Childhood Trauma as a risk factor for suicidal behaviour in prisons.

Suicide is a public health problem worldwide. Although it affects people of any age, race, gender, nationality or culture, the studies reveal that one of the groups that present high risk are the inmates of a penitentiary institution, with suicide figures higher than those of the general population. In recent years, penitentiary institutions around the world are trying to reduce cases of suicide deaths through prevention and early detection programs. However, in countries such as the United Kingdom, Wales or Spain, the figures are still very high. Researchers and professionals from different disciplines have tried to establish the causes and risk factors that can lead to committing suicide. Among them, suffering traumatic events in childhood (childhood trauma) has been established as one of these factors. Recent studies have shown that childhood trauma has a significant incidence in the prison population, thus assuming an important specific risk factor in this population. The objective of this article is to review the risk factors associated with suicide in the penitentiary institution in order to understand the role of childhood trauma, its emotional impact and its relation to suicidal behavior in the prison environment, thereby contributing to the understanding and management of the cases having repercussions in an improvement in the programs for the prevention of suicide in prisons.

El trauma infantil como factor de riesgo de conductas suicidas en las prisiones / Childhood trauma as a risk factor for suicidal behaviour in prisons

El suicidio supone un problema de salud pública en el ámbito mundial. Aunque afecta a personas de cualquier edad, raza, género, nacionalidad o cultura, los estudios revelan que uno de los colectivos que presenta alto riesgo son las personas internas en una institución penitenciaria, siendo las cifras de suicidio superiores a las de la población general. En los últimos años, instituciones penitenciarias de todo el mundo intentan reducir los casos de muertes por suicidio a través de programas de prevención y detección temprana. No obstante, en países como Reino Unido, Gales o España, las cifras siguen siendo muy elevadas. Investigadores y profesionales de distintas disciplinas han intentado establecer las causas y factores de riesgo que pueden conducir a cometer el suicidio. El hecho de sufrir eventos traumáticos en la infancia (trauma infantil) ha sido establecido como uno de estos factores. Recientes estudios han demostrado que el trauma infantil tiene una incidencia significativa en la población penitenciaria, suponiendo así un importante factor de riesgo específico en esta población. El objetivo de este artículo es revisar los factores de riesgo asociados al suicidio en la institución penitenciaria para poder entender el papel del trauma infantil, su impacto emocional y su relación con el comportamiento suicida en el entorno penitenciario, contribuyendo con ello al entendimiento y manejo de los casos, lo cual repercute en una mejora en los programas de prevención del suicidio en las prisiones

Suicide is a public health problem worldwide. Although it affects people of any age, race, gender, nationality or culture, the studies reveal that one of the groups that present high risk are the inmates of a penitentiary institution, with suicide figures higher than those of the general population. In recent years, penitentiary institutions around the world are trying to reduce cases of suicide deaths through prevention and early detection programs. However, in countries such as the United Kingdom, Wales or Spain, the figures are still very high. Researchers and professionals from different disciplines have tried to establish the causes and risk factors that can lead to committing suicide. Among them, suffering traumatic events in childhood (childhood trauma) has been established as one of these factors. Recent studies have shown that childhood trauma has a significant incidence in the prison population, thus assuming an important specific risk factor in this population. The objective of this article is to review the risk factors associated with suicide in the penitentiary institution in order to understand the role of childhood trauma, its emotional impact and its relation to suicidal behavior in the prison environment, thereby contributing to the understanding and management of the cases having repercussions in an improvement in the programs for the prevention of suicide in prisons

Health education for prevalent problems in prison, Ocaña-I proyect (Spain).

OBJECTIVE: Pilot project focusing on the implementation and evaluation of a health education (HE) program for inmates of the prison of Ocaña I (Spain). The objective was to analyze the intentions for change in health habits and perceptions, and to assess whether the HE-program had differential effects depending on whether the participants belonged to the PAIEM or not and their socio-demographic characteristics. METHODOLOGY: The participants were 65 men, who answered an ad hoc questionnaire at the end of each session. Data analysis applied was univariate and bivariate (one-way ANOVA, t-test for Equality of Means and Chi-Square test). RESULTS: The average rating of the sessions was 3.51 out of 4 (SD = 0.62). The percentage of positive answers about the intention to adopt healthy habits was higher among non-PAIEM subjects (84.8%) than among those who were part of this program (57.9%). All subjects having a couple indicated an intention to change negative habits, compared to 67.3% for those without a couple. The percentage of subjects who said that their perception on the issue had changed was highest among those without education (89.7%) than among those with education (61.5%). CONCLUSIONS: The evaluation of implanted HE-program implemented in the Ocaña I prison was very positive, there are differences between subjects belonging to the PAIEM and those who do not.

