Die Dynamik der Insulinsekretion bei der Hypothyreose vor und während der Substitutionstherapie

Zusammenfassung Bei 8 Patienten mit frisch entdeckter, spontan aufgetretener unbehandelter Hypothyreose wurden Glucoseassimilation und Insulinsekretion geprüft und mit der von 200 Normalpersonen verglichen. Die Glucoseassimilation war bei den Hypothyreoten vermindert, der Seruminsulinspiegel in Ruhe und nach Belastung jedocherhöht. Dieser Befund spricht für eine Beeinträchtigung der Glucoseassimilation in der Peripherie. Patienten, bei denen die Hypothyreose nach einer Strumektomie aufgetreten ist, zeigen ebenfalls eine schlechte Glucoseassimilation, jedoch eineverminderte Insulinsekretion in Ruhe und nach Belastung.Unter Behandlung mit Schilddrüsenhormonen lassen sich Glucoseassimilation und Insulinsekretion normalisieren.

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Summary In 8 patient with recently discovered spontaneous hypothyroidism decreased assimilation of glucose was found despite marked hyperinsulinism in the fasting state and following glucose administration. In contrast, in hypothyroidism due to thyroidectomy in both decreases in peripheral glucose assimilation and plasma insulin concentrations before and after glucose stimulation were established. The different behaviour of spontaneous and reactive insulin secretion in the two different types of myxedema remains open to discussion. In any case, treatment with thyroid hormones results in normalization of glucose utilization and insulin secretion.

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Ausgearbeitete Fassung eines Vortrages (Abstr. Nr. 2) auf dem Kongreß der Deutschen Diabetes-Gesellschaft, Ulm, am 16./17. 5. 1969.     

Palliation of malignant rectal obstruction with self-expanding metal stents

BACKGROUND: Surgical management of patients with metastatic or recurrent rectal cancer remains controversial. Self-expanding metal stents are increasingly used for palliative treatment of advanced tumors, although long-term results are not yet available. METHODS: Between 1996 and 2003, 521 patients underwent surgery for rectal neoplasms. In the same time period, self-expanding metal stents were used for palliation of 34 patients with malignant rectal obstruction and incurable disease. The outcome of the patients was analyzed retrospectively. RESULTS: Rectal stents were successfully placed in 33 of 34 patients (97%) without major complications. Early failure occurred in 7 patients (21%) because of stent migration, pain, or incontinence. Long-term success with a mean patency of 5.3 months was observed in 26 patients (79%), but restenting was required in 2 patients. Despite the initial success of stenting, a colostomy was created in 2 other patients after 3.4 months and 9.2 months because of incontinence and rectovesical fistula. Overall, 6 of 33 patients (18%) underwent palliative surgery because of early complications (n = 4) or long-term failure of stent treatment (n = 2). CONCLUSIONS: Self-expanding metal stents are useful to avoid a colostomy in selected patients with incurable rectal cancer and limited life expectancy. Nonetheless, a considerable number (18%) of patients will require surgical palliation because of failure of stent treatment.     

Ambient air particulate dry deposition, concentrations and ionic species study at Taichung Harbor near Taiwan Strait

The characterization for watersoluble species of dry deposition flux, total suspended particulate (TSP), fine particle (particle matter with aerodynamical diameter 2.5 microm, PM2.5), coarse particle (particle matter with aerodynamical diameter 2.5-10 microm, PM(2.5-10)), and dry deposition velocity were studied at Taichung Harbor sampling sites of central Taiwan during February-August 2004. The average downward dry deposition flux, TSP, PM10 concentrations obtained in Taichung Harbor were about 0.51, 0.3, and 3.4 times more than those values obtained by traffic sampling site in central Taiwan. Average dry deposition velocity for mass, Cl-, NO3-, SO4(2-), Na+, NH4+, Mg2+, and Ca2+ were 9, 3.8, 0.3, 0.25, 0.46, 0.18, 0.51 and 2.28 cm respectively at the harbor sampling site. In general, average particle mass dry deposition velocity was about 1.8 times more than those values obtained at the traffic sampling site. Chemical analysis, also indicated that three major soluble inorganic species concentrations (sulfate+nitrate+ammonium) accounted for 59.8% and 80.6% of the PM2.5 and PM(2.5-10) mass concentrations, respectively at the Taichung Harbor sampling site.     

Human metapneumovirus RNA in encephalitis patient

We describe a fatal case of encephalitis that might be correlated with primary human metapneumovirus (HMPV) encephalitis. Postmortem HMPV RNA was detected in brain and lung tissue samples from the patient. Furthermore, HMPV RNA was found in culture fluids from cells coincubated with lung tissue.     

