bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre‐clinical Cushing's syndrome: an unexpected frequent cause of poor glycaemic control in obese diabetic patients
Authors: Leibowitz Gil , Tsur Anat , Chayen Susan D. , Salameh Mohammad , Raz Itamar , Cerasi Erol , Gross David J. 
Published: November 2003

OBJECTIVE Autonomous cortisol secretion without clinical stigmata of Cushing's syndrome (CS) has been recently recognized and termed pre‐clinical or sub‐clinical CS. The common assumption is that CS is an extremely rare cause of uncontrolled diabetes; however, the prevalence of this entity has not been studied. We assessed the prevalence of pre‐clinical CS among obese patients with uncontrolled diabetes. PATIENTS AND DESIGN (1) In a retrospective analysis, the medical records of 63 patients with endogenous CS were reviewed. (2) In a cross‐sectional study, 90 obese patients (BMI >25 kg/m2) followed in a University Hospital and the local Health Fund endocrine and diabetes clinics, with poorly controlled diabetes (glycosylated haemoglobin >9%), underwent an overnight 1 mg dexamethasone suppression. In patients with non‐suppressible cortisol levels (>140 nmol/l), Liddle's 2 and 8 mg dexamethasone suppression tests and imaging studies were performed. MEASUREMENTS The prevalence of poorly controlled diabetes, the major presenting symptom of CS, was assessed in the retrospective analysis. The prevalence of ‘true’ CS and the false positive rate in the overnight dexamethasone suppression test were calculated. The endocrine evaluation of the patients with pre‐clinical CS and the effects of surgical cure on glycaemic control are described. RESULTS In the retrospective analysis, 11 (17.5%) had diabetes and 2 (3.2%) lacked the classic physical characteristics of the syndrome. In the cross‐sectional study, 4 patients failed to suppress plasma cortisol (<140 nmol/l). In one patient the diagnosis of CS was not confirmed by a standard Liddle’s test and was therefore considered false positive. In the other 3, the diagnosis of CS was confirmed (prevalence of 3.3%, 95% confidence interval 1–9%). In all other patients the overnight cortisol suppression test was normal (cortisol level 47.3 ± 2.5 nmol/l (mean ± SEM)). After surgical treatment of CS, glycaemic control was markedly improved in all 5 patients (2 from retrospective and 3 from cross‐sectional studies). CONCLUSIONS The prevalence of pre‐clinical Cushing's syndrome in obese patients with poorly controlled diabetes appears to be considerably higher than previously believed. The overnight dexamethasone suppression test proved to be a simple, sensitive and highly specific screening test for Cushing's syndrome despite the presence of obesity and hyperglycaemia.
The outcome of hypophysectomy for prolactinomas in the era of dopamine agonist therapy
Authors: Soule Steven G. , Farhi Jacob , Conway Gerard S. , Jacobs Howard S. , Powell Michael 
Published: November 2003

OBJECTIVE Dopamine agonists are the primary therapeutic modality for the majority of patients with prolactinomas, with pituitary surgery reserved for those patients intolerant of or resistant to these agents. Most published surgical series, however, contain patients treated by surgery as the primary therapeutic modality. Previous exposure to dopamine agonists or the selection of patients with prolactinomas resistant to conventional therapy may potentially compromise the surgical success rate. The purpose of this study was to evaluate the efficacy and safety of pituitary surgery for prolactinomas in a tertiary referral centre where the majority of patients were operated on after treatment with dopamine agonists. DESIGN A retrospective review of the outcome of pituitary surgery for prolactinomas performed at a tertiary neurosurgical centre by a single neurosurgeon. PATIENTS Twenty‐three patients underwent excision of a macro and 11 excision of a micro‐prolactinoma. MEASUREMENTS Pituitary tumour diameter was determined by CT or MRI imaging. Pre and post‐operative measurements were made of serum PRL concentration (off dopamine agonist therapy), free T4, free T3, LH and testosterone (males). Post‐operative restoration of a menstrual cycle was taken to indicate resolution of hypogonadism in female patients. RESULTS The majority (73.9%) of the patients with macro and all with micro‐prolactinomas had received dopamine agonists preoperatively. Of the 23 patients with macroprolactinomas, in whom the median pre‐operative PRL concentration was 13255 mU/l, 17 (73.9%) had radiological evidence of suprasellar extension and 5 (21.7%) cavernous sinus invasion. Only 4 (17.4%) of the patients with macroprolactinomas had a normal serum PRL post‐operatively, although there was an improvement in visual fields in 66% of those with preoperative defects. The median preoperative PRL concentration was 4309 mU/l in the patients with microprolactinomas, significantly lower than in the macroprolactinoma group (P = 0.02). Despite a significant fall in serum PRL post‐operatively (median PRL 860 mU/l, P = 0.0001), only 45.5% of patients had a normal serum PRL concentration after surgery. CONCLUSIONS The cure rate following pituitary surgery for prolactinomas in a tertiary referral centre was low when compared with previous series in which surgery was used as the primary therapeutic modality. We suggest this may result both from dopamine agonist pretreatment and the referral of prolactinomas resistant to conventional therapy. The outcome is probably a more realistic reflection of the results of pituitary surgery for prolactinomas as currently practised in the majority of neuroendocrine centres.
Glucose tolerance, insulin secretion, insulin sensitivity and glucose effectiveness in normal and overweight hyperthyroid women
Authors: Gonzalo Ma. Angeles , Grant Carlos , Moreno Inmaculada , Garcia Fernando J. , Suárez Ana Isabel , Herrera‐Pombo Jose Luis , Rovira Adela 
Published: November 2003

