Circadian rhythms of basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), cortisol, and melatonin in women with breast cancer

BACKGROUND

Circadian rhythms in plasma concentrations of many hormones and cytokines determine their effects on target cells.

METHODS

Circadian variations were studied in cortisol, melatonin, cytokines (basic fibroblast growth factor IbFGF], EGF, insulin-like growth factor-1 [IGF-1]), and a cytokine receptor (insulin-like growth factor binding protein-3 [IGFBP-3]) in the plasma of 28 patients with metastatic breast cancer. All patients followed a diurnal activity pattern. Blood was drawn at 3h intervals during waking hours and once during the night, at 03:00. The plasma levels obtained by enzyme-linked immunoassay (ELISA) or radioimmunoassay (RIA) were evaluated by population mean cosinor (using local midnight as the phase reference) and by one-way analysis of variance (ANOVA).

RESULTS

Cortisol and melatonin showed a high-amplitude circadian rhythm and a superimposed 12h frequency. bFGF showed a circadian rhythm with an acrophase around 13:00 with a peak-to-trough interval (double amplitude) of 18.2% and a superimposed 12h frequency. EGF showed a circadian rhythm with an acrophase around 14:20, a peak-to-trough interval of 25.8%, and a superimposed 12h frequency. IGF-1 showed a high value in the morning, which is statistically different (t test) from the low value at 10:00, but a regular circadian or ultradian rhythm was not recognizable as a group phenomenon. IGFBP-3 showed a low-amplitude (peak-to-trough difference 8.4%) circadian rhythm with the acrophase around 11:00 and low values during the night.

CONCLUSIONS

(1) Circadian periodicity is maintained in hospitalized patients with metastatic breast cancer. (2) Ultradian (12h) variations were superimposed on the circadian rhythms of the hormones and several of the cytokines measured. (3) Studies of hormones and cytokines in cancer patients have to take their biologic rhythms into consideration. (4) The circadian periodicity of tumor growth stimulating or restraining factors raises questions about circadian and/or ultradian variations in the pathophysiology of breast cancer.

The oculo-dento-digital syndrome: male-to-male transmission and variable expression in a family

We report two siblings--a 5 1/2 year old female and her 4 1/2 year old brother, both presenting the classical clinical findings of oculo-dento-digital dysplasia (ODD). 1. Digital anomalies: bilateral complete cutaneous syndactyly of fingers IV-V (III-IV-V at the left hand of the boy) and camptodactyly IV. 2. Facial and ocular anomalies: microphtalamos-epicanthal folds, small midfacies, thin nose with hypoplastic alae nasi and small nares. 3. Dental anomalies with partial dental agenesis and enamel hypoplasia. Examination of the parents showed a bilateral cutaneous syndactyly IV-V in the father as the sole partial manifestation of ODD. The findings in the present family confirm the autosomal dominant inheritance of ODD with great variability in clinical expression. Moreover, the facial morphology (thin, hypoplastic nose) observed in several ODD patients suggests nosological overlap with the Hallerman-Streiff syndrome and could indicate that both syndromes are variable expressions of a contiguous gene deletion syndrome.

Stimulation of the secretion of dehydroepiandrosterone by melatonin in mouse adrenals in vitro

Adrenals of young adult male mice kept on a LD 12:12 lighting regimen for three weeks prior to study and harvested at four different circadian stages were incubated for 2 hours with 0.4 IU synthetic ACTH in 2 ml Krebs-Ringer buffer (KR), or with 50, 150, and 450 microM of melatonin in KR containing 0.4 IU ACTH. The addition of melatonin to ACTH leads to a dose dependent stimulation of production and/or secretion of DHEA into the incubation medium irrespective of the circadian stage of harvesting of the adrenals. This relationship is of interest in view of the simultaneous decrease of dehydroepiandrosterone and melatonin in the course of aging, and the effects of these compounds upon aging related changes.

A 22-year old female with the 9p deletion syndrome

A 22-year old female patient with psycho-motor retardation, statural hypotrophy and clinical picture characteristic of the 9p deletion syndrome, i.e., trigonocephalia (corrected surgically), epicanthus, hypertelorism, long filtrum, micrognathia, low inserted and malformed ears, filiform fingers, is presented.

Radioiodine treatment in recurrences of subacute thyroiditis

The three cases of subacute thyroiditis treated by radioiodine were refractory to systemic corticoid therapy (2-3 recurrences in a mean duration of 7.6 mos) and to external antiinflammatory radiotherapy (relapses after 2 and 4 mos, respectively). No relapse after radioiodine administration has appeared (mean follow-up period: 3 yrs) and post-iodine hypothyroidism was mild.

Direct assay of 3-methoxy-4-hydroxy-phenylglycol (MHPG) in human saliva; a new approach in the assessment of noradrenergic function

The present paper offers a simple, reliable and specific method for the evaluation of salivary level of conjugated MHPG in 16 children (5-16 years) selected as control group. In the chosen group, we established the urinary level of NA: 17.64 +/- 1.38 micrograms/24 h, of A: 5.87 +/- 0.44 micrograms/24 h, of MHPG: 1.62 +/- 0.14 mg/24 h, of VMA: 1.54 +/- 10.10 mg/24 h. In all patients we assayed salivary MHPG: 57 +/- 5.25 mg/ml; in only 6 patients we also determined salivary NA: 2.21 +/- 0.11 micrograms/l and A: 0.25 +/- 0.03 micrograms/l. The MHPG in saliva correlates with urinary MHPG but doesn't correlate with NA in saliva or in urine. The assay of salivary MHPG may represent a non-invasive procedure of evaluation of noradrenergic tonus in children.

