Influence of adiposity on leptin, LH and androgen levels in lean, overweight and obese PCOS patients

BACKGROUND: Leptin modulates hypothalamic-pituitary-gohadal axis functions. OBJECTIVE: To assess the influence of leptin on LH, and to investigate the potential association of leptin with body mass index (BMI) and androgen concentrations in women with polycystic ovary syndrome (PCOS). DESIGN: Levels of leptin, LH, FSH, E2, testosterone, and androstenedione were measured. PATIENTS: 91 patients with PCOS were included in this study. METHODS: Patients were stratified into three groups according to BMI: normal weight (NW group, N=31), overweight patients (OW group N=30) and obese PCOS patients (Ob group, N=30). Results-Hyperandrogenemia was present in the studied group. A significant correlation was observed between BMI and androgens (both P < 0.01), and between leptin levels and androgens (respectfully for androstenendione P < 0.01 and for testosterone P < 0.05). A positive correlation between the LH and leptin levels in NW (P < 0.05) and OW (P < 0.001) patients was noticed, while negative correlation is seen in the Ob group (P < 0.01). In OW patients the significant positive correlation between leptin levels and androstenendione was found (P < 0.001), after correction for BMI. A linear regression model indicated that leptin concentrations and BMI contributed negatively and significantly (P < 0.001) to LH concentrations. CONCLUSION: LH secretion in PCOS patients can be viewed as a consequence of the activity of different adipocyte and neuroendocrine factors. The attenuation in basal LH levels in obese PCOS women might be related to a leptin-resistant state.     

The most frequent hormone dysfunctions in juvenile bleeding

The main goal of this study was to investigate the precise hormone dysfunction that leads to dysfunctional uterine bleeding (DUB) in adolescent girls so that, with the appropriate therapy, the occurrence of organic dysfunctions of their reproductive function can be prevented. This study included 70 adolescents with DUB aged 14.70 +/- 1.70 and 30 healthy adolescents aged 13.7 +/- 1.83. Hormone examinations indicated the presence of three typical endocrinological findings of the adolescents with DUB: the first group with FSH values within the normal range, but low LH values, the lower value of estradiol and absence of hyperandrogenism; the second group with higher LH values and normal FSH values but one third with hyperandrogenism; and the third group with normal FSH and LH values, but with hyperinsulinemia and hyperandrogenism. Comparing the hormone values obtained in the control group and the group with DUB, we have concluded that hyperandrogenism, hyperinsulinemia, lower values of progesterone, and dysfunctions in secretion of gonadotropin are statistically important factors for the origin of juvenile bleeding.     

Automated radiosynthesis of [11C]UCB-J for imaging synaptic density by positron emission tomography

An automated radiosynthesis of carbon-11 positron emission tomography radiotracer [¹¹C]UCB-J for imaging the synaptic density biomarker synaptic vesicle glycoprotein SV2A was established using Synthra RNPlus synthesizer. Commercially available trifluoroborate UCB-J analogue was used as a radiolabelling precursor, and the desired radiolabelled product was isolated in 11 ± 2% (n = 7) nondecay corrected radiochemical yield and formulated as a 10% EtOH solution in saline with molar activities of 20 to 100 GBq/μmol. The method was based upon the palladium(0)-mediated Suzuki cross-coupling reaction and [¹¹C]CH₃I as a radiolabelling synthon. The isolated product was cGMP compliant as demonstrated by the results of quality control analysis.     

Intravascular large B-cell lymphoma as a cause of hypopituitarism: gradual and late reversal of hypopituitarism after long-term remission of lymphoma with immunochemotherapy

Intravascular large B-cell lymphoma (IVL) is a rare generally fatal disease characterized by massive proliferation of lymphoid cells within the small and medium blood vessels. Hypopituitarism has been reported only in a few fatal cases. We describe the clinical course of hypopituitarism as a complication of IVL, successfully treated with immunochemotherapy (cyclophosphamide/doxorubicin/vincristine/prednisone-CHOP) plus Rituximab anti-CD20 humanized antibody). Before immunochemotherapy, basal hormonal analysis and dynamic test for pituitary function were performed in a 67-year-old female with IVL. Endocrinological evaluation of the pituitary function was repeated after complete hematological remission and during the 2 years of follow-up. Multiple pituitary hormone deficiencies were diagnosed before therapy for IVL. Magnetic resonance imaging (MRI) of the pituitary gland showed partially empty sella. The patient was replaced with thyroxine 50 microg/day and prednisone 5 mg/day between the cycles of chemotherapy. After complete hematological remission (6 months after initial diagnosis) reversal of cortisol and gonadotropin deficiency occurred. After 18 months of hematological remission there was further improvement in growth hormone (GH) response to provocative testings (partial GH deficiency), with normalization of somatotropic and thyreotropic axis after 2 years of follow-up. This is the first case of IVL complicated with hypopituitarism, treated with immunochemotherapy which resulted in complete hematological remission and gradual and late reversal of hypopituitarism.     

Sleep problems among family members of a universal parent-training

Objective

Being a parent is often associated with less sleep and sleep problems. In addition, young children often suffer from sleep problems. Hence, children’s sleep problems can evoke sleep problems in their parents. However, little is known about sleep of family members.

