Accuracy of combinations of visual inspection using acetic acid or lugol iodine to detect cervical precancer: a meta-analysis.

BACKGROUND: Visual inspection of the cervix with acetic acid (VIA) or with Lugol's iodine (VILI) have been evaluated for cervical cancer screening in developing countries. OBJECTIVES: To assess the diagnostic accuracy and clinical utility of visual methods to detect cervical intraepithelial neoplasia grade 2+ (CIN2+) using: (1) VIA alone; (2) VILI alone; (3) co-testing; and (4) VILI as a triage test of a positive VIA result. SEARCH STRATEGY: PubMed, EMBASE, and the Cochrane Library were searched up to May 2016. SELECTION CRITERIA: All reports on the accuracy of VIA and VILI, or combinations of VIA/VILI, to detect CIN2+ were identified. Histology and colposcopy when no biopsy was taken were used as the reference standard. DATA COLLECTION AND ANALYSIS: Selected studies were scored on methodological quality, and sensitivity and specificity were computed. Clinical utility was assessed from the positive predictive value (PPV) and the complement of the negative predictive value (cNPV). MAIN RESULTS: We included 23 studies comprising 101 273 women. The pooled sensitivity and specificity of VILI was 88 and 86%, respectively. VILI was more sensitive, but not less specific, compared with VIA (relative sensitivity = 1.11; 95% confidence interval, 95% CI, 1.06-1.16; relative specificity = 0.98; 95% CI 0.95-1.01). Co-testing was hardly more sensitive, but significantly less specific, than VILI alone. VILI to triage VIA-POSITIVE women was not less sensitive, but more specific, compared with VIA alone (relative sensitivity = 0.98, 95% CI 0.96-1.01; relative specificity = 1.04, 95% CI 1.02-1.05). The average PPVs were low (range 11-16%), whereas the cNPV varied between 0.3% (VILI, co-testing) and 0.6% (triage). CONCLUSIONS: Although imperfect, VILI alone appeared to be the most useful visual screening strategy. TWEETABLE ABSTRACT: VILI alone seems to be the most useful visual screening test for cervical cancer screening.

A double-blind study on a patient with tardive dyskinesia treated with pallidal deep brain stimulation.

BACKGROUND: Tardive dyskinesia (TD) is a neurological disorder typically induced by long-term exposure to neuroleptics. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) may represent a therapeutic alternative for TD, which is often resistant to conservative treatment. AIMS OF THE STUDY: This report's objective is to present a case of TD successfully treated with DBS, as well as to indicate a putative role of brain perfusion scintigraphy as a helpful tool correlating functional imaging findings with clinical responsiveness to DBS. METHODS/RESULTS: A 42-year-old male patient suffering from refractory TD underwent bilateral GPi DBS surgery. Post-operative Burke-Fahn-Mardsen Dystonia Rating Scale (BFMDRS) and Abnormal Involuntary Movement Scale (AIMS) total scores have been reduced by 90.7% and 76.7% respectively on the 6-month follow-up assessment. Brain perfusion scintigraphy, performed post-operatively in the two stimulation states, revealed a decrease in cerebral blood flow, during the 'on-DBS', compared with the 'off-DBS' state. CONCLUSIONS: Clinical improvement of this patient, correspondent to previous studies, suggests that continuous bilateral GPi DBS may provide a promising treatment option for TD. Furthermore, this report could imply, as no previous such comparison study exists, a possible correlation between brain functional imaging findings and the movement disorder's response to DBS.

Evaluation of nasal mucociliary clearance after medical or surgical treatment of chronic rhinosinusitis.

An evaluation of mucociliary clearance, with the use of rhinoscintigraphy and other objectives and subjectives measures, in medically and surgically treated patients with chronic rhinosinusitis, as well in patients with or without nasal polyposis, can add to the understanding of ciliary function and its role in the pathogenesis of chronic rhinosinusitis. Thirty-four patients medically treated and 21 surgically treated (FESS) patients evaluated with rhinoscintigraphy, CT-scans, and SNOT-20. Nine of the surgically treated patients had nasal polyps and studied as a separate group. Although the various groups differ on Lund-Mackay scores (H = 11.659, P = 0.003) and SNOT-20 results (F = 26.904, P < 0.001), a statistically significant difference between mucociliary transport velocity (MTV) values could not be found. Moreover, multiple linear regression could not prove a statistically significant correlation between MTV and other variables. The various groups of chronic rhinosinusitis patients cannot be differentiated on the basis of possible nasal mucociliary clearance alternations.