¿Es necesario el control de diuresis en pacientes con lavado vesical continuo? / No disponible

Introducción: La hematuria es frecuente en la patología urológica, pudiendo provocar la obstrucción del catéter vesical. Para prevenirla utilizamos el lavado vesical continuo (LVC). Objetivo: Valorar la conveniencia de modificar la práctica clínica de realizar control de diuresis en pacientes con LVC. Material y métodos: Estudio prospectivo aleatorizado con 105 pacientes consecutivos sometidos a cirugía endourológica en el Hospital Clínic de Barcelona entre abril y julio de 2015. Al grupo intervención se le realizó un control observacional de diuresis tras la cirugía y al grupo control se le registró entradas/salidas y diuresis. La valoración de diferencias entre grupos se ha realizado comparando cifras de creatinina previa y posquirúrgica. Resultados: Se han asignado 51 pacientes al grupo intervención y 54 al grupo control. La mediana de los valores de creatinina previa y posquirúrgica en el grupo intervención fue 0,94 y 1,01 mg/dl y de 0,87 y 0,91 mg/dl para grupo control. Conclusión: La medición de diuresis en pacientes con LVC no tiene impacto en la función renal

Introduction: The hematuria is frequent in the urological pathology, which may cause obstruction of the vesical catheter. To prevent it we use the continuous bladder washing (CBW). Objective: To assess the advisability of changing the clinical practice to perform control of diuresis in patients with CBW. Material and methods: A prospective randomized study with 105 consecutive patients undergoing surgery endo urological in the Hospital Clinic of Barcelona between April and July 2015. The intervention group was performed an observational control of diuresis after the surgery and the control group was recorded inputs/outputs and diuresis. The valuation of differences between groups has been performed by comparing figures of creatinine prior to and after surgery. Results: 51 patients have been allocated to the intervention group and 54 to the control group. The median of the values of creatinine after and postsurgical in the intervention group was 0.94 and 1.01 mg/dl and 0.87 and 0.91 mg/dl for group control. Conclusion: The measurement of diuresis in patients with LVC has no impact on the kidney function

Educacion para la salud en los problemas prevalentes del medio penitenciario, proyecto en Ocaña-I (España) / Health education for prevalent problems in prison, Ocaña-I proyect (Spain)

Objetivo: Proyecto piloto centrado en la implantación y evaluación de un programa de Educación para la Salud (EpS) en internos del Centro Penitenciario Ocaña I (España). El objetivo fue analizar las intenciones de cambio en los hábitos de salud y en la percepción, así como evaluar si el programa de EpS tenía efectos diferenciales dependiendo de si los participantes pertenecían o no al Programa de Atención Integral al Enfermo Mental (PAIEM) y de sus características sociodemográficas. Metodología: Los participantes fueron 65 varones que respondieron a un cuestionario ad hoc al finalizar cada sesión. Los análisis fueron univariantes y bivariantes (ANOVA de un factor, prueba t y test de independencia Chi-Cuadrado). Resultados: La valoración media de las sesiones fue de 3,51 sobre 4 (DE = 0,62). Las respuestas afirmativas sobre la intención de adoptar hábitos saludables fueron mayores entre los sujetos no pertenecientes al PAIEM (84,8%) que entre los que sí formaban parte del mismo (57,9%). Todos los sujetos con pareja indicaron tener intención de cambiar los hábitos negativos, frente al 67,3% entre aquellos sin pareja. El cambio en la percepción sobre el tema fue más alto entre los que no tenían estudios (89,7%) que entre aquellos que sí los tenían (61,5%). Conclusiones: La evaluación del programa de EpS implantado en el Centro Penitenciario Ocaña I fue muy positiva, existiendo diferencias entre los sujetos pertenecientes al PAIEM y los que no (AU)

