Peri–operative management of carcinoid syndrome using ketanserin

This report describes the successful use of ketanserin, a 5-HT2 receptor antagonist, for the acute control of systemic blood pressure in a patient with the carcinoid syndrome, undergoing hepatic artery embolisation. Serial measurements of plasma 5-hydroxyindoles, platelet 5-hydroxytryptamine and plasma catecholamines are also given.     

Relationship between growth hormone in vivo bioactivity, the insulin-like growth factor-I system and bone mineral density in young, physically fit men and women

CONTEXT: Bone mineral density (BMD) is influenced by growth factors, such as growth hormone (GH) and insulin-like growth factor-I (IGF-I). The in vivo bioassay for GH (bioGH) provides a more physiologically relevant measurement than an in vitro immunoassay, since bioGH is quantified on a biological outcome. OBJECTIVE: To determine if bioGH and components of the IGF-I system were associated with BMD in age-matched men (M; n=41, 19.1+/-0.2 year, 70+/-3 kg, 163+/-25 cm) and women (W; n=39, 18.6+/-0.3 year, 66+/-3 kg, 141+/-15 cm). DESIGN: Blood was analyzed for growth-related hormones [bioGH, immunoreactive growth hormone (iGH), IGF-I and associated binding proteins], and BMD was measured by pDXA, pQCT, and central DXA (spine, hip). For the bioGH assay, hypophysectomizied female Sprague-Dawley rats were injected with a s.c. bolus of either a GH standard or unknown (each subject's plasma) in four daily injections. The tibia was then examined for epiphyseal growth plate width from which bioGH concentrations were extrapolated. RESULTS: M had greater (P<0.05) calcaneal BMD when measured by pDXA (M: 1.27+/-0.02; W: 1.14+/-0.02 g/cm2), while pQCT-assessed BMD at the tibia was not different (M: 777+/-16; W: 799+/-16 g/cm2). bioGH was similar between M (5388+/-800 microg/L) and W (4282+/-643 microg/L) and was not correlated with BMD. The only BMD-related biomarkers in women were acid-labile subunit (ALS; r=0.40) and IGFBP-3 (r=0.42) with DXA-measured spine and femoral neck BMD, and ALS (r=0.47) with pQCT-assessed tibial BMD and cortical thickness, respectively. CONCLUSION: Although bioGH was not associated with BMD, IGF-I and associated binding proteins (IGFBP-3 and ALS) emerged as correlates in W only.     

早期SANFH大鼠骨组织中CGRP免疫阳性神经纤维的变化及意义

目的 观察降钙素基因相关肽（CGRP）免疫阳性神经纤维在早期激素性股骨头缺血坏死（SANFH）骨组织中的变化,并探讨其意义.方法 采用大剂量冲击造模方法,造成SD大鼠SANFH模型.应用免疫组织化学技术光镜下观察CGRP免疫阳性神经纤维在SANFH负重区骨组织中的变化规律.结果 股骨头软骨下骨髓腔内CGRP免疫阳性神经纤维的数目先增多,后减少（第6周达高峰,为10.28±0.66）,均较正常组增多,差异有统计学意义（P＜0.01）.结论 （1）CGRP免疫阳性神经纤维在激素性股骨头缺血坏死组织中的分布发生变化;（2）CGRP免疫阳性神经纤维参与激素性股骨头缺血坏死后的修复过程.     

Anaesthesia for Conn''s syndrome

We describe the peri-operative management of two patients undergoing bilateral adrenalectomy for Conn's syndrome; one using an open surgical approach and the other a laparoscopic technique. The first patient, aged 64 years, died of a myocardial infarction 5 days postoperatively; the second, aged 29 years, had an uneventful recovery. The pre-operative preparation, peroperative management and postoperative care of these patients are detailed, and the pathophysiology and clinical management of Conn's syndrome are reviewed.     

An evidence-based approach to hormonal contraception and headaches

Some controversy exists regarding contraceptive management in women with migraines, particularly migraines with aura. The available scientific literature indicates that combined hormonal contraception is safe with most headache subtypes. However, it should be avoided in women with migraine with aura and women with simple migraines who have other risk factors for stroke. Progestin only contraceptives as well as the copper intrauterine device can be safely used in women with migraines. Accurate classification of a patient's headache type can avoid unnecessary restriction of effective contraceptive methods, particularly those containing estrogen.     

Chemical meningism after lumbar facet joint block with local anaesthetic and steroids

A case is reported in which chemical meningism occurred after lumbar facet joint block with methylprednisolone acetate and bupivacaine. This complication was probably due to inadvertent dural puncture. The use of steroids in facet joint injections is questioned.     

Neural Regulation of Pituitary Function

Summary: : Neural regulation of pituitary function can serve as a basis for understanding endocrine and reproduction dysfunction in epilepsy. Because the pituitary gland is the final common pathway for central neural modulation of the endocrine system, hypothalamic control of pituitary function is important. The syndrome of functional hypothalamic amenorrhea is an example of stress-induced alteration in endocrine function and may serve as a model to suggest the impact of limbic system activation on reproduction and the endocrine milieu.     

