High prevalence of vitamin D deficiency in Japanese female patients with Graves' disease.

We reported previously that vitamin D deficiency is a causal mechanism of postoperative tetany in patients with Graves' disease. The aim of the present study was to determine the prevalence of vitamin D deficiency by reviewing serum 25(OH)D levels in 208 patients with Graves' disease (146 women, 62 men) during a 1 year period. Serum 25(OH)D levels were significantly lower (p < 0.001) in female Graves' patients (31.8 +/- 13.3 nmol/l) than in male patients (41.3 +/- 15.0 nmol/l). Vitamin D deficiency (defined as a serum 25(OH)D value below 25 nmol/l) was found in 40% of female patients and in 18% of male patients (p < 0.005). There was a significant seasonal variation in the 25(OH)D concentrations in female patients [amplitude 6.38 (95% CI, 5.42-7.56)], with values below 25 nmol/l found in 58% of female patients during the winter months. There were significant (p < 0.001) differences in serum 25(OH)D levels between age groups in the female patients. The concentrations were lowest in patients in their twenties (25.1 +/- 8.2 nmol/l) and highest in patients in their fifties and sixties (43.2 +/- 13.7 nmol/l). Serum 25(OH)D concentrations might be monitored in patients with Graves' disease during antithyroid drug therapy, and vitamin D and/or calcium supplements are recommended for patients with vitamin D deficiency.

Progression of T cell lineage restriction in the earliest subpopulation of murine adult thymus visualized by the expression of lck proximal promoter activity.

The proximal promoter of lck directs gene expression exclusively in T cells. To investigate the developmental regulation of the lck proximal promoter activity and its relationship to T cell lineage commitment, a green fluorescence protein (GFP) transgenic (Tg) mouse in which the GFP expression is under the control of the proximal promoter of lck was created. In the adult GFP-Tg mice, >90% of CD4(+)CD8(+) and CD4(+)CD8(-) thymocytes, and the majority of CD4(-)CD8(+) and CD4(-)CD8(-) [double-negative (DN)] thymocytes were highly positive for GFP. Slightly lower but substantial levels of expression of GFP was also observed in mature splenic T cells. No GFP(+) cells was detected in non-T lineage subsets, including mature and immature B cells, CD5(+) B cells, and NK cells, indicating a preserved tissue specificity of the promoter. The earliest GFP(+) cells detected were found in the CD44(+)CD25(-) DN thymocyte subpopulation. The developmental potential of GFP(-) and GFP(+) cells in the CD44(+)CD25(-) DN fraction was examined using in vitro culture systems. The generation of substantial numbers of alphabeta and gammadelta T cells as well as NK cells was demonstrated from both GFP(-) and GFP(+) cells. However, no development of B cells or dendritic cells was detected from GFP(+) CD44(+)CD25(-) DN thymocytes. These results suggest that the progenitors expressing lck proximal promoter activity in the CD44(+)CD25(-) DN thymocyte subset have lost most of the progenitor potential for the B and dendritic cell lineage. Thus, progression of T cell lineage restriction in the earliest thymic population can be visualized by lck proximal promoter activity, suggesting a potential role of Lck in the T cell lineage commitment.

[Expired nitric oxide concentration derived from nasal cavity and that derived from airway and lung in Japanese cedar pollinosis].

AIM: Japanese cedar pollinosis (Type I allergy to Japanese cedar pollen) shows a high incidence in spring in Japan, demonstrating symptoms such as pituita, rhinostenosis, lacrimation and sometimes pharyngeal pain. The following study investigated whether expired nitric oxide (NO) concentration is increased in Japanese cedar pollinosis, and whether expired NO concentration can be used to discriminate from cold syndrome which symptoms are similar to Japanese cedar pollinosis. SUBJECTS AND METHODS: In 20 healthy subjects, 20 patients with Japanese cedar pollinosis and 20 patients with cold syndrome, expired NO concentrations derived from nasal cavity and those derived from airway and lung were measured. Expired NO concentrations derived from nasal cavity and those derived from airway and lung were compared among the groups. RESULTS: In patients with Japanese cedar pollinosis expired NO concentrations derived from nasal cavity and those derived from airway and lung markedly increased. In patients with cold syndrome there were no significant increases in these concentrations. DISCUSSION: It is considered that expired NO concentration is useful for discriminating Japanese cedar pollinosis from cold syndrome. It seems interesting that not only expired NO concentrations derived from nasal cavity but also those derived from airway and lung were clevated. Generalized airway inflammation may be present, even without clinical asthma, in patients with Japanese cedar pollinosis.

Postoperative tetany in Graves disease: important role of vitamin D metabolites.

