Salivary but not plasma cortisone tracks the plasma cortisol response to exercise: effect of time of day.

INTRODUCTION: The cortisol, cortisone, corticosterone, and CBG responses to exercise in the AM and PM have not been described. This study examined the response of these glucocorticoids and CBG to intense exercise in 12 endurance-trained men in plasma (Pl) and saliva (Sa). METHODS: Each subject completed treadmill exercise in the morning and evening. Paired blood and Sa samples were obtained at rest before and after exercise. RESULTS: Significant time effect existed for Pl-cortisol and Sa-cortisol from baseline in the AM and PM (p < 0.01). Pl-cortisone and CBG significantly increased in the PM (p < 0.01). Pl-corticosterone increased in the AM and PM (p < 0.01). Unlike Pl-cortisone, Sa-cortisone was significantly higher in the AM compared to the PM, increasing in the AM and PM (All p < 0.01). Strong associations were found between Pl-cortisol and Sa-cortisol (r = 0.81, p < 0.0001), Pl-cortisol and Sa-cortisone (r = 0.81, p < 0.0001). CONCLUSIONS: (1) Intense EX induces a similar increase in Pl-cortisone (~90 %) and corticosterone (~200 %) in the AM and PM, whereas exercise increases CBG in the PM, but not in the AM; (2) vigorous exercise increases Sa-cortisone; (3) Sa-cortisone and cortisol are equally strongly correlated to Pl-cortisol, suggesting a significant role for Sa-cortisone as a novel marker of free cortisol during exercise.

Insuficiencia respiratoria aguda como manifestación inicial de esclerosis lateral amiotrófica / Acute respiratory failure as initial manifestation of amyotrophic lateral sclerosis

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Colitis linfocitaria inducida por carbamacepina / Lymphocytic colitis induced for carbamazepine

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Secreción inadecuada de hormona antidiurética secundaria a paroxetina / Inappropriate secretion of antidiuretic hormone secondary to paroxetine

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Obstrucción traumática bilateral de la arteria carótida interna / Traumatic bilateral internal carotid artery obstruction

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Colitis linfocitaria inducida por carbamacepina / Lymphocityc colitis induced for carbamazepine

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Paraparesia progresiva secundaria a fístula arterio venosa dural espinal / Progressive paraparesis secondary to spinal dural arteriovenous fistula

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[Intracranial venous thrombosis: a study of 16 cases and a review of the literature]. / Trombosis venosa intracraneal: estudio de 16 casos y revisión de la bibliografía.

INTRODUCTION: The clinical picture and aetiology of intracranial venous thrombosis are highly variable. Early descriptions reported it as a rare disease with a poor prognosis but the advent of neuroimaging techniques, and a deeper knowledge of the clinical picture, have shown it to have a higher frequency and a better prognosis. OBJECTIVE: To report the clinical and neuroimaging findings in patients diagnosed as having intracranial venous thrombosis in our department and review the state of the literature. PATIENTS AND METHODS: We reviewed all discharge reports from patients admitted to the neurology department of the Juan Canalejo Hospital between 1975 and 2000. Of these, we reviewed the medical records of those patients diagnosed as having intracranial venous thrombosis in order to obtain data relating to the clinical manifestations, complementary tests, etiological and topographical diagnosis, treatment and outcome. RESULTS: Diagnosis of intracranial venous thrombosis was made in 16 patients. The most common symptom was headache. The superior sagittal was the most frequently affected sinus. In almost all patients CT results led to the suspicion, and in some cases the confirmation, of the diagnosis. The most frequently found aetiology was oral contraceptive consumption. Outcome was generally good both with anticoagulation and symptomatic treatments. CONCLUSIONS: The most important difference between the present study and earlier reports is in the frequency of the different aetiologies. Our findings provide further evidence that intracranial venous thrombosis is not an infrequent disease and that the prognosis is generally good.

Chorea disclosing deterioration of polycythaemia vera.

Neurological manifestations occur frequently in polycythaemia. Chorea, however, is a rare complication of the disease. A case of chorea in a patient previously diagnosed with polycythaemia vera is reported. Choreic movements started after measurement of haematological variables showed deterioration. It was considered that this was caused by inappropriate treatment with iron because the chorea was markedly reduced after the two first venesections and normalisation of the packed cell volume and haemoglobin parameters.

