Renal hypouricaemia in insulin treated diabetes mellitus

Uric acid metabolism was investigated in 69 insulin-treated male diabetic outpatients and in 23 healthy male subjects, because of a reported coincidence between diabetes and gout. All subjects had normal serum creatinine concentrations and none received diuretic treatments.

Compared with normal, the diabetics had significantly lower mean serum uric acid concentrations (0.34 ± 0.08 (SD) mmol/l versus 0.23 ± 0.06 mmol/1, p < 0.001). 17% of the diabetic patients had serum concentrations below the normal mean—2 SD. In contrast, the diabetic patients had a 42% increase in renal uric acid excretion rate (p <0.01), and an 83% increase in the ratio of uric acid clearance/creatinine clearance (p < 0.001). These indices of renal uric acid excretion were both positively correlated to fasting blood glucose levels (r = 0.57, p < 0.001, and r = 0.50, p < 0.001, respectively), to the degree of glycosuria (r = 0.73, p < 0.001, and r = 0.63, p < 0.001, respectively), and to the magnitude of water diuresis (r = 0.60, p < 0.001, and r = 0.39, p < 0.01, respectively).

The hypouricaemia observed in these insulin-dependent diabetic male subjects may probably be caused by the increased renal excretion of uric acid in the presence of hyperglycaemia. The study gave no evidence of increased serum uric acid concentrations in insulin-dependent diabetics. It is therefore likely that any coincidence between gout and diabetes derives from other coexisting serum uric acid raising factors.     

Relationship between myocardial tissue density measured by microgravimetry and sound speed measured by acoustic microscopy

If myocardial tissue can be assumed to be fluid-like, myocardial tissue elasticity can be estimated by the sound speed of tissue based on the equation K=ρc², where K is the elastic bulk modulus, ρ is density, and c is the sound speed of tissue. However, little data exist regarding the relationship between the sound speed of tissue and tissue density. The purpose of the present study was to evaluate the relationship between the sound speed of tissue and tissue density of various diseased myocardia. Myocardial tissue specimens at autopsy were obtained from 10 control patients without cardiovascular disease, 8 patients with pressure overload left ventricular hypertrophy (POLVH), and 8 patients with cardiac amyloidosis (AMD). Myocardial tissue sound speed was measured using a scanning acoustic microscope operating in the frequency of 450 MHz, and tissue density was measured by microgravimetry. The sound speed in POLVH (1639 ± 17 m/s) was higher and that in AMD (1565 ± 11 m/s) was lower than that in control patients (1615 ± 15 m/s) (p < 0.001) at the temperature of 20–22°C. The density in POLVH (1.087 ± 0.004 g/cm³) was higher and that in AMD (1.072 ± 0.003 g/cm³) was lower than that in control patients (1.082 ± 0.003 g/cm³) (p < 0.001). Tissue density correlated with sound speed in all three groups (r = 0.96, p < 0.001). Therefore, myocardial tissue sound speed data obtained by acoustic microscopy enabled us to evaluate tissue elasticity without measuring tissue density directly.     

Comparative study of patients with and without SARS who fulfilled the WHO SARS case definition

To differentiate severe acute respiratory syndrome (SARS) from non-SARS illness, we retrospectively compared 53 patients with probable SARS and 31 patients with non-SARS who were admitted to Mackay Memorial Hospital from April 27 to June 16, 2003. Fever (> 38°C) was the earliest symptom (50/53 SARS vs. 5/31 non-SARS, p < 0.0001), preceding cough by a mean of 4.5 days. The initial chest X-ray study was normal in 22/53 SARS cases versus 5/31 non-SARS cases. SARS patients with an initially normal chest X-ray study developed infiltrates at a mean of 5 ± 3.44 days after onset of fever (21/22 SARS vs. 0/5 non-SARS). Rapid radiographic progression of unifocal involvement to multifocal infiltrates was seen in 22 of 24 SARS vs. 0 of 26 non-SARS patients (p < 0.0001). Pleural effusion was not present in any SARS patients but was seen in 6 of 26 non-SARS cases (p < 0.0001). Initial lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase were all more common in SARS than non-SARS (p < 0.0001). They may help differentiate SARS from non-SARS if a reliable and rapid diagnostic test is not available.     

