops, antibiotics, secretolytics and/or antipyretics. Comparisons were done by symptoms, physical findings, duration of therapy and number of relapses. The children of the study were between 1 and 11 years of age. The difference in numbers was explained by the children with otitis media being primarily treated by pediatricians using conventional methods. The median duration of pain in group A was 2 days and in group B 3 days. Median therapy in group A lasted 4 days and in group B 10 days. Antibiotics were given over a period of 8-10 days, while homeopathic treatments were stopped after healing. In group A 70.7% of the patients were free of relapses within 1 years and 29.3% had a maximum of three relapses. Group B had 56.5% without relapses and 43.5% a maximum of six relapses. Five children in group A were given antibiotics and 98 responded solely to homeopathic treatments. No side effects of treatment were found in either group.

Water turnover and body composition during long-term exposure to high altitude (4,900-7,600 m)

Thirteen healthy subjects (11 men and 2 women; 30.2 +/- 5.4 yr; 73.5 +/- 10.3 kg; 178.9 +/- 10.4 cm; body mass index, 22.9 +/- 1.6 kg/m2) participated at the 62-day expedition to the Broad Peak (8,047 m), Pakistan. Weight, body water, and water turnover (deuterium dilution and elimination) were measured eight times to assess long-term changes. Body weight fell during the ascent to the base camp [from 73.2 +/- 9.8 (baseline) to 71.7 +/- 9.7 kg; P < 0.05] and decreased until the end of the base camp stay (66.7 +/- 7.2 kg; P < 0.0001). Body compartments changed at different rates. Total body water decreased during the ascent (from 43.1 +/- 7.3 to 41.0 +/- 7.7 liters; P < 0.05) and remained unchanged until the base camp was reached (41.2 +/- 6.9 liters; P < 0.01) but decreased further during the base camp stay (40.6 +/- 5.2 liters). Water content of the body (total body water-to-body weight ratio) fell during the ascent (from 58.6 +/- 3.4 to 55.8 +/- 4.4%; P < 0.01), approached the baseline value during the base camp (57.4 +/- 4.0 and 58.3 +/- 5.1%), and increased again until the end of the base camp (60.6 +/- 3.4 and 60.9 +/- 4.3%). The compartment of the solids increased during the ascent (from 30.2 +/- 3.4 to 32.2 +/- 4.9 kg; P < 0.01) and approached the baseline value on arrival at the base camp (30.5 +/- 4.7 kg). Until the end of the base camp, the compartment of the solids fell (26.9 +/- 2.6 and 26.1 +/- 4.0 kg), indicating that weight loss was due to a loss of body solids, presumably mostly fat mass. Water turnover during the pretest period (sea level) was 45 +/- 7 ml.kg-1.day-1; it increased during the ascent (56 +/- 11 and 60 +/- 10 ml.kg-1.day-1) but remained constant during the base camp stay (63 +/- 12, 58 +/- 9, and 56 +/- 10 ml.kg-1.day-1). It increased during the ascent to Broad Peak (73 +/- 20 ml.kg-1.day-1; P < 0.05) and even more during the descent to civilization (83 +/- 17 ml.kg-1.day-1; P < 0.05).

Fourier transform infrared spectroscopy measures 1H/2H ratios of native water with a precision comparable to that of isotope ratio mass spectrometry

