Brittle diabetes: psychopathological aspects.

BACKGROUND: The term "brittle" is used to described an uncommon subgroup of type I diabetics whose lives are disrupted by severe glycaemic instability with repeated and prolonged hospitalization. Psychosocial problems are the major perceived underlying causes of brittle behaviour. Aim of this study is a systematic psychopathological assessment of brittleness using specific parameters of general psychopathology and personality traits following the multiaxial format (axis I and II) of the current DSM-IV-TR diagnostic criteria for mental disorders. METHODS: Patients comprised 21 brittle type I diabetics and a case-control group of 21 stable diabetics, matched for age, gender, years of education, and diabetes duration. General psychopathology and the DSM-IV-TR personality traits/disorders were assessed using the Syptom Checklist-90-R (SCL-90-R) and the Millon Clinical Multiaxial Inventory-III (MCMI-III). RESULTS: The comparison for SCL-90-R parameters exclusively revealed higher scores in "Phobic Anxiety" subscale in brittle diabetics. No differences in all the other SCL-90-R primary symptom dimensions and in the three SCL-90-R global distress indices were observed between the two diabetic groups, as well as in the all MCMI-III clinical syndrome categories corresponding to DSM-IV-TR specific psychiatric disorders. However, brittle patients presented lower scores in MCMI-III compulsive personality traits and higher scores in paranoid, schizoid, schizotypal, antisocial, borderline, narcissistic, avoidant, dependent, depressive, and passive-aggressive personality traits. CONCLUSIONS: In this study, brittle diabetics show no differencies in terms of global severity of psychopathological distress and axis I specific DSM-IV-TR diagnoses in comparison with non-brittle subjects (except for phobic anxiety). Differently, brittle diabetics are characterized from less functional and maladaptive personality features and suffer more frequently and intensively from specific pathological personality traits of all DSM-IV-TR clusters.

Brain abscess of odontogenic origin in a man with interatrial defect.

A 65-year-old man with previous surgery for cyanotic congenital heart disease was admitted to our hospital with fever, headache and visual disturbances due to a right occipital brain abscess as shown through CT-scan. A comprehensive workup looking for a source of infection was negative except for an orthopantomogram showing multiple dental caries. A transesophageal echocardiogram (TEE) bubble study revealed the permanence of an atrial septal defect with a moderate right-to-left shunt. The culture of the abscess content showed flora commonly found in the oropharynx that responded to antimicrobial therapy. We hypothesize that the underlying mechanism is a significant bacterial load from dental infections that enters the arterial circulation through the interatrial defect. If a brain abscess is identified without any adjacent source of infection, then a transesophageal echocardiogram is indicated to exclude right to left shunt. If a shunt is found, then hematogenous spread of flora normally found in the oropharynx should be suspected. Surgical evacuation followed by antimicrobial therapy is warranted. Once the infection is eliminated, long term anticoagulation or anatomic closure of the interatrial defect with good oral hygiene could be valid strategies for preventing recurrence.

Effect of estrogen therapy for 1 year on thyroid volume and thyroid nodules in postmenopausal women.

OBJECTIVE: Estrogen receptors are present in thyroid follicular cells in normal and neoplastic tissue. We evaluated changes in total thyroid volume and volume of thyroid nodules in postmenopausal women given either hormone therapy (HT) or no treatment in a 1-year observational follow-up. DESIGN: We studied 33 women receiving HT and 76 women receiving no treatment, comparing total thyroid volume, thyroid nodule volume, and serum concentrations of thyroid-stimulating hormone and estradiol at baseline and 1 year of follow-up. RESULTS: Serum thyroid-stimulating hormone concentrations were not different between groups either at baseline or at 1 year. Estradiol rose significantly in the HT group. The final percent changes in total thyroid volume were comparable between groups (HT, 1.59 +/- 2.56%; no treatment, 1.20 +/- 2.28%). At baseline, nodules were detected in 17 (51.5%) and 33 (43.4%) of women in the HT and no treatment groups, respectively, with no statistically significant difference between groups. The final number of nodules was unchanged or reduced in 88.2% and 81.1% and increased in 11.8% and 18.9% of women in the HT and no treatment groups, respectively, with no differences between groups. Baseline volumes of thyroid nodules were 0.8 +/- 0.4 and 1.4 +/- 0.4 mL in women in the HT and no treatment groups, respectively (P = 0.4). After 1 year the volume of thyroid nodules was unchanged or reduced in 47.1% and 52.8% and increased in 52.9% and 47.2% of women in the HT and no treatment groups, respectively, with no differences between groups. CONCLUSIONS: Estrogen administration for 1 year did not affect thyroid volume or the number and volume of thyroid nodules in postmenopausal women.

Estrogen receptor (ER)-beta, but not ER-alpha, is present in thyroid vessels: immunohistochemical evaluations in multinodular goiter and papillary thyroid carcinoma.

OBJECTIVE: Estrogen receptors (ERs) have been demostrated in the vessel structures of several systems. Little is known on the presence of ERs in the thyroid vessels. DESIGN: We immunohistochemically evaluated both ER-alpha and ER-beta immunoreactivity (IR) in both vascular and follicular thyroid cells in tissue samples from 17 cases of multinodular goiter (MNG) and 17 cases of papillary thyroid carcinoma (PTC). MAIN OUTCOME: ER-alpha IR was undetectable in either tissue examined. In 100% of MNG samples, nuclear ER-beta IR was detected in both endothelial and follicular cells. In PTC samples, endothelial nuclear ER-beta IR was found in 100% of cases, whereas the nuclear staining of follicular cells was found in 83% of cases. The intensity of staining of the endothelial ER-beta IR was comparable between MNG and PTC. However, when follicular cells were considered, a tendency toward a decrease in nuclear staining and a significant increase in cytoplasmic staining were found in PTC lesions as compared to MNG. CONCLUSIONS: This study demonstrated that ER-beta, but not ER-alpha, IR is present in the endothelium of thyroid vessels. Furthermore, although data need to be confirmed in larger observations, these results suggest the lack of differences in the pattern of vascular ER-beta IR between MNG and PTC.

Adrenocorticotropin/cortisol and arginine-vasopressin secretory patterns in response to ghrelin in normal men.

This study was performed in order to establish the secretory patterns and the possible relationships between the adrenocorticotropin (ACTH)/cortisol and arginine vasopressin (AVP) responses in normal men to the systemic administration of ghrelin, an endogenous ligand for the growth hormone secretagogue receptor. For this purpose, a bolus of 1 microg/kg ghrelin was injected intravenously in 9 normal men. AVP, ACTH and cortisol significantly rose in response to ghrelin injection; however, in all subjects the AVP rise preceded the ACTH/cortisol responses. In fact, the mean peak levels of AVP, ACTH and cortisol after ghrelin injection were observed at 15, 30 and 45 min, respectively. When peak AVP responses to ghrelin were considered together with ACTH and cortisol peak levels, highly significant positive correlations were observed (AVP and ACTH, r = 0.94, p < 0.001; AVP and cortisol, r = 0.92, p < 0.001). In conclusion, this study shows that the AVP response to ghrelin precedes the concomitant ACTH/cortisol rise and that these hormonal responses are highly positively correlated. These observations support the hypothesis that AVP mediates ghrelin-induced ACTH secretion in normal men.