AXIN1 bi-allelic variants disrupting the C-terminal DIX domain cause craniometadiaphyseal osteosclerosis with hip dysplasia

Sclerosing skeletal dysplasias result from an imbalance between bone formation and resorption. We identified three homozygous, C-terminally truncating AXIN1 variants in seven individuals from four families affected by macrocephaly, cranial hyperostosis, and vertebral endplate sclerosis. Other frequent findings included hip dysplasia, heart malformations, variable developmental delay, and hematological anomalies. In line with AXIN1 being a central component of the β-catenin destruction complex, analyses of primary and genome-edited cells harboring the truncating variants revealed enhanced basal canonical Wnt pathway activity. All three AXIN1-truncating variants resulted in reduced protein levels and impaired AXIN1 polymerization mediated by its C-terminal DIX domain but partially retained Wnt-inhibitory function upon overexpression. Addition of a tankyrase inhibitor attenuated Wnt overactivity in the AXIN1-mutant model systems. Our data suggest that AXIN1 coordinates the action of osteoblasts and osteoclasts and that tankyrase inhibitors can attenuate the effects of AXIN1 hypomorphic variants.

CHARGE syndrome and related disorders: A mechanistic link

CHARGE syndrome is an autosomal dominant malformation disorder caused by pathogenic variants in the chromatin remodeler CHD7. Affected are craniofacial structures, cranial nerves and multiple organ systems. Depending on the combination of malformations present, its distinction from other congenital disorders can be challenging. To gain a better insight into the regulatory disturbances in CHARGE syndrome, we performed RNA-Seq analysis on blood samples of 19 children with CHARGE syndrome and a confirmed disease-causing CHD7 variant in comparison to healthy control children. Our analysis revealed a distinct CHARGE syndrome pattern with downregulation of genes that are linked to disorders described to mimic the CHARGE phenotype, i.e. KMT2D and KDM6A (Kabuki syndrome), EP300 and CREBBP (Rubinstein-Taybi syndrome) and ARID1A and ARID1B (Coffin-Siris syndrome). Furthermore, by performing protein-protein interaction studies using co-immunoprecipitation, direct yeast-two hybrid and in situ proximity ligation assays, we could demonstrate an interplay between CHD7, KMT2D, KDM6A and EP300. In summary, our data demonstrate a mechanistic and regulatory link between the developmental disorders CHARGE-, Kabuki- and Rubinstein Taybi-syndrome providing an explanation for the overlapping phenotypes.

USP22 promotes HER2-driven mammary carcinoma aggressiveness by suppressing the unfolded protein response

The Ubiquitin-Specific Protease 22 (USP22) is a deubiquitinating subunit of the mammalian SAGA transcriptional co-activating complex. USP22 was identified as a member of the so-called "death-from-cancer" signature predicting therapy failure in cancer patients. However, the importance and functional role of USP22 in different types and subtypes of cancer remain largely unknown. In the present study, we leveraged human cell lines and genetic mouse models to investigate the role of USP22 in HER2-driven breast cancer (HER2+-BC) and demonstrate for the first time that USP22 is required for the tumorigenic properties in murine and human HER2+-BC models. To get insight into the underlying mechanisms, we performed transcriptome-wide gene expression analyses and identified the Unfolded Protein Response (UPR) as a pathway deregulated upon USP22 loss. The UPR is normally induced upon extrinsic or intrinsic stresses that can promote cell survival and recovery if shortly activated or programmed cell death if activated for an extended period. Strikingly, we found that USP22 actively suppresses UPR induction in HER2+-BC cells by stabilizing the major endoplasmic reticulum (ER) chaperone HSPA5. Consistently, loss of USP22 renders tumor cells more sensitive to apoptosis and significantly increases the efficiency of therapies targeting the ER folding capacity. Together, our data suggest that therapeutic strategies targeting USP22 activity may sensitize tumor cells to UPR induction and could provide a novel, effective approach to treat HER2+-BC.