A fast and easy method is described which uses Fourier transform infrared spectroscopy (FT-IR) to measure the 1H/2H ratio of aqueous samples of less than 100 microliters with high precision (+/- 0.2-0.5% in the range of 89 to 2680 microliters/l). Using a thermostat-controlled CaF2 cell, low resolution absorption specta (8 cm-1) are measured. The integral of absorption in the range of 2600 and 2460 cm-1 (O2H vibration) is used to analyse the 2H content of the sample. For measurements at low enrichment five standards are used (SLAP: 89.00 microliters/l, GISP: 126.3 microliters/l, V-SMOW: 156.0 microliters/l, all from the International Atomic Energy Agency, Vienna, Austria, standard 1: 183.3 microliters/l, standard 2: 222.5 microliters/l, both prepared by weighing and controlled by isotope ratio mass spectrometry (IR-MS)). For measurements at high enrichment three standards are used (standard 2: 222.5 microliters/l, standard 3: 1323 microliters/l, standard 4: 2680 microliters/l, all prepared by weighing and controlled by IR-MS). Measured and reported 2H concentrations coincide very well, two samples for quality control (145 and 1612 microliters/l) were measured with a precision of 0.3 and 0.4% corresponding to +/- 0.5 and 5.9 microliters/l.

Water turnover of healthy children measured by deuterated water elimination

For healthy children up to 15 years of age, no data exist regarding water turnover as directly measured using stable isotope techniques. Water turnover was measured in 171 healthy children (88 girls, 83 boys, age: 6 weeks-15 years) whilst living in their normal environment. Water turnover was calculated from the equilibrium of 2H2O concentration reached in the urine 2-3 h after an oral test load of 2 ml 2H2O/kg and the subsequent elimination rate of 2H2O. Daily water turnover decreased from 160 ml/kg (3 months), 100 ml/kg (12 months), 65 ml/kg (3 years) to 40 ml/kg at 15 years of age. Fluid intake was then calculated by subtracting the estimated metabolic water production from water turnover and this data was compared with recommended values. Our calculation of spontaneous daily fluid intake for these healthy children is within the recommended range during the 1st year of life, whereas for older children the recommendations exceed the spontaneous intake by a factor of 1.2-2.

Measurement of water turnover using a stable isotope technique: calculation of error propagation

Water turnover may be determined with stable isotope techniques from the product of tracer dilution space and tracer elimination rate. Tracer concentrations must be measured in two body fluid samples which are separated by a sampling interval. The tracer concentration of the first sample may be charged with an error which may be due to analytical errors, incomplete tracer dilution or because the necessary steady-state assumption (water influx equals water efflux) is violated at the moment of tracer loading. Error propagation shows that the influence of this error on the estimation of water turnover is partially compensated for. The goodness of compensation depends on the sampling interval and on the magnitude of the error of the first sample. The error is best compensated using sampling intervals of 1.5 tracer half life.

Androgen receptors in prostatic tissue: evaluation of systematic errors and comparison of three procedures to correct for nonspecific binding sites in the binding assays

In androgen receptor analysis, nonspecific binding can distort the measurement of the binding constants of the receptor ligand complex. We evaluate this influence with a one-ligand two-binding sites model. The binding constants correspond to those of androgen receptors in prostatic tissue. Three procedures which correct for the influence of nonspecific binding sites are compared: difference of bound radioligands measured in both assays (assay 1: only radioligand, assay 2: additional unlabelled ligand in excess), nonlinear regression, and difference of bound radioligands corrected by the ratio of the free radioligands. The subtraction of bound radioligands causes considerable errors in the estimation of the total concentration of receptor binding sites. Nonlinear regression yields the correct result when the influence of nonspecific binding is moderate. The corrected difference of bound ligand gives the correct results even in the range where nonlinear regression fails. We conclude that the latter method corrects for the influence of nonspecific binding as effectively as nonlinear regression and suggest that the free fraction of radioligand should be measured and not discarded, as it is common in the clinical practice.

