ANDROSTERONE GLUCURONIDE IS A MARKER OF ADRENAL HYPERANDROGENISM IN HIRSUTE WOMEN

Androsterone glucuronide (Andros-G), a dihydrotestosterone metabolite, is present in serum at concentrations at least tenfold greater than those of androstanediol glucuronide. To investigate the significance of serum androsterone glucuronide, we developed a direct radioimmunoassay for this compound and measured its levels in normal women, women with mild or severe idiopathic hirsutism (IH), hirsute women with polycystic ovarian syndrome (PCO), and non-hirsute obese women. To determine the source of Andros-G precursors, serum levels were measured before and after selective ovarian suppression with leuprolide, combined ovarian and adrenal suppression with leuprolide and dexamethasone, and adrenal stimulation with ACTH. Androsterone glucuronide levels (nmol/l; mean +/- SD) were significantly higher (P less than 0.025) in women with mild idiopathic hirsutism (IH) (185 +/- 91), severe IH (173 +/- 97), and hirsute women with polycystic ovarian syndrome (PCO) (178 +/- 102) than in normal women (110 +/- 26). Levels in non-hirsute obese women (64 +/- 19) were lower than in normal women (P less than 0.01). Baseline levels (mean +/- SEM) in hirsute women given 20 micrograms/kg/day leuprolide for 5-9 months (171 +/- 15) were not significantly changed after leuprolide alone (153 +/- 18), and were decreased after adding dexamethasone (19 +/- 6; P less than 0.001). Andros-G levels did not increase significantly in normal women 60 min after i.v. ACTH (112 +/- 14 to 126 +/- 19), but rose in IH (170 +/- 24 to 216 +/- 26; P less than 0.001) and in PCO (179 +/- 26 to 238 +/- 31; P = 0.002). We conclude that Andros-G in women arises primarily from adrenal gland precursors and is elevated in hirsute women as a group. Its levels do not correlate with the severity of hirsutism, or the presence or absence of PCO, but reflect an increased production of adrenal androgens in both IH and PCO.     

A Maternity Nurse Practitioner In Public Health Clinics

When a nurse-midwife was employed as a maternity nurse practitioner for four public health clinics in a metropolitan area, "maternity nursing clinics" evolved. Described are resultant refinements in clinic operations, the role of the practitioner, and the integration of her duties with those of other clinic personnel.     

The Effect of Chronic Fluvoxamine Treatment on Overnight Melatonin Secretion in Medicated Chronic Schizophrenic Patients

Overnight melatonin levels were measured in five male schizophrenic patients on steady antipsychotic treatment following the addition of fluvoxamine. Melatonin secretion increased in the first week of treatment and progressively decreased after 3 weeks. The findings are consistent with the development of tolerance in the processes underlying melatonin secretion. © 1997 John Wiley & Sons, Ltd.     

Chronic urticaria and angioedema

Of 231 patients evaluated for chronic urticaria and angioedema (CUA), 192 were diagnosed as having an idiopathic condition. The roles of serum IgE, complement (CH₅₀), and immune complexes (IC) were investigated in 112 patients with idiopathic CUA. Immediate skin tests were not helpful, but total IgE was elevated in 13%, equally divided between dermographic (D) and non-dermographic (ND) patients. Depressed haemolytic complement (CH₅₀) was noted in 10% of CUA, all of whom were D. Serum IC were elevated in 38%, equally divided between D and ND patients. There was no relationship between depressed CH₅₀ and elevated IC. Skin biopsies, evaluated by both light and immunofluorescent techniques, were negative for all specimens tested. The pathophysiology of idiopathic CUA is multifactorial, with a variety of immunological mechanisms involving serum IgE, CH₅₀, and IC. The relationship between depressed CH₅₀ and dermographism was noted but unexplained by serum or tissue studies.     

PERINATAL ASPHYXIA AND RESIDUAL PLACENTAL BLOOD VOLUME

The present data suggest that perinatal asphyxia may result in a transfer of blood, in utero, from placenta to fetus. The data contain no suggestion that asphyxia causes pooling of fetal blood in the placenta.     

Is lower IQ in children with epilepsy due to lower parental IQ? A controlled comparison study

Aim The aim of this study was to determine the relationship between parent and child Full‐scale IQ (FSIQ) in children with epilepsy and in typically developing comparison children and to examine parent–child IQ differences by epilepsy characteristics. Method The study participants were 97 children (50 males, 47 females; age range 8–18y; mean age 12y 3mo, SD 3y1mo) with recent‐onset epilepsy including idiopathic generalized (n=43) and idiopathic localization‐related epilepsies (n=54); 69 healthy comparison children (38 females, 31 males; age range 8–18y; mean age 12y 8mo, SD 3y 2mo), and one biological parent per child. All participants were administered the Wechsler Abbreviated Scale of Intelligence (WASI). FSIQ was compared in children with epilepsy and typically developing children; FSIQ was compared in the parents of typically developing children and the parents of participants with epilepsy; parent–child FSIQ differences were compared between the groups. Results FSIQ was lower in children with epilepsy than in comparison children (p<0.001). FSIQ of parents of children with epilepsy did not differ from the FSIQ of the parents of typically developing children. Children with epilepsy had significantly lower FSIQ than their parents (p<0.001), whereas comparison children did not. The parent–child IQ difference was significantly higher in the group with epilepsy than the comparison group (p=0.043). Epilepsy characteristics were not related to parent–child IQ difference. Interpretation Parent–child IQ difference appears to be a marker of epilepsy impact independent of familial IQ, epilepsy syndrome, and clinical seizure features. This marker is evident early in the course of idiopathic epilepsies and can be tracked over time.     

Three-ply walled w/o/w microcapsules formed by a multiple emulsion technique

A new method of microencapsulation is described. Interfacial rheological studies had shown the formation of a rigid bipolymer film at the interface between an aqueous solution of a water-soluble polymer and a non-aqueous solution of an oil-soluble polymer. This led to the idea that small spherical bodies might be formed on making a w/o/w emulsion from these solutions. The present work has shown that ethyl cellulose/acacia microcapsules are formed when the organic solvent ethyl acetate is removed from the multiple emulsion drops. These microcapsules may be obtained as a free-flowing powder.