Sporadic and MEN1‐Related Primary Hyperparathyroidism: Differences in Clinical Expression and Severity

Primary hyperparathyroidism (PHPT) is a common endocrine disease that is associated with multiple endocrine neoplasia type 1 (MEN1) in ～2% of PHPT cases. Lack of a family history and other specific expressions may lead to underestimated MEN1 prevalence in PHPT. The aim of this study was to identify clinical or biochemical features predictive of MEN1 and to compare the severity of the disease in MEN1‐related versus sporadic PHPT (sPHPT). We performed a 36‐mo cross‐sectional observational study in three tertiary referral centers on an outpatient basis on 469 consecutive patients with sporadic PHPT and 64 with MEN1‐related PHPT. Serum calcium, phosphate, PTH, 25(OH)D₃, and creatinine clearance were measured, and ultrasound examination of the urinary tract/urography was performed in all patients. In 432 patients, BMD was measured at the lumbar spine (LS) and femoral neck (FN). MEN1 patients showed lower BMD Z‐scores at the LS (?1.33 ± 1.23 versus ?0.74 ± 1.4, p = 0.008) and FN (?1.13 ± 0.96 versus ?0.6 ± 1.07, p = 0.002) and lower phosphate (2.38 ± 0.52 versus 2.56 ± 0.45 mg/dl, p = 0.003) and PTH (113.8 ± 69.5 versus 173.7 ± 135 pg/ml, p = 0.001) levels than sPHPT patients. Considering probands only, the presence of MEN1 was more frequently associated with PTH values in the normal range (OR, 3.01; 95% CI, 1.07–8.50; p = 0.037) and younger age (OR, 1.61; 95% CI, 1.28–2.02; p = 0.0001). A combination of PTH values in the normal range plus age <50 yr was strongly associated with MEN1 presence (OR, 13.51; 95% CI, 3.62–50.00; p = 0.0001). In conclusion, MEN1‐related PHPT patients show more severe bone but similar kidney involvement despite a milder biochemical presentation compared with their sPHPT counterparts. Normal PTH levels and young age are associated with MEN1 presence.     

Increase in chronic or recurrent rhinitis, rhinoconjunctivitis and eczema among schoolchildren in Greece: Three surveys during 1991–2003

The prevalence of allergic rhinitis, hay fever and eczema has risen worldwide during the last four decades but may have reached a plateau in some westernized societies. We examined time trends in the prevalence of childhood chronic or recurrent rhinitis, rhinoconjunctivitis and eczema in urban Greece. Using identical methodology, three population-based cross-sectional parental questionnaire surveys on current (last two years) and lifetime allergic symptoms of the nose, eyes and skin were performed among 8–10-yr-old children in 1991, 1998 and 2003 in Patras, Greece. Exactly 2417, 3006 and 2725 questionnaires were completed in 1991, 1998 and 2003, respectively. Prevalence rates of current (lifetime) symptoms of chronic or recurrent rhinitis were 5.1% (6.0%) for 1991, 6.5% (8.0%) for 1998 and 8.0% (9.8%) for 2003. Respective values for rhinoconjunctivitis were 1.8% (2.1%), 2.7% (3.4%) and 3.6% (4.6%) and for eczema 2.5% (4.5%), 3.4% (6.3%) and 5.0% (9.5%) (p for trend <0.001). Among current asthmatics there was an increase in lifetime rhinitis (p = 0.038), current (p = 0.025) and lifetime rhinoconjunctivitis (p = 0.007) and current (p = 0.001) and lifetime eczema (p < 0.001); male predominance increased throughout the study. The proportion of atopic asthma (current asthma with chronic or recurrent rhinitis and/or rhinoconjunctivitis and/or eczema) increased during the same period (p < 0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations among preadolescent children in Patras, Greece during the period 1991–2003. In our population, boys have contributed to this increase more than girls and the increase of atopy is, at least partially, responsible for the increase of asthma.     

Pharmacokinetics in obese patients

One of the many problems in providing anaesthesia for morbidlyobese patients is the influence of obesity on pharmacokineticsand pharmacodynamics. Drug administration in obese patientsis difficult because recommended doses are based on pharmacokineticdata obtained from individuals with normal weights; therefore,mistakes in the determination of the appropriate dose are oftenmade. Because of comorbidity in these patients, the functionof organs involved in drug elimination (e.g. kidney, liver)can be affected making pharmacokinetics more difficult and complex.     

