Prevalence of chronic lymphocytic thyroiditis in adolescent girls

Chronic lymphocytic thyroiditis (CLT) is the most common cause of thyroid enlargement in children and adolescents in iodine sufficient areas. The prevalence and pattern of CLT in adolescent girls in iodine deficient regions supplemented with iodine is as yet not known. We therefore, carried out clinical examination for the presence of goitre in 330 healthy girls from Delhi in the age group of 16-20 years and those with goitre were further subjected to detailed biochemical (T3, T4, TSH), immunological (ATg ad ATm) and cytomorphological examination. The prevalence of goitre was found to be 40%. Fine needle aspiration cytology (FNAC) carried out in 94 girls with goitre (74%) revealed finding consistent with CLT in 13 (13.8%), colloid goitre with non-specific thyroiditis in 7 (7.4%), colloid goitre in 71 (75.5%) and specimen was inadequate in 3 (3.2%) girls. Thyroid antibodies were estimated in 114 of the goitrous subjects and both ATg and ATm were positive in 11 (9.6%) cases. Overall prevalence of CLT in this population was 4.0% and among those with goitre was 13.8%. When thyroid antibodies were also considered as an indicator of thyroiditis, prevalence rose to 14.4% among goitrous girls. Thyroid function tests were found to be within normal limits in all goitrous girls. This study for the first time reveals a high prevalence of CLT in goitrous adolescent girls from iodine supplemented region and underscores the need to study the prevalence of CLT in different age and sex groups from different regions of the country.     

Endemic goiter in the Man region (Ivory Coast)

An epidemiological study involving 616 subjects carried out in the Man region, C?te-d'Ivoire, showed endemic goitre in 54,4% of the group overall and in 80 % of females. Thyroid function of subjects chosen at random in the goitrous and nongoitrous group (105 G and 71 NG respectively) was identical. Compared with a French control group T4 was significantly lower but T3 and TSH were higher, which represents a high TBG level with low iodine elimination. High levels of TSH are not necessarily associated with low T3 or T4 levels, or with clinical signs of a hypothyroid condition. They are probably the result of a transient reaction. T4-TSH and T3-TSH correlations for NG subjects were (--0,40) but the T3-TSH correlation for the G subjects was significantly lower (--0,23). These differences could be explained by the simultaneous high levels of T3 and TSH more frequently encountered in G subjects and by the fact that serious hypothyroid conditions are more frequent in the NG group (6 out of 9). The percentage of hypothyroid conditions is high in both clinical and biological investigations. No anti-thyroglobulin antibodies were found in any of the hypothyroid cases with goitre. The histograms illustrate the clinical and biological heterogeneity of a homogeneous non-medicalised population.     

Thyroid function after surgical treatment of nontoxic goitre. A randomized study of postoperative thyroxine administration

Following thyroid resection for nontoxic goitre, 29 euthyroid patients were randomly allocated to no medication or to 0.2 mg levothyroxine daily (17 and 12 patients). The two groups were comparable in age, sex, extent of surgery and thyroid pathology. The patients were free from other endocrine disorders and had no other medication. Serum TSH, T4 and T3 were measured and T3-resin test performed preoperatively and 14 days and 3, 6, 12 and 18 months postoperatively. All values were within normal range. Only at the 3-month follow-up could statistically significant intergroup differences be observed, with T4 higher in the thyroxine-treated and TSH higher in the untreated group, but the outset values were thereafter regained. The T3 values in both groups were slightly reduced immediately after the operation. There was no recurrence of goitre in the 18-month observation period, and none of the findings suggested that routine thyroxine treatment is of value after resection of nontoxic goitre "in Denmark".     

Children with recurrent abdominal pain and their parents: more somatic complaints, anxiety, and depression than other patient families?

Patients presenting with abdominal pain were classified into two groups: the recurrent abdominal pain (RAP) group (n = 41), consisting of patients without identifiable organic etiology for abdominal pain, and the organic group (n = 28), consisting of patients with organic findings (primarily ulcer-related conditions). A control group of well patients (n = 41) also participated. RAP and organic patients had higher anxiety, depression, and somatic complaints than well patients, but did not differ from each other. Anxiety, depression, and somatization were greater in RAP mothers than well mothers. Father symptomatology did not differ for the groups. Results suggest that psychological distress does not discriminate between patients with and without identifiable organic etiology for abdominal pain. The high levels of anxiety and depression in RAP and organic patients suggest that they should be targeted in efforts to address "the new hidden morbidity" in pediatrics.     

