IDIOPATHIC HIRSUTISM: REVIEW OF THE CONCEPT

Patients with idiopathic hirsutism form a heterogeneous group with a number of hormonal abnormalities, those most consistently demonstrated being an increase in free plasma testosterone levels, an increase in testosterone production rate and a decrease in sex hormone binding globulin levels. In most patients the principal source of androgen excess appears to he ovarian. Some have additional adrenal hyperandrogenism but a pure adrenal source is probably rare. Idiopathic hirsutism may be regarded as part of a clinical spectrum of ovarian hyperandrogenism. The ovarian patholoqy present in the majority of cases is probably that of polycystic ovarian disease. This may be a genetically determined disorder with a modified dominant form of inheritance. Ethnic and familial variations in amount and type of hair growth in androgen dependent sites undoubtedly do occur. Nevertheless the finding of normal plasma androgens in many women labelled ethnically or constitutionally hirsute may be the result of inappropriate blood sampling and failure to measure free plasma testosterone or testosterone production rate.     

FIBRIN CUFF LYSIS IN CHRONIC VENOUS ULCERS TREATED WITH A HYDROCOLLOID DRESSING

Background. Pericapillary fibrin cuffs (PFC) are a recognized part of the pathology of venous stasis ulcers. A hydrocolloid dressing capable of lysing wound surface fibrin was tested in venous ulcers for its capacity to lyse pericapillary fibrin below the wound surface. Methods. Tissue biopsies from the rims of 19 venous ulcers were evaluated for thickness of shallow and deep dermal PFCS before and after treatment with DuoDERM covered by Unna's boot and a compression bandage (DD+UB; n=9) versus the same treatment without the hydrocolloid dressing (UB; n=10). Frozen sections of all biopsies were stained with an immunofluorescent antibody to fibrin for rating of PFC thickness. Separate sections were stained with hematoxylin and eosin to assess capillary frequency, histopathology, and inflammation. All ratings and pathology assessments were performed blinded to treatment conditions. Results. Both deep and shallow PFCS were reduced in 89% of ulcers treated with DD+UB versus 40% of ulcers treated with UB (α < 0.04). No other significant differences in inflammation, histopathology, or capillary frequency were observed. Conclusions. Treatment with DD+UB reduced PFCS in twice the number of ulcers than UB alone in 1 week. This is the first scientific documentation that a topical wound dressing could reduce the pathophysiology associated with venous ulcers, beyond the known beneficial effect of graduated compression. Not all hydrocolloid dressings are fibrinolytic, so this effect may not generalize to other dressings.     

Albunex Does Not Increase the Sensitivity of the Lung to Pulsed Ultrasound

If cavitation in the vasculature of the lung is the physical mechanism responsible for lung hemorrhage, then addition of cavitation nuclei to the blood should enhance the bioeffect. To test the cavitation hypothesis, the extent of lung hemorrhage in mice injected with the echocontrast agent, Albunex®, was compared to lung hemorrhage in animals injected with saline. Animals were exposed for 5 minutes to 1.1-MHz pulsed ultrasound (10 μs pulse length, 100-Hz pulse repetition frequency) at a peak positive pressure at the surface of the animal of 2 MPa. This exposure is approximately twice the threshold pressure amplitude for lung hemorrhage. Lesion areas did not differ significantly in the two groups of animals and were approximately equal to the lesion area in uninjected mice from an earlier study where acoustic exposures were the same. Neither this study nor a related study of hemolysis in vivo suggests that use of Albunex in echocardiographic procedures increases the risk of bioeffects.     

Renal Kallikrein Excretion in Alcoholic Cirrhosis

Severe liver disease is often associated with renal hemodynamic changes, and these changes may involve vasoactive hormones. The vasodilatory renal kallikrein-kinin system has received little previous study in these patients. We measured urinary kallikrein in nine patients with alcoholic cirrhosis under rigid metabolic conditions and simultaneously evaluated renin, aldosterone and urinary prostaglandins. Plasma renin und aldosterone were generally increased as expected but urinary kallikrein was surprisingly diminished (13.3 ± 3.7 vs. 38.8 ± 11.1 SE, E.U./day. P < 0.05). despite adequate creatinine clearance (81 ± 9 ml./min.). Administration of prostaglandin inhibitors reduced urinary prostaglandin E by 72% and creatinine clearance by 56% but did not alter urinary kallikrein. Mineralocor-ticoid inhibition by spironolactone induced a natriuresis in four patients with ascites (from 1.4–140 mEq. Na⁺/day) but also failed to alter kallikrein. Thus, kallikrein excretion is paradoxically reduced and seemingly unresponsive to alterations in the prostaglandin and renin-aldosterone systems. If urinary kallikrein quantitatively reflects intrarenal kallikrein-kinin activity, the impairment in this vasodilatory system may mediate the altered renal hemodynamics of severe liver disease.     

Writing for publication

Writing for publication is rewarding; it requires specific skills which are identified and explored in this article. Intending authors are encouraged to be systematic in targeting the audience, prepararing the text, and presenting it to a publisher. The differing styles needed for academic articles, book reviews and letters are explored as are the stages in publication.     

Is fecundability associated with month of birth? An analysis of 19th and early 20th century family reconstitution data from The Netherlands

The relationship between fecundability and month of birth was investigated in a cohort of 1526 women who married between 1802 and 1929, using only women whose first marriage occurred before the age of 35 years. On the basis of their time to pregnancy (TTP, calculated as time between wedding and first birth minus gestational length), women were categorized into two groups: fecunds (TTP up to 12 months or prenuptial conceptions, n = 1348) and subfecunds (TTP >18 months, n = 118). By use of logistic regression, cosinor functions with a period of 1 year or 6 months and variable shift and amplitude were fitted through the monthly odds of subfecunds versus fecunds. The best fitting curve was unimodal, with a zenith in September (P = 0.13 for H0: no differences). Exclusion of childless women (n = 36, minimum follow-up 5 years) from the subfecunds led to a similar curve (P < 0.01), while childless women, as compared with fecunds, showed a birth distribution that was best represented with a bimodal curve with zeniths in January and July (P = 0.06). This study provides evidence for the existence of differences in fecundability by month of birth. The cause of this relationship is unclear, but may lie in a melatonin-dependent circannual variability of the quality of the oocyte.