bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and radiological features of patients with macroprolactinaemia
Authors: Strachan Mark W. J. , Teoh Wei Leng , Don‐Wauchope Andrew C. , Seth John , Stoddart Mary , Beckett Geoffrey J. 
Published: August 2003

Summaryobjectives Macroprolactin is a complex of prolactin (PRL) and IgG and may account for a significant proportion of cases of ‘idiopathic hyperprolactinaemia’. In this study, we sought to determine the prevalence and clinical features of macroprolactinaemia in patients diagnosed with hyperprolactinaemia in our region, with a view to determining how patients with macroprolactinaemia should be investigated and managed.patients and methods An Immuno‐1 automated immunoassay system with polyethylene glycol (PEG) precipitation was used to identify macroprolactin, with a recovery of ≤ 50% taken as indicating significant macroprolactinaemia. Macroprolactin was found in 58 (21%) of 273 patients with a total PRL > 700 mU/l. The clinical records of 51 (44 female) were available for retrospective review.results The mean (range) age of patients was 39·5 (18–82) years. The median (range) concentrations for the various forms of PRL were: total PRL 1130 mU/l (728–5116), monomeric PRL 240 mU/l (50–656) and macroprolactin 895 mU/l (381–4854). Classical symptoms of hyperprolactinaemia were present in 39% of patients, although in many there were other possible explanations for their symptomatology. Pituitary adenomas were identified in six out of 36 people who underwent neuroimaging. Five of these patients had a microadenoma and one had a 10‐mm macroadenoma (although, in this patient macroprolactin was identified after the discovery of the tumour). There was no relationship between macroprolactin concentrations and the presence of hyperprolactinaemic symptoms or neuroimaging abnormalities.conclusions Macroprolactinaemia is a common occurrence in patients with hyperprolactinaemia, but associated symptomatology may not necessarily be linked. The neuroimaging abnormalities were also probably incidental findings and it is questionable whether neuroimaging is necessary when significant macroprolactinaemia is identified and the concentration of monomeric PRL is not elevated (using the Immuno‐1 assay system, following PEG precipitation).
Changes in both size and cytological features of thyroid nodule after levothyroxine treatment
Authors: Vermiglio Francesco , Lo Presti Vincenzo Pio , Violi Maria Antonia , Moleti Mariacarla , Castagna Maria Grazia , Finocchiaro Maria Daniela , Mattina Filiberto , Mandolfino Mattia , Zimbaro Giovanni , Trimarchi Francesco 
Published: August 2003

Summaryobjective We prospectively evaluated the effects of 12 months thyrotropin suppressive levo‐thyroxine (L‐T4) therapy in terms of changes in both thyroid nodule size and cytological features and considered whether thyroid nodule size changes actually resulted in (or were the result of) cytological changes.design and patients We studied 142 consecutive patients with benign ‘cold’ solitary thyroid nodules. For the purposes of the study, we divided our patients into three groups according to their initial cytological nodule classification as follows: group 1, including 88 colloid nodules (CN); group 2, including 30 hyperplastic nodules (HN); and group 3, including 24 adenomatous nodules (AN).measurements The effects of TSH suppressive L‐T4 treatment on both nodule volume and cytological characteristics were evaluated by ultrasonography and fine‐needle aspiration (FNA) before and 12 months after the onset of therapy.results Twelve months of TSH suppressive L‐T4 treatment were effective in shrinking about one‐third to one‐quarter (31·8% CN, 26·7% HN and 25% AN) of thyroid nodules, irrespective of their initial cytological characteristics. Similarly, there was no difference in the prevalence of ‘non‐responders’ (increasing nodules) to L‐T4, which accounted for about one‐fifth or less (20·5% CN, 13·3% HN and 20·8% AN) of all nodules. We found also that cytological features changed in 33·8% nodules after 12 months of L‐T4 treatment. These changes were most commonly observed in HN and AN and consisted largely (∼80%) of cytological characteristics resembling colloid features, not only in shrinking but also in stable nodules, thus indicating that cytology changes might be the very first indicator of nodule sensitivity to L‐T4 therapy even in the continued absence of nodule shrinkage. When nodules were divided into three subgroups according to variations in size (shrinking, stable and increasing nodules), we observed that the distribution of the three cytological types showed a trend towards colloid lesions in shrinking nodules (χ2 3·8, P < 0·005) and towards an augmentation of hypercellular, adenomatous and suspicious characteristics in increasing nodules (χ2 3·6, P < 0·005).conclusion The frequency of shrinking nodules was not different between colloid, hyperplastic and adenomatous nodules. Repeat FNA should be advisable for thyroid nodules which increase in volume despite L‐T4 therapy and might also provide useful information about nodule sensitivity to L‐T4 treatment for both HN and AN, even where nodule size remains stable.
Increased expression of endothelin‐1 and its mitogenic receptor ETA in human papillary thyroid carcinoma
Authors: Donckier Julian E. , Michel Luc , Van Beneden Ronald , Delos Monique , Havaux Xavier 
Published: August 2003

