Sheehan's syndrome followed by successful pregnancy: A case report

Sheehan's syndrome is a complication of pregnancy rarely encountered in modern obstetric practice. The management of this condition involves substitution therapy of the hormones produced by the various endocrine glands under hypothalamic and pituitary control. There have been few reports on the occurrence of spontaneous pregnancy in patients with Sheehan's syndrome. This paper describes the investigation and management of a patient with long-standing panhypopituitarism. Hormone replacement therapy, and specifically induction of ovulation with human menopausal gonadatrophins, resulted in a successful outcome of pregnancy.

Tests of the linearity assumption in the dose-effect relationship for radiation-induced cancer

The validity of the BEIR linear extrapolation to low doses of the dose-effect relationship for radiation induced cancer is tested by use of natural radiation making use of selectivity on type of cancer, smoking habits, sex, age group, geographic area and/or time period. For lung cancer, a linear interpolation between zero dose-zero effect and the data from radon-induced cancers in miners implies that the majority of all lung cancers among non-smokers are due to radon; since lung cancers in miners are mostly small-cell undifferentiated (SCU), a rather rare type in general, linearity over predicts the frequency of SCU lung cancers among non smokers by a factor of 10, and among non-smoking females age 25-44 by a factor of 24. Similarly, linearity predicts that the majority of all lung cancers early in this century were due to radon even after due consideration is given to cases missed by poor diagnostic efficiency (this matter is considered in some detail). For the 30-40 age range, linearity over predicts the total lung cancer rate at that time by a factor of 3-6; for SCU lung cancer, the over-prediction is by at least a factor of 10. Other causes of lung cancer are considered which further enhance the degree to which the linearity assumption over-estimates the effects of low level radiation. A similar analysis is applied to leukemia induced by natural radiation. It is concluded that the upper limit for this is not higher than estimates from the linearity hypothesis. The use of the selectivities is justified by the fact that the total incidence of lung cancer or leukemia is an upper limit on the rate at which it is caused by natural radiation effects; in determining upper limits it is justifiable to select situations which minimize them.

Society's valuation of life saving in radiation protection and other contexts

Various situations are described in which societal action may be interpreted as a dollar value placed on averting a human fatality, and numerical values are derived in each case. Situations included are a variety of medical screening and medical care programs and of automobile and highway safety measures, food for overseas relief, air pollution control, fire prevention, industrial safety, and several radiation-related activities including standards for radium in drinking water, radwaste systems in nuclear plants, and defense and civilian high-level waste management. Values varying from a few thousand dollars to hundreds of millions of dollars per fatality averted are obtained. An attempt to derive data of this type from polling is described. The problem of discounting when money is spent now to save lives far in the future (as with nuclear waste) is discussed. It is concluded that nearly all of the vast variation in the results is unjustified and represents a need for educating the public, especially in the area of radiation protection.

Pituitary and ovarian function in women receiving hormonal contraception

A study was performed to further evaluate pituitary-ovarian function in women receiving an oral contraceptive preparation. Basal hormone levels (follicle stimulating hormone, luteinizing hormone, estradiol and prolactin) and gonadotropic response to gonadotropic releasing hormone were studied in 12 healthy, regularly ovulating women in the early follicular and mid-luteal phases of their menstrual cycle (non-treatment control period). These same women were then given NORDETTE (ethinyl estradiol 30 microgram +d-Norgestrel 150 microgram) cyclically for 3 months. In the third month of treatment, the tests were repeated on day 21, i.e. after 21 active pills, and on day 28, i.e. after 21 active and 7 inactive tablets. On active preparation, basal luteinizing hormone, follicle stimulating hormone and estradiol and gonadotropin response to gonadotropin releasing hormone were significantly suppressed. However, by day 28 (after completion of the inactive tablets), basal gonadotropin and estradiol concentrations and the gonadotropic response to gonadotropic releasing hormone were not significantly different to their pretreatment levels. No consistent change in prolactin concentration occurred as a result of oral contraceptive therapy. These results indicate that the 'active' component of even a relatively low-dose pill causes considerable suppression of pituitary-ovarian function but that after 7 days of placebo, pituitary function and basal estradiol secretion have virtually returned to normal.

Relative risks of saccharin and calorie ingestion

The risk of a person getting cancer from ingesting saccharin is compared with the risk of ingesting additional calories which cause excess body weight. It is found that, for a person who is 10% overweight, the risk of ingesting one diet soft drink, which would cause a decrease in life expectancy of 9 seconds, is approximately equal to the risk of ingesting one additional kilocalorie; that is, if ingesting a diet drink inhibits ingestion of more than 1 kilocalorie, its benefits exceed its risks.

Virilization with diffuse involvement of ovarian androgen secreting cells

A case is reported in which virilization of long duration and gradual progression was found in association with ovarian hyperthecosis and bilateral hilar cell lesions. The frequency occurrence of both masculinizing and nonmasculinizing ovarian tumors in association with ovarian hyperthecosis and polycystic ovaries is discussed.

Familial occurrence of the Wiedemann-Beckwith syndrome and persistent fontanel

We describe a family in which 3 sisters gave birth to 8 infants with the Wiedemann-Beckwith syndrome. The clinical manifestations in all the affected individuals included macroglossia, macrosomia and omphalocele, while their mothers all were entirely normal. Pedigree analysis suggests that familial occurrence of the Wiedemann-Beckwith syndrome may be due to delayed mutation.

Acquired methemoglobinemia and hemolytic anemia following excessive pyridium (phenazopyridine hydrochloride) ingestion

A case of accidental Pyridium (phenazopyridine hydrochloride) poison ing involving a 13-month-old white girl is presented along with its se quelae of methemoglobinemia, hemolytic anemia and transient hepatocel lular toxicity. The literature has been reviewed and the pertinent aspects of the pathophysiology, signs, symptoms, tests and therapy are reported.