Inter-group violence among early Holocene hunter-gatherers of West Turkana, Kenya

The nature of inter-group relations among prehistoric hunter-gatherers remains disputed, with arguments in favour and against the existence of warfare before the development of sedentary societies. Here we report on a case of inter-group violence towards a group of hunter-gatherers from Nataruk, west of Lake Turkana, which during the late Pleistocene/early Holocene period extended about 30 km beyond its present-day shore. Ten of the twelve articulated skeletons found at Nataruk show evidence of having died violently at the edge of a lagoon, into which some of the bodies fell. The remains from Nataruk are unique, preserved by the particular conditions of the lagoon with no evidence of deliberate burial. They offer a rare glimpse into the life and death of past foraging people, and evidence that warfare was part of the repertoire of inter-group relations among prehistoric hunter-gatherers.

ESR dosimetry of fossil enamel: some comments about measurement precision, long-term signal fading and dose-response curve fitting

This work deals with the specific studies of three main sources of uncertainty in electron spin resonance (ESR) dosimetry/dating of fossil tooth enamel: (1) the precision of the ESR measurements, (2) the long-term signal fading the selection of the fitting function. They show a different influence on the equivalent dose (D(E)) estimates. Repeated ESR measurements were performed on 17 different samples: results show a mean coefficient of variation of the ESR intensities of 1.20 ± 0.23 %, inducing a mean relative variability of 3.05 ± 2.29 % in the D(E) values. ESR signal fading over 5 y was also observed: its magnitude seems to be quite sample dependant but is nevertheless especially important for the most irradiated aliquots. This fading has an apparent random effect on the D(E) estimates. Finally, the authors provide new insights and recommendations about the fitting of ESR dose-response curves of fossil enamel with a double saturating exponential (DSE) function. The potential of a new variation of the DSE was also explored. Results of this study also show that the choice of the fitting function is of major importance, maybe more than the other sources previously mentioned, in order to get accurate final D(E) values.

Impact of enhancements in the local effect model (LEM) on the predicted RBE-weighted target dose distribution in carbon ion therapy

Biological optimization for treatment planning in carbon ion therapy is currently based on the first version of the local effect model (LEM I). Further developments implemented in the latest version (LEM IV) allowed to predict more accurately the Relative Biological Effectiveness (RBE) in-vitro. The main goal of this study is to compare the LEM IV against LEM I under treatment-like conditions for idealized target geometries. Therefore, physical dose distributions resulting from the biological optimization with LEM I were used to recalculate the RBE-weighted dose distribution based on LEM IV. Input parameters representing the clinical endpoints late toxicity in the central nervous system and the tumor control for chordoma were chosen to investigate the impact of changes on the predicted isoeffective dose levels. The recalculated RBE-weighted dose distributions show an increase within the target region, and the mean RBE-weighted dose values are dependent on the geometry and decrease with increasing target dimension. The differences between predictions of LEM IV and LEM I are less than 10% for typical tumor volumes treated in the pilot project at GSI. Median RBE-weighted doses predicted by LEM IV in the target region are consistent with clinically observed dose-response behavior as demonstrated by comparison to the 5-year local control curve for skull base chordoma.

[Gastric metastasis from small cell lung cancer]

Small cell carcinomas are most frequently localised within the lung, however, they also may be detected at extrapulmonary sites such as the gastrointestinal tract and the genitourinary tract. The confirmation of a small cell carcinoma outside of the lung may not necessarily indicate the presence of a metastasis, however, it also may represent the primary tumor itself. We present the case of a patient with a small cell carcinoma of the lung with metastases to the stomach. A regression of the primary lung tumor and the disappearance of the gastric metastases could be achieved by chemotherapeutic treatment with carboplatin, etoposide, and vincristine. However, death due to pneumonia occurred 3 months after initial diagnosis. This case illustrates that in rare cases a metastasis from small cell lung cancer may occur in the intestinal tract even without leading to distinctive symptoms.

Border Cave revisited: a revised ESR chronology

In view of a decade of progress in ESR dating we have revised the ESR chronology of Border Cave. A detailed gamma ray survey in 1994 and newly calculated beta attenuation data led to total dose rate estimations that are between 0 and 30% smaller than previously estimated. Accordingly, the resulting ESR age estimates are between 0 and 30% older. The ESR dates are now in good agreement with independent age estimates, particularly(14)C and amino acid racemization. New ESR dates for the lowermost dated sedimentary layer, 5 WA (white ash), indicate that the sedimentation of the sequence started around 200 ka ago.

