THYROID HORMONE, OESTROGEN, AND GLUCOCORTICOID EFFECTS ON TWO DIFFERENT PITUITARY GLYCOPROTEIN HORMONE ALPHA SUBUNIT POOLS

Seven hypothyroid women (six postmenopausal and one premenopausal) were treated with 200 or 300 μg of levo-T4 daily in order to suppress the secretion of TSH and its alpha and beta subunits. After such therapy, serum TSH and beta subunit of TSH (TSH-β) levels were usually not detectable. Serum alpha decreased from a mean value of 4.5 ± 0.8 ng/ml to 2.8 ± 0.4 ng/ml (P > 0.01). Serum LH and FSH levels were unchanged. Oestrogen administration (20 mg diethylstilboestrol daily for 3 or 5 days) to these patients further decreased mean serum alpha to 1.9 ± 0.2 ng/ml (P > 0.005). In addition serum LH, FSH, and the beta subunits of LH and FSH decreased with oestrogen treatment. In separate experiments glucocorticoids (dexamethasone 4 mg every 6 hours for 10 doses) were administered to eight normal individuals, four women with decreased thyroid reserve, and one hyper-thyroid woman. Not only did basal and TRH-stimulated TSH secretion decrease, but secretion of alpha and TSH-β also decreased after dexamethasone administration, with the largest fall in the patients with decreased thyroid reserve. The change in these thirteen patients’ alpha subunit increment after TRH administration was from a mean of 1.6 to 1.0 ng/ml with glucocorticoids; the change in TSH-β was from a mean of 1.1 to 0.7 ng/ml. Serum LH and FSH concentrations were not altered by glucocorticoid administration. These studies have demonstrated two different pools of alpha subunits in the pituitary gland. Thyroid hormone and glucocorticoids decreased secretion of alpha subunits arising from the thyrotroph; oestrogen decreased secretion of alpha subunits arising from the gonadotroph.     

Rodent nutritional model of steatohepatitis: Effects of endotoxin (lipopolysaccharide) and tumor necrosis factor alpha deficiency

Background and Aims: Intestinal endotoxin (lipopolysaccharide) is thought to contribute to liver injury in both alcoholic and nonalcoholic steatohepatitis (NASH). Tumor necrosis factor alpha (TNFα) is an important mediator of this process and is considered central to the inflammatory response in NASH. This study aimed to investigate the effects of lipopolysaccharide on liver injury in the methionine choline deficient (MCD) nutritional model of NASH, and to determine if TNFα is required for the development of steatohepatitis in this model. Method: Male C57/BL6 mice received a MCD diet for 4 weeks, whilst a control group received an identical diet supplemented with 0.2% choline bitartrate and 0.3% methionine. At 4 weeks, mice received either an intraperitoneal injection of lipopolysaccharide (0.5 µg/g body mass) or sterile saline, and were killed 24 h thereafter. In a separate study, TNFα knockout and wild type C57BL/6 mice received either MCD or control diets for 4 weeks. Serum transaminase levels, liver histology (steatosis, inflammation and apoptosis), hepatic triglyceride concentration and hepatic lipid peroxidation products (conjugated dienes, lipid hydroperoxides and thiobarbituric reactive substances, free and total) were evaluated. Results: Intraperitoneal administration of lipopolysaccharide augmented serum alanine aminotransferase (ALT) levels (P < 0.02), hepatic inflammation (P < 0.025), apoptosis (P < 0.01) and free thiobarbituric acid reactive substances (P < 0.025) in MCD mice. TNFα knockout mice fed the MCD diet developed steatohepatitis with histological and biochemical changes similar to those seen in wild type counterparts. Conclusions: Lipopolysaccharide augments liver injury in MCD mice, and TNFα is not required for the development of steatohepatitis in MCD mice.     

Comparison of a dietary survey and the duplicate plate method for determining dietary fluoride ingested by young children: a pilot study

Background.  Investigators have attempted to establish the diet's contribution to the total body burden of fluoride in response to a reported trend towards an increase in fluoride intake.
Aim.  The aim of this study was to compare the suitability of two methods to collect dietary data for fluoride intake assessment.
Design.  Assessments were made in 12 children using the duplicate plate and dietary diary methods following a randomized cross-over design. Foods and beverages were analysed for fluoride, and total fluoride intake per day was calculated. Results from each method were compared.
Results.  Mean beverage fluoride intake was estimated at 316 ± 120 and 422 ± 195 µg/day utilizing the diary and duplicate plate methods, respectively. Mean food fluoride intake was estimated at 188 ± 48 µg/day using the diary, whereas it was 130 ± 41 µg using the duplicate plate method. Total fluoride intake was 504 ± 138 and 552 ± 192 µg/day utilizing the diary and duplicate methods. Large variations in daily fluoride intake from both beverages and food were observed between and within children.
Conclusions.  Both methods had inherent shortcomings and sources of error. The duplicate method was more labour intensive and costly; however, the diary method required a large number of assumptions. A combination of both methods seems to be most suitable to obtain reliable data.     