OBJECTIVE: To test the authors' hypothesis of the causal mechanism(s) of postoperative tetany in patients with Graves disease. SUMMARY BACKGROUND DATA: Previous studies by the authors suggested that postoperative tetany in patients with Graves disease occurs during the period of bone restoration and resulted from continuation of a calcium flux into bone concomitant with transient hypoparathyroidism induced by surgery. PATIENTS AND METHODS: A prospective study was carried out to investigate sequential changes in serum levels of intact parathyroid hormone (iPTH), calcium and other electrolytes, 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)2D), and bone metabolic markers in 109 consecutive patients with Graves disease who underwent subtotal thyroidectomy. RESULTS: Preoperative serum iPTH levels negatively correlated with ionized calcium levels and positively correlated with 1,25(OH)2D or 1,25(OH)2D/25OHD. After the operation, there was a significant decline in levels of ionized calcium, magnesium, and iPTH. Serum iPTH was not detected in 15 patients after surgery. Four of these 15 patients, and 1 patient whose iPTH level was below normal, developed tetany. Preoperative serum ionized calcium levels were significantly lower, and iPTH levels were higher, in the 5 patients with tetany than in the 11 patients who did not develop tetany despite undetectable iPTH levels. The tetany group had significantly lower serum 25OHD levels and higher 1,25(OH)2D levels, and had increased 1,25(OH)2D/25OHD as an index of the renal 25OHD-1-hydroxylase activity than those in the nontetany group. These results suggest that patients with a high serum level of iPTH as a result of low serum calcium levels (secondary hyperparathyroidism) are susceptible to tetany under conditions of hypoparathyroid function after surgery. CONCLUSIONS: Postoperative tetany occurs in patients with secondary hyperparathyroidism caused by a relative deficiency in calcium and vitamin D because of their increased demand for bone restoration after preoperative medical therapy concomitant with transient hypoparathyroidism after surgery. Calcium and vitamin D supplements may be recommended before and/or after surgery for patients in whom postoperative tetany is expected to develop.

Production of Artemisinin and Related Sesquiterpenes in Japanese Artemisia annua During a Vegetation Period.

Seeds of ARTEMISIA ANNUA L. originating from a wild population in Japan were cultivated in the garden planters of our Institute in 1995, and the seasonal and positional variations in content of artemisinin, artemisinic acid, arteannuin B and artemisitene, were measured. The content of artemisinic acid in leaves was high [max. 1.0% (dry wt basis)], as compared with other cultivars previously reported. This is the first report on a Japanese strain of ARTEMISIA ANNUA.

Postoperative tetany in patients with Graves' disease: a risk factor analysis.

OBJECTIVE: There is little information regarding the clinical risk factors for postoperative tetany in patients with Graves' disease. We analysed the risk factors responsible for postoperative tetany by univariate and multivariate analysis in thyroidectomized patients with Graves' disease, and we discuss the mechanisms of hypocalcaemia and tetany after surgery. PATIENTS: The subjects were 1742 consecutive patients with Graves' disease who underwent subtotal thyroidectomy between 1992 and 1994. RESULTS: Univariate analysis of 15 possible risk factors demonstrated that 10 were significant: sex, required operation time, blood loss, preoperative serum calcium level, estimated weight of thyroid remnant, size of goitre, amount of excised thyroid tissue, serum alkaline phosphatase concentration, age at operation and TSH-binding inhibitory immunoglobin (TBII). In multivariate analysis in female patients, the risk factors were: preoperative lower serum calcium level, younger age, higher serum alkaline phosphatase concentration, larger size of goitre and higher value of TBII, in order of decreasing probability of significance. CONCLUSION: These results, combined with previous observations in which a significant decline in serum parathyroid hormone level was found in patients with Graves' disease who suffered postoperative tetany, suggests that postoperative tetany may occur during the period of bone restoration due to antithyroid drug therapy and be due to continuation of a calcium flux bone concomitant with transient hypoparathyroidism induced by surgery. Calcium supplements during preoperative period and/or after surgery may be appropriate for patients who are anticipated to develop postoperative tetany based on these risk factors.

[Fluorometric determination of selenium in breast milk: studies on wet ashing].

A fluorometric method for the determination of selenium content in breast milk was studied. After the wet ashing of breast milk with nitric acid and perchloric acid at 160 degrees C for about 2.5-3 hours and the reduction with 6 mol/l hydrochloric acid, selenium was determined by 2,3-diamino-naphthalene fluorescence reaction. The method described here is very simple and all procedures were performed in a single-test-tube, and fifty samples could be assayed within 5 hours. With this method, analytical recoveries of 20 ng/ml and 50 ng/ml selenium added to breast milk were 95.3% (n = 10, cv = 5.96%) and 100.8% (n = 10, cv = 5.72%). Selenium contents of breast milk obtained from 37 Japanese women delivered healthy were 22.0-71.6 ng/ml, mean = 40.79 ng/ml (1 week postpartum) and 12.0-40.8 ng/ml, mean = 24.52 ng/ml (1 month postpartum).

Infection of proplast malar implants following dental injections.

Two cases of late infections of malar implants are reported following dental work. Inadvertent inoculation of the implants by mouth organisms during injections for local dental anesthesia is implicated as the causative factor. Patients should warn their dentists that a malar alloplast has been inserted. Alternative techniques of maxillary dental anesthesia should be entertained, and antibiotic prophylaxis should be considered.

Sliding genioplasty as a local anesthetic outpatient procedure: a prospective two-center trial.

A two-center (U.C.L.A. and Georgetown) prospective trial was planned to examine sliding genioplasty as an outpatient local anesthetic procedure. Thirty-nine patients, 14 male and 25 female, underwent the procedure. Average operating time was 43 minutes (range 15 to 70 minutes). Perioperative pain was remarkably mild, and patient satisfaction was extremely high, even among patients unhappy from previous chin implants. The overall complication rate was 20 percent, including two wound infections and one mental nerve injury. Both wound infections resolved uneventfully without detracting from the final result. Neither bleeding nor airway problems were encountered. An osseus genioplasty is a useful technique for correction of the hypoplastic chin. This technique may be performed as an outpatient procedure under local anesthesia with minimum pain and excellent patient acceptance. In light of the low risk and favorable results from this procedure, we recommend this technique as a practical alternative to alloplastic chin augmentation in selected patients.