Objective: Pilot project focusing on the implementation and evaluation of a health education (HE) program for inmates of the prison of Ocaña I (Spain). The objective was to analyze the intentions for change in health habits and perceptions, and to assess whether the HE-program had differential effects depending on whether the participants belonged to the PAIEM or not and their socio-demographic characteristics. Methodology: The participants were 65 men, who answered an ad hoc questionnaire at the end of each session. Data analysis applied was univariate and bivariate (one-way ANOVA, t-test for Equality of Means and Chi-Square test). Results: The average rating of the sessions was 3.51 out of 4 (SD = 0.62). The percentage of positive answers about the intention to adopt healthy habits was higher among non-PAIEM subjects (84.8%) than among those who were part of this program (57.9%). All subjects having a couple indicated an intention to change negative habits, compared to 67.3% for those without a couple. The percentage of subjects who said that their perception on the issue had changed was highest among those without education (89.7%) than among those with education (61.5%). Conclusions: The evaluation of implanted HE-program implemented in the Ocaña I prison was very positive, there are differences between subjects belonging to the PAIEM and those who do not (AU)

Evaluating irradiation dose for sterility induction and quality control of mass-produced fruit fly Bactrocera tryoni (Diptera: Tephritidae).

The sterile insect technique has been routinely used to eradicate fruit fly Bactrocera tryoni (Froggatt) incursions. This study considers whether fly quality in a mass-rearing facility can be improved by reducing irradiation doses, without sacrificing reproductive sterility. Pupae were exposed to one of five target irradiation dose ranges: 0, 40-45, 50-55, 60-65, and 70-75 Gy. Pupae were then assessed using routine quality control measures: flight ability, sex ratio, longevity under nutritional stress, emergence, and reproductive sterility. Irradiation did not have a significant effect on flight ability or sex ratio tests. Longevity under nutritional stress was significantly increased at 70-75 Gy, but no other doses differed from 0 Gy. Emergence was slightly reduced in the 50-55, 60-65, and 70-75 Gy treatments, but 40-45 Gy treatments did not differ from 0 Gy, though confounding temporal factors complicate interpretation. Reproductive sterility remained acceptable (> 99.5%) for all doses--40-45 Gy (99.78%), 50-55 Gy (100%), 60-65 Gy (100%), and 70-75 Gy (99.99%). We recommend that B. tryoni used in sterile insect technique releases be irradiated at a target dose of 50-55 Gy, providing improved quality and undiminished sterility in comparison with the current 70-75 Gy standard while also providing a substantial buffer against risk of under dosing.

Estudio retrospectivo para determinar el nivelde calidad de vida de los pacientes urostomizadosmediante el uso del cuestionario Stoma-QoL / No disponible

La calidad de vida constituye un reto fundamental para la población mundial y cuenta con un impacto significativo y concreto en losplanes de salud. Es competencia enfermera evaluar la calidad de vida para mejorar el estado de salud del paciente (AU)

Quality of life constitutes a basic challenge for the world population and it has a significant and specific impact on health plans. It is a nursecompetence to evaluate the quality of life to improve the state of health of the patient (AU)

Optimizing irradiation dose for sterility induction and quality of Bactrocera tryoni.

The current study is an important step toward calibrating, validating, and improving irradiation methods used for Bactrocera tryoni (Froggatt) sterile insect technique (SIT). We used routine International Atomic Energy Agency/U.S. Department of Agriculture/Food and Agriculture Organization quality control tests assessing percentage of emergence, flight ability, sex ratio, mortality under stress, reproductive sterility, and sexual competitiveness, as well as a nonstandard test of longevity under nutritional stress to assess the impact of a range of target irradiation doses (60, 65, 70, 75, and 80 Gy) on the product quality of mass reared B. tryoni used in SIT. Sterility induction remained adequate (>99.5%) for sterile male-fertile female crosses, and 100% sterility was achieved in fertile male-sterile female crosses and sterile male-sterile female crosses for each irradiation doses tested. There was significant increase in mortality under stress as irradiation dose increased, and reduced participation in mating by males irradiated at higher doses. The current target-sterilizing dose for SIT of 70-75 Gy is associated with significant reduction in fly product "quality". Our data suggest that adequate sterility and improved fly quality could be achieved through a small reduction in target sterilizing dose.

