Demographic, behavioural and physician-related determinants of early melanoma detection in a low-incidence population.

BACKGROUND: Knowledge of the factors that influence early detection of melanoma is important in developing strategies to reduce associated mortality. OBJECTIVES: To identify sociodemographic, behavioural and medical care-related factors associated with melanoma thickness in a low-incidence population but with a high case fatality. PATIENTS AND METHODS: In a multicentre, retrospective, survey-based study of 202 patients with a recent diagnosis of invasive melanoma (< 1 year), we collected data on demographic and behavioural factors, attitudes towards prevention, access to medical care, frequency of skin self-examination (SSE) and physician skin examination (PSE) in relation to melanoma thickness. RESULTS: Thinner tumours (≤ 1 mm, 80 melanomas) were associated with female sex (P ≤ 0.049), nonnodular (superficial spreading melanoma, lentigo maligna melanoma, acral lentiginous melanoma) histological subtypes (P < 0.001), absence of ulceration (P ≤ 0.001), and location other than lower extremity or trunk location (P ≤ 0.004). Patients married at the time of diagnosis or who performed SSE during the year prior to diagnosis were more likely to have thinner tumours than those who did not [odds ratio (OR) 3.45, 95% confidence interval (CI) 1.48-8.04 and OR 2.43, 95% CI 1.10-5.34, respectively]. Full-body skin examination by a physician was not significantly associated with thinner melanoma (OR 1.99, 95% CI 0.66-6.07). CONCLUSIONS: SSE was shown to be an important factor in the detection of thin melanoma, in contrast to partial or full-body PSE, which did not show any statistically significant effect on tumour thickness.

Changes in donor site selection in lower limb free flap reconstructions by integrating duplex ultrasonography in the preoperative design.

BACKGROUND: The flap selection criteria in lower extremity reconstruction are based on the wound characteristics and donor site morbidity. We hypothesized that the decision-making could be influenced by integrating Duplex Ultrasound (DU) in the preoperative design. METHODS: We retrospectively reviewed data on patients who underwent lower-extremity microvascular soft-tissue reconstruction at our institution by the same surgeon. In Group A, DU was integrated in the preoperative design of the microsurgical reconstruction, whilst in Group B the choice of free flap donor site and level of anastomosis were based on clinical criteria only. RESULTS: A total of 48 microvascular reconstructions were recorded. DU was used preoperatively in 20-patients, whilst in 28-patients flap selection was based on clinical criteria. There was a significant decrease in perforator flap (45% over 64%) and a significant increase in muscle flap preference (55% over 32%) in the DU-group. There was no significant difference (10% over 11%) in the donor site selection with considerable morbidity. There was no flap failure in the DU-group, whilst 3 flaps failed in the second-group (p< 0.05, χ(2)-test). Wound healing was significantly faster in the DU-group (21±3 days) compared to 37±3 days in the other group (p< 0.05, t-test). CONCLUSION: Preoperative ultrasound studies moved flap preference towards chimeric and muscle flaps with low morbidity to match the three-dimensional defect and to promote healing. KEYWORDS: lower limb reconstruction; free flap; donor site; duplex ultrasound.

The Use of a New Wound Alginogel for the Treatment of Partial-thickness Hand Burns.

UNLABELLED:  The following retrospective analysis reports on patients with partial-thickness wounds admitted to the burn unit of the General Hospital of Athens who were treated with a new alginogel and were later compared to the burn center's standard treatment. METHODS: Patient information from January-December 2008 was analyzed for the number of days until healing and wound bacterial loads. Wound healing was characterized as a quick onset of epithelialization and low occurrence of inflammation. RESULTS: A limited number of wounds (15%) were found to be positive for wound swabs and accordingly few signs of inflammation were reported. The organisms that were retrieved from the alginogel treated wounds were Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, and Acinetobacter baumanii. CONCLUSION: These data are discussed and compared with the experience of the burn unit and its standard treatment. .

Preservation of venous outflow improves transverse rectus abdominis musculocutaneous flap survival following vascular delay.