Nail Changes and Association of Osteoarthritis in Digital Myxoid Cyst

BACKGROUND Digital myxoid cyst is relatively common on the digits. Nail changes and osteoarthritis are usually associated with this pathogenesis.
OBJECTIVE The objective was to clarify this relationship and its significance by analyzing the clinical, radiologic, and pathologic data.
METHODS AND MATERIALS Fifty-one patients with digital myxoid cysts were diagnosed and analyzed during a 5-year period.
RESULTS Thirty-eight (74.5%) of 51 patients showed radiologic evidence of primary interphalangeal joint osteoarthritis in the affected digits. Among the 39 cysts removed surgically and examined pathologically, 28 were myxomatous and 11 were ganglion. Different clinical manifestations of nail change, including longitudinal grooves (20 cases), concave canaliform dystrophy (9 cases), "washboard" transverse lines (5 cases), and longitudinal grooves with beaded ridges (1 case) were found.
CONCLUSION Osteoarthritis of the adjacent terminal joint is an important factor involved in forming digital myxoid cysts. Of the two cyst types, ganglion cysts are related to osteoarthritis more often than myxomatous cysts. Nail changes, secondary to matrix damage, are reliable clinical signs of underlying cyst formation. Understanding the pathogenesis of the digital myxoid cyst in relation to osteoarthritis and nail deformity helps inform the care of these patients.     

Genital self-mutilation

A 53-year-old man was brought to the emergency department having removed both testicles and amputated his penis using a bread knife. Examination of the amputated penis showed it to be unsuitable for an attempted replant procedure. The patient was taken to theatre where the perineal wound was debrided and the remaining urethra brought down as a perineal urethrostomy, with a local cutaneous flap rotated to provide coverage for the urethra. Discussed herein are the incidence, predisposing factors, management and complications of genital self-mutilation in the adult male, and the existing literature is reviewed on the subject.     

创伤后成人呼吸窘迫综合征的流行病学研究

背景：尽管成人呼吸窘迫综合征是钝性创伤早期重要的并发症，但是对其流行病学和发生危险因素的研究仍很欠缺。本研究的目的是通过对一组受伤后住院的病例进行前瞻性队列研究，来分析这种并发症的患病率和人口统计学特点，同时也研究了损伤的严重程度和类型对这种并发症发生的影响。我们的目标是通过确定成人呼吸窘迫综合征发病的高危因素．研究出便于早期发现该征的途径：方法：我们对8年多来收住在同一所大学医院的7192例创伤性损伤的病例进行了前瞻性研究。除髋部骨折和72小时内出院的病例外，所有创伤后需要住院，年龄在13岁以上，并且是医院属区的居民的病例都包括在本研究之内。对肌肉骨骼系统、胸部、腹部和头部创伤，包括单一或复合性创伤的病例，进行创伤后成人呼吸窘迫综合征的患病率和人口统计学的研究。根据创伤类型分析这种并发症的发病相关危险因素。应用多元logistic回归分析确定成人呼吸窘迫综合征发病的最重要的预测因素。结果：36例（0．5％）患者并发成人呼吸窘迫综合征。年轻人患病率明显较高（p=0．002），其中83％继发于高能量创伤。单一的胸部、头部、腹部或四肢创伤的成人呼吸窘迫综合征的患病率〈1％。两个解剖区域损伤者患病率较高（高达2．9％），三个解剖区域损伤者患病率更高（达10．2％）：多元logistic回归分析显示：入院时损伤严重程度评分、股骨骨折、腹部和四肢联合损伤、以及入院时观察到的生理功能受损均是后期并发成人呼吸窘迫综合征的各自独立的预测因素。结论：成人呼吸窘迫综合征的患病率随损伤的严重程度和所涉及解剖区域损伤的增加而上升。我们已经能够对这些损伤的重要性和相关危险因素进行量化：我们还对此研究结果对便于早期发现这种并发症的意义进行了讨论。