Circadian and seasonal variations in iodine excretion in children with and without endemic goiter

The urinary iodine excretion was measured in 193 children 11 +/- 1.5 years of age living in the endemic goiter area of Dîmboviţa, Romania. One hundred and thirty four of the children showed some degree of endemic goiter, 59 showed none. All children followed a diurnal activity pattern with rest during the night. They received their usual iodine supplement of 1 gm potassium iodide once a week during the school year (which included the time of all measurements made). Urine was collected in six 4-hour samples over a 24-hour span. The examinations were conducted during the months of March, June, September and December. Iodine was determined by an automated ceric ion arsenic acid method using a Technicon Autoanalyzer. Circadian and seasonal variations of urine volume and iodine excretion were statistically verified by the cosinor technique and the seasonal variations also by one way analysis of variance using the circadian means as input. A comparable circadian rhythm of iodine excretion was found in the children with and without endemic goiter, with an acrophase during the evening (20:16 with a 95% C.I., from 19:32 to 21:04). The circadian rhythm in iodine excretion has to be taken into account whenever an estimate of the 24-hour excretion is attempted from a sample covering less than the entire 24-hour span. There was a statistically significant seasonal variation of the 24-hour iodine excretion in the boys with and without endemic goiter and in the group as a whole. The 24-hour iodine excretion during March was 102 +/- 6 mcg, during June 81 +/- 4 mcg, during September 79 +/- 3 mcg and during December 102 +/- 7 mcg. The average 24-hour iodine excretion pooled over all seasons was 91 +/- 3 mcg/24 hrs in the children with and 91 +/- 5 mcg/24 hrs in the children without endemic goiter. During March and December the iodine excretion indicates an iodine intake not usually associated with a high prevalence of endemic goiter. However, during the months of June and September (and presumably even more during the months of July and August when during summer vacation no iodine supplementation was given in school) the 24-hour iodine excretion indicates some degree of iodine deficiency. The seasonal variation in urinary iodine excretion thus points to a time when increased iodine prophylaxis may be of value.

Thyroid hormone-induced reduction of urinary 5-hydroxyindole acetic acid (5 HIAA) in obese children. Comparison with hypothyroid patients of similar age having either pituitary dwarfism or congenital myxedema

Urinary excretion of monoamine metabolites (noradrenaline-NA, adrenaline-A, 3-methoxy-4-hydroxyphenyl glycol-MHPG, homovanillic acid-HVA, 5-hydroxyindole acetic acid-5 HIAA) was studied in four groups of children as follows: Group I consisting of obese children subjected to caloric restriction and to a short term course of thyroid extract in "low" dosage (1-2 mg/kg bwt), Group II consisting of obese children subjected to diet alone, Group III consisting of children myxedema and subjected to a short term course of thyroid extract given in the "high" dosage (3-5 mg/kg bwt) and Group IV consisting of GH deficient short children having (many of them) thyrotropin deficiency and subjected to a short term course of thyroid extract in "very high" dosage (5-10 mg/bwt). In obese, calorie-restricted children, the previously low mean level of 5 HIAA excretion was further lowered by thyroid extract. In obese children subjected to calorie restriction alone no urinary abnormality was noted. The congenitally hypothyroid patients had low levels of basal 5 HIAA when compared to controls. The degrees of 5-hydroxy tryptamine (5 HT) deficiency in Group III was similar to the obese groups. The thyroid extract course did not influence, at least in short term administration, the low 5 HIAA levels in group III. In GH deficient, short children (group IV) thyroid extract had no significant effect on urinary pattern of monoamine metabolites. A central 5 HT deficiency may tentatively explain the mood disturbances and possibly the other psychic disorders in both the obese and myxedematous patients. The different effects of thyroid extract on 5 HIAA may also witness the differences in the food intake behaviour in these two conditions.

Low level of urinary 5-hydroxyindole acetic acid (5 HIAA) in obese children having concomitantly high 3-methoxy-4-hydroxyphenyl glycol (MHPG) excretion

Eighty six obese children and adolescents (44 males) were screened for urinary 5 HIAA and MHPG, noradrenaline (NA), and adrenaline (A) and the results compared with age- and sex-matched controls. Significantly lower amounts of 5 HIAA were found, by contrast to the significantly higher levels of MHPG. These findings cannot be easily explained but an alteration of the normal equilibrium between the adrenergic and the serotonergic tonus may be circumstantially invoked.