Color Doppler flow criteria of breast lesions

Color Doppler technique has been available for several years. The sensitivity of the equipment has improved and allows for assessment of tumor vascularity. We investigated multiple parameters in 258 patients, with 176 benign and 82 malignant lesions to define characteristic flow criteria. Median (25–75% quartiles) and p-values are given for benign vs. malignant lesions. Number of tumor vessels: 2 (1–2) vs. 8 (5–14), p < 0.0001; mean peak systolic flow velocity: 11.1 cm/s (6.4–14.9) vs. 18.8 cm/s (13.7–25.1), p < 0.0001; maximum flow velocity: 12.5 cm/s (6.7–18) vs. 32.5 cm/s (22.5–47.3), p < 0.0001; sum of all systolic flow velocities: 18.9 cm/s (7–34.2) vs. 147 cm/s (71.3–266.7), p < 0.0001; minimum systolic flow velocity: 8.9 cm/s (5.4–12.1) vs. 9 cm/s (6.3–11.3), p > 0.05; average resistance index (RI): 0.68 (0.58–0.72) vs. 0.75 (0.67–0.81), p > 0.05; maximum RI: 0.71 (0.65–0.78) vs. 0.88 (0.78–0.99), p < 0.0001; minimum RI: 0.64 (0.57–0.68) vs. 0.64 (0.53–0.71), p > 0.05; average A/B ratio: 3.1 (2.7–3.7) vs. 4.3 (3.2–7.7), p < 0.0001; maximum A/B ratio: 3.4 (2.9–4.6) vs. 8.4 (4.5–9.9), p < 0.0001; minimum A/B ratio: 2.8 (2.3–3.2) vs. 2.9 (2.2–3.5), p > 0.05. The data analysis shows that flow resistance in malignancies is increased. This is in contrast to gynecological malignancies, where an increased diastolic flow indicates that flow resistance is decreased.     

Preliminary results of power Doppler imaging in benign prostatic hyperplasia

Power Doppler imaging was performed in 77 patients with lower urinary tract symptoms to characterize Doppler blood-flow signals in benign prostatic hyperplasia (BPH). Pulsatile blood flows were detected in all patients, demonstrating a significant increase of the resistive index (RI) in BPH cases (n = 40, 0.72 ± 0.05, p < 0.0001), compared to those with a healthy prostate (n = 37, 0.64 ± 0.04). Of 40 patients with BPH, 28 (70%) had an RI of 0.70 or higher; all but 1 patient with a healthy prostate (1 of 37, 3%) had an RI lower than 0.70 (p < 0.0001). In all 10 patients with BPH, the elevated RI decreased significantly to a normal control level after surgical treatment (0.72 ± 0.02 vs. 0.64 ± 0.05, p < 0.001). In conclusion, Doppler RI might be useful as a new urodynamic parameter in BPH.     

Plasma fibronectin in liver cirrhosis and its diagnostic value

Plasma fibronectin (FN) has been measured by immunonephelometric method in 100 cirrhotic patients and compared with that of 77 normal subjects and with that of 57 patients suffering from liver disorders different from cirrhosis. Both, compensated and decompensated cirrhotics had lower plasma FN than controls (31.14 ± 11.42 and 20.88 ± 10.43 respectively vs 40.13 ± 8.58 mg/dl; p < 0.02 and p <0.001). FN in ascitic patients was lower than in non-ascitic (p < 0.001). These differences were not due to different weight or age of patients. It appears, therefore, that FN parallels in cirrhosis the grade of liver function impairment. No significant difference has been noted between plasma FN of patients with liver diseases different from cirrhosis and control subjects. In cirrhosis, a positive relation has been observed among FN and other parameters of liver function such as serum albumin, cholinesterase activity, fibrinogen and prothrombin time. Plasma FN has a low sensitivity but a high specificity and a good positive predictive value in distinguishing normals and patients with liver disorders different from cirrhosis. This diagnostic value is similar to that of serum albumin.     