Mid-trimester maternal serum hCG levels in predicting adverse pregnancy outcome.

OBJECTIVE: In this prospective study, we investigated the association between mid-trimester maternal serum human chorionic gonadotropin (ms-hCG) levels and adverse pregnancy outcome in a South-Western Greek population. MATERIALS AND METHODS: 130 healthy Greek women with spontaneous pregnancies were investigated for ms-hCG levels between the 13th and 24th weeks of gestation and followed for adverse pregnancy outcome, hCG levels > 2.0 multiples of the median value for gestation were considered abnormal. Statistical analysis was performed by Pearson's chi-square test. RESULTS: Gestational complications developed in a total of 12 of the 130 women studied (9.23%). Elevated ms-hCG levels were detected in a total of 14 of the 130 women studied (10.77%). CONCLUSION: Multiparameter testing of placental function in the mid-trimester (uterine artery Doppler, placental morphology and ms-hCG screening) may allow us to identify women with increased risk of developing severe placental insufficiency and pregnancy complications.

Mid-trimester maternal serum markers in predicting adverse pregnancy outcome.

OBJECTIVE: In a prospective study, we investigated the association between mid-trimester maternal serum AFP (ms-AFP), maternal serum hCG (ms-hCG) levels and adverse pregnancy outcome in a South-Western Greek population. MATERIALS AND METHODS: 126 healthy Greek women with spontaneous pregnancies were investigated for ms-AFP and ms-hCG levels between the 13th and 24th weeks of gestation and followed for adverse pregnancy outcome. Abnormal outcomes were considered as ms-AFP levels or ms-hCG levels > 2.0 multiples of the median value for gestation (MoM). Statistical analysis was performed by Pearson's chi-square test. RESULTS: Elevated ms-AFP levels were detected in a total of 25 out of the 126 women studied (19.84%). Elevated ms-hCG levels were detected in a total of ten of the 126 women studied (7.93%). Elevated ms-AFP and ms-hCG levels were detected in a total of four of the 126 women studied (3.17%). CONCLUSION: Multiparameter testing of placental function in the mid-trimester (uterine artery Doppler, placental morphology, ms-AFP and ms-hCG screening) may allow us to identify women with increased risk of developing severe placental insufficiency and pregnancy complications.

Mid-trimester maternal serum AFP levels in predicting adverse pregnancy outcome.

OBJECTIVE: In this prospective study, we investigated the association between mid-trimester maternal serum alpha-fetoprotein AFP (MSAFP) levels and adverse pregnancy outcome in a South-Western Greek population. MATERIALS AND METHODS: 110 healthy Greek women with spontaneous pregnancies, investigated for MSAFP levels between the 13th and 24th week of gestation and followed for adverse pregnancy outcome. AFP levels > 2.0 multiples of the median value for gestation were considered abnormal. Statistical analysis was performed by Pearson's chi-square test. RESULTS: Elevated MSAFP levels were detected in a total of 27 of the 110 women studied (24.5%). Among them, only four women (14.8%) developed pregnancy complications. CONCLUSION: Multiparameter testing of placental function in the mid-trimester (uterine artery Doppler, placental morphology and MSAFP screening) may allow us to identify women with increased risk of developing severe placental insufficiency and pregnancy complications.

Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronic obstructive pulmonary disease.

PURPOSE: An association between activation of the renin-angiotensin system and enhanced erythropoiesis has been observed in patients with several diseases, including congestive heart failure and hypertension. Our goal was to examine whether the renin-angiotensin system is associated with secondary erythrocytosis in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Plasma renin activity, plasma aldosterone concentration, serum erythropoietin level, and serum angiotensin converting enzyme (ACE) activity were measured in 12 patients with COPD and secondary erythrocytosis [mean (+/-SD) hematocrit of 53% +/- 3%] and in 12 matched controls with COPD who did not have erythrocytosis (hematocrit 45% +/- 5%). All patients had chronic hypoxemia (PaO2 <60 mm Hg). RESULTS: Both plasma renin and aldosterone levels were threefold greater in patients with secondary erythrocytosis compared to controls. No difference in erythropoietin levels was observed between patients with or without secondary erythrocytosis. Renin levels (r = 0.45; P = 0.02) but not erythropoietin levels (r = 0.15; P = 0.47) were correlated with hematocrit in the entire sample. Renin levels and PaO2 were the only variables independently and significantly associated with hematocrit values in a multiple linear regression model. CONCLUSION: Activation of the renin-angiotensin system is associated with the development of secondary erythrocytosis in chronically hypoxemic patients with COPD. The exact mechanism is not yet fully understood, but angiotensin II may be responsible for inappropriately sustained erythropoietin secretion or direct stimulation of erythroid progenitors.