The serum osteocalcin levels in adult and aged hypothyroid patients

Osteocalcin (OC) or the bone protein containing gamma-carboxyglutamic acid (BGP or Gla-P), is a specific and sensitive marker of bone turnover. A radioimmunoassay (RIA) system for human osteocalcin was developed with the sensitivity of 0.5 ng/ml. The osteocalcin was measured in sera from 33 hormonally and/or clinically hypothyroid patients: 12 adult and 21 aged patients. For comparison, blood samples were collected from 14 hormonally hyperthyroid adult patients in whom the OC levels were 16.23 +/- 7.57 ng/ml (mean +/- SD) and from hormonally euthyroid adult patients (previously treated hyperthyroid patients) having OC 9.76 +/- 5.32 ng/ml. Abnormal low OC levels were noted in the hypothyroid adult patients group: 1.04 +/- 0.23 ng/ml by comparison to the hypothyroid aged patients 3.76 +/- 2.38 ng/ml (p less than 0.001). Moreover, great variability of the OC serum levels was observed in the aged group, four patients hormonally eu- or hypothyroid having high OC levels in the range: 13.29-55.45 ng/ml and other three patients although hormonally euthyroid but clinically hypothyroid had low OC levels 0.88-2.27 ng/ml. The abnormalities of the OC levels in hypothyroid adult and aged patients are discussed.

The assessment of the dopaminergic tonus by urinary determinations of homovanillic acid (HVA) and dihydroxyphenylacetic acid (DOPAC) in normal, obese and GH-deficient short children

In order to assess the dopaminergic tonus, urinary determinations of HVA and DOPAC and also of noradrenaline (NA), adrenaline (A), and methoxyhydroxyphenylglycol (MHPG) were performed in 86 obese children, 11 growth hormone (GH)-deficient short children and also in 40 control children. Part of the obese patients were subjected to a low carbohydrate, low calorie diet and also to short-term (9-14 days) courses of diethylpropion (DEP) 50 mg/day, meclofenoxate (MEC) 100 mg/day and thyroid extract (THE) 1-2 mg/kg/day. The GH-deficient patients received only THE in substitutive (5-10 mg/kg/day) doses. Significative correlations between DOPAC and age, weight and height were found in controls. In the obese group a significantly increased mean level of HVA was found (1.45 +/- 0.09 mg/24 h vs 1.15 +/- 0.10 in controls). The excretion of DOPAC was slightly greater but far from significance. There was also a significant decrease of HVA but not DOPAC in the DEP-treated obese. The rest of the drugs and the diet alone were not effective in any way. Normal levels in all metabolites except NA and A were found in GH-deficient short children. The therapy with thyroid extract did not alter the excretion levels. These findings indicate that in infantile obesity the dopaminergic tonus is somewhat increased but its pathophysiological significance is doubtful. In GH-deficient short children of standard appearance the dopaminergic tonus seems to be undistinguishable from normal.

Leprechaunism: report of two cases and review

Two new cases of leprechaunism are reported, one of which from consanguinous parents. Both cases show the clinical picture characteristic of this syndrome: severe pre- and postnatal growth failure, psychic backwardness, lack of adipose tissue, cutis laxa; elf-like face, large ears, globular eyes, hypertelorism, micrognathia and various degrees of external genitalia hypertrophy. Endocrinologically, one of the patients shows the syndrome of low T3. The role of the endocrine alterations in the etiology of the syndrome is discussed.

Protein content and thyroid hormone release in vitro by differentiated thyroid cancer cells in the presence of estradiol, dehydroepiandrosterone, polypeptidic hormones and pesticides

The reactivity of thyroid cancer cells treated with estradiol (E) and dehydroepiandrosterone (DHA) in the presence of other hormones (TSH, STH, insulin), myopeptide and some pesticides (aminotriazole--ATA, atrazine--ATZ, prometryne--P and ATC) proved to be active in the culture medium. Protein synthesis in sclerosing folliculo-papillary cancer cells under the treatment applied is more markedly inhibited by DHA than by E in the culture medium is compared to the control lots. Tg1 and T3 release into the culture medium under the action of T4 and TSH decreases progressively going from the control to the treated lots, in the presence of E and DHA. STH inhibits Tg1 and T3 secretion in thyroid follicular carcinoma, whether or not E or DHA are present in the culture medium.

Free 3-methoxy-4-hydroxyphenylglycol (MHPG) in human urine: metabolic routes, biochemical and clinical significance in healthy and obese children

Conjugated MHPG is an indicator of the adrenergic tonus having clinical use in the follow-up of affective disorders, arterial hypotension, anorexia nervosa and recently of obesity. Little is known about the significance of the unconjugated, free MHPG in various body fluids. Nineteen healthy and 38 obese children were studied as regards the urinary excretion of free MHPG (MHPGF), conjugated MHPG (MHPGC), total MHPG (MHPGT) and also free noradrenaline (NA) valnillyl mandelic acid (VMA) and metanephrines (MN). Part of the obese received a short-term course of drug therapy (diethyl-propion-DEP or thyroid extract) and were subjected to a low-carbohydrate diet containing 800-1000 calories a day. The same urinary determinations were made after diet alone or after diet and drug therapy. MHPGC and MHPGT were significantly higher in the obese children. The level of MHPGF was essentially the same in both groups and did not change significantly following any drug or after diet alone. It was concluded that esterification mechanisms are not involved in the pathological states expressing high or low levels of MHPGC. Suggestion is made that these mechanisms may not be saturated unless huge amounts of MHPG outflow from the brain into CSF.

