Prolactin secretion in 70 patients with growth hormone deficiency

The basal levels of prolactin (PRL) and its response to TRH stimulation were studied in 70 patients with growth hormone deficiency of various etiology. It was found that there was a low secretion of PRL which was in most cases associated with a low response of TSH to TRH as well in 8 (36%) of 22 patients with so-called isolated growth hormone deficiency (IGHD) and 3 of 21 patients with multiple pituitary hormone deficiencies (MPHD). On the basis of this observation it is suggested that IGHD patients found to have a deficiency of PRL be reclassified as suffering form MPHD due to pituitary disease. High basal levels of PRL, usually associated with a delayed response of TSH to TRH, were found in 2 patients with IGHD and in 8 with MPHD (prior to substitution therapy with thyroxine) in whom the deficiency is probably: due to disease of the hypothalamus. With two exceptions the PRL levels normalized in the MPHD patients following institution of thyroxine replacement treatment. In the idiopathic cases of GH deficiency the determination of PRL levels was therefore found to be useful in delineating the location of the defect and in correctly classifying individual patients. Among the patients with tumors a disturbance in PRL secretion was found preoperatively in 4 of the 6 cases studied, the low PRL response in 2 being suggestive of a pituitary disturbance. Post-operatively evaluation of the PRL secretion was found useful in assessing the completeness of hypophysectomy and the persistence or recurrence of the tumor.Dedicated to Prof. Dr. H.-R. Wiedemann on the occasion of his 65th birthday     

High frequency of atypical pseudocholinesterase gene among Iraqi and Iranian Jews*

A large scale survey of the frequency of atypical pseudocholinesterase was carried out in a sample of 9,500 Jewish males in Israel. A very high frequency of the Eja gene, exceeding that reported for any other population so far studied, has been found among Iraqi and Iranian Jews (gene frequencies 0.047 and 0.075, heterozygotes frequencies 8.9 % and 11.3 %). Carriers of the Ejf gene were found among Ashkenazi (European Jews) as well as among non-Ashkenazi Jews from Iraq, Yemen and North Africa. One case homozygous for E]S gene has been found among North African Jews.
In the whole sample 8 subjects of phenotype A (frequency 1 : 1188), 8 of phenotype AF (frequency 1 :1188) and 1 with phenotype S were found. Among their family members we found additional cases with phenotypes A and AF, as well as 1 subject with phenotype F. Since these phenotypes are known to be sensitive to suxamethonium, these subjects were advised to avoid suxamethonium administration.     

Simple calculator to estimate the medical cost of diabetes in sub-Saharan Africa

AIM: To design a medical cost calculator and show that diabetes care is beyond reach of the majority particularly patients with complications.METHODS: Out-of-pocket expenditures of patients for medical treatment of type-2 diabetes were estimated based on price data collected in Benin, Burkina Faso, Guinea and Mali. A detailed protocol for realistic medical care of diabetes and its complications in the African context was defined. Care components were based on existing guidelines, published data and clinical experience. Prices were obtained in public and private health facilities. The cost calculator used Excel. The cost for basic management of uncomplicated diabetes was calculated per person and per year. Incremental costs were also computed per annum for chronic complications and per episode for acute complications.RESULTS: Wide variations of estimated care costs were observed among countries and between the public and private healthcare system. The minimum estimated cost for the treatment of uncomplicated diabetes (in the public sector) would amount to 21%-34% of the country’s gross national income per capita, 26%-47% in the presence of retinopathy, and above 70% for nephropathy, the most expensive complication.CONCLUSION: The study provided objective evidence for the exorbitant medical cost of diabetes considering that no medical insurance is available in the study countries. Although the calculator only estimates the cost of inaction, it is innovative and of interest for several stakeholders.     