Technetium-99m-tetrofosmin for parathyroid scintigraphy: comparison to thallium-technetium scanning.

UNLABELLED: The efficacy of 99mTc-tetrofosmin for the detection of parathyroid lesions was investigated prospectively in patients with hyperparathyroidism referred for surgical treatment. METHODS: Twenty-seven patients with primary and 18 with tertiary hyperparathyroidism were studied. Twelve patients had undergone one or more previous neck explorations. Static imaging with 201Tl was performed first, immediately followed by a 30-min 99mTc-tetrofosmin dynamic study. Delayed views of up to 3 hr postinjection were also obtained. Technetium-99m-pertechnetate was used for thyroid delineation. The tetrofosmin/99mTc-pertechnetate subtraction scan (TF/TC), the single-tracer washout technique and the thallium/technetium subtraction (TL/TC) were compared. Quantification of relative uptakes of tracers in the thyroid and abnormal parathyroids was accomplished by measuring activity within regions of interest. Kinetics of tetrofosmin in the thyroid and abnormal parathyroids were studied by evaluating the plots of the parathyroid to thyroid ratios against time as well as by calculation of the half-clearance times from the slow component of the time-activity curves. RESULTS: The overall sensitivity, specificity and accuracy of TF/TC and TL/TC were 76%, 92% and 83% and 52%, 85% and 65%, respectively. The respective sensitivities were 87% and 70% for adenomas and 72% and 46% for hyperplasia. The parathyroid-to-thyroid activity ratios of tetrofosmin were significantly higher than those of thallium (p < 0.001). The tetrofosmin single-tracer washout study was less accurate than the subtraction technique (overall sensitivity and specificity, 70% and 69%, respectively). The washout properties of tetrofosmin in abnormal parathyroids were not substantially different from those in the thyroid, with a few exceptions (p = 0.4). No correlation of half-clearance times with parathyroid size, degree of early uptake, parathyroid hormone levels or histology could be established. Comparing adenomas to hyperplasia in respect to tetrofosmin retention, a statistically significant difference was observed (p = 0.005). CONCLUSION: Technetium-99m-tetrofosmin is suitable for parathyroid imaging. The kinetic properties of this agent in parathyroid and thyroid tissues do not warrant differential washout protocols. The diagnostic impact of the observed difference in tetrofosmin kinetics between parathyroid adenomas and hyperplasia requires further investigation.

Endometrial cytohistology by the pistol-aspiration technique: clinical applicability.

The purpose of this study was to assess the value of the endometrial pistol-aspiration technique as an office procedure for diagnosing corpus uteri cancer in symptomatic and asymptomatic women. Review of 3000 pistol aspirations in symptomatic outpatient women from 1974-1981 confirms that this method, with its high specificity and sensitivity, can be used for such women as a preliminary diagnostic procedure, eliminating risks from anesthesia and curettage as well as the cost of hospitalization. Analysis of resident incident cases shows that 82% were localized to the uterus, and more than 85% of these women were already symptomatic. Older women represent particularly difficult problems, both technical (cervical stenosis) and in recruitment. Because the natural history of the precursor lesions of corpus uteri cancer are not yet well established, use of this method for systematic population screening of asymptomatic women is questionable.

Endometrial cytohistology by aspiration technic and by Gravlee Jet Washer: a comparative study.

An office procedure of intrauterine aspiration yielded a 99% diagnostic accuracy in 100 patients admitted for either curettage or hysterectomy. After correlation with surgical diagnosis, no false-positive or false-negative results were found. The method provides tissue for cell blocks adequate for histologic diagnosis of endometrial adenocarcinoma and its precursors. The major advantage of this technic in comparison with the Gravlee Jet Washer is its low cost. Moreover, in this study, it proved to be less painful, superior for cell block preparation, and yielded more satisfactory specimens. As a screening procedure for asymptomatic patients at risk, this intrauterine aspiration technic holds promise and must be evaluated by further studies.

