Pelvic types as seen in a tropical setting.

BACKGROUND: Cephalo pelvic disproportion is still the leading indication for caesarean section in many developing countries and the contribution of pelvic typology may play some role in this regard. Our objective is to determine the proportion of pelvic types as seen in a tropical setting. METHOD: A retrospective review of preliminary films of hysterosalpingography of 400 women who underwent the study between January 2000 and December 2007 was reviewed to determine the pelvic typology. RESULT: Of the 400 films reviewed, 361 (90.3%) were gynaecoid, 36 (9%) were androidc and 3 (0.8%) were andropoid. There was no platypelloid pelvis seen in the films reviewed and a mixed type pattern was not observed in this study. CONCLUSION: The proportion of pure gynaecoid pelvis seen in this review is about the highest reported in the literature.

[Renal osteodystrophy (2): its treatment in renal insufficiency before dialysis]. / Ostéodystrophie rénale (2): Son traitement chez l'insuffisant rénal avant la dialyse.

1. In the patient with renal insufficiency before dialysis, the phosphocalcic disorders appear insidiously. They are dominated by hyperparathyroidism which will be diagnosed on the initially yearly determination of plasma intact PTH as soon as creatinine clearance decreases below 60 ml/min, eventhough there is still no modification in plasma concentrations of calcium and phosphate. Its diagnosis should lead to initiate the therapeutic measures in order to prevent the irreversible thining of the corticals by endosteal resorption and later the occurrence of histological and radiological osteitis fibrosa favoring fractures. 2. Hyperparathyroidism prevention relies on two main measures: prevention of phosphate retention and hypocalcemia is implemented by progressive phosphate and protein restriction (from 1 g/kg/day when Ccr < 60 ml/min to 0.6 g/kg/day when Ccr < 20 ml/min) and administration of CaCO3 (1.5 g at lunch and dinner to better complex the phosphate) as soon as PTH is above normal; optimal vitamin D repeletion will be implemented by systematic supplementation of native vitamin D or 25OH vitamin D3 in order to bring P25OHD between 30-60 ng/ml (75-150 nmol/l) or more generally around the upper limit of the epidemiologic range of the laboratory; these measures should aim at maintaining plasma intact PTH in its optimal range variable with the degree of renal insufficiency: 0.5-1; 1-2.5 and 2-3 folds the upper limit of normal for creatinine clearance respectively at 60-30; 30-10 and < 10 ml/min. 3. Because of their hyperphosphatemic and hypercalcemic effect, 1 alpha-hydroxylated vitamin D derivatives will be regularly efficient and safe only when non-calcemic non-aluminic phosphate binder will be available and proven to be without side-effects. 4. Instrumental (surgical or by alcohol injection) parathyroidectomy should be considered when plasma intact PTH is > 5 to 7 times the upper limit of normal in the presence of hypercalcemia (> 2.60 mmol/l) and/or hyperphosphatemia (> 1.70 nmol/l) in spite of the above measures, the decision being reinforced by coexistence of bone radiologic abnormalities and metastatic calcifications. 5. Adynamic bone diseases are rare before hemodialysis in the absence of aluminum exposition by the drinking water or the aluminum-phosphate binders. In absence of aluminum it will be prevented by maintaining PTH in its optimal range. 6. Osteomalacia before hemodialysis is mainly due, in the absence of aluminum exposition, to vitamin D deficiency, hypocalcemia and acidosis. It is readily cured by physiological doses of native vitamin D or 25OH vitamin D3 bringing plasma 25 OHD above 16 ng/ml, in association with alkaline salts of calcium and if necessary of sodium bicarbonate.

Heterogeneous signal pathways through TSH receptors in porcine thyroid cells following stimulation with Graves' immunoglobulin G.

OBJECTIVE: We compared different signal transduction pathways through thyroid stimulating hormone receptor (TSH-R) in porcine thyroid cells (PTC) following stimulation with thyroid stimulating hormone (TSH) and 11 thyroid stimulating immunoglobulin samples (TSI) obtained from patients with Graves' disease. DESIGN: Following stimulation with TSI, the level of inositol trisphosphate (IP3) and [Ca2+]i, as well as the membrane bound protein kinase C (PKC) activity and the intensity of the arachidonic acid (AA) cascade, were determined in PTC. RESULTS: Seven out of eleven TSI samples activated PTC through IP3 generation, elevated [Ca2+]i from the intracellular pools, exhibited verapamil-insensitive membrane-bound PKC activation, and enhanced release of [14C]AA derivates (however, one of the samples was also able to take up Ca2+ from the extracellular space). Four out of eleven TSI samples did not activate the phospholipase C (PLC) system in which case the Ca2+ signal occurred only in the presence of extracellular Ca2+, the membrane bound PKC activation was verapamil sensitive, and in two of these four TSI samples, the AA release was extremely high. CONCLUSIONS: The simultaneous examination of the majority of the known signal pathways using TSI samples showed that TSI samples from different patients activate thyroid cells through different pathways. Their effects differ from that of TSH and, to a certain extent, from each other. The results give a certain new insight into the intracellular mechanisms exerted by TSI.