Hereditary lymphedema: evidence for linkage and genetic heterogeneity

Hereditary or primary lymphedema is a developmental disorder of the lymphatic system which leads to a disabling and disfiguring swelling of the extremities. Hereditary lymphedema generally shows an autosomal dominant pattern of inheritance with reduced penetrance, variable expression and variable age at onset. Three multigeneration families demonstrating the phenotype of hereditary lymphedema segregating as an autosomal dominant trait with incomplete penetrance were genotyped for 366 autosomal markers. Linkage analysis yielded a two-point LOD score of 6.1 at straight theta = 0. 0 for marker D5S1354 and a maximum multipoint LOD score of 8.8 at marker D5S1354 located at chromosome 5q34-q35. Linkage analysis in two additional families using markers from the linked region showed one family consistent for linkage to distal chromosome 5. In the second family, linkage to 5q was excluded for all markers in the region with LOD scores Z < -2.0. The vascular endothelial growth factor C receptor ( FLT4 ) was mapped to the linked region, and partial sequence analysis identified a G-->A transition at nucleotide position 3360 of the FLT4 cDNA, predicting a leucine for proline substitution at residue 1126 of the mature receptor in one nuclear family. This study localizes a gene for primary lymphedema to distal chromosome 5q, identifies a plausible candidate gene in the linked region, and provides evidence for a second, unlinked locus for primary lymphedema.      

Effect of ozone and Tooth MousseTM on the efficacy of peroxide bleaching

Background:  The aim of this in vitro study was to investigate the effect of Tooth Mousse™ (TM) and ozone on the bleaching effectiveness of peroxide (P).
Methods:  Sixty enamel specimens were stained by tea infusion. P (8% carbamide peroxide solution) and the P/TM (50:50) blend were prepared freshly as required. The specimens were divided randomly into six groups: Group A – ozone followed by P; Group B – ozone concurrently with P; Group C – P alone; Group D – ozone followed by P/TM; Group E – ozone concurrently with P/TM; and Group F – P/TM alone. Ozone exposure was of 40 seconds duration. Digital photographic images were recorded at baseline and endpoint under standardized lighting and desiccation conditions. CIELAB L*a*b* values were determined.
Results:  The addition of TM to P or the application of ozone with P did not significantly affect bleaching effectiveness compared with P alone. The application of ozone prior to P significantly decreased bleaching effectiveness as indicated by the ΔL*, Δa*, ΔE and %L* values. The addition of TM to the P did enhance the aesthetic by increasing the lustre and translucency of the treated enamel.
Conclusions:  The results of this study suggest that Tooth Mousse may be applied concurrently with the bleach, and not reduce bleaching effectiveness.     

Tobacco smoking, pregnancy estrogens, and birth weight

It has been suggested that tobacco smoking during pregnancy reduces birth weight by lowering production rates or levels of total pregnancy estrogens. To evaluate this hypothesis, we examined total estrogen levels by radioimmunoassay in the blood of 141 pregnant women attending the maternity clinic of a major university hospital in Athens during their 26th week of pregnancy. Forty-nine of these women were regular smokers before and during their pregnancy, whereas the remaining 92 had never been regular smokers and did not smoke at all during their pregnancy. Birth weight of offspring was lower among smokers than among nonsmokers by 190.8 g, with a 90% confidence interval of 41.1 to 340.5 g, and higher among women with higher serum estrogen levels (slope b = 1.2 g per 1000 pg/ml with a 90% CI of 0.2 to 2.2 g). There was, however, only a small negative relation between tobacco smoking and serum estrogen levels; in smokers, total estrogen levels were reduced to 91% of the corresponding levels among nonsmokers.     

A psychoanalytically oriented combined treatment approach for severely disturbed borderline patients: the Athens project

A psychoanalytically oriented combined treatment is considered beneficial for severely disturbed borderline patients, especially during an acute crisis. The proposed treatment comprises hospitalization and specialized psychotherapeutic inpatient treatment, individual psychoanalytic psychotherapy, and psychiatric management. It is important to take into account that during inpatient treatment, projective identifications and splitting mechanisms are activated, involving different members of the therapeutic personnel or other patients. The mental health team--the psychiatrist, the nurses, the assigned psychotherapist, and other members of the therapeutic personnel--should work together in the context of teamwork in order to explore transference and countertransference manifestations. This function promotes empathy and understanding of the patient's inner difficulties. A combined treatment approach can help the patient stabilize his or her condition and develop awareness and motivation for undertaking long-term treatment and individual psychoanalytic psychotherapy, with the prospect that therapy will be maintained after the patient's discharge.