The serum osteocalcin levels in patients with thyroid diseases

The mechanism of bone, calcium, phosphorus and proteins abnormalities observed in hyperthyroidism is rather complex and as yet not wholly understood. Increased serum osteocalcin was recently reported in hyperthyroid patients and its decrease after 4-8 months of treatment. Osteocalcin was measured by RIA in the sera of 211 women and 18 men with thyroid diseases. The patients were divided into 3 groups according to diagnosis: I. polynodular goitre and subacute thyroiditis (59 women, 5 men); II. Graves' disease (70 women, 3 men) and III. thyroid cancer, after treatment by surgery and 131I (82 women, 10 men). The osteocalcin levels in the sera of these patients were: 2.97 +/- 2.63 ng/ml (mean +/- SD) for the women and 3.56 +/- 2.10 ng/ml for the men in the 1st group; 16.31 +/- 11.34 ng/ml for the women and 12.75 +/- 6.09 ng/ml for the man in the IInd group and, 1.01 +/- 0.60 ng/ml for the women and 0.78 +/- 0.46 ng/ml for the men in the IIIrd group. No differences were found between the osteocalcin concentrations in the hyperthyroid female patients treated with antithyroid drugs (no = 58) and the non-treated hyperthyroid women (no = 12): 16.22 +/- 11.40 ng/ml vs 16.74 +/- +/- 11.53 ng/ml. These data suggest that bone resorption stimulated by endogenous thyroid-hormones is a rather resistant processus, persisting even after 6-8 mos of associated anti-thyroid therapy. Further are analyzed the possible causes of the subnormal osteocalcin levels observed in patients with thyroid cancer treated by surgery and radioisotope, whose suppression therapy was discontinued 2-3 weeks before blood sampling.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytogenetic investigation in 300 couples with recurrent fetal wastage

A series of 300 couples with reproductive failure, i.e. 100 couples with a history of 2-4 spontaneous abortions (lot 1) and 200 couples with abortions and one or several dead plurimalformed children (lot 2) were cytogenetically investigated. The incidence of major chromosomal aberrations was 7% (lot 1) and 5.5% (lot 2) and minor aberrations 13% (lot 1) and 5% (lot 2). The mean percentage of chromosmal aberrations in the 300 couples was 6.03%, a figure which is close to the one reported in the literature of the recent years, i.e.6.1%.

Decrease of urinary levels of adrenergic metabolites including conjugated MHPG after a short term course of diethylpropion in obese children fed a mixed, low-calorie diet

A short term course (8-11 days) of diethylpropion 50 mg a day was administered to 12 obese children of both sexes fed a mixed low calorie diet containing about 1000 calories/day. A group of 10 obese children received the same diet and no medication. The sex-distribution was similar in both groups as well as the degree of overweight (appreciated by the Quettelet index). The urinary excretion of some noradrenergic derivative (adrenaline-A, noradrenaline-NA, vanillyl-mandelic acid VMA, metanephrines NM and methoxy hydroxyphenyl glycol-MHPG) and of homovanillic acid (HVA) was measured in both groups before and after drug therapy or diet, respectively. After the diethylpropion course, the urinary mean value of MHPG decreased (2.17 +/- 0.30, mean +/- SE vs 1.47 +/- 0.21) but the significance was borderline. The mean level excretion of NA, VMA, MN and HVA were significantly lower following diethylpropion. No significant change was observed in the diet-only group of patients as regards the same determinations. These observations are not entirely explained by the previous pharmacologic knowledge on diethylpropion and other sympathomimetic amines.

Extra-small marker chromosomes in couples with reproductive failure

From a pre-selected series of couples with reproductive failure, the authors are presenting 4 couples in which one of the members has an extra marker chromosome in mosaic with a normal line. The relationship between the caryotype and the reproductive failure of these couples is discussed.

Morphologic relationships between thyroid carcinoma and associated thyroid lesions in thyroidectomized patients. Comparison between 60 malignancies and 40 non-malignant goiters

Given the endemic goiter in Romania, the authors sought to evaluate the morphologic prognostic factors with histogenetic implications in the development of thyroid cancer. On this purpose, the morphologic factors that correlate the type of thyroid cancer to the host stromal alterations were studied on 3 groups of 20 patients each and 2 control lots for multinodular goiter and nodular goiter. One group consisted of cases of thyroid carcinoma associated with endemic goiter, the second group included cases of thyroid carcinoma with thyroiditis and nodular goiter and the third group, the cases of thyroid sclerosing occult carcinoma. The study showed in all the cases, that thyroid cancer evoluates as an autonomic lesion, independent of the endemic goiter which is not a risk factor.

