Soy Phytoestrogens Do Not Fully Reverse Changes in Rat Pituitary Castration Cells: Unbiased Stereological Study

The aim of the study was to examine the potential of the principal soy isoflavones, genistein and daidzein, or isoflavone rich soy extract to recover pituitary castration cells in orchidectomized adult male rats in comparison with the effects of estradiol. Two weeks post orchidectomy (Orx), animals received estradiol‐dipropionate, genistein, daidzein or soy extract subcutaneously for 3 weeks. Control sham‐operated (So) and Orx rats received just the vehicle. Changes in the volumes of pars distalis, of individual follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) containing cells, their volume, numerical density and number were determined by unbiased design‐based stereology. The intracellular content of βFSH and βLH was estimated by relative intensity of fluorescence (RIF). Orchidectomy increased all examined stereological parameters and RIF. Compared to Orx, estradiol increased the volume of pars distalis, but reversed RIF and all morphometric parameters of gonadotropes to the level of So rats, except their number. Treatments with purified isoflavones and soy extract decreased RIF to the control So level, expressing an estradiol‐like effect. However, the histological appearance and morphometrical features of gonadotropes did not follow this pattern. Genistein increased the volume of pars distalis, decreased the volume density of LH‐labeled cells and raised the number of gonadotropes. Daidzein decreased the cell volume of gonadotropic cells but increased their number and numerical density. Soy extract induced an increase in number and numerical density of FSH‐containing cells. Therefore, it can be concluded that soy phytoestrogens do not fully reverse the Orx‐induced changes in pituitary castration cells. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.     

Congenital diaphragmatic hernia in older children

The incidence of congenital diaphragmatic hernia (CDH) is about 4.8/10,000 live births. Its typical clinical presentation is respiratory distress occurring immediately after birth or in the first few hours or days of a child's life. It is characterized by a high mortality rate. Exceptionally, CDH can occur at an older age, its symptoms then frequently reflecting gastrointestinal obstruction or mild respiratory symptoms. In such cases CDH presents a far more complex diagnostic problem. The paper presents the cases of two girls without typical symptomatology, aged 5.5 and 10 years, in whom CDH was detected incidentally upon thorough physical examination and chest x-rays. Further radiographic evaluation, which included barium contrast study and spiral computed tomography, confirmed the suspicion of a left-sided posterolateral diaphragmatic hernia with associated intestinal malrotation. Surgical intervention conclusively confirmed a diaphragmatic defect at the site of Bochdalek's foramen in both cases. The vital capacity of the older girl, which was low before the surgery (VC 1.66 L; 69% of predicted), was significantly increased a month after the surgical treatment (VC 2.25 L; 92% of predicted). The generally expressed view that the clinical onset of CDH is rare after the neonatal period seems to be erroneous. Some papers report on the clinical presentation of CDH after the neonatal period in as many as 13%-14% of infants and young children suffering from CDH. Infants and young children with a delayed clinical occurrence of CDH can present with respiratory or gastrointestinal symptomatology. Children presenting with gastrointestinal symptoms have been shown to be significantly older than those presenting with respiratory symptoms. In older children and adolescents, the symptoms and signs of CDH, which include acute hernial incarceration, nausea, recurrent vomiting, diarrhea, obstipation, acute gastric dilatation, subcostal pain, failure to thrive and recurrent chest infections, habitually present a significant diagnostic problem. Diagnostic errors are mainly due to the fact that the possibility of CDH in that age is totally neglected. The most recurrent diagnostic misinterpretations in such cases are pneumonia or massive pleuropneumonia, empyema, pneumothorax, lung cysts and bullae, and gastric volvulus. Thus, whenever a child presents with uncommon respiratory or gastrointestinal symptoms and an anomalous chest x-ray, a differential diagnosis of CDH should be considered. Otherwise, an accurate diagnosis in both young and older children will most probably be only reached at autopsy. In conclusion, the presented cases corroborate the finding that CDH in older children may present with scarce symptoms, mostly gastrointestinal, or may be altogether asymptomatic and unrecognized until as late as adolescence. However, when a diagnosis of CDH has been established, albeit asymptomatic, it must be promptly treated surgically in order to prevent complications, such as strangulation or bowel perforation, and thus avert a potentially fatal outcome. The size itself of the herniac foramen is unlikely to be a determining factor at the time of clinical presentation of CDH. Surgical occlusion of CDH may in older children result in an improved vital capacity, as such cases are rarely associated with major pulmonary hypoplasia. Complications resulting from surgical treatment of CDH in older children are more likely to occur in the gastrointestinal system, as a consequence of the associated bowel malrotation and inadequate bowel fixation. Finally, these two cases corroborate the diagnostic value of accurate history taking and thorough physical examination.     