Direct ESR dating of a Pliocene hominin from Swartkrans

Two fragments of a hominin tooth (Australopithecus robustus) and two bovid teeth from the Hanging Remnant of the Swartkrans Formation were analysed with ESR. Research was complicated by the fact that the samples came from a curated collection and their precise provenance is unknown. The environmental dose rate was reconstructed by a series of in situ gamma spectrometric measurements and elemental analyses of a range of sediment samples. U-series isotopic analyses indicated that each of the teeth had a significantly different uranium uptake history, rendering the assumptive early U-uptake and linear U-uptake models ineffective. ESR and U-series data were combined to calculate open system ages, resulting in a best estimate of 1630+/-160 ka for the Hanging Remnant. An open-system model which provides the maximum age for given U-series and ESR measurements yielded an estimate of about 2100 ka. Two bovid teeth from Member 2, previously estimated to be between 1.0 and 2.0 Ma, yielded age estimates of between about 100 and 200 ka. No known geochemical processes are likely to explain this severe age underestimation. We conclude that these samples are of Middle to Upper Pleistocene age and their presence in Member 2 was either due to reworking or inadequate stratigraphical discrimination of these deposits.

EPR spectrum deconvolution and dose assessment of fossil tooth enamel using maximum likelihood common factor analysis

In order to determine the components which give rise to the EPR spectrum around g = 2 we have applied Maximum Likelihood Common Factor Analysis (MLCFA) on the EPR spectra of enamel sample 1126 which has previously been analysed by continuous wave and pulsed EPR as well as EPR microscopy. MLCFA yielded agreeing results on three sets of X-band spectra and the following components were identified: an orthorhombic component attributed to CO2-, an axial component (CO3(3-)), as well as four isotropic components, three of which could be attributed to SO2-, a tumbling CO2- and a central line of a dimethyl radical. The X-band results were confirmed by analysis of Q-band spectra where three additional isotropic lines were found, however, these three components could not be attributed to known radicals. The orthorhombic component was used to establish dose response curves for the assessment of the past radiation dose, D(E). The results appear to be more reliable than those based on conventional peak-to-peak EPR intensity measurements or simple Gaussian deconvolution methods.

Australia's oldest human remains: age of the Lake Mungo 3 skeleton

We have carried out a comprehensive ESR and U-series dating study on the Lake Mungo 3 (LM3) human skeleton. The isotopic Th/U and Pa/U ratios indicate that some minor uranium mobilization may have occurred in the past. Taking such effects into account, the best age estimate for the human skeleton is obtained through the combination of U-series and ESR analyses yielding 62,000+/-6000 years. This age is in close agreement with OSL age estimates on the sediment into which the skeleton was buried of 61,000+/-2000 years. Furthermore, we obtained a U-series age of 81,000+/-21,000 years for the calcitic matrix that was precipitated on the bones after burial. All age results are considerably older than the previously assumed age of LM3 and demonstrate the necessity for directly dating hominid remains. We conclude that the Lake Mungo 3 burial documents the earliest known human presence on the Australian continent. The age implies that people who were skeletally within the range of the present Australian indigenous population colonized the continent during or before oxygen isotope stage 4 (57,000-71,000 years).

ESR and U-series analyses of teeth from the palaeoanthropological site of Hexian, Anhui Province, China

ESR and U-series analyses of teeth from the palaeoanthropological site of Hexian which contained Homo erectus remains, illustrate the limited effectiveness of stand-alone ESR and U-series age estimates on faunal materials. The problem lies in the unknown U-uptake history causing very large uncertainties in the age results of both techniques. This study demonstrates the particular strength that lies in the integration of ESR and U-series dating analyses allowing the estimation of the U-uptake history. We obtained a combined ESR/U-series age estimate of 412 +/- 25 ka (average of six analyses on two teeth). This pinpoints the deposition of the faunal remains to the time of the transition between oxygen isotope stages 12 and 11. This is in agreement with the faunal composition which show a mixture of cold adapted northern mammals and more subtropical-tropical southern elements. The age also implies that the advanced Hexian Homo erectus occurred at a similar time as the less advanced Homo erectus specimens at Locality 1 at Zhoukoudian (LI-LIII).