Thyroglobulin autoantibodies in endocrine diseases

A simple, rapid haemagglutination laboratory kit was developed for the measurement of the thyroglobulin autoantibodies (Tgl-AAb). The Tgl-AAb kit was applied to the measurement of the AAbs titres in the sera collected from 2861 endocrine patients either hospitalized in the Institute of Endocrinology (about 75%) or endocrine outpatients--the great part of patients (over 90%) being however diagnosed as thyroid disorders. The sex classification showed the F/M ratio 6.61/1 for the whole group and 7.4/1 for the positive cases. The prevalence of the Tgl-AAbs positive sera at low titre (under 1:200) is 11.6% about twofold higher than in a population of 700 blood donors (6.4%), previously reported. Among the significant Tgl-AAbs titres, chosen more or less arbitrarily over 1:200, 30.47% of the patients have titres in the range 1:200-1:5000. The Tgl-AAbs positive and negative sera are classified and analysed according to the endocrine pathology but especially thyroid disorders and the positive thyroid disease are grouped by low, high and very high Tgl-AAbs titres and by Tgl-precipitin positive. Our results are rather similar to those reported for endocrine collectivities in other countries. The technical and methodological sources of some discrepancies between the laboratory Tgl-AAbs results and the clinical symptoms and/or anatomo-pathologic results are commented as well as some of the future perspectives of the laboratory investigation of the thyroid autoimmune diseases. Concluding, a strategy schema for a possible immunogram is presented.

The excretion of noradrenergic metabolites, particularly MHPG, in obese children and adolescents

Eighty obese children and adolescents (41 males) aged 4-18 were screened for urinary adrenergic derivatives (NA, A, AVM, MN, MHPG) and the results compared with age- and sex-matched controls. Significantly higher amounts of A (8.1 +/- 0.38 micrograms/24 h), MN (0.327 +/- 0.032 mg/24 h) and MHPG (2.74 +/- 0.192 mg/24 h) were found and significantly linear regression curves of MHPG were plotted against urinary creatinine and NA but not against age, weight and Quettelet index. A subgroup of 26 obese having urinary MHPG over 3 mg/24 h ("high MHPG excretors") revealed significantly greater means of weight Quettelet index, A and NA than the remaining 54--member subgroup ("low MHPG excretors"). It was concluded that in randomly selected obese children and adolescents there are obvious humoral signs of sympathetic nervous system overactivity and, possibly, of adrenomedullary increased tonus and that these manifestations may be due, at least in part, to increased central (encephalic) noradrenergic activity, especially in more overweight patients.

Action of some pesticides on T4 to T3 conversion in cultured kidney and liver cells in the presence or absence of cysteine

The influence of aminotriazole (ATA), atrazine (ATZ), prometryne (P) and ATC on T4 to T3 conversion in kidney and liver cell cultures in the presence or absence of cysteine was studied. The experiment was carried out on cell cultures (rat renal cells and human embryo cells) and organotypic cultures (rat liver cells), treated with the above mentioned pesticides in 2 doses each, in the presence of 1 microgram and 10 micrograms T4 in the culture medium. This experiment was reproduced in the same conditions supplementing the culture medium with 30 mg cysteine per 100 ml culture medium. T3 and T4 in the culture medium were measured by RIA. The proteins in the monolayer cultures were also assayed. Cysteine proved to stimulate T4 to T3 conversion at the level of human and rat kidney cells with little variation depending on the pesticide and the dose applied. Between the activities of the human and the rat cells in the presence of the same pesticide, there were clear differences. The latter are also expressed in the values of proteic synthesis taking place in the renal human embryo cells and rat renal cell cultures under the same influences.

Urinary excretion of catechol metabolites particularly MHPG in children. Relation to age, body mass indices and thyroid function

Determinations of noradrenaline (NA), adrenaline (A), vanillylmandelic acid (VMA), metanephrines (MN), homovanillic acid (HVA) and 3-methoxy-4-hydroxy-phenylglycol (MHPG) were performed in 24 h urine samples of three groups of children: 26 normal children, 7 cases of congenital myxedema (not treated for at least one month) and 8 obese children to whom a short (9-14 days) course of thyroid extract was administered. No sex difference was noted in any group. The results in the control group (mean +/- SE) were as follows: NA 23.8 +/- 2.18 micrograms, A 6.2 +/- 0.35 micrograms, VMA 1.58 +/- 0.22 mg, NM 0.526 +/- 0.079 mg, HVA 1.24 +/- 0.142 mg, MHPG, 1.60 +/- 0.232 mg. The excretion of MHPG was significantly (cor)related to NA (p less than .05) and completely unrelated to the other derivatives. Significant equations and curves were obtained from linear regression analysis of MHPG excretion to age (p less than .025), weight (p less than .025), body surface (p less than .05), and creatinine excretion (p less than .05) but not to height and Quetelet index. No significant change was encountered in both myxedema or thyroid extract-treated obese group in any urinary metabolite determined. It was concluded that in children the urinary MHPG excretion is closely correlated to NA excretion and is linearly dependent on age, weight and creatinine extraction. Thyroid activity seems to have no evident effect on urinary excretion of various catechol metabolites. Suggestion is made that the MHPG (cor)relation(s) found originate(s) in corresponding change(s) of noradrenergic receptor sensitivity within the brain.