Reduced cortisol potentiates the exercise-induced increase in corticotropin to a greater extent in trained compared with untrained men.

We examined the effect of acute exercise and reduced cortisol on pituitary and adrenal responsiveness and the impact of reduced plasma cortisol on maximal oxygen consumption (VO2max) in eight trained (T) and eight untrained (UT) males. Subjects completed two graded maximal exercise tests (GXT), each preceded by either overnight metyrapone (MET) or placebo (PLA) administration. Blood samples were collected before and after GXT. With PLA, resting corticotropin (ACTH) levels were higher in T versus UT men; however, cortisol and 11-deoxycortisol were similar between groups. Following GXT on PLA, cortisol was unchanged but 11-deoxycortisol increased in both groups; however, ACTH increased only in UT men. For both groups, cortisol, 11-deoxycortisol, and ACTH were different post-GXT with MET versus PLA. Furthermore, following GXT with MET, the ACTH response was greater in T versus UT subjects. VO2max was not altered by MET in either group. We conclude that (1) at rest, only ACTH levels differed between T and UT men; (2) individually, the GXT and MET provide a similar ACTH response in UT but not in T subjects; (3) when GXT and MET are superimposed, they provide a stronger stimulus to pituitary and adrenal reserve than either test alone; (4) the combination of MET and GXT elicits a greater ACTH response in T compared with UT men; and (5) an acute reduction in plasma cortisol does not alter VO2max.

Metabolic effects of low cortisol during exercise in humans.

This study examined the physiological effect of reduced plasma cortisol (C) during prolonged exercise in humans. The effects of normal C (NC) were compared with metyrapone-induced low C (LC) on plasma substrate availability and the respiratory exchange ratio during 2 h of exercise at approximately 60% peak O2 consumption in nine subjects. The C responses were compared with preexercise (Pre) levels and with a rest day (Con). At rest, C was attenuated by approximately 70% for LC compared with NC. At rest, plasma glucose, lactate, glycerol, beta-hydroxybutyrate, alanine, branched-chain amino acids, insulin, glucagon, growth hormone, epinephrine, and norepinephrine were similar under LC and NC (P > 0.05). During exercise under NC, plasma C increased compared with Pre, whereas it remained unchanged during LC. During NC, plasma C was elevated at 90 min (compared with Con) and at 120 min (compared with Con and Pre). During exercise, plasma glucose decreased to the same extent and lactate was similar under both conditions, whereas plasma glycerol, beta-hydroxybutyrate, alanine, and branched-chain amino acids were higher (P < 0.01) under NC. Plasma insulin declined (P = 0.01) to a greater extent under LC, whereas growth hormone, epinephrine, and norepinephrine tended to be higher (0.05

Blood lactate and perceived exertion relative to ventilatory threshold: boys versus men.

The purpose of this study was to examine blood lactate (BLa) levels and ratings of perceived exertion (RPE) in nine boys (10.5 +/- 0.7 yr) and nine men (25.3 +/- 2.0 yr) during exercise relative to ventilatory threshold (VT). VT and VO2max were determined during a graded exercise test on a cycle ergometer. On three additional days each subject exercised for 10 min at either 80, 100, or 120% of the VO2 at VT. Capillary BLa levels and RPE were assessed at minutes 5 and 10 of each trial. VO2max averaged 47.7 +/- 5.4 and 50.2 +/- 6.2 mL x g(-1) x min(-1) in the boys and men, respectively (P > 0.05). VT expressed as %VO2max was 67.2 +/- 3.5% in the boys and 67.3 +/- 4.9% in the men (P > 0.05). BLa levels ranged from 2.0 +/- 0.7 to 4.7 +/- 0.9 mmol x L(-1) in the boys and from 2.6 +/- 0.5 to 8.2 +/- 2.1 mmol x L(-1) in the men across the three intensities. Corresponding RPE values ranged from 11.2 +/- 1.8 to 16.2 +/- 2.2 in the boys and from 10.2 +/- 1.2 to 15.8 +/- 1.7 in the men. A group x time x intensity interaction (P < 0.05) indicated that BLa in the men increased more so across time and intensity. There were no significant group difference or interactions involving RPE during exercise. Setting exercise intensity relative to VT did not abolish child-adult differences with respect to submaximal BLa levels. Despite maintaining lower BLa levels, RPE values were similar between boys and men.