OBJECTIVE Inter‐relationships between insulin sensi‐tivity and body weight in patients with hyperthyroidism remain incompletely understood. We have examined whether a mild excess of body weight exacerbates the metabolic abnormalities of spontaneous hyperthyroidism. DESIGN AND PATIENTS Insulin‐modified intravenous glucose tolerance tests were performed on 14 hyperthy‐roid women with body mass indices (BMI) ranging from 21 to 31 kg/m2. A control group of 19 healthy women matched for age and BMI was also studied. MEASUREMENTS Intravenous glucose tolerance (KG), first and second‐phase integrated insulin responses to glucose, the integrated glucose area under the curve (AUC), and minimal model parameters of insulin sensitivity (SI) and glucose effectiveness (SG) were determined. RESULTS Hyperthyroid women had mean KG, glucose‐induced insulin secretion and SG values similar to those in control women. The mean glucose AUC was higher in hyperthyroid patients (P<0.05). Lower insulin sensitivity was observed in hyperthyroid patients than in control women (SI=0.38±0.07 vs 0.59±0.07 l/min pmol 104 (mean±SEM), P<0.05). A steeper decline in insulin sensitivity with increase in body mass index was found in hyperthyroid women when compared with the control group, after adjusting for age. When groups were compared according to their BMI, hyperthyroid women with normal weight (BMI≤25 kg/m2, n=8) had mean KG, insulin response to glucose, glucose AUC, SG and SI values similar to those in normal weight control women (n=11). Overweight hyperthyroid patients (BMI>25 kg/m2, n=6) had a higher (P<0.05) second‐phase insulin response to glucose than normal weight patients, a higher glucose AUC (P<0.05) than normal weight patients and overweight controls (n=8), and a lower SI (P<0.05) than normal weight patients and overweight controls. SG was not influenced by BMI in hyperthyroid patients. CONCLUSIONS These results suggest that overall glucose tolerance was not significantly affected in normal weight hyperthyroid women. However, when a moderate excess of weight is also present, a state of clear insulin resistance occurs.
Circulating inhibins and activin A during GnRH‐analogue down‐regulation and ovarian hyperstimulation with recombinant FSH for in‐vitro fertilization‐embryo transfer
Authors: Lockwood G. M. , Muttukrishna S. , Groome N. P. , Knight P. G. , Ledger W. L. 
Published: November 2003