BACKGROUND: The rat abdominal island model has proved to be a reliable and reproducible model for the study of surgical delay procedures. It has been customary to simultaneously divide both the artery and the accompanying vein to obtain maximum survival of the rat TRAM flap undergoing delay procedure. This study evaluates the effect of selective arterial interruption compared to standard vascular delay on flap survival in the rat TRAM flap model. METHODS: Thirty-six Wistar rats were randomly assigned to three groups (n=12), depending on the vascular ligation selected for the initial experimental delay stage. In group A (control group) no vessels were ligated. In group B the right deep inferior epigastric vessels were preserved and the right superior and left inferior and superior deep vessels were ligated. In group C the right inferior epigastric vessels and the left inferior epigastric vein were preserved while superior epigastric vessels and the left inferior epigastric artery were ligated. For the second stage one week later, TRAM flaps were elevated based on the right deep inferior epigastric vessels, re-inset in their original position and digitally photographed. Skin island viability was determined 96 hours later using digital photography and image-analysis software SigmaScan (SPSS, Inc., Chicago, IL). RESULTS: The percentage of flap survival in control group A was 50+/-6%, in group B 60+/-4% and in group C 85+/-4%. The occlusion of the three vascular pairs in group B improved the survival percentage in comparison to the control group A, but this did not achieve statistical significance. In contrast, the percentage of flap survival in control group C was statistically significant compared to groups A and B (p<0.05, ANOVA). Zone IV exhibited no necrosis in any group C animals. CONCLUSIONS: This indicates that delay with preservation of the venous outflow of zone IV results in increased blood supply.

The beneficial effect of genetically engineered Schwann cells with enhanced motility in peripheral nerve regeneration: review.

BACKGROUND: The importance of Schwann cells in promoting nerve regeneration across a conduit has been extensively reported in the literature, and Schwann cell motility has been acknowledged as a prerequisite for myelination of the peripheral nervous system during regeneration after injury. METHODS: Review of recent literature and retrospective analysis of our studies with genetically modified Schwann Cells with increased motility in order to identify the underlying mechanism of action and outline the future trends in peripheral nerve repair. FINDINGS: Schwann cell transduction with the pREV-retrovirus, for expression of Sialyl-Transferase-X, resulting in conferring Polysialyl-residues (PSA) on NCAM, increases their motility in-vitro and ensures nerve regeneration through silicone tubes after end-to-side neurorraphy in the rat sciatic nerve model, thus significantly promoting fiber maturation and functional outcome. An artificial nerve graft consisting of a type I collagen tube lined with the genetically modified Schwann cells with increased motility, used to bridge a defect in end-to-end fashion in the rat sciatic nerve model, was shown to promote nerve regeneration to a level equal to that of a nerve autograft. CONCLUSIONS: The use of genetically engineered Schwann cells with enhanced motility for grafting endoneural tubes promotes axonal regeneration, by virtue of the interaction of the transplanted cells with regenerating axonal growth cones as well as via the recruitment of endogenous Schwann cells. It is envisaged that mixed populations of Schwann cells, expressing PSA and one or more trophic factors, might further enhance the regenerating and remyelinating potential of the lesioned nerves.

Poland syndrome in a female patient reconstructed by endoscopically assisted technique.

A two-stage, endoscopically assisted technique was used to reconstruct the chest wall and breast deformity in a female patient with Poland syndrome. In the first stage the latissimus dorsi muscle was transferred anteriorly, and a tissue expander was placed under the transposed muscle to adjust the size of the breast accordingly. In the second stage the same incision in the midaxillary line was used to remove the expander and place a permanent implant endoscopically. The two-stage technically demanding endoscopically assisted reconstruction of Poland syndrome was rewarded by inconspicuous scars and a fine aesthetic result.

The use of artificial skin in plastic surgery and burns.

The use of artificial skin restores the depth and the elasticity of the skin, through restoration of the dermis, with no significant morbidity. Thus we have permanent release of contractures and a pleasing contour with satisfactory functional and cosmetic results. Still, these advantages must be weighed against the necessity for meticulous surgical technique and intensive post-operative care, the waiting period and the cost of the product.

Reduction mammaplasty specimens and occult breast carcinomas.

AIM: The aim of this study was to report the incidence of occult cancer in reduction mammaplasty (RM) specimens. METHODS: A retrospective study of 314 women who underwent RM from February 1996 to August 2001. RESULTS: Occult carcinomas were detected in three patients, in two of which the lesions were invasive. Atypical ductal or lobular hyperplasia was found in five cases and other carcinoma risk lesions in four patients. Other benign changes were identified in totally 133 patients. CONCLUSION: Incidental carcinomas will occasionally be found in RM procedures.

Burn injuries and soft tissue traumas complicated by mucormycosis infection: a report of six cases and review of the literature.

