Abnormal inhibin A and inhibin B secretion in obese women with and without insulin resistance.

AIM: The present study aimed to establish inhibin A and B serum levels during the menstrual cycle of obese women, and its usefulness as an index of luteal-phase follicular development. MATERIALS AND METHODS: Twenty-one obese patients (mean body mass index: 34.9+/-3.7 kg/m2; range: 30.0-45.0 kg/m2) were submitted to basal hormonal measurements and an oral glucose tolerance test after challenge with 75 g glucose. Progesterone and inhibin A and B levels were determined 5-7 days after the menstrual cycle and 7 days prior to expected menses. RESULTS: As expected, an increase in inhibin A and a decrease in inhibin B were observed when first-phase samples were compared with samples obtained after 15-20 days. On the other hand, the percentage variation of both inhibin A and B was at least four times smaller than the values for normal women described previously by other authors employing the same enzyme-linked immunosorbent assays. A small number of obese women presented ovulatory cycles characterized by progesterone concentration higher than 5.8 ng/ml. The percentage elevation (>190%) of inhibin A in the second samples was in agreement with the progesterone levels, but it seemed to be more sensitive for the detection of follicle luteinization. CONCLUSION: We conclude that obese women present less percentage variation of both inhibin A and B during the menstrual cycle, associated with a low frequency of ovulatory cycles. In obese women, the percentage increase of inhibin A can represent an additional marker to recognize follicle luteinization.     

Fast fluctuations of glycosylated hemoglobins. II. Hemoglobin A1c determination and oral glucose tolerance test

Hemoglobin A₁ (Hb A₁) levels were determined during glucose tolerance tests. A good correlation (r = 0.83) was observed between fasting Hb A₁ and the area of the hyperglycemia peak. During the tests the levels of Hb A₁ increased by about 10% of the initial value and about one third of this rapidly formed glycosylated hemoglobin remained stable after a 4 days storage period.     

Measurement of lower oesophageal pH during induction of anaesthesia: use of oesophageal probe

Gastric contents regurgitation into the oesophagus during induction of anaesthesia may easily fail to be recognized. The incidence of this complication was investigated in 59 consecutive patients. They were scheduled for elective thoracic surgery. Anaesthesia was induced with thiopentone (6 mg.kg-1), fentanyl (3 micrograms.kg-1), and either atracurium (0.4 mg.kg-1), vecuronium (0.1 mg.kg-1) or suxamethonium (1.5 mg.kg-1). Oesophageal pH was monitored with an oesophageal pH probe, connected to a portable computer. The pH probe had a virtually instantaneous response time and was positioned in the lower oesophagus. Acid reflux was defined as a decrease in pH to less than 4.0. During the course of induction, three patients (5%) presented an episode of acid reflux. No patient presented any clinical or radiological signs of pulmonary aspiration. This study suggests that monitoring oesophageal pH is a simple method of detecting gastric reflux during the period of induction.     

Aceclofenac spares cyclooxygenase 1 as a result of limited but sustained biotransformation to diclofenac

OBJECTIVE: The mechanism of action of aceclofenac is currently unclear. This study investigated whether biotransformation to metabolites (4'-hydroxy-aceclofenac, diclofenac, 4'-hydroxy-diclofenac) contributes to inhibitory effects on the cyclooxygenase (COX) isozymes in vitro and ex vivo. METHODS: In vitro investigations were performed with human whole blood and human blood monocytes. A randomized crossover study was performed in volunteers receiving 100 mg aceclofenac or a sustained-release resinate formulation of 75 mg diclofenac to assess the pharmacokinetics and the ex vivo inhibition of COX-1. RESULTS: In short-term in vitro assays, neither aceclofenac nor 4'-hydroxy-aceclofenac affected COX-1 or COX-2, whereas diclofenac and 4'-hydroxy-diclofenac inhibited both isoforms. In long-term in vitro assays, aceclofenac and 4'-hydroxy-aceclofenac suppressed both COX isoforms. However, this inhibition was paralleled by a conversion to diclofenac and 4'-hydroxy-diclofenac, respectively. Maximal plasma concentrations of diclofenac after oral administration of aceclofenac (0.39 micromol/L) or diclofenac (1.28 micromol/L) were sufficient for a greater than 97% inhibition of COX-2 (50% inhibitory concentration, 0.024 micromol/L) and a 46% (aceclofenac treatment) or 82% inhibition (diclofenac treatment) of COX-1 (50% inhibitory concentration, 0.43 micromol/L). Moreover, ex vivo COX-1-dependent thromboxane B(2) synthesis was inhibited significantly less by aceclofenac than by diclofenac. CONCLUSIONS: Inhibition of COX isozymes by aceclofenac requires conversion into diclofenac. Although 100 mg aceclofenac yielded diclofenac concentrations substantially lower than 75 mg diclofenac, these were sufficient for a sustained block of COX-2 but caused a minor and shorter inhibition of COX-1 than 75 mg diclofenac. In conclusion, both COX-1-sparing and COX-2-inhibitory actions of aceclofenac may rest in its limited but sustained biotransformation to diclofenac.     

Retikuläre Drusen über die Zeit mittels SD-OCT

Aim

The aim of the study was the analysis of reticular drusen (RDR) in patients with age-related macular degeneration using simultaneous confocal scanning laser ophthalmoscopy (cSLO) and spectral domain optical coherence tomography (SD-OCT) at different time points.