[Short-term infusion therapy in childhood. A comparison of individually mixed with commercial infusion solutions]

Data of parenteral sodium dosage in healthy children recommended by several textbooks vary by the factor 4. Therefore, we studied the effect of low and high i.v. dosage administered in 5-5.5% glucose for 12 hrs to probands without renal disease. Group 1: n = 13; Na 2.2 +/- 0.4, K 1.7 +/- 0.2, Cl 4.2 +/- 0.6 mmol/kg/d, individually composed solutions. Group 2: n = 17; Na 5.1 +/- 1.3, K 1.6 +/- 0.5, Cl 5.8 +/- 1.5, acetate 2.4 +/- 0.6 mmol/kg/d; Ca, Mg, malate, glycerol phosphate below 0.3 mmol/kg/d; commercial ready-for-use mixtures. Compared to the control period, the excretion of Na into the urine was unchanged in group 1 during the infusion but significantly lowered in group 2. Regression analysis reveals that infusion of 2.7 mmol Na/kg/d would have given a balanced sodium balance. The real parenteral requirement, however, may be below this value, as the excretion of Na during the control period indicates that the probands in both groups were overloaded with Na before the beginning of the study. During infusion, the renal clearance of creatinine was unchanged in group 1 but significantly lowered in group 2 (131 +/- 58 vs. 94 +/- 38 ml/min/1.73 m2; p less than 0.01). We would like to recommend to elucidate the mechanism and the clinical significance of this effect before using the commercial solution in clinical routine.

Seasonal and diurnal changes of prostatic androgen receptor and circulating testosterone in young mature rats

Low- and high-salt (600 mM KCl) extractable androgen receptors were measured in the ventral prostate lobes of 70-day-old rats which were housed in constant environmental conditions (22 +/- 2 degrees C, 65 +/- 5% air humidity, light 6.00h-18.00h). Seasonal variations were observed during 2 years, exhibiting elevations in late summer and autumn and depressions in late winter and spring time. These fluctuations were superposed by steep changes from month to month. The maximum and minimum values of the low- and high-salt extractable receptors differed within 1 year by a factor 8.5 and 2.4, respectively. Both receptor fractions showed a diurnal rhythm as measured during 1 day in January with maximal concentrations at 9.00 h (low-salt: median = 1308 fmol/mg DNA) and minimal values at 18.00 (424) and 24.00 (230). The electrophoretic mobility in agar gel of pH 8.2 also showed a diurnal variation with maximal values at 18.00 h in either receptor fraction. Neither the seasonal nor the diurnal variations were correlated to the corresponding rhythms of serum testosterone concentrations. As steroid receptors may be regulated by neural transmission, in a final experiment the parasympathic innervation of the prostate was blocked by infiltrating the plexus pelvicus with a local anesthetic drug. One hour later, the total receptor concentration was not changed, while the ratio of low- to high-salt extractable receptors and the electrophoretic mobility of both fractions were elevated as compared to the control animals. This finding indicates that peripheral neural transmission rather than circulating testosterone may be involved in the regulation of androgen receptors in rat ventral prostate.

Measurement of D2O concentrations at tracer levels in small samples obtained from paediatric patients

A micro-method is described for the determination of trace amounts of D2O in serum, saliva and urine, requiring 100 microliters of sample. H2O/D2O are rapidly isolated from serum, saliva or urine by vacuum distillation. D2O concentrations in H2O are detected by infrared spectroscopy utilizing the integrated absorption of the OD-bond at 2510 cm-1 in the range of 2675 to 2460 cm-1. Calibration is done using standard solutions of H2O/D2O. The separation of D2O/H2O is necessary because of the varying background absorption of the sample. The recovery of D2O after distillation is 100%. The absolute error is 25 mg/kg (+/- 2 s) of D2O leading to a precision of 17.5% at 150, 2.8% at 1000, 1.3% at 2000, 0.9% at 3000, 0.7% at 4000 and 0.5% at 5000 mg/kg of D2O. The usefulness of the method is evaluated by 9 determinations of total body water and water turnover in 7 healthy subjects drinking a mixture of H2O/D2O. Total body water related to body surface is 23.3 +/- 0.9 l/m2 in males and 20.5 +/- 1.5 l/m2 in females. Water turnover is determined by analysing the decrease of D2O concentrations in blood between 6 and 31 days. A mean of 1.53 +/- 0.13 l/m2.d in males in 1.48 +/- 0.17 l/m2.d in females was found.