Serum nitrates and vasoactive intestinal peptide in patients with gastroesophageal reflux disease

Background: The normal esophageal motility is a balance between excitatory cholinergic “muscarinic” innervations and noncholinergic nonadrenergic inhibitory innervations. The latter is mediated by nitric oxide (NO) and/or vasoactive intestinal polypeptide (VIP).

Methods: The study included 50 patients with gastro-esophageal reflux disease (GERD), and 10 healthy controls of matched age and sex. Patients were divided into five groups according to the degree of lower end esophagitis (Savary-Miller classification). Serum VIP was measured using enzyme immunoassay after peptide purification. Serum nitrate as an index of nitric oxide generation was determined biochemically.

Results: Serum nitrate and VIP levels were significantly higher in GERD patients than the control group (p < 0.001). Grade 0 serum nitrates was significantly higher than the control group (p < 0.05) with some overlap between the individual values of the two groups. Serum VIP was significantly higher in grade 0 group compared to control group (p < 0.001) with no overlap in the individual values. There was a significant positive correlation between the grade of lower end esophagitis and each of serum nitrate and VIP (p < 0.001), as well as between serum nitrate and each of serum VIP, cigarette smoking index (CSI) and BMI (p < 0.001).

Conclusion: Abnormally high levels of serum VIP and NO may have a role in the pathogenesis of GERD. Exposure of esophageal mucosa to noxious effect of acid refluxed due to the relaxant effect of VIP on lower esophageal sphincter may cause increased NO levels. BMI and CSI are risk factors for GERD progression.     

Ultrasonic tissue characterization with integrated backscatter during inotropic stimulation

Ultrasonic tissue characterization with integrated backscatter is an objective method to quantitatively define the physical state of the myocardium. To determine if backscatter imaging during inotropic stimulation could be used objectively to determine the myocardial viability and ischemia in patients with ischemic heart disease, the backscatter changes were examined in 23 patients with myocardial infarction during dobutamine stress two-dimensional (2-D) echocardiography. Coronary angiography was performed within 1 to 2 days after the stress test. The results of this study demonstrated that changes in backscatter variability correlated significantly with the wall motion changes in stress echocardiography during dobutamine infusion (p < 0.0001). In addition, it was shown that the backscatter changes were significantly different in various types of myocardial tissue. In 23 healthy control segments, the ultrasonic backscatter variability was preserved and unchanged during inotropic stimulation (p = NS). In 15 viable infarct zones, restoration or an increase in backscatter variability during low-dose dobutamine infusion was noted, this being lost when ischemia developing during high-dose dobutamine infusion (p < 0.01). In 9 nonviable infarct zones, the phase-weighted variation was usually ≤ 0 and did not change significantly during inotropic stimulation, regardless of the patency of the infarct-related arteries. In 15 remote ischemic myocardial zones, the backscatter variability was preserved at the baseline level, did not change during low-dose dobutamine infusion, but decreased significantly during high-dose dobutamine stress (p < 0.01). In conclusion, dobutamine stress tissue characterization could offer an objective approach for the detection of myocardial viability and ischemia, and might be a useful adjunct to the conventional stress echocardiography.     

The impact of a stage-matched intervention to promote exercise behavior in participants with type 2 diabetes

This study was designed to develop and evaluate a stage-matched intervention (SMI) in Korean participants with type 2 Diabetes. The SMI was based on main constructs derived from the Transtheoretical Model match to the individual’s stages of readiness for exercise behavior. The SMI was developed according to the results of the content validity tested by an expert group (n=9). A control group pre- and post-test design was used for evaluating the impact of the SMI: the intervention group (n=22) participated in the SMI for 3 months, while the control group (n=23) received usual educational advice. The intervention group, compared to the control group, showed significant improvements in stages of change for exercise behavior (p < 0.001), physical activity levels (p < 0.001), and reductions in FBS (p < 0.05) and HbA₁c (p < 0.05). This study yielded evidence for the beneficial impact of the SMI in participants with type 2 Diabetes.     