The ACIST power injection system reduces the amount of contrast media delivered to the patient,as well as fluoroscopy time,during diagnostic and interventional cardiac procedures

The ACIST injection system is an automatic power injection device that allows for online control of injection rate and volume of contrast. Limited data is available whether this technology allows reducing use of contrast and fluoroscopy time. Accordingly, we compared the use of this system to manual injection among 450 consecutive patients who underwent diagnostic coronary angiography and/or angioplasty who were randomly assigned to either manual contrast injection (control; n = 198) or to the ACIST system (study group; n = 252). The amount of contrast, fluoroscopy and total procedural times were recorded for each patient. In the diagnostic group, the mean total amount of contrast (including wasted) was reduced by 63% when the ACIST was used compared to control (100±42?ml versus 163±56?ml; P<0.001, respectively). When only the net amount of contrast delivered to the patient was considered, the differences were smaller (20%, P = 0.004). During angioplasty, the amount of contrast was also lower in the ACIST group (206±65 versus 230±69, P = 0.008), whereas no difference were noted in net amount of contrast. Fluoroscopy time was significantly shorter in the ACIST group compared to control both during diagnostic catheterization (4.7±3.5?min versus 6.3±5.5?min, respectively; P = 0.014), and angioplasty (16.7±9.1?min versus 19.6±12.4?min, respectively; P = 0.05). Routine utilization of the ACIST system during diagnostic and interventional procedure significantly reduced the total amount of contrast media used and fluoroscopy time.     

Inflammatory bowel disease in military aviators: 14 cases with return to flying duty

Inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, is not a rare entity among military aviators. This relapsing inflammatory condition which may also affect extra intestinal organs can cause recurrent symptoms with considerable morbidity. The unpredictable nature of the disease, side effects of medications, and potential surgical procedures are obvious aeromedical concerns let alone the disease's extra-intestinal manifestations, some of which may result in sudden incapacitation. We present 14 military aviators who were diagnosed with inflammatory bowel disease and returned to flight duty after stabilization of symptoms. Mean follow-up period was 102 months (total of 1,429 months) without any adverse effects on flight safety. Only 4 aviators were grounded for a cumulative duration of 35 months during that period. We believe that because adequate disease control is readily feasible in most cases, safe return to flight duty within a short period is reasonable in uncomplicated cases.     

Elevated serum placental isoferritin in newly diagnosed Type 1 (insulin-dependent) diabetes mellitus. A possible marker for identification of high risk subjects

Summary Placental isoferritin is produced by activated T lymphocytes and may, therefore, be considered as a manifestation of T cell involvement. Placental isoferritin is measured using CM-H-9 monoclonal antibody which binds exclusively to placental isoferritin. Placental isoferritin has been determined in the serum of 80 patients with Type I (insulin-dependent) diabetes mellitus, 100 healthy first degree relatives and 81 healthy children. Serum levels which were measured in Type 1 diabetic patients, (24,0–140 U/ml; median and range) were significantly higher than those of family members (0,0–73; median and range; p<0.0001) and normal control subjects (0,0–48; median and range; p<0.0001). Using 0–10 U/ml as the upper limit of normal, it was found that 31 of 50 (62%) of Type 1 diabetic patients, 25 of 100 (25%) family members and 7 of 81 (8.6%) healthy control subjects had abnormal placental isoferritin levels. Islet cell antibodies were positive in 31 of 44 tested diabetic patients and, in 8 of 71 tested family members, and among them 54.8% and 50% respectively also had elevated placental isoferritin levels. However, no statistically significant correlation was found between islet cell antibodies and placental isoferritin levels. Treatment of Type 1 diabetic patients with insulin was accompanied by a significant decrease (p<0.002) of serum placental isoferritin within 2–4 weeks of treatment. It is noteworthy that placental isoferritin was below detection in 34 of 35 Type 2 (non-insulin-dependent) diabetic patients. Our findings suggest that placental isoferritin may be a marker of T cell involvement in autoimmune diabetes and that it could be used to identify high risk healthy first degree relatives.