Hypothalamic disease presenting as amenorrhoea: value of computed tomography

Summary. Five women presenting with amenorrhoea (three with secondary amenorrhoea and galactorrhoea, and two with primary amenorrhoea) were shown to have suprasellar abnormalities by computed tomography. Organic hypothalamic disease was confirmed at surgery (craniopharyngioma in three, intra- and suprasellar Rathke's cleft cyst in one, aqueductal stenosis and suprasellar arachnoid cyst in one). Moderate hyperprolactinaemia was present in the first four, while the last had isolated gonadotrophin deficiency of hypothalamic origin. One o f the hyperprolactinaemic women had entirely normal residual pituitary function, visual fields and tomography of the sella. Two of the patient, with secondary amenorrhoea and galactorrhoea had resumption of menses during bromocriptine therapy before operation. Spontaneous menarche and subsequent pregnancy occurred after ventriculoatrial shunt in the girl with aqueduetal stenosis. Organic hypothalamic diseases may present with amenorrhoea (sometimes as the only symptom) more commonly than previously appreciated. Computed tomography should replace conventional tomography of the sella and should be an essential part of the clinical investigation in all patients with amenorrhoea of hypothalamo-pituitary origin.     

Transcriptional and post-transcriptional regulation of granulocyte-macrophage colony-stimulating factor production in human growth factor dependent M-07e cells

Summary. Human myeloid leukaemia cell lines have been shown to differentiate into distinct cell lineages in vitro in response to several differentiation-inducing agents. A human eosinophilic leukaemia cell line, EoL-1, has been shown to differentiate into mature eosinophilic granulocytes by treatment with the culture supernatant of a human T-cell line, HIL-3. In this study we have studied whether the EoL-1 cell line has potential to differentiate into cell lineage other than eosinophils. We found that EoL-1 cells cultured in the presence of tumour necrosis factor (TNF)-α (10u/ml) and interferon (IFN)-γ (1000u/ml) for 2–4d differentiated into macrophage-like cells in morphology, and expressed CD14 antigen on their cell surface. It is possible that the small subpopulation of EoL-1 cells which contains non-specific esterase (NSE) activity may be preferentially differentiated by TNF-α and IFN-γ. To clarify this issue, we have cloned the EoL-1 cell line and obtained NSE negative and positive sublines. Both EoL-1 sublines differentiated into monocyte/ macrophage-like cells, because: (a) EoL-1 sublines were induced to express CD14 antigen, and (b) they attached firmly to the plastic wells; (c) after differentiation they became strongly positive for NSE staining, and secreted TNF-α in response to the stimulation with lipopolysaccharide; and (d) they exhibited potent phagocytic activity. Therefore, we found that the EoL-1 cell line has the ability to differentiate not only into mature eosinophilic cells but also into monocyte/macrophage cell lineage, suggesting that EoL-1 cells represent immature cells with ability to differentiate into multiple cell lineages.     

Radiofrequency Catheter Ablation and Modulation of Atrioventricular Conduction in Patients with Atrial Fibrillation

We attempted radiofrequency ablation of the AV junction with a sequential right- and left-sided approach in 78 patients affected by severely symptomatic, drug refractory atrial fibrillation. Stable third-degree A V block was obtained in 99% of cases and, after 3 months, persisted in 92% of cases. Single session, stepwise, radiofrequency modulation of the AV node was attempted in 13 patients with paroxysmal atrial fibrillation. During sinus rhythm, ablation of the slow and fast AV node pathways was performed in order to increase the nodal refractory period or to slow conduction. Clinically successful modulation of AV conduction was achieved in 15% of cases and persisted during a 3-month follow-up. In conclusion. AV junction ablation is a well-established means of treating atrial fibrillation, but implies the implant of a permanent pacemaker. AV node modulation avoids the pacemaker implant, but is efficacious only in a minority of patients. Thus, in patients affected by paroxysmal atrial fibrillation, AV modulation should be attempted first; if this is ineffective. AV ablation can be performed during the same session.