Duodenal meal stimulation leads to coeliac artery vasoconstriction and superior mesenteric artery vasodilatation: an intra-abdominal ultrasound study

To evaluate the influence of duodenal feeding on splanchnic blood flow, 14 patients with normal coeliac and superior mesenteric arteries underwent intra-abdominal duplex scanning of the systemic and splanchnic circulation under standardised basal and meal-stimulated conditions. Doppler samples and diameter measurements were taken of the aorta, coeliac artery, common hepatic artery, splenic artery, superior mesenteric artery, and inferior mesenteric artery. Duodenal meal stimulation has no systemic effects (p > 0.4). However, duodenal meal stimulation results in coeliac artery vasoconstriction (p < 0.06) and superior mesenteric artery vasodilatation (p < 0.05). This study supports other reported results that gastrointestinal blood flow is dependent on the site of food stimulation.     

Chemiluminescence in inflammatory bowel disease patients: a parameter of inflammatory activity

Background: Reactive oxygen species (ROS) are produced in excess in the inflamed mucosa and peripheral blood of patients with inflammatory bowel disease. These species have emerged as a common pathway of tissue injury in a wide variety of inflammatory and other disease processes. The present study was conducted to assess ROS production and to correlate this with parameters of inflammatory activity. Methods: In 25 patients with Crohn's disease (CD), 20 patients with ulcerative colitis (UC) and 65 age- and sex-matched healthy volunteers ROS production was measured using the whole blood luminol enhanced chemiluminescence assay (LECA). Disease activity was assessed using the Crohn's disease activity index and the Ulcerative Colitis Symptoms Score (UCSS) for CD and UC, respectively. Furthermore, the effect of various scavengers, enzymes and enzyme inhibitors on LECA was studied to assess the contribution of different ROS. Results: LECA was significantly higher in CD and UC patients compared with healthy controls (7.1±4.7 and 9.8±6 vs. 5.2±2.8×10³ counts per minute (cpm), p<0.05 and <0.001). In CD, relative LECA (patient/control) was correlated with the Crohn's disease activity index and C-reactive protein (CRP) (r=0.54, p=0.001 and r=0.51, p=0.01). In UC, CRP but not LECA was correlated with the Ulcerative Colitis Symptoms Score (C-reactive protein: r=0.42, p=0.01). Addition of azide, superoxide dismutase, deferoxamine and dimethylthiourea resulted in a decrease of LECA values. Conclusion: Whole blood LECA is increased in patients with CD and UC. This parameter is correlated with disease activity in CD. The observed chemiluminescence is probably due to generation of superoxide and the hydroxyl radical.     

Normal sonographic values of maternal spleen size throughout pregnancy

This study aims to establish normal range of sonographically measured maternal spleen size throughout pregnancy. Currently, 288 healthy pregnant women between 6 and 42 weeks’ gestation underwent ultrasonographic measurements of spleen length and width. The relationships between ultrasound measurements with prepregnancy body mass index (BMI) and gestational age were assessed using the Pearson correlation coefficient. A linear regression model was applied to construct the appropriate equation for measuring the spleen area relative to BMI and gestational age. A significant correlation (R) was found between gestational age and spleen dimensions length (R = 0.486; p < 0.001), width (R = 0.455; p < 0.001) and area (R = 0.522; p < 0.001)) as well as between prepregnancy BMI and spleen length [(R = 0.314; p < 0.001), width (R = 0.380; p < 0.001) and area (R = 0.413; p < 0.001)]. We divided the spleen area by the BMI, thus enabling to perform a linear regression analysis with gestational age (weeks) as an independent continuous variable. A high multiple correlation (R) between spleen area and this variable was found (R² = 0.47; p < 0.001). The equation [spleen area/BMI = 1.598 + 0.032 × gestational age in weeks] was performed for calculating the spleen area throughout pregnancy. A significant overall growth pattern of spleen area in pregnancy with increasing gestational age was found. Normograms from these data can be used to evaluate splenomegaly throughout pregnancy. (E-mail: intposgr@post.tau.ac.il)     

The effect of dietary treatment on erythrocyte lipid peroxidation, superoxide dismutase, glutathione peroxidase, and serum lipid peroxidation in patients with type 2 diabetes mellitus

Objectives: The aim of the present study was to investigate the effect of dietary treatment on serum and erythrocyte lipid peroxidation and erythrocyte antioxidative enzyme activity of patients with Type 2 diabetes.