T, B and K cells in autoimmune thyroid disease.

The K-cell cytotoxic activity of peripheral blood lymphoid cells from 104 patients with autoimmune thyroid disease and from age and sex matched control subjects was measured using chicken erythrocytes as target cells. Patients with Hashimoto thyroiditis,primary hypothyroidism and thyrotoxicosis who were either newly diagnosed and untreated or had received therapy for less than or equal to 1 year showed a significant increase in K-cell cytotoxic activity. Patients who had received treatment for greater than 1 year and less than or equal to 5 years showed no such comparable increase in cytotoxic activity. Within the group of patients with untreated thyrotoxicosis it was found that K-cell cytotoxic activity was related to both goitre size and serum antibody titre. Thus patients with little or no goitre showed a highly significant elevation of cytotoxic activity whereas patients with moderate to large goitres gave values within the normal range. Similarly patients with no detectable serum thyroid autoantibodies showed high K-cell activity while patients with positive antibody titres did not. It was also shown that neither the absolute number nor the proportion of circulating T and B lymphocytes in patients with autoimmune thyroid disease as assessed by the sheep red cell rosette method and by indirect immunofluorescence was significantly different from that observed in the normal control population. No correlation was found between peripheral blood K-cell cytotoxic activity and the percentage of circulating null cells, i.e. 100-(percentage T + percentage B) in either patients or control subjects.     

Characterization of the natural killer cell activity in Hashimoto's and Graves' diseases

Natural killer (NK) cell activity and blood mononuclear cell subpopulations were characterized in patients with Hashimoto's thyroiditis ( n = 11), Graves' disease ( n = 20), non-toxic goitre ( n = 10) and in normal controls ( n = 22). NK cell activity against K 562 target cells and the capability of IFN-α, Il-2, and indomethacin to enhance NK cell activity in vitro did not differ significantly between the groups. The percentages of large granular lymphocytes, CD5 +, CD4 +, CD8 + and CD16 + cells were normal in patients with non-toxic goitre, Hashimoto's and Graves' diseases. There was no correlation between NK cell activities and TgAb, MAb and TSAb. Although NK cell activity is suppressed in several autoimmune diseases, NK cell function is normal in patients with autoimmune thyroid disorders.     

Congenital adrenal hyperplasia. II. Cognitive and behavioral studies

A sample of 31 patients with congenital adrenal hyperplasia was matched to a control group by sex, age, height, full-scale IQ score, and urban/rural site of residence. Patients and matched controls were tested on measures of masculinity and femininity and on sex-typed tests of cognitive ability. The two groups did not differ significantly on these measures. The finding is in disagreement with earlier reports of “masculinization” of behavior in female patients with congenital adrenal hyperplasia.     

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We studied 15 children with recurrent infections and normal serum IgG, IgM, IgA, and IgG-subclass levels. After immunization, the geometric mean serum IgG antibody concentration to Haemophilus influenzae type b (Hib) was eightfold lower than that of age-matched control subjects (p = 0.002). The patients also had a lower geometric mean concentration of serum IgM and IgA directed to Hib, although these differences did not reach significance. However, the groups did not differ in their response to diphtheria toxoid and pneumococcal polysaccharides. To confirm these findings, an additional 11 patients were identified and immunized. The geometric mean serum IgG anti-Hib concentration for this group of patients was also significantly lower than of normal subjects (p = 0.004). We propose that the defect in the antibody response to Hib may be a marker for a poor antibody response to a variety of bacterial and viral antigens that results in an increased propensity to recurrent infections. The defect was not associated with IgG-subclass deficiency. The identification of children with selective antibody deficiency and recurrent infections is important for diagnostic and therapeutic reasons.     

Genetic similarity and maintenance of Candida albicans strains from a group of AIDS patients, demonstrated by DNA fingerprinting.