Methods

Included in this retrospective analysis were 47 eyes from 32 patients (median age 80.1 years, range 66–89 years) with RDR at baseline and at least one follow-up visit. Registration of the cSLO near-infrared reflectance image and the SD-OCT B-scan (Spectralis HRA + OCT, Heidelberg Engineering, Heidelberg) at different time points was carried out using the AutoRescan tool.

Results

While either no alterations or increase in the RDR area (n?=?19 eyes) or RDR density (n?=?15) were seen by cSLO imaging, the analysis of the SD-OCT B-scans at different time points revealed a more complex picture. An increase in two well visible lesions at the baseline visit was detected in 8 eyes at the first follow-up and in 3 eyes at the second follow-up examination. A regression was seen in 5 eyes at the first follow-up and in 3 eyes at the second follow-up visit. In most eyes (n?=?23), an increase of one with a parallel decrease of the second RDR lesion in the identical B-scan was identified at the first follow-up visit, whereas individual RDR showed an increase at the second follow-up examination that had initially shown a decrease in size at the first follow-up visit.

Conclusions

The results indicate underlying dynamic processes in the development and changes of RDR over time. For a more accurate analysis, the exact registration of SD-OCT B-scans at different time points and the use of high-resolution very dense volume scans would be helpful in order to assess such discrete changes of miniscule intraretinal lesions over time.     

Radioanatomie des cancers du rhinopharynx

Rhinopharyngeal cancer is one of the best indications for conformal radiotherapy with modulated intensity. Due to the high dose gradient, accurate delineation of target volumes and organs at risk is a critical success factor with this technology. This requires a good knowledge of rhinopharyngeal radioanatomy and optimal imaging techniques.     

Efficacy of long‐ and short pulse alexandrite lasers compared with an intense pulsed light source for epilation: a study on 532 sites in 389 patients

BACKGROUND: Undesirable hair growth presents a significant problem for many patients, and photoepilation has become a very popular procedure in aesthetic and cosmetic practice. Among the systems used are the long‐ and short‐pulsed alexandrite lasers (LP‐Alex, SP‐Alex) and intense pulsed light (IPL) sources. The present study retrospectively examined the outcome of these systems from the viewpoint of efficacy and side effects.

PATIENTS AND METHODS: Three hundred and eighty‐nine patients (370 females and 19 males, mean age 36.4?yrs, skin types II–V) were admitted to the study, with a total of 532 treated sites. They were treated either with the LP‐Alex, SP‐Alex or IPL. Subjective evaluation and interview of the patients was held prior to every treatment session. Six to eight treatments were required with the alexandrite lasers, 2.4–2.8 months between treatments, and the IPL source required 8–9 treatments, 2–2.5 months apart.

RESULTS: No significant difference was seen between the LP‐ and SP‐Alex, or between both of them and the IPL source, although the period to regrowth was longer for the lasers. Erythema and oedema were more noticeable with the LP‐Alex, as were crusting and hyper‐ and hypopigmentation. Discomfort was greatest with the LP‐Alex and the IPL source. Hair induction at the borders of the treated area on the face and neck was seen only with the LP‐Alex, and correlated statistically significantly with any episode of severe erythema, crusting or hyperpigmentation.

CONCLUSIONS: There was no statistically significant difference between the LP‐, SP‐Alex and IPL photoepilation with regard to efficacy. Transient side effects were highest with the LP‐Alex, and least with the IPL system. In the LP‐Alex treated face and neck sites, 3.1% had hair induction in the borders of the treated areas.     

Determining the incidence of horseshoe kidney from radiographic data at a single institution

PURPOSE: An estimated 150,000 children are born with birth defects each year. One of the most frequent genitourinary abnormalities is horseshoe kidney (HSK). The incidence of HSK in the population is estimated to be 1/400 to 1,600 births based on autopsy data from the 1940s and 1950s. We prospectively evaluated the incidence of HSK based on radiographic studies to determine the contemporary incidence of HSK. MATERIALS AND METHODS: In a 6-month period patients undergoing abdominal computerized tomography, renal ultrasonography and excretory urography were screened for HSK. After identification medical charts were reviewed for demographics, history, study indication and findings. A literature review of 12 studies of 825 patients with HSK was compared with the current series with regard to common associated findings. RESULTS: From 15,320 radiographs 23 patients were identified with HSK for an overall incidence of 1/666. Computerized tomography, excretory urography and ultrasound identified 16, 5 and 2 patients, respectively, while 16 were male, 7 were female, 20 were adults and 3 were children. The most common concomitant urological disorder was nephrolithiasis in 9 patients (39%), prompting operative intervention in 4. The radiographic incidence of HSK closely matched data from autopsy series and yet it differed from that in current radiographic series using ultrasound in the perinatal period. CONCLUSIONS: Our radiographic evaluation of the HSK incidence closely matches past autopsy series. This finding suggests that the incidence of HSK remains stable despite an increasing number of birth defects. Moreover, it appears that radiographic studies can accurately estimate the incidence of congenital anatomical disorders. Our data suggest that HSK is a relatively benign condition with a low requirement for operative intervention in these incidentally identified patients.