Calidad de vida y afrontamiento: diferencias entre los pacientes de diálisis peritoneal continua ambulatoria y hemodiálisis hospitalaria / Quality of life and coping: differences between patients receiving continuous ambulatory peritoneal dialysis and those under hospital hemodialysis

Objetivo: Comparar la satisfacción con la vida y calidad de vida de pacientes en hemodiálisis hospitalaria(HDH) y diálisis peritoneal continua ambulatoria (DPCA), y analizar su asociación con las estrategias de afrontamiento. Método: Se estudiaron, mediante un estudio de corte transversal, 61 pacientes de HDH y 32 de DPCA, con edad 70 años. Se aplicaron los cuestionarios de índice de Charlson, Stai-R, estrés percibido-PSS, percepción de control, soporte social MOS, formas de de afrontamiento, calidad de vida (SF-36) y satisfacción con la vida. Los análisis estadísticos se ajustaron por edad y sexo. Resultados: La proporción de mujeres fue del 35,5%, la edad media de 54 años. El grupo DPCA era más joven con una proporción de mujeres superior. El índice Charlson (comorbilidad) fue similar en HDH y DPCA. El grupo de HDH utilizó psicofármacos en un porcentaje superior a DPCA (el 38 frente al 13%; p 0,01). El grupo DPCA puntuó significativamente más alto en las estrategias de búsqueda de apoyo, regulación emocional, resolución de problemas y distracción, sin diferencias en el soporte social. No se encontraron diferencias en los componentes físico y mental, ni en las 7 dimensiones del SF-36. La satisfacción con la vida fue superioren DPCA (7,12 frente a 6,21; p ¼ 0,07). Conclusiones: Entre las 2 modalidades no hay diferencias en la percepción de calidad de vida. Los pacientes de DPCA tienden a una mayor satisfacción con la vida y un afrontamiento más adaptativo (de regulación emocional y búsqueda de sentido), esto sugiere que podrían tener una mayor asimilación y control del proceso de enfermedad(AU)

Objective To compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies. Methods. We performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex. Results. Women accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups. No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07). Conclusions. No differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process(AU)

[Quality of life and coping: differences between patients receiving continuous ambulatory peritoneal dialysis and those under hospital hemodialysis]. / Calidad de vida y afrontamiento: diferencias entre los pacientes de diálisis peritoneal continua ambulatoria y hemodiálisis hospitalaria.

OBJECTIVE: To compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies. METHODS: We performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex. RESULTS: Women accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups. No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07). CONCLUSIONS: No differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process.

[Constraints faced by hospitalized maternity patients in Niamey (Niger)]. / Les contraintes des malades hospitalisées à la maternité de référence à Niamey (Niger).

A cross-sectional survey was conducted in the main maternity hospital in Niamey (Maternité Poudrière) in July 1995 to evaluate the domestic and financial pressures faced by the patients. One-hundred-and-five women were included in this exhaustive survey which analyzed the socio-demographic characteristics of the patients' households, the reasons for their hospitalization, the organization of their daily life while in hospital, and the costs involved (type of costs, the amounts, and who paid which cost). Fifty-seven women lived in Niamey, and forty-eight in a rural area. The socio-demographic characteristics of the survey population were in agreement with the characteristics of Niger's census in 1988. Analysis of the patients' incomes showed that they were highly dependent on their husbands. Fifty-eight received surgical treatment, and forty-seven received medical treatment. The costs of hospitalization included the standard fee, traveling expenses, and the costs of drugs and surgery. On average, 72% of the hospitalization costs were paid by the husbands, and 15% by close members of the family. The contribution by extended family members and friends was very small. Only 40.5% of the total amounts exceeding 25,000 FCFA were wholly paid. Niger has a policy of recovering medical costs. Our survey shows the difficulties of attempting to reconcile the operation of health centers with access to specialist care.

Biologic markers in blood reflecting thyroid hormone effect at peripheral tissue level in patients receiving levothyroxine replacement for hypothyroidism.

Plasma fibronectin, serum procollagen-III-peptide and sex-hormone binding globulin as not specific markers of thyroid hormone effect at peripheral tissue level were determined and their values were related with serum levels of TSH, free-thyroxine and triiodothyronine during levothyroxine sodium replacement therapy for hypothyroidism. Low levels of biologic markers characteristic of hypothyroidism were normalized in consequence of hormone replacement and a negative correlation between their serum levels and TSH concentration was demonstrated in most subjects. However, in some patients a discrepancy in the response to levothyroxine between the pituitary and other target organs could be revealed. Additional evidence was disclosed that the pituitary thyrotroph sensitizes a minor decrease in serum thyroxine level, which would not be recognized by other target organs. Furthermore, it was revealed that during L-T4 replacement therapy in a large fraction of patients with subnormal serum TSH concentration blood levels of the measured markers often exceeded the upper limit of the normal range indicating the possibility of "tissue"-thyrotoxicosis beside the pituitary in other target organs, too. According to the present study which takes into consideration markers reflecting end-organ responsiveness to thyroid hormones it is recommended to adjust the dose of levothyroxine to maintain serum TSH in the normal range. For patients with subnormal TSH concentration a close follow-up is obligatory and in case od concomitantly raised free-thyroxine level the reduction of the levothyroxine dosage is proposed.