By using the computer-assisted Dendron system to analyze the patterns of Southern blots probed with the repetitive sequence Ca3, we have compared oral isolates of Candida spp. from a group of 11 nonhospitalized patients with AIDS suffering from recurrent episodes of oral thrush in Leicester, England, with oral isolates from a group of control individuals. Genetic diversity among the AIDS strains was significantly reduced compared with that of control strains. In addition, the same strains persisted through recurrent infections in patients with AIDS. Although AIDS strains were genetically less diverse than either control strains or oral commensal strains analyzed in previous studies, the majority did not form a genetically distinct group. The results of this study suggest that in the majority of patients with AIDS in this group from Leicester, original commensal strains were replaced, replacement occurred early in the manifestation of AIDS, and replacement occurred only once.     

Cytophotometric determination of nuclear size and DNA distribution in different hyperfunctioning thyroid lesions

Summary Nuclear enlargement in hyperfunctioning thyroid lesions which has been found in earlier cytophotometric studies is also one of the criteria in the subjective histological estimation of thyroid function. Histopathological assessment is, however, often unreliable. In the present study stage scanning cytophotometric measurements in Feulgen-stained tissue sections were used to determine the nuclear changes encountered in non-toxic and toxic nodular goitre, and in toxic diffuse goitre. To ensure optimal selection of specimens for measurements autoradiography was used. Specimens of toxic diffuse goitre invariably had enlarged nuclei, but no difference was found between nodules in non-toxic and toxic nodular goitre. In fact, the same nuclear area was found in hot nodules, warm nodules and perinodular tissue in non-toxic nodular goitre, and in hot nodules in toxic nodular goitre.Thus there are lesions with clear-cut clinical, biochemical, and autoradiographic hyperfunction that do not have enlarged nuclei. Against this background it is possible that the nuclear enlargement present in toxic diffuse goitre reflects the disorder in itself and not the hyperfunctioning state.Hyperdiploid cell nuclei were found in all cases of toxic diffuse goitre and in a higher precentage than in the other lesions. It was not possible to distinguish nontoxic and toxic nodular goitre on this basis.     

In VitroChromosomal Radiosensitivity in Common Variable Immune Deficiency

Common variable immune deficiency (CVID) is characterized by low immunoglobulin levels and recurrent infections in patients with a period of normal immune function several years after birth. It is associated with diarrhea, malabsorption, bronchiectasis, and lymphoreticular malignancies. Radiation-induced chromosome instability may contribute to the high degree of susceptibility to neoplasia. Peripheral blood lymphocyte cultures were obtained from six patients with CVID and the healthy control group matched by age and sex. The groups did not differ in the frequency of spontaneous chromosome aberrations. After exposure to X-ray radiation, mitotic indices were found to be significantly low and incidence of chromosomal alterations were high in the CVID group. We conclude that chromosomes of cells from patients with CVID are significantly more radiosensitive than those of controls. Thus these patients must be protected from unnecessary X-ray examinations and in case of radiosensitive tumour, the dose of irradiation should be carefully monitored.     

血液回收在脑膜瘤切除术中应用安全性的研究

目的评价血液回收用于脑膜瘤切除术中的安全性。方法选择1999年1月～2006年12月期间134例在北京天坛医院进行脑膜瘤切除手术的病人．进行最短为期12个月的术后随访。其中应用术中血液回收的病人89例（Ⅰ组）,男性44例．女性45例;未应用血液回收的病人45例（Ⅱ组）,男性21例,女性24例。两组术后平均随访期分别为25个月（12—58个月）及30个月（12～82个月）。通过头部影像学复查及包括胸片或胸透和腹部B超在内的全身体检,判断肿瘤是否复发或发生了颅外转移。结果Ⅰ组病人术中回输回收血液平均525ml（150～2000ml）,有7例（7．9％）病人术中输入异体血液：Ⅱ组有11例（24．4％）病人术中输入了异体血液（P〈0．001）。随访期内,两组肿瘤Simpson Ⅰ级切除的病例中,分别有5例（7．6％）和4例（11．8％）复发（P=0．75）。两组术后均未发现肿瘤颅外转移者。结论血液回收用于脑膜瘤切除术中．尚未发现其导致的肿瘤颅外转移或增加复发。     