Design and methods: A total of 30 patients with newly diagnosed as Type 2 diabetes were enrolled to the study. A total of 30 healthy subjects served as controls. Diabetic patients were given standard dietary treatment that was composed of 50% to 55% carbohydrate and 30% fat for 2 months. No diet was applied for controls. For both groups serum and erythrocyte lipid peroxidation and erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were obtained at first and at the end of 2 months.

Results: Diabetic patients had higher serum and erythrocyte lipid peroxidation than those of controls before dietary treatment(p < 0.05). However, there was no absolute differences in erythrocyte SOD and GSH-Px (p > 0.05). At the end of 2 months of dietary treatment, while diabetics had still higher glucose and erythrocyte lipid peroxidation than controls (p < 0.05), serum lipid peroxidation, erythrocyte SOD, and GSH-Px levels did not differ significantly from those of controls (p > 0.05). In diabetic patients, after 2 months of dietary treatment, whereas serum and erythrocyte lipid peroxidation decreased, erythrocyte SOD and GSH-Px activities showed significant increase (p < 0.05).

Conclusions: Our results showed significant alteration in serum and erythrocyte lipid peroxidation and erythrocyte antioxidant enzyme status of patients with Type 2 diabetes by dietary treatment. However, whether such alterations have clinical importance for diabetic patients needs further investigation.     

Serum haptoglobin and C-reactive protein in human skeletal fluorosis

Circulating levels of haptoglobin and C-reactive protein were studied in patients of skeletal fluorosis and compared with two types of controls. The first type of control included normal healthy individuals consuming water containing permissible levels of fluoride (up to 1 mg/L). The second type of control included individuals consuming water contaminated with fluoride (1.2–14.5 mg/L) but not exhibiting clinical manifestations of skeletal fluorosis. A significant increase in the levels of haptoglobin (p < 0.01) and C-reactive protein (p < 0.01) as well as a raised erythrocyte sedimentation rate were seen in patients of skeletal fluorosis as compared to both types of controls. The present study suggests the possibility of a subclinical inflammatory reaction occurring in patients with skeletal fluorosis.     

Isovolumic relaxation flow propagation velocity: a promising load-independent relaxation parameter in hemodialysis patients

The aim of this study is to evaluate whether isovolumic relaxation flow propagation velocity (IRFPV), a newly proposed relaxation parameter, is independent of load alterations. Thirty-nine uremic patients (21 men; age 62 ± 10 y) who underwent echocardiography 1 h before and 1 h after hemodialysis (HD) were included. After HD, body weight, systolic blood pressure, early transmitral filling wave velocity (E), early diastolic mitral annular velocity (Ea) and early diastolic inflow propagation velocity (EPV) decreased significantly (p ≤ 0.007), while IRFPV kept constant (p = 0.550). A subgroup analysis showed that in patients with body weight reduction <2.5 kg, E (p = 0.005) decreased significantly, but Ea (p = 0.078), EPV (p = 0.155) and IRFPV (p = 0.324) did not change after HD. In patients with body weight reduction ≥2.5 kg, E (p < 0.001), Ea (p = 0.001) and EPV (p = 0.001) decreased significantly but IRFPV (p = 0.715) was still constant after HD. In conclusion, IRFPV may be a load-independent parameter in assessing left ventricular diastolic function. However, Ea and EPV are load-independent only at minor load alterations. In evaluating left ventricular diastolic function in HD patients whose loading conditions frequently vary with time, IRFPV seems to be more adequate than Ea and EPV. (E-mail: wcvoon@giga.net.tw)     

