Sex hormone binding globulin levels across the adult lifespan in women--the role of body mass index and fasting insulin

SHBG is a major carrier of androgens. In men, SHBG levels increase with age, while in women data are scant. There is evidence that body mass index (BMI) and fasting insulin influence SHBG concentration. Since low SHBG levels are predictors of insulin resistance and diabetes, understanding the relationship of SHBG with age, insulin, and BMI is important to gain insight into the role of SHBG as a cardiovascular risk factor in women. Differences in SHBG across adult life span and their relationship with insulin and BMI were evaluated in a representative cohort of 616 Italian women free of diabetes and not on hormone replacement therapy enrolled in the InCHIANTI Study. The relationship of SHBG with age, BMI, and fasting insulin levels was analyzed using linear regression and by loess smoother. Serum SHBG levels showed a U-shaped trajectory with age, declining from the 2nd to the 6th decade of life and increasing after the 6th decade (p<0.0001). Age-related trends for BMI and fasting insulin mirrored the trend observed for SHBG. After adjusting for fasting insulin, the relationship between log (SHBG) and age square was attenuated (beta coefficient from 0.00044 to 0.00039) and was further reduced after adjustment for BMI (from 0.00039 to 0.00028). SHBG levels show an age-related U-shaped trajectory. These changes mirror the age-related changes in BMI and fasting insulin, suggesting that BMI and insulin negatively influence SHBG concentration.     

Quantitative evaluation of oxidative stress status on peripheral blood in beta-thalassaemic patients by means of electron paramagnetic resonance spectroscopy

High oxidative stress status (OSS) is known to be one of the most important factors determining cell injury and consequent organ damage in thalassaemic patients with secondary iron overload. Using an innovative hydroxylamine 'radical probe' capable of efficiently trapping majority of oxygen-radicals including superoxide we measured, by electron paramagnetic resonance (EPR) spectroscopy, OSS in peripheral blood of 38 thalassaemic patients compared with sex-/age-matched healthy controls. Thalassaemic patients showed sixfold higher EPR values of OSS than controls. Significantly higher EPR values of OSS were observed in those with a severe phenotype (thalassaemia major, transfusion-dependent) with respect to mild phenotype (sickle-cell/beta-thalassaemia, not transfusion-dependent) or thalassaemia intermedia. In patients with thalassaemia major, EPR values of OSS were positively correlated with serum ferritin and with alanine aminotransferase levels. In patients with sickle cell/beta-thalassaemia, there was no correlation between EPR value of OSS and all parameters considered. The type of chelating therapy (desferrioxamine or deferiprone) did not have an effect on EPR value of OSS. In conclusion, EPR 'radical probe' seems to be a valid innovative method to determine total OSS in patients affected by thalassaemia and might be used for evaluating new strategies of chelation, new chelators, or the efficacy of antioxidant formula.     

Acute changes in circulating hormones in older patients with impaired ventricular function undergoing on-pump coronary artery bypass grafting

OBJECTIVES: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) causes an acute stress response characterized by changes in the levels of several hormones, which might play a role in the high complication rate experienced by older patients after CABG. Thus, the aim of the study was to investigate changes in the circulating levels of anabolic and catabolic hormones in old people undergoing CABG with CPB. Design: Intervention case study. METHODS: 19 patients (12 males, 7 females) aged 70.1 +/- 6.1 yr (age range 62-80) with coronary artery disease and an ejection fraction <40% who underwent cardiac surgery. Cortisol (Cort), DHEA, DHEAS, LH, estradiol (E2), total testosterone (Te), SHBG, IGF-I were measured the day before, on the day of the procedure and 1, 2, 3, 4, and 30 days after CABG. Results: After surgery, serum IGF-I levels decreased (p<0.001), while levels of Cort, DHEAS and E2 significantly increased in both men and women. Alterations in Te levels differed between the two sexes with a significant decline in men and a significant increment in women. CONCLUSION: CABG with CPB resulted in a dramatic drop in Te levels in old men and a significant decline in IGF-I in both sexes. Serum Cort levels also significantly increased in both sexes. These hormonal changes may, at least partially, explain why the elderly need prolonged rehabilitation after CABG.     

Seroepidemiology of pertussis infection in an urban childhood population in Cameroon

In 1989, the prevalence of IgG antibodies to pertussis toxin (PT) in a sample of 367 unvaccinated apparently healthy children 5–14 years old was estimated by ELISA in Kumba City (Cameroon). Children were recruited using a systematic random sampling from six primary schools located in different districts of the city. The sample was representative of the various socio-economic classes.The overall prevalence was 75%; it increased from 62% in 5 year old children to 81% in children 12–14 years old (P < 0.01). IgG antibody prevalence was positively related to the family size. Children belonging to households of nine or more members had a 2.2-fold risk (C.I. 95 per cent =1.1–4.6) of previous exposure to B. pertussis infection. No association was found with the father's occupation (O.R. = 1). These findings demonstrate a great impact of pertussis infection in Cameroon, with a nearly total exposure by late childhood.Corresponding author.     