OBJECTIVE We have investigated serial changes in plasma concentrations of inhibin A, inhibin B, pro αC and activin A in women undergoing stimulation with recombinant FSH in ‘long‐protocol’ down‐regulated cycles of IVF treatment. DESIGN Blood samples were collected during the entire IVF treatment cycle at points coinciding with the early follicular phase of the cycle preceding treatment, pituitary down‐regulation, stimulation with recombinant FSH, ovulatory triggering, and the luteal phase of the cycle. In patients who achieved conception, blood samples were also taken during the first 2 weeks of pregnancy. All samples were analysed for inhibin A, inhibin B, pro αC, activin A and oestradiol. PATIENTS Fifteen women with normal ovarian function undergoing IVF treatment with tubal factor, mild endometriosis or idiopathic infertility. RESULTS During pituitary desensitization, both inhibin A and inhibin B were significantly (P<0.001, P=0.002, respectively) reduced whereas levels of pro αC and activin A were largely unaltered. Levels of both inhibins rose markedly (P<0.01) during FSH stimulation and a further rise in inhibin A was detected on the day after ovulatory trigger. Levels of both inhibin A and inhibin B then fell during and after oocyte pickup and continued to fall during the luteal phase. Activin A levels rose less markedly during gonadotrophin stimulation. Statistical analysis showed a high degree of correlation between the number of follicles (>10 mm) and serum inhibin A (r=0.65, P<0.01) and pro αC (r=0.65, P<0.01) concentrations during the late follicular phase. CONCLUSIONS These results indicate that ovarian production of dimeric inhibin A and B are gonadotrophin dependent, whereas activin A may have a significant gonadotrophin independent or extra‐gonadal source. Inhibin A and pro αC may be useful markers for monitoring the effects of gonadotrophin stimulation.
Size at birth and adrenocortical function in childhood
Authors: Clark Phillipa M. , Hindmarsh Peter C. , Shiell Alistair W. , Law Catherine M. , Honour John W. , Barker David J. P. 
Published: November 2003

OBJECTIVE The mechanisms underlying the association between reduced size at birth and cardiovascular disease and non‐insulin‐dependent diabetes mellitus in adult life are not known. One possibility is that the intra‐uterine environment has permanent effects on the function or activity of the hypothalamo‐pituitary‐adrenal axis. We tested this by relating size at birth to the urinary excretion of adrenal androgen and glucocorticoid metabolites in a population sample of 9‐year‐old children. SUBJECTS AND METHODS One hundred and ninety children (89 boys and 101 girls) of known present height, weight and size at birth collected a 24‐hour urine sample. The urinary breakdown products of dehydroepiandrosterone sulphate and of cortisol and cortisone were measured by gas chromatography and their respective breakdown products summed (‘adrenal androgen metabolites’ and ‘glucocorticoid metabolites’). Excretion was expressed in μg/day. RESULTS Urinary adrenal androgen metabolite excretion was higher in children who had been light at birth. A 1‐kg decrease in birthweight was associated with a 40% (95% CI 9–79%) increase in metabolite excretion. Excretion was positively associated with current weight and age, but the relation with birth weight was independent of weight, age or sex. Urinary glucocorticoid metabolite excretion was positively associated with current weight, but not independently with age. The urinary excretion of total glucocorticoid metabolites was higher in children who had been light at birth, but the relation was best described as U‐shaped, with the highest average urinary glucocorticoid metabolite excretion being found in children who had been either light or heavy at birth. The U‐shaped (quadratic) relation persisted after adjustment for sex and current weight (P for quadratic term 0.006). CONCLUSION These findings suggests that the intra‐uterine environment, as measured by fetal size at birth, has long‐lasting effects on the function of the hypothalamo‐pituitary‐adrenal axis.
Decreased nocturnal melatonin secretion in patients with Klinefelter's syndrome
Authors: Luboshitzky Rafael , Wagner Oded , Lavi Schachar , Herer Paula , Lavie Peretz 
Published: November 2003