Renin-angiotensin system stimulates erythropoietin secretion in chronic hemodialysis patients.

A series of observations suggests an interrelationship between the renin-angiotensin system (RAS) and erythropoietin (EPO) secretion. To further evaluate the role of RAS in erythropoiesis of chronic hemodialysis patients, we studied two groups of such patients: Group A consisted of 16 patients (14 male and 2 female, 54.7 +/- 3.3 years old), who maintained a target hematocrit value of 0.30 (0.32 +/- 0.01), without recombinant human EPO (rhEPO) supplementation. Group B consisted of 14 patients (7 male and 7 female, 50 +/- 5.3 years old), who required subcutaneous injections of rhEPO (90.8 +/- 10 IU.kg-1.week-1), to maintain the same target hematocrit value of 0.30 (30 +/- 0.01). Plasma renin activity (PRA) was found to be the major feature to distinguish patients in these two Groups and it was five times higher in Group A (10 +/- 2 ng.ml-1.h-1) compared to Group B patients (1.8 +/- 0.6 ng.ml-1.h-1) (p < 0.001). Moreover, activation of RAS in Group A patients by volume depletion (2.2 +/- 0.2 l) during hemodialysis resulted in a 118 +/- 33 percent increment of PRA (p < 0.01) which was accompanied by a 69 +/- 25 percent increment of serum EPO levels (p < 0.05). Repetition of the same protocol after inhibiting the converting enzyme with 50 mg of Captopril prior to dialysis session, resulted in a 315 +/- 64 percent increment of PRA (p < 0.001), while at the same time completely blocked the expected rise in serum EPO levels (1.25 +/- 12.5 percent increment).(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary results of the use of Re-186-HEDP for palliation of pain in patients with metastatic bone disease.

We evaluated the effectiveness of Re-186-HEDP in 25 patients with painful metastatic bone disease. Twenty-five patients with known prostatic (n = 19), non-small-cell lung cancer (n = 1) and breast cancer (n = 5) and multiple confirmed skeletal metastases were studied. All were taking analgesics daily (nonsteroidal antiinflammatory drugs/opiates). Re-186-HEDP (mean 35.2 mCi) was administered and patients were monitored for at least 50 days. In five patients, a repeat dose was administered 9 to 10 weeks later. The evaluation of the analgesic effect was based on a "pain diary" and by recording the use of analgesics. In 80% (20 of 25) of the patients, the effect was significant palliation, moderate in 3 patients (12%), and insignificant in 2 (8%). No significant myelotoxicity was observed. Transient pain flare was recorded in 8 of 25 patients. These results indicate that Re-186-HEDP can offer pain palliation in patients with painful bone metastases without being complicated by significant myelotoxicity.

The application of immunocytochemical techniques to routinely-fixed and stained cytologic specimens. An aid in the differential diagnosis of undifferentiated malignant neoplasms.

Routinely-fixed and Papanicolaou stained smears with the cytologic diagnosis of undifferentiated malignant neoplasm that had been prepared with cells obtained by fine needle aspiration biopsy (n = 7), pulmonary lavage (n = 5), or thoracentesis (n = 3) from 15 unselected patients were stained by an immunocytochemical technique to evaluate the presence of keratin proteins and the leukocyte common antigen (LCA). Commercially available, well-characterized monoclonal antibodies with specificities for keratin proteins and the leukocyte common antigen, and a streptavidin-biotin-horseradish peroxidase labelling method were used. Evaluation of the stained smears revealed the presence of one of the two antigens in material obtained from each patient, thus indicating the probable cell-lineage of the neoplastic cells. The specificity of the monoclonal antibody reagents used was further evaluated in routinely-fixed and stained cytologic material from 24 histologically confirmed carcinomas and 12 lymphomas. In conclusion, immunocytochemical techniques may be successfully applied to routinely processed archival cytologic smears to determine the antigenic profile of morphologically undifferentiated cells and therefore aid in the differential diagnosis of undifferentiated malignant neoplasms.

Herpetic endometritis after pregnancy.