Electron spin resonance (ESR) dating of the origin of modern man

Many materials found in archaeological sites are able to trap electronic charges as a result of bombardment by radioactive radiation from the surrounding sediment. The presence of these trapped charges can be detected by electron spin resonance (ESR) spectroscopy: the intensity of the ESR signal is a measure of the accumulated dose and thus of the age. Tooth enamel is ubiquitous at archaeological sites and is well suited for ESR dating, with a precision of about 10-20%. This method has now been used to date many sites critical to the biological and cultural evolution of modern man. Dates for sites in Israel and Africa have demonstrated the existence of anatomically modern humans more than 100 ka ago.

ESR analysis of teeth from the palaeoanthropological site of Zhoukoudian, China

An ESR dating study on teeth collected from layers 3, 6/7 and 10 at Locality 1, Zhoukoudian provides results that are in general agreement with an earlier multi-dating study and confirm an age range of 300-550 ka for the Homo erectus remains in the Peking Man Cave. Uncertainties due to U-uptake and the external gamma dose rates do not allow very precise age estimates for the respective layers.

Dated co-occurrence of Homo erectus and Gigantopithecus from Tham Khuyen Cave, Vietnam

Tham Khuyen Cave (Lang Son Province, northern Vietnam) is one of the more significant sites to yield fossil vertebrates in east Asia. During the mid-1960s, excavation in a suite of deposits produced important hominoid dental remains of middle Pleistocene age. We undertake more rigorous analyses of these sediments to understand the fluvial dynamics of Pleistocene cave infilling as they determine how skeletal elements accumulate within Tham Khuyen and other east Asian sites. Uranium/thorium series analysis of speleothems brackets the Pleistocene chronology for breaching, infilling, and exhuming the regional paleokarst. Clast analysis indicates sedimentary constituents, including hominoid teeth and cranial fragments accumulated from very short distances and under low fluvial energy. Electron spin resonance analysis of vertebrate tooth enamel and sediments shows that the main fossil-bearing suite (S1-S3) was deposited about 475 thousand years ago. Among the hominoid teeth excavated from S1-S3, some represent Homo erectus and Gigantopithecus blacki. Criteria are defined to differentiate these teeth from more numerous Pongo pygmaeus elements. The dated co-occurrence of Homo erectus and Gigantopithecus blacki at Tham Khuyen helps to establish the long co-existence of these two species throughout east Asia during the Early and Middle Pleistocene.

Mass-spectrometric U-series dates for Israeli Neanderthal/early modern hominid sites

The nature of the relationship between Neanderthals and early modern Homo sapiens is controversial, yet it is fundamental to our understanding of early human evolution. The Middle Palaeolithic sites of Israel are critical to this debate, because unlike those of western Europe and Africa they contain both Neanderthal (at Tabun and Kebara for example) and anatomically modern hominids (as at Skhul and Qafzeh). Here we present new mass spectrometric 230Th/234U dates for dental fragments from the Middle Palaeolithic burial sites of Tabun, Qafzeh and Skhul. These data, combined with published ages from electron spin resonance (ESR), provide compelling evidence that the Tabun Neanderthals and Qafzeh early modern Homo sapiens were approximately coeval in the southern Levant some 100 +/- 5 kyr ago, but indicate that some of the Skhul material is younger. The study also shows that combined mass-spectrometric 230Th/234U and ESR dating is an invaluable technique for dating archaeological sites beyond the range of radiocarbon dating.

[Incidence and importance of thyroid gland changes in clinical patients]

The thyroid gland of 536 patients of a medical hospital in an iodine deficient area was investigated by ultrasound. According to the sonographic pattern and to the scintigraphic imaging the focal lesions were analysed as micro- or macrofollicular adenomas, autonomous adenomas, cysts and chalk. The prevalence of goitres was 37.7%. The prevalence of goitres was higher in women (45%) than in men (30%). Focal lesions could be observed in 27.6%, equally more often in women (36%) than in men (18.9%). The frequency of focal lesions increased with the age of the patients and with the volume of the thyroid gland. Autonomous adenomas were found three times more often in women than in men. Hyperthyroidism was only observed in patients with nodules larger than 4 cm in diameter. Sonographic screening examinations of the thyroid gland seem to be useful in all patients of a clinic of medicine because of the risk (25%) of iodine contamination by diagnostic measures.

