Cerebrospinal fluid rhinorrhea occurring in long-term bromocriptine treatment for macroprolactinomas

Two patients harboring invasive macroprolactinomas, on treatment with bromocriptine, developed cerebrospinal fluid rhinorrhea 16 and 17 months after the beginning of the medical therapy. Neither patient had previously been submitted to surgery or radiotherapy. The fistulae were surgically corrected. Cerebrospinal fluid leakage is a well-documented complication of pituitary tumors, mainly after surgery and/or radiotherapy, but the reports of its occurrence after primary treatment with bromocriptine are rare. Therefore, the possibility of this complication must be considered, especially in patients with invasive macroprolactinomas.     

Ovariectomy fails to affect rats' quinine aversion

Three studies investigated the effects of ovariectomy on the intake of quinine solutions. Despite significant elevations of body weight due to surgery, no change in quinine preference was noted. Varying the age of surgery (prepuberty, postpuberty, and adulthood), age of testing, and time between these events did not alter the basic findings.     

Temporomandibular joint surgery: patient-based assessment and evaluation

Surgery has been important in the treatment of internal derangement of the TMJ. Many patient series have been reported concerning surgeons' evaluation of the surgery but only a few articles regarding patient-based assessment can be found. This study presents responses of 83 patients to personal interviews and mail questionnaires. A high degree of patient acceptance of the surgery and satisfaction with the results are reported. Eighty percent consider their joint status better and would repeat the surgery if faced with the same problems, 70% are essentially pain-free, and 18% experience pain mainly during heavy chewing. Diligent preoperative patient preparation and postsurgical care are recommended for success.     

Estrogenic properties of 3,9-dihydroxy-7,12-dimethylbenz[a]anthracene in rats.

Previously, the 3,9-dihydroxy derivative of benz[a]-anthracene was shown to be weakly estrogenic. The availability of the related diol of the mammary carcinogen dimethylbenz[a]-anthracene, i.e., 3,9-dihydroxy-7,12-dimethylbenz[a]anthracene (3,9-diOHDMBA), prompted a similar study of its estrogenic properties. The competitive binding studies of 3,9-diOHDMBA with 17beta-estradiol in the uterine cytosol of immature SD rats gave a Ka of 1.7 x 10(8) M-1. 17beta-Estradiol (10(-9) M) binding to the 8S binding protein was inhibited by 3,9-diOHDMBA at concentrations similar to those of nafoxidine HCl (1 x 10(-5) M). Bioassay demonstrated that the diol possesses 1/4,464 the activity of 17beta-estradiol.     

Cholestasis and hepatic metastases: a factor contributing to extreme elevations of carcinoembryonic antigen

Records of 19 autopsied patients with metastatic carcinoma were studied to elucidate the contribution to the elevation of antemortem plasma carcinoembryonic antigen (CEA) levels (range, 5.9--136,000 ng/ml) of 1) liver pathology and dysfunction, 2) tumor morphology and CEA content, and 3) tumor spread and location. Liver function tests and plasma CEA recorded within 8 weeks of death, autopsy records of tumor spread, liver weight (as an index of liver tumor mass), and histologic sections were reviewed. Tissue CEA was demonstrated in 15 patients by an immunoperoxidase method. Cholestasis was seen in histologic sections of tissue from 8 of 10 patients, and elevated bilirubin was seen in 7 of 10 patients with hepatic metastases and CEA levels greater than 1,000 ng/ml In contrast, histologically observed cholestasis and elevated bilirubin were seen in only 1 of 8 patients with CEA less than 500 ng/ml. A significant correlation was found between the plasma CEA level and histologically observed cholestasis (P less than 0.01). Serum bilirubin also correlated significantly (P less than 0.01), but alkaline phosphatase did not. Liver weight (tumor mass) showed a positive correlation with cholestasis (P less than 0.01) but not with circulating CEA. Markedly elevated plasma CEA levels (greater than 1,000 ng/ml) seen preterminally may partially reflect impaired excretion of CEA by the hepatobiliary system rather than, or in addition to, preterminal increase in CEA-producing tumor.     

Desipramine and cutaneous reactions in pediatric outpatients

The association of adverse cutaneous effects with administration of the tricyclic antidepressant drug desipramine was systematically reviewed in a clinic population of 205 child psychiatry outpatients over a 3-year period. Transient maculopapular rashes developed in 12 children and adolescents treated with desipramine. The rashes had a benign course, disappearing completely in 2 to 7 days, and were not associated with clinical or chemical hepatitis or any other physical symptoms.     

Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects

Glucosamine is a popular nutritional supplement used to treat osteoarthritis. Intravenous administration of glucosamine causes insulin resistance and endothelial dysfunction. However, rigorous clinical studies evaluating the safety of oral glucosamine with respect to metabolic and cardiovascular pathophysiology are lacking. Therefore, we conducted a randomized, placebo-controlled, double-blind, crossover trial of oral glucosamine at standard doses (500 mg p.o. t.i.d.) in lean (n = 20) and obese (n = 20) subjects. Glucosamine or placebo treatment for 6 weeks was followed by a 1-week washout and crossover to the other arm. At baseline, and after each treatment period, insulin sensitivity was assessed by hyperinsulinemic-isoglycemic glucose clamp (SI(Clamp)) and endothelial function evaluated by brachial artery blood flow (BAF; Doppler ultrasound) and forearm skeletal muscle microvascular recruitment (ultrasound with microbubble contrast) before and during steady-state hyperinsulinemia. Plasma glucosamine pharmacokinetics after oral dosing were determined in each subject using a high-performance liquid chromatography method. As expected, at baseline, obese subjects had insulin resistance and endothelial dysfunction when compared with lean subjects (SI(Clamp) [median {25th-75th percentile}] = 4.3 [2.9-5.3] vs. 7.3 [5.7-11.3], P < 0.0001; insulin-stimulated changes in BAF [% over basal] = 12 [-6 to 84] vs. 39 [2-108], P < 0.04). When compared with placebo, glucosamine did not cause insulin resistance or endothelial dysfunction in lean subjects or significantly worsen these findings in obese subjects. The half-life of plasma glucosamine after oral dosing was approximately 150 min, with no significant changes in steady-state glucosamine levels detectable after 6 weeks of therapy. We conclude that oral glucosamine at standard doses for 6 weeks does not cause or significantly worsen insulin resistance or endothelial dysfunction in lean or obese subjects.