[A strategy for the diagnosis of thyroid function]. / A pajzsmirigyfunkció kivizsgálásának stratégiája.

The characteristics of thyroid function tests are analysed. The author stress the importance of the right strategy for investigating thyroid function in the view of expenses, labor and time consuming tests. The guidelines of American Thyroid Association for use of laboratory tests are presented. Finally there is published another investigating protocol, which can be applied for our domestic situations.

Combined cyclosporin-A and methylprednisolone treatment of Graves' ophthalmopathy.

Twelve patients with Graves' ophthalmopathy (grade 1-6, ATA classification) were treated with Cyclosporin-A, systemically in combination with methylprednisolone. We observed slight or moderate favourable effect in 9 cases. Our data suggest that the benefit was due to the methylprednisolone, the effectivity of which was enhanced by the cyclosporin even in the glucocorticoid-resistant cases.

Lymphocytes resided in the thyroid are the main source of TSH-receptor antibodies in Basedow's-Graves' disease?

The source of TSH-receptor antibodies (TRAb) in Basedow's-Graves' disease is still under debate. Previous studies by other groups had found TRAb levels in the thyroid vein higher than or equal to that in the peripheral vein. The aim of the present work was to investigate the suspected presence of this TRAb gradient in 14 Graves' patients who underwent surgery. Interestingly, in 6 patients higher levels of TRAb were measured in the antecubital vein when compared to the thyroid vein, in another 6 there was no gradient and 2 exhibited higher TRAb levels in their thyroid veins. A clear gradient of thyroid hormones in favour of the thyroid vein was also present, while no gradient of TSH, anti-thyreoglobulin and anti-microsomal antibodies, total IgG, IgA and IgM levels and no differences of the CD4+/CD8+ cell ratios were found between the two sampling sites. We conclude that cells other than lymphocytes residing in the thyroid gland must also be involved in TRAb production.

Sera but not immunoglobulins of ophthalmic Graves' patients stimulate human embryonal fibroblasts' biosynthetic activity in culture.

The retroocular connective tissue changes in the ophthalmopathy of Graves' disease are known, however, the mechanism which leads to the increase in fibroblast number and activity is poorly understood. Using human embryonal fibroblast monolayers, fibroblast biosynthetic activity in the presence of sera, immunoglobulin deprived sera or immunoglobulins of Graves' patients with and without ophthalmopathy has been measured. Both sera and immunoglobulin deprived sera of the ophthalmic Graves' patients caused a marked increase of protein synthesis and a moderate increase of the sulphated glycosaminoglycan synthesis of fibroblasts. The same stimulatory effect was not found when immunoglobulin in fetal calf serum was used instead of sera, though anti-fibroblast IgG-s were present both in the sera and separated immunoglobulin fractions, as it has been demonstrated in an ELISA system. We conclude that the sera of ophthalmic Graves' patients contains a factor which stimulates human embryonal fibroblasts' biosynthetic activity in culture; this factor is not an immunoglobulin. The system described here seems to be suitable for studying the accompanying connective tissue changes in Graves' disease.

Late results of thyroid surgery for hyperthyroidism performed in childhood.

The authors report on the complex follow-up of 60 patients operated on for hyperthyroidism in childhood, on average 13.7 years after surgery. In 16.7% of the patients manifest hypothyroidism, in 45% subclinical hypothyroidism was found; 30% of the patients were euthyroid, and manifest hyperthyroidism recurred in 8.3%. Autonomous adenomas were enucleated in two children and three young adults. Severe disorders in thyroid function developed especially after the surgery of diffuse toxic goiters accompanied by ophthalmopathy. The disorders of humoral and cellular immunity were detected most frequently in recurrent manifest hyperthyroidism. There was no case where ophthalmopathy progressed after the operation. In the offspring of the operated patients the incidence of hyperthyroidism was not increased in childhood. The authors call attention to the importance of postoperative follow-up and hormone treatment.

[Rheologic investigation of electrode gels. III. Study of temporal changes of gel structure]. / Elektródagélek reológiai vizsgálata. III. A gélszerkezet idöbeni változásainak tanulmányozása.

In the publication consisting of 3 parts nine electrode gels have been investigated siú of them are used in hospital pharmacies of this country. Character and stability of gel structure have been studied and controlled by rheological methods. Structural forces have been numerically characterized with maximum and equilibrium viscosity, values of "M and B coefficients" and directional tangents of viscosity curves. Mechanical and thermal stability have been determined, changes for six months storing have been studied by means of all rheological parameters, respectively. Besides investigating rheological parameters electric conductivity values--which are important in respect of practical use of electrode gels--have been determined too. On the basis of results Carbopol "G" designated gel has been found to be the best its use has been proposed not only in supersonic tests but also in ECG.

[Bone scintigraphy in uremic osteodystrophy]. / Csont scintigráfia végzése uraemiás osteodystrophiában.