[Ultrasonic diagnosis of tumors of the cecum and ascending colon]

The results of preoperative ultrasound investigations were compared with the intraoperative findings in 42 patients (27 women, 15 men) operated on because of tumours of the cecum or colon ascendens. In 34 of 42 patients (i.e. 81%) the tumour could be correctly diagnosed by ultrasound. In 3 cases the investigator was not sure about imaging the tumour. Only in 5 cases (i.e. 12%) the tumour was not identified by ultrasound scanning. 4 out of these 5 patients had attended the hospital to be operated on because of a carcinoma of the rectum and the second carcinoma of the large bowel was found by chance intraoperatively. In 16 patients in whom the diagnosis of a large bowel carcinoma had not been established before, the tumour could be primarily diagnosed by ultrasound.

ESR dating evidence for early modern humans at Border Cave in South Africa

The archaeological and hominid site of Border Cave (KwaZulu, South Africa) has a stratigraphic sequence covering the Middle and Later Stone Ages (MSA and LSA). It has been proposed that four hominid specimens recovered there (BC1 and BC2 of uncertain provenance, and BC3 and BC5 recovered from MSA layers) represent very early examples of anatomically modern humans, supporting an early late-Pleistocene appearance of modern Homo sapiens in Africa. This early appearance, however, has been questioned, largely because of doubts about the stratigraphic positions associated with the specimens and because of the lack of a reliable chronology for the stratigraphic sequence. We now report on the first comprehensive radiometric dating analysis of Border Cave, using electron spin resonance (ESR) on teeth within sediment layers. BC3 is likely to be approximately 70-80 kyr old, and BC5, 50-65 kyr old. BC1 and BC2 are almost certainly less than 90 kyr old. These results, although younger than some age estimates, support the early occurrence of anatomically modern humans at Border Cave. In addition, our results suggest that the Howiesons Poort lithic industry (approximately 45-75 kyr) and the MSA-LSA transition (approximately 35 kyr) are younger than often believed.

[Hyperestrogenemia following various shunt operations: on the role of estrogens in the development of focal nodular hyperplasia of the liver]

Hormones especially estrogens have been suspected to induce liver cell tumours or hepatic focal nodular hyperplasia (FNH). In rats 6 months after portocaval anastomosis (PCA) the occurrence of FNH has been observed. Modified portocaval anastomosis (mPCA) does not lead to FNH. To test the concept of estrogen induced tumour formation we measured in both groups as well as in a shamoperated control group (SOP) the levels of estradiol (E2), estrone (E1) and of testosterone (T). In a further experiment the hormone levels were measured in rats with portocaval transposition (PCT), an operation which leads to high gonadal hormone production. In groups of 6 male rats each (280-300 g) either SOP, PCA, mPCA or PCT were performed. 30 days later the blood levels of E2, E1, and of T were measured by radioimmunoassay. In PCT-rats hormone levels were measured in the blood synchronously taken from the inferior vena cava (prehepatic) and from the heart (posthepatic), to get an information of the hepatic hormone degradation. After PCA the median level of E2 (77 pg/ml) and E1 (63 pg/ml) are significantly elevated when compared with SOP-rats (41 and 43 pg/ml). Equally after mPCA the E2 and E1 levels are significantly higher (61 and 70 pg/ml) than in controls rats. In contrast the concentrations of T are significantly reduced (PCA 0.03, mPCA 0, 10, SOP 1.0 ng/ml). PCA as well as mPCA result in a hyperestrogenic and hypoandrogenic status. When PCA and mPCA are compared, only the testosterone blood levels are significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

[Growth hormone in females with liver cirrhosis]