A pilot clinical evaluation comparing the Mitek bone-tendon-bone cross pin and bioabsorbable screw in anterior cruciate ligament reconstruction fixation, a randomized double blind controlled trial

PURPOSE: To compare the clinical efficacy of ACL reconstruction using the Mitek bone-tendon-bone cross pin (RIGIDfix) to the Linvatec Bioscrew (control device). METHODS: Forty subjects were randomized into one of two groups: the RIGIDfix or control group. Eligible subjects were male and female, 18 years of age and older, with an ACL injury of at least 3 weeks duration and no evidence of ACL insufficiency on the contralateral side. Subjects were followed for 24-month post-operatively. Evaluations included the International Knee Documentation Committee (IKDC) Knee Ligament Standard Evaluation, Mohtadi's ACL Deficiency Quality of Life (ACL-QOL) questionnaire and the attainment of six rehabilitation milestones. Subjects and assessors were blinded to the surgical device used. RESULTS: Four subjects in the RIGIDfix group and four controls were lost to follow-up. The change in final IKDC scores did not differ significantly between groups with the majority demonstrating an improvement of one to two grades. The change in ACL-QOL scores did not differ significantly between the RIGIDfix subjects (40.0+4.4) and controls (46.0+3.6). Furthermore, the number of weeks that the RIGIDfix subjects versus controls attained full active extension, functional range of motion, normal gait, stair climbing, running gait and sprinting did not differ significantly. CONCLUSIONS: The RIGIDfix results in a similar post-operative course to the control device and is efficacious for the reconstruction of the ACL. No adverse events were associated with the use of the RIGIDfix. The results of this study should be considered preliminary due to the small sample size.     

Magnetic resonance imaging correlates of attention-deficit/hyperactivity disorder in children

This study compared magnetic resonance imaging size differences in several brain regions and neurocognitive function in a group of male and female children with attention-deficit/hyperactivity disorder (ADHD) with no comorbid learning disorders with a normal control group of children. The ADHD group demonstrated smaller total brain, superior prefrontal, and right superior prefrontal volumes, as well as significantly smaller areas for cerebellar lobules I-V and VIII-X, total corpus callosum area, and splenium. No group differences were observed for the inferior prefrontal, caudate, or cerebellar volumes, or for the area of cerebellar lobules VI-VII. In the ADHD group but not in the control group, greater right superior prefrontal volume predicted poorer performance on a test of sustained attention. Patterns of brain abnormality did not differ in male and female children with ADHD.     

3H]yohimbine binding to platelet alpha 2-adrenoceptors in depression

[3H]Yohimbine binding to platelet alpha 2-adrenoceptors was studied in depressed patients and healthy volunteers. Where possible platelet binding measurement was repeated in depressed patients following treatment. Bmax of [3H]yohimbine binding did not differ significantly between depressed patients and control subjects and did not change with treatment in depressed patients. KD was significantly lower in female depressed patients, particularly in those who were post-menopausal. Multivariate analysis showed significant effects on KD of depression, season of testing and assay protein concentration.     

女性经前期复发性阿弗他溃疡患者血清IL-6、IL-8、TNF-α和sICAM-1的含量变化及其意义

目的:研究女性经前期复发性阿弗他溃疡(经前期RAU)患者血清中白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和可溶性细胞间粘附分子-1(sICAM-1)的变化状况, 并探讨经前期RAU的发病机制。方法:用酶联免疫吸附双抗体夹心法(ELISA)检测女性经前期RAU患者外周血中IL-6、IL-8、TNF-α、sICAM-1的水平, 与正常对照组和无经前发作规律的女性RAU对照组相比。结果:经前期RAU患者的血清IL-6、IL-8、TNF-α水平不仅显著高于正常对照组(P＜0.01), 而且高于女性RAU对照组(P＜0.01)。而sICAM-1无明显变化。女性RAU患者血清中TNF-α亦高于正常对照组(P＜0.05)。结论:经前期RAU患者体内存在IL-6、IL-8、TNF-α介导的免疫功能异常, 可能对RAU局部损害起作用。     

Cell-Mediated Immunity to Yersinia enterocolitica Serotype 3 in Patients with Thyroid Diseases

