Abnormal conjugated dopamine levels in patients with normoprolactinaemic amenorrhoea and in insulin-dependent diabetic patients

We determined the circulating dopamine levels in 17 patients with insulin-dependent diabetes mellitus (IDDM), of whom eight had amenorrhoea (DM-AM) and nine were normally menstruating (DM). Seven non-diabetic women with normoprolactinaemic, normogonadotrophic secondary amenorrhoea (AM) and nine normally menstruating women (controls) were studied. In all subjects basal blood concentrations of free dopamine (f-DA), conjugated dopamine (c-DA), epinephrine (E), norepinephrine (NE), prolactin (PRL), luteinizing hormone (LH), thyroid-stimulating hormone (TSH) and oestradiol-17 beta were determined and all subjects, except for three AM patients, had a Metoclopramide test performed for measurements of f-DA, c-DA, PRL, LH and TSH. Plasma c-DA was significantly (p less than 0.05) increased in patients with amenorrhoea compared to the respective control groups. In diabetic patients c-DA levels were significantly (p less than 0.05) lower compared to controls. The ratio between basal f-DA and c-DA concentrations was significantly (p less than 0.01) higher in diabetic patients compared with non-diabetic patients. After Metoclopramide stimulation DM-AM patients showed a significant (p less than 0.05) rise in c-DA, whereas this was not seen in other groups. DM-AM patients had significantly (p less than 0.05) lower basal PRL and LH levels than DM patients and controls. In addition DM-AM patients had a significantly (p less than 0.05) lower PRL response to Metoclopramide compared with DM patients. There were no significant correlations between catecholamines and basal as well as Metoclopramide stimulated pituitary hormones. This study suggests that the abnormal pituitary hormone secretion in patients with amenorrhoea may in part be caused by an increased dopaminergic activity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Simultaneous quantification by double rocket immunoelectrophoresis of apolipoproteins A-I and B in blood spotted on filter paper

We describe double rocket immunoelectrophoresis for simultaneous quantification of apolipoprotein A-I (apo A-I) and B (apo B) in blood on filter paper. The apolipoproteins from blood spots on filter paper were eluted with detergents (sodium dodecyl sulfate and Triton X-100). The eluates were subjected to electrophoresis on agarose gel containing antisera against both apolipoproteins. Within- and between-assay CVs for apo B/A-I ratios were less than 5.5% and 7.2%, respectively. The apo B/A-I ratio was influenced by length and temperature of storage. In results for 121 venous blood samples, the apo B/A-I ratios in dried blood spots correlated well with those in serum (r = 0.92) and correlated somewhat with the ratios for low-density lipoprotein/high-density lipoprotein cholesterol in serum (r = 0.87). Of these specimens, 68 were from patients with known familial hypercholesterolemia, all of whom had an apo B/A-I ratio greater than 0.90. We think this method will be of value for detecting familial hypercholesterolemia and possibly familial hyperapobeta- and hypoalphalipoproteinemia.     

Blood pressure in adult Lapps and Skolts.

Casual blood pressures were recorded in 331 Lapps and 221 Skolts over the age of 20. The systolic pressure was found to rise more with age in women than in men. In neither sex did age affect the diastolic pressure. A general tendency towards higher blood pressure in Lapps than in Skolts was noted up to the age of 50-60 years. Comparison with a Finnish population and one from the Aland Islands revealed similar systolic blood pressures in females, but definitely lower values in male Lapps and Skolts. The Lapps and Skolts did not have the clear age dependence of the diastolic blood pressure as occurs in Finns. These findings, together with other population studies, support the hypothesis that the setting of the resting blood pressure level is influenced by different kinds of stress associated with technological development and with an urbanized way of life.     

Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.     

Traumatic rupture of the pericardium

Isolated pericardial rupture due to nonpenetrating chest injury was diagnosed in a 21 year old man with multiple traffic injuries. Radiologic examination showed displacement of the heart to the left and therefore gave rise to a suspicion of pericardial rupture. The diagnosis was proved by establishing left-sided pneumothorax when the air passed into the pericardial cavity. The patient had no cardiac symptoms. His electrocardiogram, cardiac volume and hemodynamics at rest and during exercise were entirely normal. The physiologic and clinical implications of pericardial defects are briefly discussed.