A case of endometrial herpex simplex virus infection with severe uterine post-partum bleeding is reported. Histopathologic analysis of curettage samples revealed endometrial necrosis and diffuse herpes-type nuclear inclusions in the glandular epithelial cells. Immunohistochemistry, in situ hybridisation, and electron microscopy confirmed the diagnosis.

In vivo determination of radiation dose in kidneys and bladder during renogram: a new approach.

The radiation dose absorbed by a patient from a radiopharmaceutical is usually calculated with the help of the equations published by the Society's Medical Internal Radiation Dose (MIRD) Committee and the use of a Reference Man. However, the (MIRD) estimations are based on the assumption that the patient is a normal subject with the characteristics of the Reference Man. This is not always true particularly in some pathological situations which present large deviations from normal. The purpose of this paper is to determine the dose in kidneys and bladder, during renograms, on the basis of real data. A protocol is formulated by means of which the processing of the frames acquired in the various stages of the renogram enables the determination of the kidney and bladder mass as well as the time distribution of radioactivity in these organs. Our results are in accordance with MIRD estimations for normal cases, whereas very significant deviations are observed in pathological ones. This is due to the fact that the mass of the 'source' and 'target' organs as well as the biodistribution of the radiopharmaceuticals are essential in the dose determination and large deviations are expected between estimated and real doses when in some pathological cases the mass of kidney is particularly reduced or its clearance retarded.

In vivo estimation of radiation dose in renal pelvis and parenchyma during renography.

A method is presented for the determination of the spatio-temporal distribution of the radionuclide in the kidney and estimation of the dose in the renal pelvis wall and parenchyma, during renograms, on the basis of real data. A protocol was formulated by means of which the processing of the frames acquired in the various stages of the renogram enables the determination of the mass of the renal pelvis and the parenchyma as well as the time distribution of radioactivity in these compartments. The proposed methodology was applied to 30 normal subjects and 35 patients with obstructive nephropathy, acute and chronic obstructive uropathy and hydronephrosis. Our results, when compared with the MIRD dose estimations for the entire kidney showed slight deviations in normals, whereas very significant deviations were observed in the cases with pathology. This is due to the fact that the mass of the 'source' and 'target' organs as well as the biodistribution of the radiopharmaceuticals are essential in dose determination and were completely different in our calculations from those used in the MIRD estimations. Comparing the absorbed dose in renal parenchyma and pelvis wall with that estimated in vivo for the kidney considered as a system of one compartment, we found large differences only in abnormal cases. Differences were also noted between the absorbed dose in the aforementioned renal compartments depending on the considered abnormal renal states.

Localization of alpha 2, alpha 5 and alpha 6 integrin subunits in human endometrium, decidua and trophoblast.

Integrins are heterodimeric glycoproteins acting as membrane receptors for extracellular matrix components. The specificity of these receptors towards one particular matrix glycoprotein depends on the type of alpha and beta subunit combination. Since integrins are involved in the migratory behaviour of cells and since cytotrophoblastic cells are constitutively invasive, we undertook to immunolocalize the alpha 2, alpha 5 and alpha 6 integrin subunits in normal and hydatidiform molar trophoblast, in an implantation site as well as in decidualized and non-decidualized endometrium. alpha 6 positivity was confined to villous cytotrophoblast and was clearly polarized towards the basement membrane. Extravillous cytotrophoblastic cells were alpha 6-negative but became alpha 5-positive. In contrast to normal trophoblast, villous cytotrophoblast from hydatidiform molar tissue was alpha 5-positive. We conclude that the expression of a alpha 5 integrin subunit on cytotrophoblastic cell surfaces is correlated with the appearance of an invasive phenotype. alpha 6 and alpha 2 integrin subunits were both localized on the surface and glandular epithelium of the endometrium and their expression was increased during the secretory phase but became low or undetectable after decidualization. In contrast, alpha 5 subunit positivity was weak in the same epithelial during the first half of the cycle but disappeared after ovulation. Stromal cell alpha 5 positivity was present throughout the cycle but increased dramatically in decidualized endometria. We conclude that the alpha 5 integrin subunit which disappears from the epithelium at the end of the cycle might allow migration of the epithelial cells and repair of the endometrium after menses. We also wonder if alpha 5 positivity is part of a change in the stromal cell phenotype induced by decidualization.