OBJECTIVE We have recently demonstrated that GnRH deficient male patients have increased nocturnal melatonin secretion which decreases to normal levels during testosterone treatment. The results suggested that sex steroids, rather than LH, modulate pineal melatonin in an inverse fashion. The purpose of this study was to characterize circulating melatonin levels in untreated males with hypergonadotrophic hypogonadism due to Klinefelter’s syndrome (KS). DESIGNS Prospective, controlled. SUBJECTS Eleven patients with Klinefelter’s syndrome and seven controls. Patients were subdivided into two groups: (1) with low testosterone, and (2) with normal testosterone levels. MEASUREMENTS Serum samples for melatonin concentrations were obtained every 15 minutes from 1900 to 0700 h in a controlled light–dark environment. RESULTS All patients had elevated FSH, LH and oestradiol (E2) levels. Mean (±SD) dark time nocturnal melatonin levels were significantly lower in low testosterone KS (92±19 pmol/l) compared with 146±42 pmol/l in normal testosterone KS and 179±59 pmol/l in controls (P<0.02). A similar pattern was observed for the mean (±SD) peak melatonin levels (165±41, 236±59 and 293±89 pmol/l) in low testosterone KS, normal testosterone KS and controls, respectively (P<0.01). Integrated nocturnal melatonin secretion values (AUC) were also lower in low testosterone KS (64±13) compared with 96±26 in normal testosterone KS and 116±39 pmol/min l×103 in controls (P<0.02). The time of melatonin peak and the time of the nocturnal melatonin rise as well as the light‐time mean (±SD) serum melatonin levels were similar in all three groups. No correlations were found between melatonin and LH, FSH, or E2 levels. CONCLUSIONS Melatonin secretion is decreased in male patients with low testosterone hypergonadotrophic hypogonadism whereas in normal testosterone Klinefelter's syndrome patients, melatonin secretory profiles are normal. The results suggest that the suppression of melatonin secretion in these patients is mediated by GnRH (either directly or indirectly) and/or oestradiol.
EFFECTS OF TRAPIDIL ON THE HEALING OF COLONIC ANASTOMOSES IN AN EXPERIMENTAL RAT MODEL
Authors: Colak Tahsin , Nayci Ali , Polat Gurbuz , Polat Ayse , Comelekoglu Ulku , Kanik Arzu , Turkmenoglu Ozgur , Aydin Suha 
Published: November 2003

Background:  Trapidil has various properties including vasodilatation, inhibition of lipid peroxidation and platelet aggregation as well as, and reduction of, the inflammatory response to injury. The aim of the present study was to investigate the effects of trapidil on dexamethasone‐impaired colonic anastomotic healing in an experimental rat model.Methods:  Twenty‐four Wistar rats underwent colonic transsection and primary anastomosis. Rats were divided into four groups of six: group 1 (G1), control; group 2 (G2) trapidil, 8 mg/kg per day intravenously; group 3 (G3) dexamethasone, 0.1 mg/kg per day intramuscularly; and group 4 (G4) dexamethasone 0.1 mg/kg intramuscularly and trapidil 8 mg/kg intravenously per day, for 1 week. Anastomotic bursting pressure, hydroxyproline level, histopathological grading, malondialdehyde and nitrite/nitrate levels were determined.Results:  Dexamethasone‐impaired anastomotic healing was found to be improved by trapidil administration in terms of anastomotic bursting pressure and hydroxyproline content (P = 0.026, and P = 0.017). In addition, histopathological examination revealed an increase in fibroblast proliferation and collagen deposition (P = 0.004, and P = 0.015) and a decrease in leucocyte infiltration (P = 0.004). Moreover, serum nitrite/nitrate and malondialdehyde levels decreased when G3 was compared to G4 (P < 0.001, P= 0.38).Conclusions:  Trapidil may improve the dexamethasone‐impaired anastomotic healing due to its preventive effects on inflammatory response and lipid peroxidation in rats.
ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY: IMPLICATIONS OF PROLONGED WAITING TIMES FOR SURGERY
Authors: Lawrentschuk Nathan , Hewitt Peter M. , Pritchard Michael G. 
Published: November 2003

Background:  The aim of the present study was to assess the impact of surgical waiting times on patients scheduled for elective laparoscopic cholecystectomy (LC), with emphasis on morbidity and costs incurred.Methods:  A retrospective review of all patients who underwent cholecystectomy at the Launceston General Hospital between 1 January 1999 and 31 December 2001 was performed.Results: A total of 322 LCs was performed during the study period. Median time on the waiting list was 130 (1−1481) days. While awaiting surgery, 44/322 patients (14%) re‐presented to the emergency department with biliary symptoms (89 separate presentations); 21 patients (6%) were admitted (28 admissions), of whom 18 (86%) were on the waiting list for biliary colic symptoms only. Reasons for emergency admission included pancreatitis (1), cholangitis (3), choledocholithiasis (7), cholecystitis (7), and exacerbation of symptoms (10). Median hospital stay was 4 days (1−14 days) (total cost of 124 hospital days, excluding subsequent admission for cholecystectomy, $A128 712 according to average bed day costs), and 11 patients required endoscopic retrograde cholangiopancreatography (13 procedures). Mean (median) time on the surgical waiting list for patients who developed complications was 238 (203) days versus 185 (126) days for patients who had LC without interval complications. A total of 198 cancellations occurred in 124/322 patients (39%) before surgery.Conclusions:  Prolonged waiting times for elective LC are associated with morbidity in 14% of patients at the Launceston General Hospital. This, combined with frequent cancellation of elective surgery, may result in significant costs to the health‐care sector.
DOES NECK EXTENSION ELEVATE THE THYROID GLAND CEPHALAD TO POTENTIALLY IMPROVE ACCESS DURING THYROIDECTOMY?
Authors: Serpell Jonathan W. , Grodski Simon F. A. , O'Donell Christopher 
Published: November 2003