Effect of Non-Sex Hormones on Neuronal Excitability, Seizures, and the Electroencephalogram

Summary: : Several of the non-sex hormones have been found to be useful in the treatment of seizures. These hormones have an effect on seizures, and seizures have an effect on these hormones. Adrenocorticotropic hormone (ACTH) and corticosteroid drugs have been found to be useful in the treatment of infantile spasms and other seizure disorders. Unfortunately, there is no clear consensus regarding superiority of ACTH versus prednisone in regard to efficacy and long-term benefits, dosage, or duration of treatment. There is also considerable debate regarding reasons why ACTH and prednisone are useful in infantile spasms, their mechanism of action, and their long-term effects on brain development. Thyrotropin-releasing hormone also has been used in the treatment of infantile spasms and other seizure types in children, with modest success. As with ACTH and prednisone, the mechanisms of action remain unclear.     

Quantitative monitoring of brain function,vital signs,and hormonal response during acute insulin-induced hypoglycemia

Acute insulin-induced hypoglycemia provokes changes in central nervous system activity and release of counterregulatory hormones. The clinical relationship between central nervous system activity, hormone secretion, and vital signs has not to our knowledge been previously reported. We used computerized electroencephalographic (CEEG) analysis to monitor 5 nondiabetic subjects during acute insulin-induced hypoglycemia (0.75 U/kg intravenous push). Their glucose nadir was 38±6 mg/dl (mean ± 1 SD). A three-phase pattern of change in CEEG power in response to hypoglycemia was observed: phase 1 was characterized by an increase in total CEEG power (natural log of activity = 9.1±1.3 µV²) over baseline (8.7±1.2 µV²) in the theta, delta, and beta frequency bands. This phase preceded and coincided with the glucose nadir. During phase 2, power in all frequency bands fell significantly below baseline. A nadir in CEEG power (8.0±1.6 µV²) occurred 40 to 55 minutes after insulin injection as glucose levels were rising. During phase 3 there was a return to baseline in CEEG power and frequency spectra. Heart rate increase just before phase 1; peak heart rate (91±8 beats/min) coincided with peak CEEG power and was significantly higher than basal rate (71±11,P<0.05). A significant increase in respiratory rate occurred during phase 1 of the CEEG and persisted through phase 2. A significant decrease in mean blood pressure (nadir = 73±6 mm Hg) below preinsulin blood pressure (81±8 mm Hg,P<0.05) coincided with the nadir of CEEG power in phase 2. Blood pressure returned to basal levels during phase 3. Peak plasma epinephrine (652±207 versus 46±30 pg/ml), norepinephrine (500±219 versus 273±107 pg/ml), and pancreatic polypeptide levels (1,023±689 versus 114±24 pg/ml) were all significantly elevated over respective basal concentrations (P<0.05). Peak hormone levels occurred during CEEG phase 2. This study demonstrates a temporal association of changes in CEEG power, vital signs, and hormonal secretion. These techniques may be applicable for further investigation of the clinical neuroendocrinology of the response to acute hypoglycemia.Supported in part by the Diabetes Research and Education Fund and the Juvenile Diabetes Foundation.The authors thank Diane Ogorzalek and Patsy Thomas for secretarial assistance and Pediatric Endocrine Unit nurses Debra Pitarra and Joyce Hylton. Baiba Pironis performed the catecholamine assays. Specific reagents for the human pancreatic polypeptide assay were provided through the courtesy of Dr Ronald Chance, Lilly, Indianapolis, IN. Presented in part at the 70th Annual Meeting of the Endocrine Society, New Orleans, June 1988, and at the Annual Meeting of the American Society of Anesthesiology, San Francisco, October 1988.     

Correlates of depressive symptoms among women undergoing the menopausal transition

Objective

Studies indicate that approximately 25% of women undergoing the menopausal transition experience depressive symptoms. The purpose of this study was to examine whether menopausal status was associated with the experiencing of depression among midlife women, to assess which demographic and health habit characteristics were associated with depressive symptoms experienced during the menopausal transition, and to analyze the associations between hormone levels and depressive symptoms.

Methods

Data from a community-based sample of 634 women aged 45 to 54 years were analyzed. Each participant completed a questionnaire and provided a blood sample that was used to measure estrogen and androgen concentrations by enzyme-linked immunosorbent assay. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D).

Results

Approximately 25% of the women in the study were experiencing depressive symptoms (CES-D ≥16). The data showed that being a current smoker, having little/no regular physical activity, being in poor health, and reporting a greater number of menopausal symptoms were independently and significantly associated with depressive symptoms. Menopausal status and the measured hormone levels were not significant independent correlates of depressive symptoms.

Conclusions

These findings confirm the relatively high prevalence of depressive symptoms among midlife women and suggest that certain demographic, health habit, and menopausal symptom characteristics may be more important correlates of depressive symptoms in midlife than menopausal status and hormone levels.