Estimation of wrist fracture load using phalangeal speed of sound: an in vitro study

This study aimed to evaluate the ability of speed of sound (SOS) measured at the phalanges to estimate simulated wrist fracture load and stress. SOS was measured along the proximal phalanges of the second, third and fourth fingers using an ultrasound (US) system operating in axial transmission mode. The bone mineral density (BMD) of the radius and the phalanges was also measured with quantitative computed tomography (QCT) and dual x-ray absorptiometry (DXA), and the combined cortical thickness (CCT) of the phalanges was measured from hand radiographs. After the measurements were completed, the radius was excised from the cadaver, embedded in polymethylmethacrylate and tested to failure on a servohydraulic testing machine. The configuration of the radius was chosen to simulate a fall onto the hand. Linear regression analysis showed a highly significant correlation between SOS (r = 0.76–0.94, p < 0.001), CCT (r = 0.86–0.90, p < 0.001) and BMD (r = 0.92–0.96, p < 0.0001) in the three proximal phalanges measured. SOS, BMD and CCT were significant predictors of fracture load (r = 0.60–0.69, p < 0.03) and stress (r = 0.65–0.77, p < 0.02). Cortical area and bone mineral content (BMC) of the radius were consistently higher predictors of fracture load (r = 0.76–0.82, p < 0.01 for area and R = 0.78–0.88, p < 0.01 for BMC) than BMD. The correlation of BMC and area was poorer with fracture stress. In a step-wise regression analysis using both phalangeal BMD and SOS, only SOS remained a significant predictor of fracture stress. In forward stepwise regression analysis, both cortical area and SOS were entered into the regression model to estimate fracture load. Only SOS remained significant in the model for estimating fracture stress. Phalangeal BMD was only entered in the combined model with the cortical area at the 4% site (r = 0.84, p = 0.002). Phalangeal SOS is a useful parameter in the assessment of bone status of the radius.     

The prognostic value of early transcranial Doppler ultrasound following cardiopulmonary resuscitation

The aim of the presented study was to estimate the prognostic value of transcranial Doppler sonography (TCD) for the prediction of clinical outcome of patients after cardiopulmonary resuscitation (CPR) on the basis of the measured flow velocity changes in the basal cerebral arteries. Thirty-nine patients (27 men, 12 women) aged 66 ± 15 y (±SD) who had undergone CPR were involved. Serial TCD examinations of the intracranial arteries were performed 1.5, 4, 8, 16, 24 and 72 h after CPR. Plasma neuron specific enolase (NSE), ventilation parameters (pH, paO₂, paCO₂) and hemodynamic parameters were registered. Seventeen patients (group 1) survived with moderate or without neurologic deficits. Twenty-two patients (group 2) either died (n = 21) within 9 ± 14 days or remained in vegetative state (n = 1). NSE levels ranged from 9 to 29 μg/L in group 1 and from 22 to 1242 μg/L in group 2 (p < 0.05). Four and 72 h after CPR, peak systolic flow velocities in the middle cerebral artery (MCA) were significantly higher in group 1 than in group 2 (p < 0.05). Twenty-four h after CPR, peak systolic and diastolic flow velocities in the ACA and PCA were also significantly higher in group 1 than in group 2 (p < 0.05). At this time, patients of group 2 showed significantly higher resistance index-values (RI = (sys-dia)/sys) in the anterior cerebral artery (ACA) and the posterior cerebral artery (PCA) (p < 0.05). A high correlation between peak systolic blood flow velocity in the MCA and systemic systolic blood pressure was observed in group 2 early 4 to 16 h after CPR (r = +0.52 to + 0.81, p < 0.05), while there was no such correlation in group 1. Using serial TCD examinations, patients with severely disabling or fatal outcome could be identified within the first 24 h. Besides established clinical and laboratory parameters, postanoxic myoclonus and NSE, serial TCD examinations following CPR may be helpful to predict the clinical outcome, but further studies with a larger number of patients are necessary to approve this hypothesis. (E-mail: tiemo.wessels@uni-duisburg-essen.de)     