Dermatoglyphics in thyroid cancer

Digito-palmar dermatoglyphics in 93 subjects with thyroid cancer (34 males, 59 females) of which 87.1% had folliculo-papillar adenocarcinoma were studied qualitatively and quantitatively. The findings were compared to the dermatoglyphics of 100 males and 100 females from the clinically healthy autochthonous population. The thyroid cancer subjects had a lower total digital ridge count (TDRC) and a reduced number of papillar ridges between the a-d triradii, than the control subjects. The A line showed a more marked transversality in cancer males and a more marked obliquity in cancer females. Qualitative examination showed more patterns in the second interdigital area and a higher incidence of typical and atypical form of sulcus transversus in the cancer group as against the controls. Qualitative and quantitative variations in dermatoglyphics were found with respect to the relation between the anatomo-pathologic form and the A, B, or O blood group. However, this variation is not conclusive enough to support the hypothesis of an association between dermatoglyphics and the blood groups in the A, B, O system on the one hand, and dermatoglyphics and the anatomo-pathologic form of thyroid cancer, on the other.

The "cat eye" syndrome--report of a case with hypothyroidism

Clinical, genetic and endocrine findings in a male patient aged 27, diagnosed as a "Cat Eye" syndrome bearer are presented. Clinically the patient shows: moderate psychic retardation, high forehead, epicanthus, strabismus, microretrognathism, large, low inserted ears, kypho-scoliosis, genu valgum; mild hypothyroidism. Cytogenetic examination reveals the presence of an additional small acrocentric chromosome.

Hyperthyroidism in the elderly. II. Laboratory tests

The paraclinical findings in 100 elderly hyperthyroid patients were analysed. T3-thyrotoxicosis was found in 26% of the patients and T4-thyrotoxicosis in 7.6%. T3-thyrotoxicosis was found in 50% of the cases of toxic adenoma investigated. Hypomagnesiemia and hypocholesterolemia were found in 40.4% and 20.41%, respectively, and low values of Achilles' reflex test were found in 38.4%.

Trisomy 8 syndrome. A report of 2 cases

Two new cases of trisomy 8 mosaicism are reported. Both patients present the "evocative facial traits" of trisomy 8; large square face, everted lower lip, deep skin furrows on the palms and soles, joint rigidity and psychomotor retardation. The whole literature on trisomy 8 is reviewed.

Partial 9p monosomy--a case with hypothyroidism

A 4-yr-old boy with psycho-motor retardation, microcephaly, flat occipital, mongoloid slant, macrostomia with thickened lower lip and long filiform fingers is presented. Cytogenetically, the boy presents a "de novo" terminal 9p deletion. Complex endocrine exploration reveals the presence of hypothyroidism.

Endocrine diagnosis by ultrasound. II. The ovary

With the improvements in the echographic technique achieved over the last 10 years, the echographic diagnosis in ovarian pathology has become more reliable. Understanding of the stages of development of follicles and ovulation has made it possible to control the efficacy of the treatment for infertility in females with ovulation failure, by ovulation inducing drugs and by selecting the best time for fertilization or extraction of the ovum for in vitro fertilization. Echography is at present a screening method for evaluating the gonadal morphologic status in gonadal failure and ovarian tumors.

Primary hyperparathyroidism. Report of a clinical case without bone lesions

A 26-year-old woman was admitted to the Institute of Endocrinology in Bucharest for evaluation of primary hyperparathyroidism (P-HPT). Anamnesis revealed a 10-year history of nephrolithiasis; peptic ulcer, chronic pancreatitis, cholelithiasis. Eight months previously, she had given birth to a child who had neonatal hypocalcaemic tetany. Investigations revealed the presence of moderate hypercalcaemia, hypercalciuria, hypo-phosphoremia; serum chloride level was above 100 mEq/1, and the chloride phosphate ratio was greater than 33. X-ray films of the abdomen revealed the presence of nephrolithiasis and right nephrocalcinosis. Selenium methyonine scanning, ultrasonography and computerized tomography were negative. On surgical exploration a 2-3 cm parathyroid adenoma was removed from between the trachea and the esophagus.

Reactivity of cold thyroid nodule under hormonal influences: study on cell cultures

The authors have studied the reactivity of cold thyroid nodule cells (CN) by comparison with the reactivity of normal thyroid cells (Ty), hot nodules cells (N), Graves' disease cells (G) and cells from the area proximal to cold nodules (TyC), under the influence of increased amounts of T3, TSH, STH, insulin, estradiol and KI present in the culture medium. The experiment lasted for 9-10 days. The study was carried out on monolayer cultures of cells obtained by tripsinization and on organocultures. Proteic synthesis, cytochemical and cytoenzymatic activities in the culture under the influence of the above substances were examined comparatively. After interruption of the treatment, the monolayer cultures were stained with Giemsa and examined by light microscopy. Proteic synthesis and release of Tg, T3 and T4 into the culture medium, were also examined. The organocultures were used in evaluating 125I uptake from the medium under the influence of the treatment. The results showed variation in relation to the tissue and hormone dose applied. It was especially found that TSH and estradiol cause enlargement of CN cell nuclei and an increased number of mitoses and polyploidia which might be premises for possible malignization.

Hyperthyroidism in the elderly. I. Clinical manifestations

The most frequent clinical manifestations in 100 elderly hyperthyroid patients entered in our study were: weight loss (83%), palpitations (85%), nodular goiter (71%) and tremor (74%). Association of weight loss with anorexia and constipation was found in 6% of the patients. The apathetic form of thyrotoxicosis was present in 2% of our patients. Thyrotoxic atrial fibrillation and thyrotoxic heart disease were found in 42% and 51% respectively.