[Pentoxyverine poisoning via maternal milk in a fully breast-fed newborn infant]

A four-week-old male infant who had been exclusively breast-fed by his mother developed acute respiratory failure with intermittent arrest of breathing for up to 15 sec, in between sighing breaths and normal ones. For two weeks his mother had been taking pentoxyverine-containing cough drops for an upper respiratory tract infection. Pentoxyverine was demonstrated in maternal serum and breast milk, as well as the child's serum and urine, in some in very high concentrations. The course of the illness and comparison with reported instances of pentoxyverine poisoning in infants makes it likely that this, too, was such a case.

Receptor analysis: an arithmetic correction improves precision and accuracy

Data of receptor analysis by ligand binding experiments should be processed using the formula DCORR = (B1 - B2.F1/F2)/VS.DCORR is an estimate of the concentration of receptor-bound radioligand; B1 and F1 are estimates of bound and free radioligand in assay 1; B2 and F2 are the corresponding values obtained from the parallel assay 2, which contains an additional excess of nonlabeled ligand; VS is the volume of assays 1 and 2 that was submitted to separation. DCORR will be superior to the conventional formula, D = (B1 - B2)/VS, if the radiolabeled receptor-ligand complexes are incompletely separated from nonspecifically bound and free radioligands. DCORR corrects for the systematic underestimation of the specifically bound radioligand implicated in D as well as for random errors due to imprecise pipetting during preparation of the parallel assays. The superiority of DCORR over D is verified by processing the data of androgen receptor analyses using agar gel electrophoresis for separation of bound and free radioligand.

[Diagnosis and therapy of hyponatremic syndromes]

Hyponatremia is the most common abnormality in electrolyte and water metabolism. In adult patients it is related to high morbidity and mortality. The degree of CNS-damage depends 1st on the absolute serum sodium concentration (NaS) and 2nd on the rapidity with which NaS is lowered. The most frequent etiology of hyponatremia in pediatric patients is dilutional hyponatremia (SIADH, infusion-therapy). Nephrotic syndromes and congestive heart insufficiency associated with cardiac low output are further causes. Being aware of the different pathophysiological mechanism prevention of hyponatremia is easily achieved by monitoring serum electrolytes, water balance and compensating renal factors in critically ill patients. Hyponatremias accompanied by neurological symptoms should be corrected by rapid infusion of hypertonic saline (514 mmol/l). NaS concentration should increase at a rate of 2 mmol/1 hour. Symptoms of central pontine myelinolysis in hyponatremia were not yet described in pediatric patients.

Ontogeny of the androgen receptor in rat ventral prostate during sexual development

Concentrations of cytosolic androgen receptor, DNA and soluble protein, contents of DHT, and in-vivo uptake of 3H-DHT were measured in rat ventral prostates at 5-day intervals during sexual development. Regarding prostate weight two phases of growth were noted being separated by a period of stagnation from Day 40 to 45. Cytosolic androgen receptor, particle-bound DHT, and uptake of 3H-DHT into the 100,000-g sediment showed a clear pattern: a maximum in the prepubertal animal at age Day 20, a minimum at age Day 30 (4 days after the early pubertal rise of LH, testosterone, and DHT) followed by a second maximum on Day 55 (2 days before the beginning of fertility), and a second minimum in the young mature animal on Day 70. An intermediate peak seen at age Day 37 was not significant. Neither the time-dependent profile of the cytosolic androgen receptor nor the contents and in vivo uptake of DHT were correlated to concentrations of circulating gonadotrophins, growth hormone, and sex-steroids measured during puberty in the same strain of animals. Therefore, the regulating mechanism remains unclear.