[Biological markers reflecting peripheral effects of thyroid hormones in autonomous thyroid adenoma]. / Pajzsmirigyhormonok perifériás hatásaira utaló biológiai markerek vizsgálata pajzsmirigy autonom adenomában.

In some patients with functioning thyroid autonomous nodules preclinical hyperthyroidism is detected. It is important to know, whether in this intermediate clinical state beside the suppression of pituitary TSH secretion other target organs are also affected by serum free-thyroxine and free-triiodothyronine levels still within the normal range. Determining some sensitive, but not specific biologic markers reflecting the impact of thyroid hormones at the peripheral tissue level, it was demonstrated that in the group of preclinical hyperthyroidism the mean level of plasma fibronectin exceeded that of the controls (mean +/- S. D.: 583.5 +/- 163.9 vs. 424.2 +/- 84.1 micrograms/ml, p less than 0.001), serum procollagen-III-peptide concentration was already significantly raised, though its value was still within the normal range (mean +/- S. D.: 0.73 +/- 0.17 vs. 0.57 +/- 0.16 U/ml, p less than 0.05), conversely, mean sex-hormone binding globulin level was the same as in euthyroid controls (mean +/- S. D. 47.4 +/- 18.2 vs. 48.3 +/- 16.3 nmol/l). The value of all three parameters was significantly elevated in patients with toxic nodular goiter. Based on the results of this study "tissue"-thyrotoxicosis is suspected in some patients with preclinical hyperthyroidism, which may have therapeutical implications.

Biologic blood markers reflecting thyroid hormone effect at peripheral tissue level in patients receiving levothyroxine replacement for hypothyroidism.

Plasma fibronectin, serum procollagen-III-peptide and sex-hormone-binding globulin as non-specific markers of thyroid hormone effect at peripheral tissue level were determined and their values were related with serum levels of TSH, free-thyroxine and triiodothyronine during levothyroxine sodium replacement therapy for hypothyroidism. Low levels of biologic markers characteristic of hypothyroidism were normalized in consequence of hormone replacement and a negative correlation between their serum levels, and TSH concentration was demonstrated in most subjects. However, in some patients a discrepancy in the response to levothyroxine between the pituitary and other target organs was revealed. Additional evidence was disclosed that the pituitary thyrotroph sensitizes a minor decrease in serum thyroxine level, which would not be recognized by other target organs. Furthermore, it was revealed that during L-T4 replacement therapy in a large fraction of patients with subnormal serum TSH concentration blood levels of the measured markers often exceeded the upper limit of the normal range indicating a possibility of "tissue" thyrotoxicosis, besides the pituitary, in other target organs, too. According to the present study, which takes into consideration markers reflecting end-organ responsiveness to thyroid hormones, it is recommended to adjust the dose of levothyroxine to maintain serum TSH in the normal range. For patients with subnormal TSH concentration a close follow-up is obligatory and in case of concomitantly raised free-thyroxine level the reduction of the levothyroxine dosage is proposed.

[Serum sex hormone-binding globulin levels in thyroid diseases]. / Szérum "sex-hormone binding globulin" tartalom vizsgálata pajzsmirigybetegségekben.

Synthesis of "sex-hormone binding globulin" is influenced by the thyroid hormones and its concentration in the serum may be a marker of the thyroid hormone effect at the peripheral tissue (liver) level. Compared to euthyroid controls serum "sex-hormone binding globulin" concentration is elevated in overt hyperthyroidism (141.6 +/- 37.6 vs 48.3 +/- 16.2 nmol/l; p less than 0.001), conversely, its mean level is decreased in the hypothyroid group of patients (24.9 +/- 14.8 vs 48.3 +/- 16.2; p less than 0.001). In the group of subclinical hyperthyroidism the mean value of "sex-hormone binding globulin" corresponds to that in control subjects (47.4 +/- 16.8), while its serum level is near the lower border of the normal range in subclinical hypothyroidism (33.6 +/- 6.1 vs 48.3 +/- 16.2; p less than 0.01). During thyroid hormone replacement for hypothyroidism measurement of serum "sex-hormone binding globulin" may help to assess the response of the target organs to the hormone therapy. In patients with peripheral thyroid hormone resistance serum "sex-hormone binding globulin" level is within the normal range (51.3 +/- 9.8), its determination supports the diagnosis of this disease.