Summaryobjective Since the isolation of endothelin‐1 (ET‐1) in 1988, there has been tremendous interest in the pathophysiological roles of ET‐1 as a vasoconstrictive and mitogenic peptide. Whereas ET‐1 is mainly released by vascular endothelial cells, it also proved to be produced by various tissues including the thyroid. Because of its mitogenic properties in malignancy and its role as an inflammatory modulator, ET‐1 could be involved in thyroid carcinogenesis and thyroiditis.design and patients Studies were performed in human thyroid samples obtained at the time of surgery from 39 men and women aged 15–72 years. Thyroid samples were classified in four groups according to conventional histology: normal thyroid (n = 7) papillary thyroid carcinoma (n = 12), Hashimoto's thyroiditis (n = 9) and benign nontoxic nodular goitres (n = 11). Immunohistochemistry and real‐time quantitative polymerase chain reaction were used to determine the expression of ET‐1 and its receptors (ETAR and ETBR).results ET‐1 and ETAR mRNA levels were, respectively, 3·8 ± 1·3 and 4·1 ± 1·5 times greater (P < 0·001) in papillary thyroid carcinoma than in normal thyroid. Expression of ETBR was unaltered. In Hashimoto's thyroiditis, ET‐1 and ETAR were also overexpressed (P < 0·005). Furthermore, immunohistochemistry demonstrated a greater percentage of ET‐1‐positive follicular cells in these conditions (P < 0·001). In nodular goitres, the expression was increased by 1·7 ± 0·7 times (P < 0·05) but expression of receptors remained unchanged.conclusions ET‐1 and ETAR overexpression observed in thyroid carcinoma suggest a mitogenic role of ET‐1 that theoretically could be countered by ETAR antagonists. ET‐1 and ETAR overexpression in thyroiditis supports a role of ET‐1 in the inflammatory process.
Accuracy of ultrasonography to establish the diagnosis and aetiology of permanent primary congenital hypothyroidism
Authors: Kreisner E. , Camargo‐Neto E. , Maia C. R. , Gross J. L. 
Published: August 2003

Summaryobjective To compare ultrasonography and 99mTc thyroid scintigraphy for the aetiologic diagnosis of permanent congenital hypothyroidism (CH).study design Eighty‐eight consecutive patients with CH were recruited at an endocrinology outpatient clinic and submitted to high‐frequency ultrasonography and to 99mTc scintigraphy.results Seventy‐six patients were diagnosed with permanent CH and 12 with transitory CH. The agreement between ultrasound and scintigraphy was very high (kappa coefficient = 0·866; P < 0·001) for the entire group. In permanent CH patients, ultrasonography identified 67 cases of dysgenesis (absence of thyroid gland in the usual anatomical location in 66 and hemiagenesis in one), and this diagnosis was confirmed by scintigraphy (absence of functional thyroid tissue in 43 and ectopia in 24). In the other nine permanent CH patients, the thyroid was in the usual anatomical location on ultrasonography but scintigraphy did not identify functional tissue in one patient. In the 12 transitory CH patients, a normally shaped thyroid was detected by ultrasound in the usual location, whereas scintigraphy showed absence of functional tissue in two identical twins and scarce concentration of isotope in a third patient.conclusion Ultrasonography is an accurate method to establish the presence of dysgenesis and might be used as the first imaging tool in patients with CH, whereas scintigraphy should be used mainly to distinguish agenesis from ectopia. Further examination is required to differentiate permanent CH with a normally located and shaped gland from transitory hypothyroidism.
An investigation of fetal, postnatal and childhood growth with insulin‐like growth factor I and binding protein 3 in adulthood
Authors: Ben‐Shlomo Y. , Holly J. , McCarthy A. , Savage P. , Davies D. , Gunnell D. , Davey Smith G. 
Published: August 2003