Mucor fungus infection is a rare opportunistic infection, rapidly progressive and often fatal in immunocompromised patients, or in patients with chronic debilitating diseases. We report six cases of trauma patients with mucormycosis. Three had severe thermal burns, one of them with a medical history of diabetes mellitus. The other three patients suffered from severe soft tissue injuries caused by traffic accidents. In all cases there had been spontaneous exposure and contact of the wounds with soil. During hospitalization, fungi cultures and/or biopsies of all wounds were performed and all resulted positive. The patients were treated with Amphotericin B (AmB) and surgical debridement. Two of them died and the other four were fully healed and discharged. Mucormycosis should be considered in any case of aggressive skin tissue necrosis with a history of soiled wounds. We suggest that mucormycosis is treated by intravenous and local administration of AmB, extensive and repeated debridement and cautious coverage of the wound. The plastic surgeon must wait for negative swab cultures and biopsies before covering the defects with skin grafts or flaps. Reconstruction may be challenging, depending on the extent, depth, location and special indications of the affected site and the donor site availability.

L'infection fongique (mucor mycose) est une infection rare, opportuniste, d'aggravation rapide et d'évolution souvent fatale chez les patients immunodéprimés ou porteurs d'affections chroniques fragilisantes. Nous rapportons 6 cas de traumatismes avec mucor mycoses; 3 d'entre eux présentaient des brûlures thermiques sévères: l'un était atteint de diabète, les 3 autres patients souffraient de graves lésions des parties molles secondaires à des accidents de circulation; dans tous les cas, il s'agissait de plaies largement ouvertes et souillées; pendant l'hospitalisation les cultures ou les biopsies objectivaient la présence fongique; les patients furent traités par Amphotiricine B (AmB) et détersion chirurgicale; 2 patients moururent et les 4 autres évoluèrent vers la cicatrisation complète. La mucor mycose doit être évoquée devant tout cas de lésions cutanées profondes et nécrotiques avec notion de souillure. Nous suggérons que la mucor mycose soit traitée par administration intraveineuse et locale d'AmB avec détersion répétée, large et protection prudente de la plaie. Le chirurgien plastique doit attendre la négativité des cultures après écouvillonnage et biopsie avant de couvrir les pertes de substance par greffe ou lambeau. La reconstruction est un challenge qui dépend de l'étendue, de la profondeur, de la localisation et des particularités de la lésion ainsi que de la disponibilité de zone donneuse.

Changes of arterio-venous differences in pH and pCO2 by hemodialysis.

Normally the differences in arterial-venous pH (A-VpH) and veno-arterial pCO2 (V-ApCO2) are small and constant. This study deals with A-VpH and V-ApCO2 and their effect on arterial-venous saturation hemoglobin percentage (A-VSHb%) in uremic patients under hemodialysis (HD). In 17 uremic patients under HD with acetate, blood samples were collected anaerobically in heparinized syringes from artery (fistula) and vein (forearm without fistula) pre- and post-HD. In these samples pH, pCO2 and SHb% were determined and A-VpH, V-ApCO2 and A-VSHb% were estimated. Comparison between the values pre- and post-HD of A-VpH, V-ApCO2 and A-VSHb% shows that these three values were decreased significantly post-HD (p < 0.001). The correlation of all values (pre- and post-HD) of A-VpH and V-ApCO2 with that of A-VSHb% was significant and positive (r = 0.514 p < 0.01, r = 0.505 p < 0.01, respectively).

Perforated diverticulitis: a surgical dilemma.

Thirty-eight patients, 18 males and 20 females (mean age 61 years) have been operated on for perforated diverticulitis, over the past 14 years. We assigned the patients into stage A (n = 12) when the inflammation was confined to the mesosigmoid folds, stage B (n = 16) when an intraabdominal abscess was walled off and stage C (n = 10) when a generalized peritonitis had developed. Resection of the perforated sigmoid was carried out in 24 patients either as Hartmann's procedure (n = 18) or with primary anastomosis (n = 6). The mortality rate in this setting was 0.0% and 16.6% respectively. In 14 patients, no resection was carried out in 24 patients either drainage and colostomy (n = 10) or only drainage (n = 4) with corresponding mortality rate 30% and 25%. Mortality rate in relation to the stage was: Stage A 16.16%, Stage B 12.5% and Stage C 10%. The higher mortality rate in stage A and B was due to the fact that less radical operations were carried out. Four of our five deaths in all stages occurred in patients in whom the perforated sigmoid was not resected. In conclusion resection of the perforated sigmoid with or without primary anastomosis regardless of the stage of the disease is recommended.