The measurement of the serum sex-hormone binding globulin in various thyroid diseases.

Synthesis of "sex-hormone binding globulin" (SHBG) is influenced by thyroid hormones and its concentration in the serum of female subjects may be a marker of thyroid hormone effect at the peripheral tissue (liver) level. Compared to the levels found in euthyroid females (n = 46), the mean (+/- S.D.) serum SHBG concentration was found elevated in overt hyperthyroidism (Graves' disease: n = 56; 141.6 +/- 37.6 vs. 48.3 +/- 16.2; toxic nodular goiter: n = 16; 119.9 +/- 50.7 vs. 48.3 +/- 16.2 nmol/l; P less than 0.001). In contrast, it was decreased in manifest hypothyroidism (n = 25; 24.9 +/- 14.8 vs. 48.3 +/- 16.2; P less than 0.001). In the group of preclinical hyperthyroidism (n = 43), despite suppressed TSH secretion, the serum value of SHBG was normal (47.4 +/- 16.8), while its serum level approached the lower border of the normal range in subclinical hypothyroidism (n = 10; 33.6 +/- 6.1 vs 48.3 +/- 16.2 nmol/l; P less than 0.01). Data indicate that the pituitary responds more sensitively than the liver to a slight change of the serum thyroid hormone level. During thyroid hormone replacement for hypothyroidism, measurement of serum SHBG may provide help to assess the response of the target organ to the given therapy. In patients with generalized resistance to thyroid hormone, the serum SHBG level is within the normal range (51.3 +/- 9.8 nmol/l), thus, its determination supports the diagnosis of this disease.

Plasma fibronectin level in patients with functional thyroid adenoma.

1. Plasma fibronectin level may serve as a sensitive, but not specific marker of thyroid hormone effect at peripheral, connective tissue level. 2. In some patients with preclinical hyperthyroidism an inverse relationship is detected between pFn and serum TSH reflecting an excessive effect of thyroid hormones at the target organ level. This finding suggests that suppressed TSH secretion might be deleterious in the long-term, which may have therapeutical implications.

[Anterograde tachycardia caused by the antitachycardia mechanism in a DDD pacemaker]. / Taquicardia anterógrada inducida por el mecanismo antitaquicardia en un marcapasos DDD.

If there is a demonstrable ventriculo-atrial conduction at the time of a DDD pacemaker implantation, the possibility of a pacemaker mediated tachycardia is always present. The latest technological advances tries to solve this problem by the refractory time programmability and specially by the automatic extension of the atrial refractory period. A new and special mode of premature ventricular contraction-synchronous atrial stimulus has been developed as an additional and more effective mechanism anti pacemaker mediated tachycardia. We present one case in which this anti pacemaker mediated tachycardia mode just unchains one tachycardia. The understanding of this tachycardia doesn't offer difficulties and the correction would be made by different steps.

[Thyroid function in severe non-thyroidal diseases]. / Pajzsmirigymüködés súlyos nem-pajzsmirigy eredetü betegségekben.

The aim of the present study was to find out whether a change in the function of the pituitary-thyroid axis can be revealed in a relatively homogenous group of hematological patients. To clarify this problem serum levels of total-thyroxine and triidothyronine, free-thyroxine and free-triiodothyronine, reverse-triidothyronine and thyrotropin were detected in these patients. The majority of subjects with chronic myelogenous leukemia (in the remission phase) have normal pituitary-thyroid function, however a change in the peripheral metabolism of thyroxine can be revealed. Longitudinal studies in patients with acute myelogenous leukemia indicate that in some cases with the progression of the disease serum TSH and thyroid hormone levels decrease referring to secondary hypothyroidism and in these cases the measurement of serum free-thyroxine content by an analogue tracer method is not recommended. On the basis of the investigational results it is stated that in hematological patients the pituitary-thyroid function is influenced by the phase of illness and by the results of the given treatment.