High dose intravenous methylprednisolone pulse therapy versus oral prednisone for thyroid-associated ophthalmopathy

PURPOSE: To compare the effectiveness of intravenous (i.v.) methylprednisolone pulse therapy and oral prednisone when used as the initial treatment of patients with mild or moderate thyroid-associated ophthalmopathy. METHODS: Thirty-three consecutive patients with thyroid-associated ophthalmopathy in Helsinki and Turku University Hospitals were randomly assigned either i.v. methylprednisolone pulse therapy (group A, n = 18) or oral prednisone (group B, n = 15). Treatment outcomes were measured by subjective changes in the grade of diplopia and quantitatively in several ophthalmic variables at 3 and 12 months. Any decision to proceed with additional treatment at 3 months was made on clinical grounds. The study was open in respect of both the initial treatment and the need for additional therapy. RESULTS: No significant differences in the grade of diplopia, proptosis or soft tissue activity scores were noted between groups A and B from 0 to 3 months. However, group A required additional forms of therapy at 3 months less frequently than did group B (p = 0.038). CONCLUSIONS: Our data suggest that i.v. methylprednisolone pulse therapy and oral prednisone are equally effective as initial treatments for thyroid-associated ophthalmopathy where diplopia, proptosis and signs of soft tissue inflammation are concerned. When additional treatment is required, i.v. methylprednisolone pulse therapy may be more effective than oral prednisone. However, the study's limitations meant that any decision to give additional treatment after the initial therapy was made on clinical grounds.     

The laboratory diagnosis of ocular Lyme borreliosis

· Background: A study was carried out to evaluate indirect enzyme-linked immunosorbent assay (ELISA), immunoblot analysis, and polymerase chain reaction (PCR) in the diagnostic work-up of ocular Lyme borreliosis. · Methods: Twenty patients with ocular Lyme borreliosis were examined. IgG and IgM antibodies to Borrelia burgdorferi were measured by ELISA in serum, and in cerebrospinal fluid (CSF) when indicated, and immunoblot analysis of B. burgdorferi IgG antibodies in serum was performed. A nested PCR was used to detect a segment of a gene coding for B. burgdorferi endoflagellin. The samples used in PCR testing were serum and CSF and in isolated cases conjunctiva and vitreous. · Results: Seventeen patients had elevated Borrelia antibodies in serum or CSF by ELISA. Seven patients, including two with negative ELISA, had a positive immunoblot. Seven of the 13 patients in whom PCR was examined during clinically active disease had a positive PCR result. Immunoblot analysis gave a negative result from the sera of five PCR-positive patients. · Conclusions: For efficient diagnosis of ocular Lyme borreliosis, immunoblot analysis and PCR should be used in addition to ELISA. A positive PCR seems to be associated with a negative immunoblot. Received: 5 January 1998 Accepted: 14 May 1998     

Carotid thromboendarterectomy. Comparison of two anesthesiologic techniques

The authors have examined two homogeneous groups of patients suffering from "carotid stenosis", operated by TEAC with two different techniques of anaesthesia: general and local-regional (block). Neurological and cardiovascular complications have been recorded in pre and post-operative period. The results analysed statistically with the Pearson test, were homogeneous. However the authors, on the basis of their experience, prefer local-regional (block) anaesthesia for good haemodynamic stability and a better neurologic control. Moreover the block anaesthesia was better in patients.     

Precision, consistency, and reproducibility of blood pressure in diabetic and non-diabetic pregnancy: the appraisal of repeated measurements

A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect to reproducibility and variations on precision and consistency. Some 133 women with type 1 diabetes mellitus and 59 non-diabetic women were recruited. During pregnancy, systolic BP was between 6 and 12 mmHg higher in the oscillometric than the auscultatory readings, and diastolic BP was between 1 and 2.6 mmHg. The association of difference with the mean BP disappeared with progression of pregnancy and the repetition of measurements in diabetic pregnancy. The precision, reproducibility, and trend of association over the scale of measurement were improved in the repeated compared to individual measurements, whereas consistency did not improve.     

北京市不同营养状况中学生胰岛素抵抗状况分析

目的了解不同营养状况青少年胰岛素抵抗状况,为早期预防胰岛素抵抗提供理论依据。方法在北京市东城区选择初中三年级学生935名,进行身体测量、空腹血糖和胰岛素抵抗指标的测定。结果体重正常、超重和肥胖中学生胰岛素抵抗指标FINS(空腹胰岛素),HOMA-IR(稳态模型胰岛素抵抗指数),IAI(胰岛素敏感性指数)差异均有统计学意义(P值均<0.05),FPG差异无统计学意义(P>0.05)。随着BMI(体质指数)的升高,FINS,HOMR-IA,IAI绝对值逐渐升高。结论青少年肥胖与胰岛素抵抗存在一定相关性。超重和肥胖青少年已经出现胰岛素抵抗的现象,应重视并积极防治。     

The results of treatment of epithelial ovarian cancer after centralisation of primary surgery. Results from North Jutland, Denmark

