Changes in blood lipid levels following silastic ring vertical gastroplasty.

BACKGROUND: The purpose of this study was to evaluate the effect of the Silastic Ring Vertical Gastroplasty (SRVG) operation on blood lipid levels in obese men and women during the first year following surgery. METHODS: 25 patients (11 men and 14 women) age 17-50 (mean 33 years) who suffered from morbid obesity (BMI >40, range 45.9+/-4.7 kg/m2) underwent SRVG. Blood samples were collected before operation and 3, 6 and 12 months following surgery and tested for: triglycerides, total cholesterol, HDL-C, LDL-C, VLDL-C, and Lp(a). RESULTS: Both men and women lost weight significantly. Mean BMI decreased from 48.0 to 32.5 kg/m2 in men and from 44.3 to 29.0 kg/m2 in women (P<0.01). Blood lipid levels 1 year following surgery demonstrated the following changes: In women, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 160.7 mg/dL to 67.7 mg/dL (P<0.01), from 220 mg/dL to 189 mg/dL, from 138.3 mg/dL to 111 mg/dL, from 17 mg/dL to 12 mg/dL, and from 77.5 mg/dL to 18.5 mg/dL (P<0.01), respectively, and HDL increased from 45 mg/dL to 50.5 mg/dL. In men, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 246 mg/dL to 140 mg/dL (P<0.01), from 206 mg/dL to 170 mg/dL (P<0.01), from 134 mg/dL to 112 mg/dL (P<0.05), from 25 mg/dL to 15 mg/dL (P<0.01), and from 30.3 mg/dL to 11.6 mg/dL (P<0.01), respectively, and HDL increased from 31.3 mg/dL to 37.4 mg/dL (P<0.05). CONCLUSION: SRVG improved blood lipid profile in obese patients during the first year following surgery. Reduction in cholesterol and its fractions reaches statistical significance only in men.

TSH-secreting pituitary adenomas: follow-up of 11 cases and review of the literature.

Thyrotropin (TSH)-secreting pituitary adenomas account for less than 1% of all pituitary tumors. In the last two decades, their clinical management has changed markedly due to technological advances that made earlier diagnosis possible and the introduction of somatostatin analog therapy. We retrieved the data of 11 patients in Israel diagnosed with TSH-secreting pituitary tumors since 1989. There were six men and five women of mean age 44.8 +/- 19.5 years (range 18-80 years). All had elevated thyroxine and triidothyronine levels with nonsuppressed TSH and imaging evidence of a pituitary tumor. In three patients the tumor co-secreted growth hormone. Ten patients had macroadenomas (> or =10 mm) and one patient had a microadenoma (<10 mm). Nine patients underwent surgery, and all had postoperative evidence of residual tumor. Ten patients received long-term somatostatin analog therapy (9 postoperatively, 1 primarily), which controlled the hyperthyroidism in all of them. In addition, three patients showed tumor shrinkage and seven, stabilization of tumor growth.In conclusion, in patients with TSH-secreting pituitary adenomas, somatostatin therapy appears to be highly effective in treating hyperthyroidism and in halting tumor growth or promoting tumor shrinkage.

Increased prevalence of antithyroid antibodies and subclinical hypothyroidism in children with juvenile idiopathic arthritis.

OBJECTIVE: To estimate the occurrence of antithyroid antibodies (ATA) and hypothyroidism in children with juvenile idiopathic arthritis (JIA) compared to matched healthy controls. METHODS: The occurrence of ATA, including antithyroglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies, was evaluated by quantitative immunometric ELISA in children with JIA and in a healthy matched control group. Thyroid function was assessed in both groups. RESULTS: The study group included 66 patients with JIA (50 girls, 16 boys) of mean age 11.7 +/- 4.4 years (range 2-23). The control group included 89 children (71 girls, 18 boys) of mean age 10.8 +/- 4.2 years (range 2-18). Mean age at onset of joint disease was 7.3 +/- 3.6 years (range 1-15). Anti-TG antibodies were found in 7 of 62 patients (11.3%) in the JIA group and 2 of 89 controls (2.2%) (p = 0.03); anti-TPO antibodies were found in 5 of 65 patients (7.9%) and one of 89 controls (1.1%) (p = 0.08). All patients with ATA had oligoarticular type JIA (p = 0.01). Mean thyroid stimulating hormone (TSH) levels were higher in the study group than in controls (2.6 +/- 2.3 vs 1.9 +/- 1.0 mIU/l; p = 0.01); levels were above normal range (0.4-4 mIU/l) in 8 study patients (12%) and 3 controls (3.4%) (p = 0.055). Overall, ATA were found in 9 of the 150 study participants, 4 (44%) of whom had TSH levels above 4 mIU/l (p = 0.001). CONCLUSION: Children with JIA have a higher than normal incidence of ATA and subclinical hypothyroidism and should be routinely screened for these variables.