Summaryobjective Weight at birth and adult height are positively associated with cancer risk. These patterns may be mediated by the insulin‐like growth factor (IGF) axis. We have examined whether pre‐ and postnatal growth patterns have a long‐term influence on adult IGF‐I and IGFBP‐3 levels.design A follow‐up study of a randomized controlled trial of milk supplementation in pregnancy and childhood.subjects A total of 951 individuals took part in a study of diet and growth in South Wales between 1972 and 1974 followed up from birth until their mid‐20s.measurements Anthopometric measures at birth, postnatally up to 5 years of age and in adulthood, and serum measures of IGF‐I and IGF‐I to IGFBP‐3 ratio at mean age of 25 years.results A total of 63 subjects (70%) provided blood for analysis. We found no association between birth dimensions and adult IGF‐I. Subjects who exhibited ‘catch‐down growth’ had lower IGF‐I levels (P‐value for trend 0·02). Adult height was positively related to IGF‐I, for every one standard deviation increase in adult height, IGF‐I increased by 3·75 ng/dl (95% CI 0·46–7·08, P = 0·03). Adiposity was inversely associated with the IGF‐I and IGF‐I to IGFBP‐3 ratio and positively associated with IGFBP‐3. The strength of the associations increased with age. Downward centile crossing at any time in childhood was associated with lower IGF‐I whilst the highest levels were observed in subjects who were tall throughout their early life course. Adult height remained a significant predictor of IGF‐I even after adjustment for earlier growth.conclusions Our results indicate that IGF‐I levels in early adulthood are associated with patterns of childhood growth as well as adult stature and adiposity. These associations suggest the IGFs may contribute to anthropometric associations with cancer risk.
Obstructive sleep apnoea syndrome impairs insulin sensitivity independently of anthropometric variables
Authors: Tassone Francesco , Lanfranco Fabio , Gianotti Laura , Pivetti Sonia , Navone Fabrizia , Rossetto Ruth , Grottoli Silvia , Gai Valerio , Ghigo Ezio , Maccario Mauro 
Published: August 2003

Summaryobjectives Obstructive sleep apnoea syndrome (OSAS) is strongly associated with obesity and characterized by endocrine and metabolic changes including impairment of insulin sensitivity. The aim of this study was to further clarify the insulin dynamics and glucose metabolism in this condition.design, patients and measurements We studied 30 obese patients with OSAS [OSA, 21 males, 9 females; age, mean ± SEM: 53·1 ± 1·7 years; body mass index (BMI): 38·6 ± 1·1 kg/m2; waist‐to‐hip ratio (WHR): 0·99 ± 0·07; Apnoea/Hypopnoea Index (AHI): 40·5 ± 5·8 events/h of sleep] by means of overnight polysomnography and oral glucose tolerance testing. Mathematical models were used to assess: (i) whole‐body insulin sensitivity index (ISI composite); (ii) hepatic ISI; (iii) the first phase of insulin secretion (ΔI30′−0′/ΔG30′−0′). Results were compared with those in 27 weight‐matched patients with simple obesity (OB, 12 males, 15 females; age: 48·1 ± 2·8 years, BMI: 38·5 ± 1·4 kg/m2, WHR: 0·94 ± 0·09; AHI: 2·15 ± 0·5 events/h of sleep) and with 20 normal subjects (NS, 15 females; 5 males, age: 40·4 ± 2·9 years; BMI: 22·2 ± 0·6 kg/m2).results ISI composite value was significantly lower in OSAS (1·71 ± 1·41) than in OB (3·08 ± 0·27) and in NS (6·1 ± 0·4) even after age‐, BMI‐ and WHR‐adjustment. Similarly, hepatic ISI was significantly different among the three groups (OB = 0·25 ± 0·02, OSAS = 0·16 ± 0·014 and NS = 0·55 ± 0·04). Sex did not affect ISI indices. Insulin secretion estimates were not significantly different among the three groups.discussion Obese patients with obstructive sleep apnoea syndrome are more insulin resistant than patients with simple obesity independently of the degree and distribution of adiposity. The worsening in insulin sensitivity in obstructive sleep apnoea syndrome patients could reflect the hypoxic state and would account for the increased vascular risk in this condition.
Relationship between longitudinal behaviour of some markers of eye autoimmunity and changes in ocular findings in patients with Graves’ ophthalmopathy receiving corticosteroid therapy
Authors: De Bellis Annamaria , Bizzarro Antonio , Conte Marisa , Coronella Concetta , Solimeno Stefano , Perrino Silvia , Sansone Daniela , Guaglione Mariangela , Wall Jack R. , Bellastella Antonio 
Published: August 2003