The median plasma concentration of growth hormone (GH) in 63 women with liver cirrhosis was significantly elevated when compared with a control group (4.4 ng/ml vs 1.8 ng/ml, p less than 0.01). In 38% of the patients GH concentration was higher than 6.0 ng/ml. GH correlated significantly with the degree of decompensation of the cirrhosis (Child A-C). It was not influenced by the concentrations of estradiol, estrone, or testosterone. Thyrotropin releasing hormone (TRH) induced paradoxial GH increase (delta-GH) in 23 patients showed no significant difference to the data of the control group (2.7 ng/ml vs 0.8 ng/ml). The etiology of cirrhosis (alcoholic or non alcoholic) proved to be unimportant concerning the GH elevation. A missing correlation of GH to thyroid stimulating hormone (TSH), and of delta-GH to TRH induced increase of TSH (delta-TSH) argues against the hypothesis that latent hypothyroidism - often described in cirrhosis - might be responsible of the GH elevation.

ESR dates for the hominid burial site of Es Skhul in Israel

The Middle East has been critical to our understanding of recent human evolution ever since the recovery of Neanderthal and early anatomically modern fossils from the caves of Tabun and Skhul (Mount Carmel) over 50 years ago. It was generally believed, on archaeological and morphological grounds, that middle eastern Neanderthals (such as those from Tabun, Amud and Kebara) probably dated from more than 50,000 years ago, whereas the earliest anatomically modern specimens (from Skhul and Qafzeh) probably dated from about 40,000 years. Recent thermoluminescence and electron spin resonance (ESR) determinations, however, have supported biostratigraphy in dating the Qafzeh deposits to an earlier part of the late Pleistocene, probably more than 90,000 years ago. These dates have been questioned on unspecified technical grounds, and it has also been argued that they create explanatory problems by separating the morphologically similar Qafzeh and Skhul samples by some 50,000 years, thus implying a long-term coexistence of early modern humans and Neanderthals in the area. Here we report the first radiometric dating analysis for Skhul, using ESR on bovine teeth from the hominid burial levels. Early uptake and linear uptake ages average 81 +/- 15 and 101 +/- 12 kyr respectively. These analyses suggest that the Skhul and Qafzeh samples are of a similar age and therefore it is possible that the presence of early modern humans in the area was episodic, rather than long-term during the early late Pleistocene.

[Sex hormones and the hypophyseo-gonadal axis in females with liver cirrhosis in postmenopause]

The hormonal status of men with cirrhosis of the liver has been investigated in numerous studies. Little, however, is known about changes of sexual hormones in women afflicted by this disorder. In a study of 31 postmenopausal women (mean age 63 +/- 8 years) suffering from cirrhosis of various etiology (alcoholic, n = 8; posthepatitic B, n = 1; PBC, n = 5; cryptogenetic, n = 17) the blood levels of estradiol (E2), estrone (E1), androstenedione (A), testosterone (T) and basal and stimulated values of gonadotropins are reported and compared with the data obtained in an age-matched control group (n = 9). In cirrhosis a significant increase of the median E2 (28 vs 12 pg/ml, P less than 0.01) was found, whereas the changes of the blood levels of E1 (88 vs 76 pg/ml), A (63 vs 111 ng/dl), and T (0.30 vs 0.15 ng/ml) did not attain statistical significance in comparison to controls. Within the study group, however, a significant positive correlation with the degree of decompensation of cirrhosis (Childscore A-C) was observed for the steroid hormones measured. Thus, in subgroup C the hormone levels are higher than physiologically expected for postmenopausal women. On the other hand the median FSH (32 vs 48 mU/ml, P less than 0.05) is significantly lower in cirrhosis compared to controls with a trend to decreased values of LH. Very low levels of LH and FSH are found in decompensated cirrhosis. The decrease of LH and FSH can partly be explained by the rise of peripheral hormones (i.e. E2, E1, and in some cases T and A).(ABSTRACT TRUNCATED AT 250 WORDS)

[Thyroid hormones in women with liver cirrhosis]