Background:  Patients undergoing thyroidectomy are positioned with the neck extended to facilitate exposure of the neck. Computed tomography (CT) scanning of the thyroid, without i.v. contrast, is often used preoperatively to investigate the extent of large goitres. Currently, patients are scanned in the neutral position rather than the surgical position of neck extension. The aim of the present study was to determine the degree, if any, of movement of the thyroid, as measured by CT, achieved by neck extension.Methods:  A trial was designed using CT scanning of the neck. Fourteen patients were studied. Patients attended for the usual CT thyroid. In addition, they were then rescanned with their neck extended. The position of the inferior aspect of the gland in relation to the sternal notch was measured in both positions. The degree of neck extension was measured and correlated with the extent of thyroid gland movement. The data were analysed with the Wilcoxon signed rank test and Spearman correlation coefficients.Results:  Results showed a median difference between the two positions of 5 mm (P = 0.0002).Conclusion:  The minimal cephalad movement of the thyroid achieved by neck extension, although statistically significant, is of doubtful clinical use, and overextension of the neck should be avoided because of its associated risks of pain, vomiting and spinal damage.
Methods for crack opening load and crack tip shielding determination: a review
Authors: STOYCHEV and S. , KUJAWSKI D. 
Published: November 2003

ABSTRACTIn this paper a review of the literature on crack closure/opening load and crack tip shielding effects determination methods is presented. Commonly used ‘subjective’ (visual) and ‘non‐subjective’ approaches have been included. Procedures associated with the determination of an effective crack driving force for both Elber type and that of partial (or incremental) crack closure models have been covered. Comparison among different methods of analyses based on compliance and fatigue crack growth rate measurements is discussed together with their implications and difficulties in fatigue crack growth correlations.
Identification of patients requiring out‐patient follow‐up after transurethral prostatectomy: is there a role for nurse‐led screening of post‐operative outcomes by telephone?
Authors: Brough R. J. , Pidd H. , O'Flynn K. J. , Payne S. R. 
Published: November 2003

Objective To determine the most efficient method to follow patients after transurethral prostatectomy (TURP) such that only those patients suffering significant post‐operative problems are reviewed. Patients and methods The study comprised two parts: (1) a retrospective review of the case notes of 100 consecutive patients who underwent TURP under one consultant to determine whether any factors could be identified pre‐ or post‐operatively by which those patients most likely to require clinic review could be selected and; (2) a prospective review of the succeeding 100 patients undergoing TURP, using a telephone ‘screening’ call made by the urological research nurse 3 months after the operation. Patients who requested follow‐up and those patients with malignancy or admitted in high‐pressure chronic retention were reviewed in the out‐patient department. Results In the first part, 17 patients (17%) required an out‐patient review for malignancy. Only nine patients (11%) with benign histology required further treatment after TURP; this subgroup could not be identified on the basis of their pre‐ or post‐operative symptoms. In the second part, 23 patients were not reviewed by telephone; 14 had carcinoma of the prostate, eight had no telephone and one could not be contacted after seven attempts. Of the remaining 77 contacted by ‘phone, 61 (79%) declined further clinic review and 16 (21%) requested follow‐up for persistent problems. A mean of two calls was made per patient and the mean duration of each call was 6.3 min. Conclusions Based on pre‐ or post‐operative symptoms at the time of discharge, there is no reliable method of identifying those patients who have a poor result after TURP. Telephone screening of patients at 3 months identified successfully those patients who required an out‐patient review and enabled resources to be targeted towards this difficult group of patients.