OBJECTIVE: The study was performed to evaluate the results of treatment of ovarian carcinoma after the introduction of centralised primary surgery in the County of North Jutland, Denmark. METHOD: Prospective study of consecutive cases of ovarian cancer undergoing primary surgical treatment at the Gynecologic Oncologic Center after the introduction of centralised primary surgery. Results of treatment recorded up to the date of last examination or death. RESULTS: From 1999 to 2002, 107 patients with primary epithelial ovarian cancer underwent primary surgery at the Gynecologic Oncologic Center, Aalborg. This corresponds to 95.5% of patients with invasive carcinoma in the County of North Jutland. All patients with Stage I to Stage IIIB disease had a complete, macroscopically radical cytoreduction performed. In patients with Stage III and IV invasive tumors, the optimal debulking rate was 79.5%, and, in Stage IIIC and IV, the optimal debulking rate was 78.2%. Intra-operative and post-operative complications were generally few. Post-operative death, defined as death within 30 days after surgery, was observed in 4 cases (3.7%). After primary surgery, platinum-based chemotherapy was given in most cases. For Stage I to IV invasive cancer, the median survival was 46 months. In patients with Stage IIIC and IV disease, the median survival was 32 months. In optimally debulked Stage IIIC and IV disease, the median survival was 41 months. CONCLUSIONS: The results indicate a survival benefit after introduction of centralised primary surgery. Compared to existing national and regional data on survival in ovarian cancer, the results indicate an increase in median survival for all stages of approximately 15 months. Centralisation of primary surgery to centres with the necessary expertise may be the most significant way to increase survival in ovarian cancer in Denmark.     

Congenital unilateral hydronephrosis: a review of the impact of diuretic renography on clinical treatment

PURPOSE: The natural history of and optimal treatment for asymptomatic congenital hydronephrosis is unknown, mainly because most published series are nonrandomized or retrospective with nonstandardized followup regimens. In this survey we provide an overview of the different strategies used for the treatment of congenital unilateral hydronephrosis. MATERIALS AND METHODS: A comprehensive literature review of clinical studies of asymptomatic congenital unilateral hydronephrosis is presented. RESULTS: Different criteria for surgical intervention and different followup regimens have been used. Identification of the population at risk has been attempted but results are ambiguous. Surgery is done in approximately 25% of cases when using deteriorating differential function, symptoms and/or increasing hydronephrosis as criteria for operation. A nonstandardized renographic assessment does not compromise evaluation of the ideal followup but it may compromise the functional outcome. CONCLUSIONS: More studies of kidneys with decreased function, severe hydronephrosis or poor drainage investigated with a standardized protocol are needed to clarify the natural history and establish optimal guidelines for treatment and followup.     

Maternal and grandmaternal age effects on developmental instability and wing size in parthenogenetic <Emphasis Type="Italic">Drosophila mercatorum</Emphasis>

Age is known to have a large effect upon fertility and survival. Here we study the impact of maternal and grandmaternal age on wing size and developmental instability (DI) in offspring using a parthenogenetic strain of Drosophila mercatorum. This enabled us to cancel out any genetic variance between individuals. The mean centroid size of the wings was estimated in offspring from four maternal/grandmaternal age groups. Further, DI was calculated by measuring phenotypic variability and correcting this index for the bias produced by the environmental variability. The offspring developed from eggs laid by mothers belonging to four different age groups with young (Y) or old (O) mothers and grandmothers. The age groups are: YY, YO, OY and OO, with the first letter referring to the age of the grandmother and the second letter to the age of the mother. We consider flies between three to six days of age as young and flies between 15 and 18 days of age as old. We found that environmental variability was present in this study and therefore the correction for its bias on phenotypic variability was shown to be necessary for a correct interpretation of the results. DI displayed, for most of the traits investigated, a significantly higher level in the OY and OO age groups, as compared to the YY and YO age groups. The mean centroid size of the wings were in almost all cases significantly different among the age groups with the highest mean value in the OY group for all traits. This investigation shows that offspring are affected by maternal age and that this effect can be transmitted maternally across more than one generation.     

Influence of Prevastein, an isoflavone-rich soy product, on mammary gland development and tumorigenesis in Tg.NK (MMTV/c-neu) mice

We investigated spontaneous mammary tumor development and mammary gland morphogenesis in female Tg.NK mice postnatally exposed to dietary soy isoflavones (0, 11, 39, and 130 mg aglycones/kg diet) added to a Western-style diet. Instead of preventing mammary tumorigenesis, the highest dose of isoflavones was associated with a small but significant increase in the number and size of tumors as compared to mice administered a Western-style control diet (P < 0.05). At postnatal Week 6, dynamic activity (measured as apoptotic density) at the highest dose and the degree of branching of the mammary tree in all isoflavone-exposed groups was increased as compared to controls (P < 0.05). At adulthood, the epithelium appeared more quiescent in the medium- and high-dose groups evident by reduced apoptotic density and a reduction in the percentage of terminal end buds (TEBs), respectively, as compared to controls (P < 0.05). The number of actively dividing cells within the TEBs was unaffected by isoflavone exposure as was the activity of drug-metabolizing and antioxidant enzymes. In conclusion, isoflavones may augment mammary gland and mammary tumor development.