47,XXX/48,XXXX in a retarded three year old girl with multiple somatic anomalies

A 3-year old girl with 47,XXX/48,XXXX caryotype is presented. She suffers from psychomotor retardation, dolichocephaly, malformed ears, "a false air of trisomy 21", malformation of the legs, obesity. The authors discuss briefly the available data on the triplo and tetra X phenotype and syndromes.

The Wolf-Hirschhorn syndrome. New endocrine data

A little girl with the Wolf-Hirschhorn syndrome showing a characteristic essential insomnia was examined clinically, genetically and hormonally. The values of arginin-vasotocin (AVT) implied in producing paradoxical sleep were normal. The relationship between AVT and insomnia is discussed.

Endocrine diagnosis by ultrasound. I. The thyroid, parathyroid and adrenal glands

The value of ultrasounds in diagnosis endocrine disorders and especially in localizing the tumors of the endocrine glands such as the thyroid, parathyroid, ovary and adrenal has been proved. Ultrasounds are also useful in following up the structural changes occurring in these glands after drug or radioisotopic therapy.

Determination of urinary mucopolysaccharides in Graves' disease

Urinary mucopolysaccharides (u MPZ) were determined in 114 patients with thyroid diseases. The values were elevated in 95.8% of patients with Graves' disease with infiltrative ophthalmopathy, and in 66.6% of patients with Graves' disease without clinically manifest infiltrative ophthalmopathy; in the second group of patients we consider that there is a subclinical infiltrative ophthalmopathy. In conclusion, the determination of u MPZ can be considered as a criterion for the diagnosis of Graves' disease in patients with hyperthyroidism without clinically manifest infiltrative ophthalmopathy; in a number of these cases, infiltrative ophthalmopathy may become clinically manifest. For that reason, increased u MPZ can represent a criterion for an eventual delay of an ablative therapy in Graves' disease. It is not a significant statistic difference (p greater than 0.1) between the values of u MPZ in patients with Graves' disease with clinically manifest ophthalmopathy and in those with subclinical infiltrative ophthalmopathy. The thyroid functional status does not influence in any way the values of u MPZ (p greater than 0.1). There is no correlation between the degree of eye protrusion and the values of u MPZ (r = = -0.05)

Fine-needle aspiration biopsy of the thyroid correlated with clinical scintigraphic, echographic and pathologic data in nodular and diffuse goiter

In order to make thyroid aspiration biopsy, a routine diagnostic and therapeutic procedure in the "C. I. Parhon" Institute of Endocrinology, the authors carried out a study on 100 patients with nodular or diffuse goiter. The results were corroborated by clinical, scintigraphic and echographic data. The cytologic diagnosis was compared with the histopathologic one in 50 operated cases and confirmed by the post-therapeutic clinical course in the remaining 50. The study of the cases classified as benign (83%), suspect (6%) and malignant lesions (11%) was made for each individual diagnosis, taking into account the specific clinical, scintigraphic, echographic, and cytologic aspects. The cytology of cold nodules showed that only 30% of the patients required surgery, the rest of them having benign lesions that benefited from puncture and drug therapy. The cytohistologic concordance in malignant tumors was 93.3% (73.3% for certain, 20% with suspicion). The proportion of false negative diagnoses was 6.6% (one case). None of the findings was falsely positive. The advantages of this procedure are discussed.

Diagnosis and treatment of hyperthyroidism in elderly patients

The clinical signs of hyperthyroidism in the elderly are often atypical and have an insidious onset. The hyperkinetic form and the exophthalmic syndrome are rare. Apathetic thyreotoxicosis occurs, with few exceptions, in the elderly. Part of the clinical signs of hyperthyroidism may be erroneously attributed to the normal aging process. Most authors consider radioiodine as the treatment of choice in elderly hyperthyroid patient.

Circadian rhythm of TSH in adult onset non-insulin dependent (type II) diabetics with altered thyroid state

Twenty adult onset non-insulin dependent (Type II) diabetic patients and twenty non-diabetic subjects matched for sex, age, height and weight were studied. The diabetes was controlled by diet only in 10 patients and by oral hypoglycemic agents in 10. All patients were diurnally active and rested at night. Blood was sampled at 4-hour intervals over a 24-hour span (6 samples). TSH, total T3 and total T4 were determined by radioimmunoassay. The circadian rhythm in TSH was statistically significant by cosinor analysis and was comparable in all rhythm parameters in diabetics and non-diabetics. The rhythms of total T3 and T4 also seem to persist with comparable timing although the small number of subjects did not allow rhythm detection at the 5 per cent level in all groups. The circadian mean of the total T3 plasma concentration in the diabetics, however, was statistically significantly lower than the usual range of this laboratory and the total T4 was elevated but within the usual range. The changes in total T3 and T4 were most pronounced in the patients on oral hypoglycemic agents. This study indicates persistence of a circadian rhythm in TSH (and presumably also in the plasma concentrations of total T3 and T4) in non-insulin dependent diabetic patients in spite of a lowered circadian mean concentration of total T3 and a slightly but statistically significantly higher total T4 than in the matched non-diabetic subjects. The altered thyroidal state in the diabetic patients thus does not interfere with the circadian periodic secretion of TSH.