The efficacy of recombinant human activated protein C (rhAPC) vs antithrombin III (at III) vs heparin, in the healing process of partial-thickness burns: a comparative study.

This is an experimental study regarding the positive effect of recombinant human activated protein C (rhAPC) in the healing process of partial-thickness burns, in comparison to antithrombin III and heparin. On a porcine model we induced superficial partial-thickness and deep partial-thickness burns and performed intravenous administration of the elements of study during the first 48 h. The progress of the condition of the injured tissues was evaluated by histopathological examination at specific time intervals. The results showed an improved healing response of the specimens treated with rhAPC compared to those treated with antithrombin III, heparin, and placebo.

Is expansion of artificial dermis a reliable reconstructive option?

Reconstruction of full-thickness defects with the use of artificial dermis has been well established in the recent literature. The capacity of artificial dermis to expand over a period of years, months, or even days is described. Three such cases are reported. Two female patients, aged 21 and 30 years, with post-burn contractures of the chest with right breast hypoplasia and abdominal wall post-burn contractures respectively, and a 14-year-old male with a giant congenital naevus on the forearm, are presented. After excision of the contractures and the congenital naevus, the patients underwent staged reconstruction with the use of artificial dermal template and split-thickness skin autografts at monthly intervals. The 21-yr-old female also had a tissue expander placed submuscularly which six months later was replaced by a permanent silicone implant. Gradual expansion of artificial dermis within three weeks resulted in reconstruction of a breast of natural shape, size, and volume. In the second patient the artificial dermis was expanded over a period of months, until full-term pregnancy, while the third patient took years to achieve expansion naturally as he grew up. In conclusion, artificial dermis can be expanded over various periods of time (days to years), providing a reliable and safe alternative reconstructive method, particularly in areas where expansion is an absolute necessity for a good functional and aesthetic result.

Quality and safety of fresh-frozen plasma inactivated and leucoreduced with the Theraflex methylene blue system including the Blueflex filter: 5 years' experience.

BACKGROUND AND OBJECTIVES: The objective of this paper is to present 5 years' experience of pathogen inactivation of fresh-frozen plasma with the methylene blue system in a blood centre in Athens. MATERIALS AND METHODS: Eight thousand and five hundred units treated by methylene blue and 54 435 untreated were issued for transfusion in four hospitals during the period 2000-2005. Eighty-eight units were evaluated for changes in coagulation factor activity and cytokine concentrations following treatment. RESULTS: Coagulation factor losses were in the accepted range. Adverse reactions were 1 : 8500 with treated and 1 : 2177 with untreated units. The five serious reactions were all in untreated units. No seroconversions for infectious diseases were reported. CONCLUSIONS: Methylene-blue-treated fresh-frozen plasma is safer than the untreated product even in patients who require large quantities of plasma transfusion.

p53 codon 72 Pro homozygosity increases the risk of cutaneous melanoma in individuals with dark skin complexion and among noncarriers of melanocortin 1 receptor red hair variants.

BACKGROUND: p53 has a common polymorphism at amino acid 72, encoding either arginine or proline. p53Arg and p53Pro exhibit differences in various biological activities, such as cell-cycle arrest and induction of apoptosis. Numerous epidemiological studies have examined the role of this polymorphism in several human malignancies, including cutaneous cancers, with contradictory results. OBJECTIVES: To investigate the germline frequency of p53 codon 72 polymorphism in malignant melanoma in a Mediterranean population, and to examine possible associations with various clinicopathological factors. METHODS: In this hospital-based case-control study we used allele-specific polymerase chain reaction for p53 codon 72 genotyping in blood specimens from 107 Greek patients with sporadic cutaneous melanoma and 145 healthy controls. RESULTS: After adjustment for age, sex and phototype the Pro/Pro genotype was associated with increased risk for cutaneous melanoma compared with the Arg/Arg genotype (adjusted odds ratio, OR 3.17, 95% confidence interval, CI 1.03-9.78). This correlation was more pronounced in subjects with phototypes III or IV (adjusted OR 9.56, 95% CI 1.56-58.46), dark skin (adjusted OR 10.96, 95% CI 1.64-73.28), dark eyes (adjusted OR 8.86, 95% CI 1.69-46.52) and dark hair (adjusted OR 3.17, 95% CI 1.01-9.95), and among noncarriers of melanocortin 1 receptor gene (MC1R) red hair polymorphisms (adjusted OR 2.99, 95% CI 1.02-8.78). CONCLUSIONS: p53 codon 72 Pro/Pro genotype could be a risk factor for the development of melanoma in the Greek population, especially in subgroups with darker skin pigmentation, as well as among noncarriers of the MC1R red hair polymorphic variants.