Uremia accelerates both atherosclerosis and arterial calcification in apolipoprotein E knockout mice

Chronic renal failure (CRF) favors the development of atherosclerosis and excessive calcification of atheromatous lesions. CRF was induced in apolipoprotein E knockout (apoE(-/-)) mice to study (1) a possible acceleration of aortic atherosclerosis, (2) the degree and type of vascular calcification, and (3) factors involved in the calcification process. For creating CRF, 8-wk-old apolipoprotein E gene knockout (apoE(-/-)) mice underwent partial kidney ablation. Control animals underwent sham operation. Aortic atherosclerotic plaques and calcification were evaluated using quantitative morphologic image processing. At 6 wk after nephrectomy, CRF mice had significantly higher serum urea, cholesterol, and triglyceride concentrations than non-CRF controls. The serum levels of advanced oxidation protein products were elevated in the uremic group and were correlated with serum urea levels. Atherosclerotic lesions in thoracic aorta were significantly larger in uremic apoE(-/-) mice than in nonuremic controls. The relative proportion of calcified area to total surface area of both atherosclerotic lesions and lesion-free vascular tissue was increased in aortic root of uremic apoE(-/-) mice when compared with controls. The calcium deposits were made of hydroxyapatite and calcite crystals. In addition, plaques from uremic animals showed a significant increase in collagen content, whereas the degree of macrophage infiltration was comparable in both groups. There was no difference in mean arterial BP. These findings demonstrate that CRF aggravates atherosclerosis in apoE(-/-) mice. Moreover, CRF enhances arterial calcification at both atheromatous intimal sites and atheroma-free medial sites. We anticipate that this experimental model will be useful to test treatment strategies aimed at decreasing the accelerated atherosclerosis and arterial calcification in uremia.     

Distribution and effects of polymorphic RANTES gene alleles in HIV/HCV coinfection -- a prospective cross-sectional study

AIM: Chemokines and their receptors are crucial for immune responses in HCV and HIV infection. RANTES gene polymorphisms lead to altered gene expression and influence the natural course of HIV infection. Therefore, these mutations may also affect the course of HIV/HCV coinfection. METHODS: We determined allele frequencies of RANTES-403 (G→A), RANTES-28 (C→G) and RANTES-IN1.1 (T→C) polymorphisms using real-time PCR and hybridization probes in patients with HIV (n = 85), HCV (n = 112), HIV/HCV coinfection (n = 121), and 109 healthy controls. Furthermore, HIV and HCV loads as well as CD4+ and CD8+ cell counts were compared between different RANTES genotypes. RESULTS: Frequencies of RANTES-403 A, RANTES-28 G and RANTES-IN1.1 C alleles were higher in HIV infected patients than in healthy controls (-403: 28.2% vs 15.1%, P = 0.002; -28: 5.4% vs 2.8%, not significant; IN1.1: 19.0% vs 11.0%, P = 0.038). In HIV/HCV coinfected patients, these RANTES alleles were less frequent than in patients with HIV infection alone (15.4% P = 0.002; 1.7%; P = 0.048; 12.0%; not significant). Frequencies of these alleles were not significantly different between HIV/HCV positive patients, HCV positive patients and healthy controls. CONCLUSION: All three RANTES polymorphisms showed increased frequencies of the variant allele exclusively in patients with HIV monoinfection. The finding that the frequencies of these alleles remained unaltered in HIV/HCV coinfected patients suggests that HCV coinfection interferes with selection processes associated with these alleles in HIV infection.     

Trends in educational and occupational differentials in all-cause mortality in Austria between 1981/82 and 1991/92

Comparative international studies regularly find an increase in mortality differentials by education and socioeconomic group. We are interested in whether the same is true for Austria, a country for which no previous comparable study exists. On the basis of linked death and census records for the Austrian population in the years 1981/82 and 1991/92, we observed a widening gap in educational and occupational differentials of Austrian men in relative and absolute mortality from all causes. The increase was restricted to ages 50 to 74, whereas mortality differentials at younger and older ages were unchanged or slightly lower. The growing gap resulted from increasing mortality advantages for men with tertiary education, the highest educational group. Their absolute mortality and relative mortality risks decreased faster than those of all other educational groups. Educational differentials among women remained unchanged.     

Diagnosis of schizophrenia by computer and clinicians: A pilot study

Investigations show significant disagreement among mental health professionals in diagnosing schizophrenia.^1–11 Recently, computer-based systems have been used in attempts to improve diagnostic consistency. Spitzer and Endicott, among others, have devised a computer program using the Mental Status Examination Report (MSER) as input data.^12–19 The MSER is a systematic, relatively objective inventory of observed behaviors used to obtain a mental status. The MSER was used at the Hillside Division during 1973 and 1974. It was filled out 1 week after admission by therapists who were specially trained for this task. It was noted that a nonschizophrenic computer diagnosis was given to a number of patients diagnosed schizophrenic by clinicians, but the reverse rarely occurred. Was this due to the computer program, the MSER, clinicians, or other factors? These questions have heightened relevance in light of the imminence of Professional Standards Review Organization (PSRO).²⁰ Hospitals may be required to establish definitive operational diagnostic criteria and correlated treatments in order to maintain accreditation and be reimbursed by third-party payers. This study investigated these diagnostic discrepancies in order to ascertain what specific criteria could be used in making a schizophrenic diagnosis in hospitalized patients. Secondarily, the study sought to shed further light on whether such a computer system could be useful as an adjunctive diagnostic modality to pinpoint difficult cases.