99mTc-HEDP bone scan was carried out on 12 long-time haemodialysed patients, suffering from bone pains. X-ray examinations of the bone and laboratory tests (serum calcium, -phosphor, -alkaline phosphatase, -parathormone, -aluminium, -ferritin) were also performed. The scintigrams were evaluated by two semiquantitative scores. Based on diffuse, increased radiopharmacon uptake of the bones and more than five points in the Fogelman score 5 patients most likely had serious and 3 had moderate hyperparathyroidism. In two patients osteomalacy was presumed based on decreased radiopharmacon uptake of the bones, increased uptake of the soft tissues and zero Fogelman score. Mixed or other bone disease was suggested in two other patients. Good correlation was found between the results of bone scans, the parathormone values and the results of histology obtained after parathyreoidectomy of 4 patients and autopsy of two others. This non-invasive examination (ie. bone scan) is helpful in differential diagnosis of uraemic osteodystrophy and its wide use is proposed in domestic nephrological practice.

[Rheologic investigation of electrode gels. II. Mechanical and thermal stability]. / Elektródagélek reológiai vizsgálata. II. A mechanikai és höstabilitás vizsgálata.

In the publication consisting of 3 parts nine electrode gels have been investigated six of them are used in hospital pharmacies of this country. Character and stability of gel structure have been studied and controlled by rheological methods. Structural forces have been numerically characterized with maximum and equilibrium viscosity, values of "M and B coefficients" and directional tangents of viscosity curves. Mechanical and thermal stability have been determined, changes for six months storing have been studied by means of all rheological parameters, respectively. Besides investigating rheological parameters electric conductivity values--which are important in respect of practical use of electrode gels--have been determined too. On the basis of results Carbopol "G" designated gel has been found to be the best its use has been proposed not only in supersonic tests but also in ECG.

[Rheologic investigation of electrode gels]. / Elektródagélek reológiai vizsgálata.

Nine electrode gels have been investigated 6 of them are used in hospital pharmacies of this country. The results were compared to properties of two gels from abroad, the recommended electrode gel has been developed on this basis. Character of formed gel structure has been studied by flow curves and structural forces have been numerically characterized by determining the parameters of the function made linear. By determination of electric conductivity the proposed Carbopol gel has been found suitable not only to supersonic tests but also to ECG and may be to EEG.

A non-isotopic screening test for antibodies to TSH receptor: dot immunobinding assay.

A dot immunobinding assay (DIBA) for thyrotropin (TSH) receptor antibodies is described. The method depends on the detection of antibody binding to highly purified thyroid plasma membrane attached to nitrocellulose solid support by horse-radish peroxidase - conjugated anti-human IgG. The method can detect down to 0.75 mU LATS standard and 1/1000 dilution of Graves' serum or immunoglobulin fraction. The interaction is inhibited dose-dependently by bTSH but not by insulin or human chorionic gonadotropin. The DIBA results show close correlation to those of TRAK (TBII) but not to cyclic AMP generation assay. DIBA is reproducible when tested monthly for 4 months. Sera and immunoglobulins gave virtually the same results. The method has a sensitivity of 90%, validity of 90% and specificity of 80% for both. We have, thus developed a sensitive and reliable method for screening for TSH receptor antibodies which can be performed in routine clinical laboratories.

Euthyroid infiltrative ophthalmopathy: clinical-immunological characteristics.

The thyroid hormone titres of the sera of 25 euthyroid infiltrative ophthalmopathic patients was examined, TRH test was performed, and thyroid-stimulating antibodies were studied by membrane receptor assay and TRAK assay. Previously, other diseases causing exophthalmos could be excluded by ophthalmological, radiological examinations, orbital ultrasonography and/or CT. Following TRH administration, 18 out of 25 patients showed abnormal TSH response, 16 of them were TSI - positive. Five of them became hyperthyroid 2-2.5 years later. After TRH administration 7 patients produced normal TSH response, none of them became hyperthyroid in the subsequent 2-4 years follow-up period. In the 7 TRH-negative patients, four were found to have higher hTG and an antithyroid microsome antibody titre. In those patients the fine needle biopsy verified chronic lymphocytic thyroiditis. In three patients there was no evidence of a pathological change of the thyroid gland. Based on our results, the patients could be divided into three groups. The prognostic and therapeutic differentiation of these groups seems to be justified.

Immunology of elastin: study of anti-elastin peptide antibodies by DOT immunobinding assay.

In order to further investigate the role of the immune system in the arteriosclerotic process, we investigated the anti-elastin peptide antibodies (AEAb) of the IgG and IgM types by DOT immunobinding assay in the sera of patients suffering from various arteriosclerotic diseases. In total 232 control and pathological sera were studied. In obliterative arteriosclerosis of the legs 90%, ischemic heart disease 67% and hypertension 60% of sera were positive for AEAb of the IgG type independent of age. In the case of diabetes mellitus, however, the duration of the disease was determinant. In rheumatoid arthritis, the results were negative. No clear-cut positivity could be demonstrated in stroke patients either. These results indicate that AEAb can be detected in some diseases and DOT appears to be an appropriate method for the AEAb screening in various diseases.