Summaryobjective To investigate whether variations over time of TSH‐receptor antibodies (TRAb) and antibodies against G2s (G2sAb) and extraocular muscles (EMAb) can predict worsening of ophthalmopathy in Graves’ patients treated with intravenous glucocorticoid (IVGC) therapy.patients Of 65 consecutive patients with treated Graves’ disease and severe and active ophthalmopathy (GO) chosen to undergo IVGC treatment, only 57 patients, persistently euthyroid under methimazole therapy, were studied longitudinally for ocular parameters, TRAb, G2sAb and EMAb before therapy, at the end of therapy and, subsequently, every month for 21 months.measurements TRAb was detected by radioimmunoassay (RIA), G2sAb by enzyme‐linked immunosorbent assay (ELISA) and EMAb by indirect immunofluorescence.results Forty‐three out of 57 patients (75·4%, group 1) responded positively to therapy [improvement in diplopia and decrease in proptosis and clinical activity score (CAS)] but 14 (24·6%) did not (group 2). During follow‐up after IVGC therapy, 12 out of 43 patients in group 1 (28%) showed a worsening in GO (group 1a), while 31 (72%) had stable ocular conditions or further improvement (group 1b). At the start of the study, TRAb, G2sAb and EMAb were not significantly different among the three groups. At the end of IVGC therapy TRAb levels decreased significantly with respect to starting values in all three groups of patients, whereas G2sAb and EMAb decreased significantly in groups 1a and 1b but not in group 2. During the subsequent follow‐up, 10 patients in group 1a one/two months before and all 12 patients at the time of GO worsening showed an increase in G2sAb and EMAb but not in TRAb, which were consistently absent or present at low titre in all patients in this group. In group 1b TRAb, G2sAb and EMAb further decreased or became negative during the follow‐up period. In all patients, TRAb were positively correlated with both CAS and proptosis only at the start of the study; by contrast, a significant correlation between both G2sAb and EMAb and diplopia was observed in groups 1a and 1b at all the times during the study, except one/two months before the worsening of GO in group 1a.conclusions Our results indicate that TRAb, G2sAb and EMAb can be considered sensitive markers of Graves’ ophthalmopathy during the initial stages of ophthalmopathy, but that only G2sAb and EMAb seem to be good predictive markers of the outcome in patients after corticosteroid therapy. Thus, taking into account the cost/benefit ratio, a longitudinal evaluation of either EMAb or G2sAb could be useful in monitoring the intravenous glucocorticoid therapy in patients with severe and active ophthalmopathy to predict a possible worsening of Graves’ ophthalmopathy.
Risk factors for and prevalence of thyroid disorders in a cross‐sectional study among healthy female relatives of patients with autoimmune thyroid disease
Authors: Strieder Thea G. A. , Prummel Mark F. , Tijssen Jan G. P. , Endert Eric , Wiersinga Wilmar M. 
Published: August 2003