Surfactant administration in severe inhalation injury: case report.

Inhalation injury is one of the main causes of death in patients with severe burns. Administration of exogenous surfactant appears promising for the treatment of acute respiratory failure. We report our clinical experience with this approach. A 35 yr-old man was admitted to our burns unit after an industrial accident. He had sustained a 60% total body surface area full-thickness burn combined with severe inhalation injury. Fiberoptic bronchoscopy confirmed the diagnosis, demonstrating severe blisters and ulcers of the bronchial mucosa. Refractory hypoxaemia (PaO (2)/FiO (2)56 mm Hg, where PaO (2)is oxygen tension in arterial blood and FiO (2)is the fraction of inspired oxygen) was treated with optimal mechanical ventilatory support; additionally, an initial dose of natural bovine surfactant (Alveofact) of 50 mg/kg body weight was administered by intrabronchial instillation on day 3 postburn. A significant improvement in oxygenation was observed 12 h after administration (from 56 mm Hg initially to 194 mm Hg), followed by an improvement in dynamic compliance (from 26 ml/cm H (2)O initially to 41 ml/cm H (2)O) and inspiratory resistance (from 14 cm H (2)O/lps initially to 11 cm H (2)O/lps). The same dose of surfactant was repeated 48 h later to prevent potential deterioration, resulting in maintenance of gas exchange and lung mechanics at the above levels. No complication associated with the surfactant administration was observed. However, the patient died on day 9 post-burn owing to extrapulmonary causes. Our results demonstrate a significant improvement in gas exchange and lung mechanics in a burn patient with severe inhalation injury after repeated administration of exogenous surfactant. Further study is needed in order to elucidate the clinical impact of surfactant administration and the complications associated with its use in cases of inhalation injury.

Temozolomide in combination with celecoxib in patients with advanced melanoma. A phase II study of the Hellenic Cooperative Oncology Group.

BACKGROUND: There is now increasing evidence that a constitutive expression of cyclooxygenase (COX)-2 plays a role in the development and progression of malignant epithelial tumors. Expression of COX-2 is seen in 93% of melanomas, as determined by immunohistochemistry. Temozolomide (TMZ) has demonstrated activity against melanoma and has been investigated as single agent or in combination. We designed a phase II study to assess the efficacy and toxicity of the combination of TMZ and celecoxib (a COX-2 inhibitor) in patients with advanced melanoma. PATIENTS AND METHODS: From January 2003 to July 2004, 52 patients were enrolled in the study. Nineteen patients were M1a, six M1b and 27 M1c. Patients received TMZ 200 mg/m(2) per day p.o. for 5 consecutive days every 4 weeks and celecoxib 400 mg b.i.d. p.o. for a maximum of six cycles. Celecoxib was continued until progression. RESULTS: The median age was 63 years. There were 29 males and 23 females. Among 50 assessable patients, there were 11 (21.5%) objective responses including five complete responses and six partial responses. Twenty patients (38.5%) had stabilization of their disease, and 19 (36.5%) progressed. The median time to progression was 4.6 months and the median survival 9.5 months. Twenty-two patients (41.5%) completed all cycles of treatment. Median relative dose intensity of TMZ was 0.99 (range 0.6-1.2). Most commonly seen toxic effects included anemia (27.5%), neutropenia (17.5%), thrombocytopenia (33%), nausea/vomiting (75%), gastrointestinal (52%) and fatigue (46.5%). One patient discontinued due to severe toxicity. COX-2 was determined by immunohistochemistry and was expressed in all cases. CONCLUSION: The combination of TMZ and celecoxib is safe and potentially effective in the treatment of metastatic melanoma. Randomized studies are needed to explore the role of celecoxib in combination with chemotherapy or as maintenance treatment in these patients.

The Value and Prognostic Role of the CT Scan versus Chest Radiography in the Follow-up of Intubated Burn Patients with Possible Inhalation Injury.