The effects of cyproterone acetate on statural growth in children with precocious puberty

Forty-four patients (42 f, 2 m) with precocious puberty (31 idiopathic, 1 familial, 7 cerebral, 5 McCune-Albright) were treated with cyproterone acetate for periods of 1-8.75 years in different (P less than 0.05) daily dosages of 117 +/- 6.1 mg/m2 per day (mean +/- SEM, group A, N = 20) and 60.8 +/- 2.42 mg/m2 per day (group B, N = 24). Thirty-three girls had experienced menarche before therapy at a mean age of 4.89 +/- 0.42 years. Treatment was started at a chronologic age of 5.45 +/- 0.33 years in the girls and 5.74 +/- 1.34 years in the boys. At the time of evaluation, 31 of our patients had reached final height. With respect to the effects of treatment on statural growth, the Standard Deviation Scores were retrospectively determined for height, weight, and growth velocity. The initial Bayley-Pinneau height predictions were compared with final height and target height, and the skeletal maturation was studied. There were no significant differences between those parameters in the patients of group A and B or between treated and untreated subjects as far as final height and target height were concerned. It is concluded that cyproterone acetate administered orally at daily doses from 50-150 mg/m2 does not improve statural growth of patients with precocious puberty.

[Necrotizing gingivitis in an infant with chronic benign neutrocytopenia]

A necrotizing inflammation in the mucosa of the superior maxilla is described in an infant suffering from benign chronic neutrocytopenia. A connection between primary dentition which occurred at the same time and the basic illness is assumed.

Chronopharmacology of hydrocortisone and 9 alpha-fluorhydrocortisone in the treatment for congenital adrenal hyperplasia

The conventional treatment of CAH with hydrocortisone (16-19 mg/m2 per day) and 9 alpha-F-cortisol (just enough to normalise renin concentrations, started at 07:00 h) was ineffective in suppressing the early morning rise of 17-OH-progesterone and in turn androgens in about 20% of our patients. The present work explored the effect of a modified dosage regimen of the drug in five patients. The schedule was: 03:00 h F 33% + 9 alpha-F-F 33%; 07:00 h F 30%; 12:00 h F 22% + 9 alpha-F-F 33%; 17:30 h F 15% + 9 alpha-F-F 33%. Monitored levels of circulating 17-OH-progesterone, testosterone, and individual urinary 17-ketosteroids showed significant improvement, which was not achieved by giving higher or later evening doses. Menarche was induced in two girls (bone age 15 years). The modified dosage schedule offers on the one hand the possibility of better management of CAH, and on the other, cuts down the risk of enhanced Cushing-like effects, which in animal models have been related frequently to dosage schedules not corresponding to the circadian rhythm. The difficulty of administering the drugs at 03:00 h should be overcome by the development of a late-releasing preparation.

Pseudopituitary dwarfism due to resistance to somatomedin: a new syndrome

The case of an infant is described who at birth was already small and postnatally grew extremely slowly. At age 3 the girl's height was 65 cm, weight 5.6 kg, bone age 21 months. Basal plasma GH was 36-66 ng/ml, basal SM activity was rather high, being around 2.0 U/ml. RIA- and RRA-SM were also increased. Prolonged GH administration did not raise plasma SM. There was a tendency for hypoglycemic episodes in the presence of low insulin levels. Receptor studies with skin fibroblasts showed a diminution of the specific binding of SM-C by 50%. Apparently only the specific IGF-receptor is defective whereas the insulin receptor responds to the increased SM with hypoglycemia. The observation that the high plasma SM did not suppress the enhanced GH-secretion suggests that perhaps the hypothalamic IGF-receptor was also defective.