Evaluation of contrast echocardiography and lung perfusion scan in detecting intrapulmonary vascular dilatation in normoxemic patients with early liver cirrhosis.

BACKGROUND/AIMS: Intrapulmonary vascular dilatations (IPVD) are extrahepatic complications occurring in liver transplant candidates, that can result in severe hypoxemia. The aim of this study was to compare the use of two diagnostic modalities, contrast echocardiography and lung perfusion scan, in detecting IPVD in normoxemic patients with early liver cirrhosis. METHODOLOGY: Fifty-six consecutive outpatients with biopsy-proven cirrhosis had contrast-echocardiography, a lung perfusion scan, pulmonary function tests, and arterial blood gas estimations. All patients were grade A or B according to the Child-Pugh classification. Patients with chronic intrinsic lung disease, heart failure or malignancy were excluded from the study. RESULTS: All patients had normal arterial blood-gas analyses. Eight out of 56 patients (14.3%) had a positive contrast echocardiogram, all with a decreased diffusion capacity (DLCO < 75% of the predicted value). An isolated DLCO impairment was observed in 40% of the patients with normal spirometry. None of the patients with echocardiography-proven IPVD had a positive lung perfusion scan (p<0.005). CONCLUSIONS: In normoxemic cirrhotic patients, subclinical pulmonary vasodilatation and gas-exchange abnormalities can occur. Contrast-enhanced echocardiography is the most valuable screening test in detecting IPVD in the early stages of hepatic insufficiency.

Human papillomavirus (HPV) DNA assay as an adjunct to liquid-based Pap test in the diagnostic triage of women with an abnormal Pap smear.

OBJECTIVE: The diagnostic performance and clinical value of the combined use of liquid-based Pap test and human papillomavirus testing were determined in 336 patients with a previous abnormal smear. METHOD: Subsequent histologic evaluation was used as definitive diagnosis. RESULT: The combined use of liquid-based Pap test and HPV DNA testing showed higher rates in sensitivity (99.0%), specificity (59.3%), positive predictive value (89.9%) and negative predictive value (94.5%) than either cytology alone (sensitivity 98.8%, specificity 45.7%, positive predictive value 84.7%, negative predictive value 92.6%) or HPV DNA testing alone (sensitivity 84.9%, specificity 67.4%, positive predictive value 88.8%, negative predictive value 59.5%). CONCLUSION: The study demonstrated that the diagnostic accuracy for cervical cancer and its precursors was improved by using the liquid-based Pap test as a primary diagnostic procedure and HPV assay as an adjunctive test. This information may assist the clinicians in triaging patients with equivocal cytologic cervical atypias.

Euthyroid sick syndrome in acute ischemic syndromes.

The purposes of this study were to assess the occurrence of euthyroid sick syndrome in patients with acute myocardial infarction (AMI) or unstable angina (UA), and the relationship with beta-blocker or thrombolytic therapy. Plasma triiodothyronine (T3), reverse T3 (rT3), free T3 (FT3), thyroxine (T4), free T4 (FT4), thyroid-stimulating hormone (TSH), thyroxine-binding globulin (TBG), and albumin (ALB) levels were determined in 95 patients (59 males, 36 females, aged 58.4+/-9) with AMI and 19 patients (13 males, 6 females aged 54.7+/-12.3) with UA for 5 consecutive days from the onset of the acute syndrome and 1 month later. Patients were divided according to beta-blocker therapy and thrombolytic therapy. There was a significant T3 decrease and rT3 increase in all patients during the first 5 days following admission (p < 0.05). FT3 and FT4 remained unchanged during the study. In patients with complicated infarctions, the rT3 increase and the T3 decrease were significantly greater compared to those with uncomplicated infarctions (p<0.03). TSH, T4, TBG, and ALB were significantly (p<0.05) decreased only in complicated infarctions. No differences were observed between patients with or without thrombolysis or patients with or without beta-blocker treatment. The apparent decrease in T3, the increase in rT3 levels and the decreased TSH and T4 levels, show clearly that the euthyroid sick syndrome (low T3) occurs not only in AMI but also in UA. In addition, these hormonal changes are not affected by beta-blocker therapy and thrombolysis does not influence the occurrence of the syndrome. The degree of T3 decrease is proportional to the severity of cardiac damage and may have a possible prognostic value.