The admission and follow-up chest radiographs as well as the follow-up CT scans of 13 burn patients admitted to our clinic requiring ventilatory support were analysed for signs of inhalation injury and pulmonary complications. The findings were compared with the results of the clinical examination, the blood gas tests, and bronchoscopy. Eleven out of the 13 patients underwent bronchoscopy revealing inhalation injury. The CT scan detected pleural effusion in two patients with a normal chest radiograph. In two patients the CT scan detected asymmetrical expansion between the right lung and the left. In one patient soft tissue oedema made evaluation of the chest radiograph impossible, while the CT revealed bilateral pleural effusions and consolidations or atelectasis in both the lower lobes. In one patient the CT scan detected oedema of consolidatory pattern in every lobe (superior middle-inferior), while the image in the chest radiograph was not similar. CT identified an area of consolidation in one patient in the right middle lobe with a normal chest radiograph. The results of the CT scan correlated with the clinical course and blood gas determinations, while similar findings in the chest radiograph were observed at a later stage. In conclusion, compared to chest radiographs, the CT scan often yielded additional information in the follow-up of intubated burn patients with inhalation injury. It can be performed in order to confirm and/or more precisely define the full extent of lung injury and is also feasible in patients who are critically ill and hard to move.

Temozolomide and cisplatin versus temozolomide in patients with advanced melanoma: a randomized phase II study of the Hellenic Cooperative Oncology Group.

PURPOSE: Temozolomide (TMZ) is an oral alkylating agent that produces methyl adducts at the 0.6 position of guanine. The methyl adducts are removed by the DNA repair enzyme AGAT. As demonstrated by in vitro studies, cisplatin (CDDP) is able to down-regulate the AGAT activity, suggesting that CDDP could enhance the antitumor activity of TMZ. We designed a randomized phase II study to evaluate and compare the activity and safety profile of the combination versus single-agent TMZ in patients with advanced melanoma. PATIENTS AND METHODS: From January 2000 to April 2002, 132 patients were enrolled on the study. Patient and tumor characteristics were well balanced between the two arms. Patients with cerebral metastases were included. Patients received TMZ 200 mg/m(2)/day orally for five consecutive days every 4 weeks or TMZ + CDDP 200 mg/m(2) daily on days 1-5 and 75 mg/m(2) of CDDP on day 1. RESULTS: Tumor responses (complete and partial responses) were seen in 16 patients (26%) in arm A and 19 patients (29%) in arm B. The median time to progression (TTP) was 3.8 months in arm A and 5.8 months in arm B. The median overall survival (OS) was 11.5 months in arm A and 12 months in arm B. The difference between treatment arms regarding objective response rates, TTP and OS were not statistically significant. Toxicity was comparable between the two arms for anemia, leukopenia, neutropenia, thrombocytopenia, fatigue, constipation and arthralgias/myalgias. There was significantly more grade 3 and 4 emesis in the combination arm. CONCLUSIONS: No clear benefit in terms of response rates, median TTP or OS was shown with the combination of TMZ + CDDP. Additionally, the combination was associated with higher incidence of grade 3 and 4 emesis.

The effect of successful renal transplantation on hormonal status of female recipients.

The pituitary, thyroid, and ovarian hormone levels were measured by enzyme and fluorescence polarization immunoassays in 18 women with successful renal transplants (recipients): 10 menstruating, mean age 34.7 years, mean time after transplantation (Tx) 112.00 months, mean SCr 130.60 mumol/L; and 8 menopausal, mean age 52.7 years, mean time after Tx 61.00 months, and mean SCr 119.00 mumol/L. Five women of the menstruating group conceived 7 times and gave birth to 4 healthy infants. The findings were compared to 30 age-matched healthy subjects (controls) and to 13 women under chronic hemodialysis (hemodialyzed patients): 2 menstruating, 24 and 36 years old, and 11 menopausal, mean age 59.4 years. Serum prolactin (PRL) showed a highly significant increase in hemodialyzed patients (p less than .0001) compared to controls. In recipients, PRL levels were significantly lower than in hemodialyzed patients, but higher than in controls (p less than .0001). LH and FSH were elevated in menstruating hemodialyzed patients (p less than .0001, p less than .02, respectively) and significantly high in menopausal hemodialyzed patients (p less than .02, p less than .01, respectively). In menstruating recipients, LH was also highly elevated (p less than .001), while FSH showed no significant difference from controls. In menopausal recipients the increase of LH was less prominent (p less than .02) but FSH was highly increased (p less than .001). T3, T4, and FTI were absolutely normal in recipients, while they were significantly lower than normal (p less than .0001) in hemodialyzed patients. Estradiol showed no significant difference in both groups of recipients, as well as in menopausal hemodialyzed patients.(ABSTRACT TRUNCATED AT 250 WORDS)