Thyroid disease in pregnancy

Twenty-seven million Americans are affected with thyroid disease, yet over half of this population remains undiagnosed. Thyroid disease often manifests itself during the reproductive period of a woman's life and is the second most common endocrinopathy that affects women of childbearing age. The physiologic changes of pregnancy can mimic thyroid disease or cause a true remission or exacerbation of underlying disease. In addition, thyroid hormones are key players in fetal brain development. Maternal, fetal and neonatal thyroid are discussed here. Moreover, this article serves as a review of the more common thyroid diseases that are encountered during pregnancy and the postnatal period, their treatments, and their potential effects on pregnancy.     

Structural relationships in the inhibition of [3H]tryptamine binding to rat brain membranes in vitro by phenylalkylamines

The ability of various phenylalkylamines to inhibit the binding of [3H]tryptamine to rat frontal/parietal cortical membranes was examined in vitro. Affinity for [3H]tryptamine binding sites improved as the alkyl side chain was extended to include four carbons or when a methoxy group was added at the para position of the ring. One compound, p-methoxyphenylpropylamine (IC50 = 3.6 nM), was as potent as unlabelled tryptamine as a displacing agent. Based on the unique structure-activity relationship obtained, it appears that [3H]tryptamine binding sites do not mediate the actions of phenethylamines on serotonin uptake or release.     

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective　To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods　Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results　All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion　Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle.     

Sleeping at the margins: a qualitative study of homeless drug users who stay in emergency hostels and shelters

A growing social science literature demonstrates that sleep is not merely a personal matter but also a political problem and a public health issue. Taking this as a point of departure, our article presents an analysis of sleeping practices amongst homeless drug users (HDUs) who make use of emergency hostels and night shelters in England. Data generated by way of qualitative interviews undertaken with 29 men and 11 women reveal that, as we might expect, securing sleep for this group is by no means easy. The strategies they pursue to find places to sleep are described, as are the threats and barriers to their sleeping. Emergency hostels and night shelters can afford a lifeline; providing warmth, water, food and access to support services. But if these are inadequately resourced they can be experienced as volatile environments and inimical to sleeping. It is argued here that although sleep is an essential prerequisite for health, for this population it can, somewhat ironically, be experienced as a risky behaviour. Vulnerable to both physical risks (e.g. inclement weather) and social threats (e.g. abuse and violence), falling asleep can exacerbate exposure to such dangers. These vulnerabilities are compounded by the social position of HDUs who live in socially and physically marginal places. It is this marginality that prevents them from being able to secure sleep that is both restful and restorative.     

Human papillomavirus vaccination: Where are we now?

The development of efficacious prophylactic human papillomavirus vaccines provided an opportunity for the primary prevention of related infections and diseases. Certain oncogenic human papillomaviruses that preferentially infect the genital epithelium cause cervical cancer and a substantial proportion of anal, penile, vaginal, vulvar and oropharyngeal cancers. Following extensive clinical trials demonstrating their efficacy and safety, two vaccines have been in global use for over 6 years. This review summarises the accumulated evidence regarding their high level of efficacy, safety in population usage, reductions in genital warts, infections and cervical disease following their adoption, and facilitators and barriers to achieving high vaccination coverage. The review also discusses practical issues and frequently asked questions regarding duration of effect, vaccination of women treated for cervical disease and alternate vaccination schedules, as well as the need to review cervical screening strategies in the post‐ vaccination environment.     

Physician accuracy in diagnosing colorectal polyps

Since the medical management of persons with adenomatous colorectal polyps differs from that of those with hyperplastic polyps, accuracy of diagnosis is essential. Although many physicians have grown confident that their skills of visual diagnosis are adequate, few data exist to support this confidence. In order to examine the accuracy of physicians' judgments regarding colorectal polyp histology, the visual diagnosis of physicians experienced in endoscopy was compared with the histologic report. Eighty-one polyps were discovered by flexible sigmoidoscopy among 718 participants in a colon cancer screening program. Eighty percent of all polyps were detected accurately. The diagnostic sensitivity of detecting adenomas was 69 percent, while specificity (accurate diagnosis of hyperplastic polyps) was 86 percent, and there were an additional eight false negative and eight false positive diagnoses. Further analyses revealed that there are individual patterns of diagnostic mistakes made by physicians and that mistakes frequently are related to polyp size. These findings are particularly important in light of the expanding numbers of relatively inexperienced primary care providers performing flexible sigmoidoscopy whose diagnoses may be strongly dependent on polyp size. This research was done through, and supported by, the Center for Occupational Health, Department of Family Medicine, Wayne State University, Detroit, Michigan.     

Heterogeneous phenotypes of platelet and plasma von Willebrand factor in obligatory heterozygotes for severe von Willebrand disease

To characterize the heterogeneity of severe (type III) von Willebrand disease (vWD), plasma and platelet von Willebrand factor antigen (vWF:Ag) and ristocetin cofactor activity (Ricof) were measured in 28 obligatory heterozygotes (ie, parents or children of probands from 15 different kindreds with severe vWD). On the average, heterozygotes had low levels of vWF in both platelets and plasma. There was, however, considerable heterogeneity, with four distinct patterns. Eleven heterozygotes had concordant reduction of vWF:Ag and Ricof in both plasma and platelets; five had low levels of vWF:Ag and Ricof in plasma contrasting with normal levels in platelets; eight had a peculiar pattern, the reverse of the above (ie, low levels in platelets and normal levels in plasma); and in one, both vWF measurements were normal in plasma and platelets. These patterns were genetically determined: they were consistent in four couples of consanguineous heterozygotes and in two couples carrying the same gene deletion. Only the remaining three heterozygotes had no clearly identifiable pattern. Other findings of this study were that although most of the heterozygotes had normal bleeding times, the 7 of 28 who had prolonged bleeding times had concordantly low levels of vWF measurements in both plasma and platelets. In conclusion, this large series of obligatory heterozygotes provides evidence for phenotypic and genotypic heterogeneity of severe vWD.