Role of the pineal gland in the regulation of prostatic androgen receptors in pubertal and mature rats

The effects of exposure to continuous light, continuous darkness, and administration of melatonin on prostatic androgen receptors in relation to pubertal development in rats were examined. Darkness produced dissimilar results between the pubertal and adult groups. Whereas the prostate weight in the pubertal group remained unaltered, it increased in the adult group. In the pubertal group exposed to darkness, plasma melatonin increased significantly, and androgen receptors declined, whereas in the adult group these receptors rose significantly with a simultaneous increment of melatonin concentration in plasma. Exposure to continuous light did not produce any effective alterations in the parameters examined. The afternoon melatonin administration showed trends similar to those seen in animals exposed to darkness. The results indicate that exposure to darkness or administration of melatonin both have age-dependent effects on prostatic androgen receptors. Exposure to darkness may interfere with the process of sexual maturation in the pubertal animal as a result of increased melatonin production.

A quantitative assay for the cytoplasmic androgen receptor using [3H]dihydrotestosterone in the presence of NAD+-nucleosidase

In prostatic cytosol DHT1 is metabolized to 5 alpha-androstane-3 alpha (or beta), 17 alpha-diols with a half life of 2 h even at 4 degrees C. Thus, [3H]DHT appears to be a poor marker for a quantitative assessment of androgen receptors (AR). Methyltrienolone (R1881) seems to be advantageous as it is not metabolized. However, because of considerable binding to progestin receptors, assays using [3H]R1881 are not specific for AR in tissues containing progestin receptors. We, therefore, developed a specific assay for AR using [3H]DHT (14 nM) as marker, where metabolism of DHT is prevented by pre-incubation with NAD+-nucleosidase. The [3H]DHT-receptor complex is separated from free, SHBG-bound and unspecifically bound [3H]DHT by agar gel electrophoresis. The binding sites of high affinity and low capacity are characterized by suppression with unlabelled R1881 (2 microM) in a parallel assay. Under these conditions DHT and R1881 appear to have the same kinetics of association and dissociation. Weighted non-linear regression analysis of specific binding capacity at various ligand concentrations reveals that in rat prostatic cytosol the affinity of DHT (Kd = 0.405 +/- 0.0839 nM) is significantly higher (P less than 0.01) than that of R1881 (Kd = 1.25 +/- 0.271 nM).

Data on linkage relations between GLO and 21-hydroxylase

Linkage between GLO and 21-hydroxylase was investigated in 11 families with 24 children. Positive lod score values with a maximum of +1.618 at theta = 0.05 indicate close linkage between these marker loci.

[Alteration of TSH secretion in children with goitre after short-term treatment with potassium iodide (author's transl)]

300 microgram of potassium iodide daily were administered over a period of two weeks to 12 children with goitre. Basal TSH concentrations, maximal TSH increase after TRH and integrated TSH secretion after TRH were significantly decreased in this group whereas the increase of total thyroxine (T4-RIA) did not reach significance. It appears that in the development of iodine deficiency goitre in children a sensitive feed-back system is predominant. Early administration of iodine or even better general iodinated salt prophylaxis seem to be the pathogenetically correct approach in solving the common goitre problem.

[On the calculation of the volume deficit in hypertonic dehydration (author's transl)]

It has been suggested in the literature than volume deficit in hypertonic dehydration can be calculated from actual osmolarity. But for an accurate estimation of volume deficit a number of factors must be given. The initial concentration and the loss of substance during the development of dehydration must be known, the distribution of the substance within the compartment must be homogeneous, and no shift between dissolved and undissolved compartments is allowed. For the osmotically active substances the second and the forth condition are not satisfied. Therefore, the calculation of volume deficit, based on actual osmolarity, can induce an error from 40 ml to as much as 100 ml per kg body weight.

Precision electronically controlled optical printer for 3-d stereoorthophoto mapping

A precision optical printer is described for producing stereoorthophoto maps from aerial stereo photos, complete with the rectified image of the terrain, contours, symbols, and annotation. The printer forms part of the stereoorthophoto system that was conceived and is currently under development at the National Research Council of Canada. Stereoorthophotos bring to potential users for the first time a complete, precise, accurately scaled, stable stereo terrain image that can be viewed with simple equipment. The digital electronic techniques used to realize the precision control and versatility required in such an optical device are described generally.