Relation between QT dispersion and reperfusion in acute myocardial infarct

BACKGROUND: QT dispersion (QTd) represents the parameter of the expanded heterogeneity of myocard of ventricles. The aim of this study was to examine the dynamics of changes of QTd during the first 5 days of the acute myocardial infarction (AMI) in dependence to noninvasively estimated success of thrombolytic therapy. METHODS: Thirty six patients with AMI were included in the study. All patients were treated with alteplaze according to rapid protocol. QTd (QTc max-QTc min) was measured immediately after the reception (0 min), after the thrombolytic therapy (90 min) and since the 2nd to the 5th day of the hospitalization. Reperfusion was estimated on the basis of electrocardiographic and biohumoral parameters. RESULTS: In the group of 36 patients, 22 male and 11 female, both parameters of the reperfusion were not compatible in 3 patients. The other 23 patients had the reperfusion, while 10 patients did not have it. At the reception there was no significant difference of QTd between the group with reperfusion (79 +/- 34 ms) and the group without reperfusion (65 +/- 19 ms). After receiving alteplase, the average QTd in the group with reperfusion was 67 +/- 31 ms, which was not shorter in relation to the group without reperfusion (70 +/- 23 ms). Since the 2nd day of AMI, significantly smaller QTd in pa-patients with reperfusion was not registered compared with the patients without the reperfusion (54 +/- 17 vs. 73 +/- 20 ms), whereas since the 3rd day the difference became significant (46 +/- 16 vs. 87 +/- 24 ms). On the 4th day it was 43 +/- 12 vs. 78 +/- 21 ms, and on the 5th day it was 38 +/- 11 vs. 62 +/- 23 ms. On the 1st day significant difference of QTd between the groups with and without reperfusion was not registered in the group of patients with anterior AMI (0 min: 97 +/- 47 vs. 72 +/- 16; 90 min: 68 +/- 47 vs. 72 +/- 20) whereas on the 2nd day it became statistically significant (51 +/- 15 vs. 74 +/- 20 on the 2nd day, 51 +/- 20 vs. 88 +/- 24 on the 3rd day, 46 +/- 10 vs. 81 +/- 19 on the 4th day and 40 +/- 8 vs. 69 +/- 22 ms on the 5th day. In the group of patients with inferolateral AMI, only on the 3rd day significant difference of QTd between the group with and the group without reperfusion was registered (43 +/- 14 vs. 69 +/- 29 ms), while in all other measuring it was not registered (0 min: 69 +/- 22 vs. 42 +/- 9; 90 min: 67 +/- 20 vs. 67 +/- 41; 55 +/- 19 vs. 60 +/- 25 on the 2nd day; 41 +/- 14 vs. 51 +/- 6 on the 4th day and 51 +/- 12 vs. 37 +/- 8 ms on the 5th day). CONCLUSION: Qt dispersion was of significantly shorter duration in patients with the successfully performed reperfusion in relation to the patients without the reperfusion. In patients with the anterior AMI, QTd was significantly different in patients with in relation to the patients without the reperfusion in distinction with the patients with inferolateral AMI.     

Importance of personality traits and psychosocial factors for the development of coronary heart disease

BACKGROUND/AIM: Numerous studies have provided clear and convincing evidence that psychosocial factors contribute to the pathogenesis and expression of coronary heart disease (CHD). These factors have been related to the following psychosocial domains: personality factors and character traits, depression, anxiety, social isolation and chronic life stress. The aim of this study was to estimate the influence of personality traits and psychosocial risk factors for the development of coronary heart disease. METHODS: The investigation was conducted as observational cross-sectional (case-control) study. Based on medical records all subjects were divided into two groups: the group of patients with CHD (61 participants), and the control group of 41 healthy participants. All participants fulfilled the Eysenck Inventory Questionnaire, Paykel stress scale and Bortner scale of A-B self-estimation. RESULTS: The participants with CHD were shown to have lower education than healthy participants, but were comparable by gender, age and place of residence. According to the Bortner scale, most participants with CHD expressed type A personality, whereas most healthy participants expressed types B and AB. The patients with CHD achieved higher scores on the Paykel stress scale of life events, and they had the higher level of neurotic and psychotic tendencies, as well as the lower level of extroversion compared to the healthy participants. Multivariate logistic regression model identified chronic stress (odds ratio 1.018; 95% confidence interval 1.007-1.028) as an important predictor for the occurrence of coronary heart disease, when adjusted for age, gender, nourishment and blood pressure. On the other side, the lower risk for the occurrence of CHD was observed among the participants who had the higher level of extroversion (odds ratio 0.859; 95% confidence interval 0.636-0.902). CONCLUSION: Chronic stress and introversion can be considered important risk factors for the development of coronary heart disease, independent of other predictors such as obesity and hypertension, supporting the biopsychosocial model of the occurrence of coronary heart disease.     