Summaryobjective Autoimmune thyroid disease (AITD) is a common disorder especially in women, and both genetic and environmental factors are involved in its pathogenesis. We wanted to gain more insight into the contribution of various environmental factors. Therefore, we started a large prospective cohort study in subjects at risk of developing AITD, for example healthy female relatives of AITD patients. Here we report on their baseline characteristics.subjects Only first‐ or second‐degree female relatives of patients with documented AITD were included.measurements Smoking habits, oestrogen use, pregnancy history and iodine exposure were assessed by questionnaires, and correlated to the thyroid function and antibody status.results Of 803 subjects, 440 came from families with more than one patient with documented AITD. Of these families, 33% had documented cases of both Graves’ disease and Hashimoto's thyroiditis. Although the subjects were in self‐proclaimed good health, 3·6% were found to have hypothyroidism (overt disease in 1·3%) and 1·9% had hyperthyroidism (overt disease in 0·4%). These patients were older than the euthyroid subjects and were mostly positive for thyroid peroxidase (TPO) antibodies. Oestrogen use was associated with a lower rate of hyperthyroidism [relative risk (RR) 0·169; 95% confidence interval (CI) 0·06–0·52], whereas having been pregnant was associated with a higher relative risk for hyperthyroidism (RR 6·88; 95% CI 1·50–30·96). Of the 759 euthyroid subjects, 24% had TPO antibodies. Smoking and oestrogen use were negatively correlated with the presence of TPO antibodies. In the euthyroid subjects, TPO antibody titre correlated positively with TSH levels (r = 0·386; P < 0·001).conclusions The high prevalence of evidence for autoimmune thyroiditis at baseline supports the importance of genetic factors in its pathogenesis. The co‐occurrence of Hashimoto's thyroiditis and Graves’ disease within one family suggests a common genetic basis for these diseases. Oestrogen use is associated with a lower risk, and pregnancy with a higher risk for developing hyperthyroidism. The positive correlation between TPO antibody titres and TSH levels in euthyroid subjects suggests that TPO antibodies are indeed a marker of future thyroid failure.
Time management strategies in nursing practice
Authors: Waterworth Susan 
Published: August 2003

Background. With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation.Aim. To explore how nurses organize and manage their time.Methods. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi‐structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995–1999.Findings. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice.Conclusions. Ignoring the influence of ‘others’, the team and the organization perpetuates a rather individualistic and self‐critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co‐ordinating of care involving other health care workers.
The ideal attributes of Chief Nurses in Europe: a Delphi study
Authors: Hennessy Deborah , Hicks Carolyn 
Published: August 2003

Background. Policy decisions to advance the role of Chief Nurse in member countries of the World Health Organization European Region will necessitate the systematic selection and recruitment of suitable postholders who can develop the role and status of nursing within a wide range of political frameworks and structures. Such posts are clearly of great importance for providing appropriate care through strategic and policy decisions, both nationally and internationally. The appointment and development of suitable personnel are, therefore, essential elements in the success of these roles. To date, no information exists about the qualities and attributes required for effective delivery of the Chief Nurse role.Aim. To identify the characteristics considered to be most relevant in a Chief Nurse, in order to inform and systematize recruitment.Method. A Delphi study was undertaken of 22 European member states. Consensus was reached by the second round, in which 12 countries participated.Results. Sixteen relevant qualities were identified and listed in order of importance.Of the eight countries for which statistical analysis was possible, seven demonstrated a significant level of accord [Belgium, Denmark, the Netherlands, the United Kingdom (UK), Iceland, Sweden, Hungary and Switzerland], with only Finland showing no intra‐country agreement.Conclusions. To the extent that there is a high level of inter and intra‐country consensus on the desirable qualities of Chief Nurses, these could be used to inform the future systematic selection and operational development of this role in European member states.
Critical realism and psychiatric nursing: a philosophical inquiry
Authors: Littlejohn Christopher 
Published: August 2003

Background. There is a tension within contemporary psychiatric nursing between those who would embrace the knowledge and methods of psychiatry and psychology, and those who instead argue for the development of an autonomous nursing profession. This tension cannot be resolved by way of the underpinning philosophies of these positions, namely empiricism and idealism. Instead, critical realism, positioned between these philosophies offers a methodology through which to seek a new paradigm.Aim. This paper aims to determine whether psychiatric nursing has the potential to exist as an independent and autonomous profession, concerned with providing a helping response to those in mental distress.Method. The paper asks critical realism's transcendental question in order to identify the a priori requirements of an autonomous psychiatric nursing, independent of both psychiatry and psychology. Consideration of these a priori requirements includes selected information from contemporary texts in order to identify potentially helpful nursing responses to mental distress, as opposed to the theorising that surrounds these helping responses.Findings. The theories of psychiatry and psychology are neither necessary nor sufficient in providing a foundation for an autonomous psychiatric nursing. While medications have an intrinsic helpfulness for some people, for some of their problems, for some of the time, this does not illuminate the causes of mental distress. There is an intrinsic helping response in human interpersonal communication, yet this is not specific to ‘psychotherapy’ and does not ‘belong’ solely to psychotherapists.Conclusion. Support is found for an autonomous and independent profession of psychiatric nursing, able to provide a helping response to those in mental distress independent of psychiatry and psychology.