A radioimmunoassay system for human myoglobin: method development and applications

double antibody radioimmunoassay (RIA) system for human myoglobin (hMb) was developed using our own reagents. The antigen (hMb) was isolated from human muscle, purified and stored frozen until needed for immunization, radiolabeling or reference preparation. The anti-hMb serum raised in rabbits was used at 1:2.10(4) dilution (initial). The Chloramine-T method was used for the hMb labeling obtaining at 10-15 muCi/micrograms (370-550 KBq/micrograms) specific activity. Working standards were prepared having concentrations in the range of 2.0 to 500 ng/ml. The reagents were incubated at +4 degrees C for 48 plus 24 hrs. The specificity and accuracy of our hMb-RIA system were validated using for parallel assays an already validated immunochemical system, the hemagglutination inhibition (HI) technique and the parallelism test using serum dilutions from patients with acute myocardial infarction (AMI). The serum hMb concentration in normal subjects (no = 23) was 54.14 +/- 15.08 ng/ml (X +/- SD), being higher in short-term hypothyroidism (no = 13), 87.95 +/- 20.90 ng/ml (p less than 0.0005) or in treated hyperthyroidism (no = 5), 80.03 +/- 21.81 ng/ml. In AMI (no = 6) the serum hMb concentration varied in the range of 123 to 1510 ng/ml. The sensitivity of our hMb-RIA system is 2 ng/ml and the intraassay average error (coefficient of variability % in %B) is 2.26%. Trials to shorten the incubation time showed that adequate binding of labelled Mb may be obtained with 2 plus 4 hr intervals at room temperature. It is necessary to establish, in our conditions, the variation limits for serum hMb in normal subjects according to sex and age as a comparison basis for the study of its physiological and pathological variations.

The anaplastic transformation of differentiated thyroid carcinoma. An ultrastructural study

The authors studied 60 thyroid carcinomas (29 folliculo-papillary carcinomas, 20 follicular carcinomas and 11 undifferentiated carcinomas), using ultrastructural, morphometrical and immunohistochemical methods. The anaplastic transformation correlates with the following aspects: decrease of intercellular junctions and of microvilli together with alteration of cell organelles. Immunohistochemically, thyroglobulin is present in various amounts in differentiated carcinoma, but it is absent in undifferentiated tumors. A good correlation is found between the pattern of thyroglobulin and the ultrastructural aspects of neoplastic cells. The authors consider that anaplastic tumors originate from differentiated carcinomas. The decrease of junctions, the modifications in the number and shape of microvilli, the alterations of cell organelles and the changes of thyroglobulin pattern are the principal parameters involved in the anaplastic transformation. These criteria can be also used in order to ascertain an early diagnosis in the thyroid carcinoma evolving anaplastic changes.

Plasma renin activity (PRA) and plasma aldosterone in the adrenal cortex hyperactivity. Studies on 50 hypertensive patients

The authors have studied on 50 patients hospitalized in the Adrenal Pathology unit of the Institute of Endocrinology, the etiopathogeny of arterial hypertension (AH) in hypercorticism and the therapeutic implications, arriving at the conclusion that in 20% of the cases AH was probably due to an increased activity of renin-angiotensin and in 47% to elevated levels of aldosterone. The authors hypothesize that AH in the remaining 30% of the hypercorticism cases in this study is due to other mineralocorticoids in excess and suggest that the treatment should be pathogenic and strictly individualized.

Results of 131I therapy in hyperthyroidism at 7-18 years of age

Twenty-seven patients aged 7-18 years, with hyperthyroidism and diffuse goite received 131I and 125I in doses of 200-350 muCi/gm of gland. The drug was given in a unique dose to 14 patients and fractioned (maximum 4 doses) to the rest. The total maximum dose was 15 mCi. Doubtless recovery was obtained in 25 cases and probable improvement in another 2 (the patients were lost track of). Exophthalmometric values did not increase in any of the patients and in 2 cases of edematous exophthalmos the protrusion and edema disappeared after this treatment. Clear improvement in the nutritional state occurred and puberty followed a normal course. The incidence of both early and late transient hypothyroidism was 1/25, while permanent hypothyroidism occurred in 5/25. In 5 cases administration of 125I in doses of 500 muCi/gm of gland was not effective and necessitated 131I readministration. It was concluded that radioactive iodine (131 isotope) is an effective radiopharmaceutical for radical treatment of hyperthyroidism in children and adolescents. The therapeutical innocuity of 131I was perfect and the dose of 200-350 muCi/gm of gland was the most adequate. A follow-up of the functional status is however advocated in these patients for detection of late hypothyroidism.

A case of long arm deletion of the X-chromosome in a patient with Turner syndrome

The work presents the clinical and cytogenetic findings in a 16 year-old female-patient with Turnerian phenotype and 46 XX, del(X)(q 13 leads to q ter) caryotype. The authors discuss the difficulties of correlating the caryotype to the phenotype in X chromosome structural aberation cases.