Leptin levels in infertile male patients are correlated with inhibin B, testosterone and SHBG but not with sperm characteristics

In the present study, differences in leptin levels between different groups of male patients presenting with infertility problems and possible correlations between leptin levels and clinical, spermiological, histological and hormonal characteristics were examined. Two hundred and ten male partners from infertile couples were included in the study. Based on clinical examination, spermiogram and testicular histology results, patients were divided into four groups: 42 men with non-obstructive azoospermia, 15 men with obstructive azoospermia, 68 men with oligoasthenoteratozoospermia and 85 men with normozoospermia. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), inhibin B, testosterone, sex hormone binding globulin (SHBG) and leptin were measured. After adjustment for body mass index, there was a negative correlation between serum levels of leptin and inhibin B, total testosterone and SHBG (r = -0.189, p = 0.009, r = -0.250, p = 0.001 and r =-0.221, p = 0.003 respectively) but there was no correlation between leptin and classical sperm characteristics. Our results therefore demonstrate a link between leptin and testicular function, independently of FSH and LH, possibly involving testosterone and SHBG through a regulation of Leydig cell function.     

Mammographic Density and Estimation of Breast Cancer Risk in Intermediate Risk Population

It is not clear to what extent mammographic density represents a risk factor for breast cancer among women with moderate risk for disease. We conducted a population‐based study to estimate the independent effect of breast density on breast cancer risk and to evaluate the potential of breast density as a marker of risk in an intermediate risk population. From November 2006 to April 2009, data that included American College of Radiology Breast Imaging Reporting and Data System (BI‐RADS) breast density categories and risk information were collected on 52,752 women aged 50–69 years without previously diagnosed breast cancer who underwent screening mammography examination. A total of 257 screen‐detected breast cancers were identified. Logistic regression was used to assess the effect of breast density on breast carcinoma risk and to control for other risk factors. The risk increased with density and the odds ratio for breast cancer among women with dense breast (heterogeneously and extremely dense breast), was 1.9 (95% confidence interval, 1.3–2.8) compared with women with almost entirely fat breasts, after adjustment for age, body mass index, age at menarche, age at menopause, age at first childbirth, number of live births, use of oral contraceptive, family history of breast cancer, prior breast procedures, and hormone replacement therapy use that were all significantly related to breast density (p < 0.001). In multivariate model, breast cancer risk increased with age, body mass index, family history of breast cancer, prior breast procedure and breast density and decreased with number of live births. Our finding that mammographic density is an independent risk factor for breast cancer indicates the importance of breast density measurements for breast cancer risk assessment also in moderate risk populations.     

Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the AOSpine North America and International prospective multicenter studies

Background Context

It remains unclear whether cervical laminoplasty (LP) offers advantages over cervical laminectomy and fusion (LF) in patients undergoing posterior decompression for degenerative cervical myelopathy (DCM).

Peripheral blood eosinophilia associated with gastrointestinal administration of iodinated contrast media

OBJECTIVE: This study was designed to assess whether gastrointestinal administration of iodinated contrast media results in peripheral blood eosinophilia. MATERIALS AND METHODS: We studied 110 patients in a retrospective review. Diatrizoate meglumine and diatrizoate sodium for abdominal CT were administered to 98 of these patients; 22 of the 98 had also been given the same contrast medium administered by enema. The remaining 12 patients were given diatrizoate sodium for gastrointestinal fluoroscopy. A control group of 65 patients underwent single-contrast barium upper gastrointestinal or enema examinations. WBC and eosinophil counts were determined approximately 24 hr before the examination and every 24 hr thereafter, through the ninth day. RESULTS: Eosinophilia was detected in 17 (15.5%) of 110 patients after gastrointestinal administration of iodinated contrast media. The prevalence of eosinophilia after administration of iodinated contrast media was statistically significantly different compared with that in the control group, in which none of the 65 patients had eosinophilia (p < 0.001). Eosinophilia was detected 48 hr after application of iodinated contrast agents and lasted through the sixth day, with a peak on the fifth day. The prevalence of eosinophilia was independent of route of application, dose, or type of iodinated contrast medium. Eosinophilia in all cases was clinically asymptomatic. CONCLUSION: Eosinophilia that is caused by gastrointestinal administration of iodinated contrast media is a transient, clinically silent phenomenon. It may lead to unnecessary workup for known conditions associated with eosinophilia.