Basal thyroid hormone levels were measured in 68 women with liver cirrhosis (LC) of different etiology (alcoholic n = 34, posthepatitic B n = 9, PBC n = 5, cryptogenetic n = 18, M. Wilson n = 2). In addition the rise of TSH after 400 micrograms TRH was measured in 23 women with LC and compared with the data obtained from 17 women of a control group. There was no difference of the median T4-concentrations (LC 8.0 micrograms/dl versus 7.2 micrograms/dl) but a significant correlation of T4 to the grade of decompensation of LC. In contrast of T4 there was a marked decrease of T3 in LC-patients (109 ng/dl versus 143 ng/dl) and a rise of reverse T3 (0.21 ng/ml versus 0.13 ng/ml). The decrease of T3 and rise of reverse T3 equally correlated to the severeness of LC. TBG concentrations fell according to the grade of decompensation of LC and T4/TBG-quotient exhibited no difference to the control data (0.51 both). Though basal thyroid hormones and TSH show euthyroidism the significant augmented TSH release after TRH (delta-TSH 7.0 versus 3.2 microU/ml) indicate a status of latent hypothyroidism. In alcoholic cirrhosis the degree of TSH release was much higher than in non alcoholic cirrhosis. Estradiol and estrone levels correlated significantly negatively to T4, T3, estrone negatively to TBG and positively to reverse T3 but not to TSH and TSH release. Otherwise TSH release correlated positively to estradiol. The thyroid status in women with liver cirrhosis does not differ from the thyroid hormone profile found in men with cirrhosis.

[Prolactin in females with liver cirrhosis]

The median plasma level of prolactin in 94 women with cirrhosis of the liver did not differ significantly when compared with a control group (8,0 versus 7,2 ng/ml). Nevertheless 22% of the investigated women exhibited a plasma prolactin level higher than 15 ng/ml. The prolactin concentrations correlated to the severeness of cirrhosis and in the subgroup with decompensated cirrhosis the prolactin concentrations were found to be significantly elevated (12 ng/ml). Like basal prolactin the TRH-induced prolactin release showed no significant difference between cirrhotic women and controls (36,1 versus 38,5 ng/ml). No difference could be observed between the prolactin concentrations of alcoholic or non alcoholic cirrhotic women, and prolactin did not correlate with estradiol or estrone plasma levels. Other factors than cirrhosis itself (i.e. medical treatment, renal insufficiency, stress) must be discussed as causing hyperprolactinemia in cirrhosis.

Ultrasound diagnosis of C-cell carcinoma of the thyroid

Ultrasound screening in 9 and 21 members, respectively, of two families affected by familial C-cell carcinoma, as well as sonographic findings in 6 patients with sporadic medullary carcinoma of the thyroid (MCT), are reported. Unilateral and bilateral tumor nodules were identified by sonography in 12 of a total of 13 patients with MCT (n = 9) or local tumor recurrence following thyroidectomy (n = 4); one carcinoma, 3 X 6 mm in diameter, was missed. Nine of the 12 (75%) were clinically occult, nonpalpable C-cell carcinomas. The smallest occult MCT correctly diagnosed by ultrasound had a diameter of 4 mm. A positive correlation was found between the sonographically determined tumor mass (number/size of nodules/metastases) and the plasma calcitonin level. Pheochromocytomas were diagnosed by ultrasound as part of a multiple endocrine neoplasia (MEN IIa) in two patients with MCT. The echomorphologic findings of the intrathyroid C-cell carcinomas and their metastases display characteristic but nonspecific features. Sonographic findings on these tumors should therefore not be interpreted without consideration of plasma calcitonin assays.

[Sex hormones and fertility following portacaval anastomosis in rats]

Portocaval anastomosis (PCA) in the normal male rat causes profound alterations in testicular morphology and function and in plasma levels of sex steroids as well as of gonadotropins. Testicular atrophy is accompanied by a significant decrease of plasma testosterone (0.03 ng/ml versus 0.99 ng/ml) and an increase of estradiol (76.2 pg/ml versus 39.7 pg/ml) and estrone (68. pg/ml versus 45.5 pg/ml). Plasma levels of gonadotropins (LH, FSH) and prolactin are lowered too (LH: 15 ng/ml versus 28.5 ng/ml, FSH:119 versus 182 ng/ml, prolactin:53 versus 109 ng/ml). The altered sex hormone metabolism is reflected in marked changes of the morphology and nucleic acid content of the metabolizing organs i.e. liver, gonades and kidney. The results of this study are consistent with the hypothesis that portosystemic shunt per se plays an important role in the pathogenesis of the disturbed metabolism of sex hormones observed in patients with liver cirrhosis and portal hypertension.