THE SCREENING OF PATIENTS WITH SUSPECTED THYROTOXICOSIS USING A SENSITIVE TSH RADIOIMMUNOASSAY

A radioimmunoassay was optimized to measure serum TSH with maximum sensitivity (sTSH). With this assay sTSH was less than 0.5 mIU/l in 100% of 64 patients with proven thyrotoxicosis and greater than 0.5 mIU/l in 92% of 76 normal subjects. sTSH correctly predicted the TSH response to TRH (delta TSH) in 93% of 125 patients with suspected thyrotoxicosis. In this group thyrotoxicosis was excluded by an sTSH greater than 0.5 mIU/l in 52% of patients thus avoiding the need for further testing.     

Value of Schwangerschaftsprotein 1 (SP1) and pregnancy-associated plasma protein-A (PAPP-A) in the clinical management of threatened abortion

Summary. Pregnancy-associated plasma protein-A (PAPP-A) and Schwangerschaftsprotein 1 (SP₁) levels were measured in single serum samples from 60 patients admitted with vaginal bleeding in the first 14 weeks of pregnancy. When based on ultrasound diagnoses the prediction of non-viability (the predictive value) was 97% for SP₁ and 84% for PAPP-A. Whereas the prediction of viability (above –2SD of the normal range) with SP₁ was 88% the value with PAPP-A was only 57%; the poorer result obtained with PAPP-A probably reflects its longer half-life. Pregnancy outcome is not related to the duration of bleeding.     

RELATIONSHIPS BETWEEN THE CIRCADIAN RHYTHMS OF TSH, PROLACTIN AND CORTISOL IN SURGICALLY TREATED MICROPROLACTINOMA PATIENTS

Pharmacological doses of glucocorticoids inhibit TSH release both in vivo and in vitro and since the circadian rhythms of TSH and cortisol show a reciprocal relationship, the hypothesis has been advanced that changes in cortisol levels may be a primary determinant of circadian TSH changes. We have tested this hypothesis by studying the relationship between circadian cortisol and TSH rhythms in subjects before and during blockade with metyrapone. Seven patients were studied during their routine post-operative assessment following selective transethmoidal adenomectomy for microprolactinomas. PRL levels were restored to normal (less than 420 mU/l) in all patients by surgery (pre-op: 930-2752 mU/l, post-op: 33-376 mU/l) and the patients also had normal pituitary function in other respects. Blood was sampled hourly for 24 h before and on the third day of treatment with metyrapone (250 mg, 2 hourly). In order to compare circadian rhythms, hormonal data were subjected to cosinor analysis which involved fitting of the data with a cosine function using the method of least squares. The 6% cross reactivity of the cortisol antibody with 11-deoxycortisol was taken into account during the calculation of results. All subjects showed a normal cortisol rhythm which was strikingly blunted during metyrapone treatment. Group mean (+/- SD) TSH mesors, amplitudes and acrophases for control and metyrapone treated subjects were 1.5 +/- 0.26, 1.29 +/- 0.48; 0.46 +/- 0.26, 0.23 +/- 0.13 and -49 degrees +/- 9.8 degrees; -62 degrees +/- 2.7 degrees respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

The maturation of respiratory patterns in normal full term infants during the first six postnatal months. I: Sleep states and respiratory variability.

ABSTRACT. Four term healthy infants had their respiratory pattern monitored during a 2-hour afternoon nap recording period at monthly intervals up to six months of age. The time spent asleep significantly decreased with a marked reduction in active sleep (66% to 10%) while maintaining one long epoch of quiet sleep (mean 31 mins). Mean breathing rate at one week was higher in active sleep than quiet sleep (47 vs 41 breaths/min.) and decreased by 6 months in both sleep states (31 breaths/min. in both). Variability of breathing rate at 1 week was significantly increased in active sleep compared to quiet sleep and both decreased by 6 months. These findings confirm a significant maturational change in the respiratory pattern and variability of normal infants in the afternoon nap from 1 to 6 months.     

A double-blind assessment of additive intolerance in children using a 12 day challenge period at home

Alleged food-additive intolerance (respiratory, dermatological, behavioural or abdominal) was assessed in 19 children using daily challenge drinks of either, base product alone, base product plus sunset yellow/tartrazine, or base product plus sodium metabisulphite/sodium benzoate. The same type of drink was given for 12 days, double-blind and in random order. During the trial the children were maintained on an additive-free diet under supervision. Diary cards were used to record symptoms and medication usage. If there was an apparent association between symptoms and drink ingredient the trial was repeated, again double-blind. Additive intolerance was confirmed by a consistent deterioration of symptoms in only three children. In one, urticaria was induced by the colourings, in another extremely abnormal behaviour was induced by the preservatives and a third child was only free of asthma and abdominal pain on placebo. This form of individual trial, using 12 daily drinks, overcomes some of the objections to a single challenge study. Despite this, intolerance to the additives was only confirmed in 3/19 children in whom it had been believed to occur.     

Treatment of internal root resorption with thermoplasticized gutta-percha. A case report

Summary. A case is described in which thermoplasticized gutta-percha was successfully used to repair a buccal perforation caused by internal root resorption.