Method

A total of 54 parents with their children between 4 and 12 years of age (mean 7.04 years) participated in this study prior to a universal parent-training. Sleep problems were assessed by the Child Behavior Checklist (CBCL) and the Symptom Checklist 90-R (SCL-90-R). Psychological problems of the children and parental burden were further evaluated with the Eyberg Child Behavior Inventory (ECBI). In addition, parental behavior was assessed with the short form of the Parenting Scale of Arnold (“Erziehungsfragebogen für Eltern”, EFB-K).

Results

In sum, 13?% of the children showed shorter overall sleep duration than other children, whereas 5.6?% slept more. None of the parents reported daytime sleepiness in their children, but 3.9?% reported that their children do often have nightmares and also 3.9?% often talk during sleep. Altogether 15.4?% of the parents thought that their child suffered from sleep problems. Problems falling asleep were reported by 19.6?% of mothers and 10.5?% of fathers and disturbed sleep was reported by 33.3?% of mothers and 12.6?% of fathers, whereas 15.8?% of mothers and 8.4?% of fathers were suffering from waking up too early in the morning. Children with sleep disturbances did not differ significantly from children without sleep problems regarding their psychological disturbances. However, parents differed with regard to parental burden, depression, anxieties, and sleep problems. The main limitations are the small sample size and the lack of a healthy control group.

Conclusion

In contrast to their parents, children with or without sleep problems did not differ concerning psychological disturbances. Consequently, even if the child is not affected by sleep problems these issues need to be considered for parents participating in a universal parent-training. Furthermore, fathers also need to be integrated into diagnostics, not only mothers, because sleep problems and other psychological problems are often experienced by both parents.     

The Relationships Between Obsessive–Compulsive Symptom Dimensions and Cognitions in Obsessive–Compulsive Disorder

Several studies have linked obsessive–compulsive symptoms to specific obsessive–compulsive cognitions, however methodologies have varied, and no study has determined obsessive–compulsive symptoms using the most widely used clinician rating scale, the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS). Considering that almost all studies that used factor analysis to ascertain OCD symptom dimensions were based on the Y-BOCS and that self-report instruments assessing obsessive–compulsive symptoms correlate poorly with the Y-BOCS, there is a need to use the Y-BOCS to examine the relationship between obsessive–compulsive cognitions and obsessive–compulsive symptom dimensions. This study examined the relationship between five Y-BOCS-derived obsessive–compulsive symptom dimensions and the three obsessive–compulsive cognitive domains identified by the obsessive-beliefs questionnaire (OBQ). The symmetry/ordering symptom dimension was associated with increased perfectionism/intolerance of uncertainty, the unacceptable/taboo thoughts symptom dimension was associated with increased importance/control of thoughts and the doubt/checking symptom dimension was associated with increased responsibility/threat estimation. There was no statistical evidence of an association between any OBQ belief sub-scale and the hoarding symptom dimension nor the contamination/cleaning symptom dimension. The findings encourage symptom-based approaches to cognitive-behavioural therapy for some OCD symptoms and call for further research on cognitions associated with contamination/cleaning symptoms and hoarding.     

Free wall rupture (FWR) in patients with acute ST-elevation myocardial infarction (STEMI) receiving fibrinolytic therapy (FT): a 7-year prospective study

Previous studies have shown a paradoxical increase in early mortality in older patients (>70 years) with acute STEMI treated with fibrinolytic therapy (FT), which has been attributed to the development of free wall rupture (FWR). Our aim was to assess occurrence of FWR in STEMI patients receiving FT. In this 7-year prospective study, data from 1701 consecutive patients were obtained. We analyzed predictors of the in-hospital mortality in patients > 70 years old. The independent contribution of several variables to overall mortality and FWR development was assessed using multiple logistic regression analyses. The mortality of entire cohort was 18% (306/1701). Diabetes mellitus, anterior infarction, smoking, female gender and hypercholesterolemia were independent predictors of in-hospital mortality. FT was given to 18% of all patients (304/1701) of which 13% died (39/304). FWR was 18.4-times more often in patients who received FT. Among patients younger than 70 years who received FT there was no FWR, while in patients ≥70 years of age FWR was found in almost half of the deceased (30/68; 44%). Application of FT in STEMI patients is not associated with higher mortality, but significantly increases number of FWR, especially in patients over 70 years of age.     

Spigelian hernia repair as a day-case procedure

Purpose

Only a few series of patients with a spigelian hernia managed on an outpatient basis have been reported in the literature. The aim of this prospective study was to evaluate the results of the elective spigelian hernia repair as an ambulatory procedure.

Methods

From June 2007 to June 2010, 8 patients with 9 spigelian hernias were electively operated on under local anesthesia as a day case. Four patients had unilateral spigelian hernia, 1 had spigelian and inguinal on the same side, 1 had spigelian and epigastric, 1 had spigelian and umbilical, and 1 patient had bilateral spigelian and umbilical hernia. Spigelian hernia was managed by the “open preperitoneal flat mesh technique.” In patients with several ventral hernias at different sites, “the open preperitoneal flat mesh technique” was performed using one separate flat mesh for each of the hernias; for the patient with inguinal hernia, the Lichtenstein procedure was performed in addition.

Results

No complications and recurrences were recorded during a mean follow-up of 23.5 months (range: 11–35).

Conclusion

The elective spigelian hernia can be successfully repaired under local anesthesia as a day-case procedure. The “open preperitoneal flat mesh technique” provides excellent results under these conditions.