US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules

The aim of the study was to define the effectiveness and safety of ultrasound-guided percutaneous radiofrequency (RF) thermal ablation in the treatment of compressive solid benign thyroid nodules. Thirty-one patients not eligible for surgery or radioiodine (¹³¹I) treatment underwent RF ablation for benign nodules; a total of 33 nodules were treated (2 patients had 2 nodules treated in the same session): 10 cold nodules and 23 hyperfunctioning. Fourteen patients complained of compressive symptoms. Nodule volume, thyroid function and compressive symptoms were evaluated before treatment and at 1, 3 and 6 mo. Ultrasound-guided RF ablation was performed using a Starbust RITA^® needle, with nine expandable prongs; total exposure time was 6 to 10 min at 95° C in one area or more of the nodule. Baseline volume (measured at the time of RF ablation) was 27.7 ± 21.5 mL (mean ± SD), but significantly decreased during follow-up: 19.2 ± 16.2 at 1 mo (–32.7%; p < 0.001), 15.9 ± 14.1 mL at 3 mo (–46.4 %; p < 0.001) and 14.6 ± 12.6 mL at 6 mo (–50.7%; p < 0.001). After treatment, all patients with cold nodules remained euthyroid: five patients with hot nodules normalized thyroid function, and the remaining sixteen showed a partial remission of hyperthyroidism. Besides a sensation of heat and mild swelling of the neck, no major complications were observed. Improvement in compressive symptoms was reported by 13 patients, with a reduction on severity scale from 6.1 ± 1.4 to 2.2 ± 1.9 (p < 0.0001). Radiofrequency was effective and safe in reducing volume by about 50% and compressive symptoms in large benign nodules. Hyperfunction was fully controlled in 24% of patients and partially reduced in the others. (E-mail: mdeandrea@libero.it)     

Usefulness of monitoring β-glucuronidase in pleural effusions

Background: The objective of the study was to evaluate the additional value of β-glucuronidase (BGD), a lysosomal enzyme in the analysis of transudative and exsudative pleural effusions, especially between malignant and non-malignant effusions.

Design and methods: Pleural fluid samples obtained from four respective diagnostic groups: transudates parapneumonic effusions, malignant effusions or pleuritis carcinomatosa, and empyema were evaluated.

Results: Beta-glucuronidase was significantly different between transudative and exsudative effusions (p < 0.001) as well as between parapneumonic and malignant effusions (p < 0.03), parapneumonic effusions and empyema (p < 0.002), and malignant and empyema (p < 0.002), respectively. Logistic regression analysis yielded a weak discrimination between the parapneumonic and malignant groups.

Conclusions: Beta-glucuronidase activity differed between pleural effusions of various origin. However, including BGD in the biochemical work-up of pleural effusions did not reveal discriminatory value in the assessment of the classification of these effusions.     

The interobserver reliability of ovarian volume measurement is improved with three-dimensional ultrasound, but dependent upon technique

The effect of measurement technique on the interobserver reliability of ovarian volume calculation from three-dimensional (3-D) ultrasound (US) data was investigated. Ovarian volume was calculated in 20 patients by two observers using both the “prolate ellipsoid formula” and a new 3-D rotational technique (VOCAL). There was a significant difference between observers in mean ovarian volume calculated by the prolate ellipsoid formula (31.54 mL vs. 26.54 mL: p < 0.05), which proved to be a significantly less reliable technique than 3-D rotational volume calculation with VOCAL. Image quality was significantly better (p < 0.001) and measurements were significantly more reliable (p < 0.05) in the B-plane than in the C- plane of the multiplanar display. Rotational measurement of ovarian volume from 3-D US data is significantly more reliable between observers than volume estimation from 2-D parameters using the prolate ellipsoid formula, but is dependent upon image quality, which is significantly better in the B-plane than in the C-plane. (E-mail: nick.fenning@nottingham.ac.uk)