The cellular immunity to Yersinia enterocolitica serotype 3 and crude human thyroid extract in 64 patients with thyroid diseases and 25 controls was studied by the leucocyte migration test. In the patient group as a whole and in patients with Graves' disease and nontoxic diffuse goitre a significantly reduced leucocyte migration towards Yersinia was found when compared with the controls. In controls the migration index was not related to the presence or titre of circulating yersinia antibodies, whereas the migration index of patients with yersinia antibodies was lower than the migration index of patients without yersinia antibodies as well as that of the controls. The leucocyte migration inhibition in two patients with recent yersiniosis was normal during the recovery phase.
In the presence of thyroid extract leucocyte migration inhibition differed only significantly in Graves' disease. However, a significantly positive correlation between inhibition of migration by thyroid extract and by Yersinia was found, while no correlation could be demonstrated in the controls.
The cell-mediated immunity towards Yersinia in thyroid diseases thus demonstrated adds further evidence to the association between Yersinia and thyroid disease.     

Expansion of extracellular volume in early polycystic kidney disease

Blood volume (BV), extracellular volume (ECV), blood pressure (BP), creatinine clearance (CCr), plasma levels of angiotensin II (AII), aldosterone (Aldo) and arginine vasopressin (AVP), and serum osmolality (Sosm) were determined in 18 patients with adult polycystic kidney disease, 8 normotensive (group I), 10 hypertensive (group II), and in 11 control subjects (group III). ECV but not BV was increased in group I compared with group III, whereas BV and ECV did not differ significantly between groups II and III. In group II, Aldo and AVP were increased and AII tended to be increased, while in group I the hormone levels did not differ significantly from those in group III. Sosm did not differ significantly between the groups. In the combined patient group, CCr correlated positively with BV and ECV and negatively with BP. In the patients, AII and AVP were positively correlated with BP but not with CCr. The results suggest that both the renin-angiotensin system and AVP might be involved in the BP elevation, whereas expansion of ECV can be found without an increase in BP.     

Sequential Changes in Cell-Mediated Immune Responses to Herpes Simplex Virus After Recurrent Herpetic Infection in Humans

Lymphocyte responses to herpes simplex virus (HSV) were studied in 23 patients with recurrent herpes labialis and in 19 control subjects. Lymphocytes of seropositive, but not seronegative, controls responded to HSV by thymidine incorporation, and the supernatant fluids inhibited the migration of guinea pig macrophages. Lymphocytes from patients with a recurrent herpetic lesion responded to HSV by significantly greater thymidine incorporation than seropositive controls, but supernatants did not show an increased macrophage migration inhibition response. During the 28 days after the onset of a lesion, the thymidine incorporation to HSV fell to the level of the seropositive controls, and supernatants then induced an increased inhibition of macrophage migration. Lymphocyte responses to Candida albicans, purified protein derivative, or phytohemagglutinin did not fluctuate according to the presence of a lesion and did not differ from those of the controls. Lymphocyte responses to HSV were unaffected by culture in the presence of serum from seronegative or seropositive controls, or from patients with or without a herpetic lesion. It is suggested that in patients with recurrent herpes labialis a periodic defect of the migration inhibition response might have allowed the recurrent infection to develop, and that the increased thymidine incorporation stimulated by HSV in vitro is a result of antigenic stimulation from the lesion.     

The TRH stimulation test in endemic goitre in Greece

Summary The serum T₄=T₄(D), T₃ in vitro uptake=RT₃U and TSH were measured before and 30 min after the injection of 200 µg of TRH in 30 subjects from an iodine deficient area of Central Greece. These persons were divided in two groups of 16 goitrous and 14 nongoitrous patients and the results from each group compared to each other and also with the same parameters obtained from 14 controls subjects, all nongoitrous and from a nonendemic area. It has been found that in this area with a mild iodine deficiency serum T₄ is the only hormone decreased whereas RT₃U and TSH both before and 30 min after TRH injection are normal. There existed however a negative correlation between serum T₄ and TSH in the goitrous group. Why the nongoitrous iodine deficient persons achieve the same compensation without thyroid gland enlargement remains unresolved but it may be stated from the present results that goitre development should be regarded as a maladaptation rather than a compensatory process.This work was supported by the Hellenic Ministry of Social Services.