Current role of hysterosalpingography in the assessment of female infertility: review of a series of cases

The authors reviewed 463 hysterosalpingographies from a series of patients examined for primary infertility. 25.5% of them had been studied with echotomography and 4.1% with therapeutic and explorative laparoscopy. Hysterosalpingographic results were compared with positive findings at clinical examination and with various pathologic associations: the method proved to be extremely valuable in the diagnosis of the primary causes of female infertility, and even showed secondary, sometimes unsuspected, causes--e.g., iatrogenic and inflammatory. Moreover, high agreement (50%) was observed with echotomographic findings. The examination was carried out on an outpatient basis, and proved less dangerous and cheaper than other invasive techniques, its cost being more or less the same as that of US, which however is still the least dangerous and expensive method for the diagnosis of female infertility. Therefore, the authors suggest that diagnostic laparotomy be a second choice and be employed only in the cases where it can have therapeutic purposes. In all the extant cases, combined hysterosalpingography and US are still recommended.     

Androgen deficiency in older men

Androgen deficiency in older men can be related to age associated changes of neuro-endocrine mechanisms controlling the hormones secreted by the testis and adrenal cortex. We listed the clinical consequences of androgen deficiency at three different levels in three areas: somatic (body composition, glucidic and lipid metabolism, erythropoiesis), sexual and psychological (cognition and affectivity). Observational studies and randomized placebo controlled trials have been reviewed from medical literature. Testosterone, now preferentially administered as transdermal gel, and dehydroepiandrosterone represent two possible treatments. New compounds designed to target androgen receptors in specific tissues are promising options as anabolic agents.     

Elevated Asthma and Indoor Environmental Exposures Among Puerto Rican Children of East Harlem

Objective. East Harlem in New York City, a community with a large Puerto Rican population, has among the highest rates of asthma hospitalizations and mortality in the United States, but it is not known if the high rates are related to the ethnic composition, environmental or community factors, or if the higher rates reflect differentials in access to appropriate asthma care. A survey was conducted to: (a) estimate the prevalence of current asthma by ethnicity among school-age children, (b) assess indoor environmental risk factors for childhood asthma, and (c) assess health care utilization and school absences associated with childhood asthma. Design. A cross-sectional survey of parents of elementary school children, using a self-administered questionnaire with a 12-month recall on asthma symptoms based on the International Study of Asthma and Allergies in Childhood. Setting. Two public elementary schools in East Harlem (n = 1615 students 5-12 years of age). Results. Among the 1319 respondents (response rate 82%), the prevalence for current asthma (doctor or nurse diagnosis at any time plus wheezing in the past 12 months) was 23%. Puerto Rican children had a prevalence of 35%. Puerto Rican children reported both higher symptomatic frequencies and higher rates of physician diagnosis. Living in a home where cockroaches, rats, or mice had been seen in the past month and with a dust-enhancing heating system also was associated with having asthma, regardless of ethnicity. Compared with other children with asthma, Puerto Rican children with asthma were more likely to live in homes where rats or mice had been seen in the past month. Regardless of ethnicity, children with more frequent, more severe asthma symptoms and incomplete asthma action plans were more likely to have visited the emergency department in the past year. Puerto Rican children were more likely to have missed school because of their asthma in the past year. Conclusion. The prevalence of current asthma was significantly higher among Puerto Ricans, who had higher symptomatic frequency and greater diagnosis rates. Although all children with asthma in the East Harlem study appear to be sensitive to selected indoor environmental risk factors, only Puerto Rican children with asthma appear to be sensitive to the presence of rodents in their buildings. However, their higher school absence rate suggests problems with routine asthma management that could be addressed by improved medical management, programs to help parents manage their children's asthma, or school staff assistance with medications.     

Communicating bicornuate uterus with double cervix and septate vagina: an uncommon malformation diagnosed with MR imaging

We report a case of communicating uterus diagnosed with MRI. These uterine malformations are characterized by a communicating tract between two separate uterocervical cavities, which is usually detected with hysterosalpingography performed for a suspected uterine malformation. In our patient MRI was performed after the clinical finding of a double cervix and a vaginal septum and demonstrated two separate uterine cavities, each of them with its own junctional area, and an isthmian transverse communicating tract with endometrial tissue inside, which helped make the diagnosis of a type-4 a communicating uterus according to Toaff. Received 20 July 1995; Revision received 26 April 1996; Accepted 30 April 1996