A case-control study of the androgen receptor gene CAG repeat polymorphism in Australian prostate carcinoma subjects.

BACKGROUND: The development of prostate carcinoma is androgen-dependent. The coding sequence of the androgen receptor (AR) gene contains a CAG repeat polymorphism that has been shown to influence AR activity in vitro. Studies of this polymorphism as a prostate carcinoma risk factor have been conflicting. METHODS: A matched case-control design was used in a clinic-based multicenter study of Australian prostate carcinoma subjects. Cancer subjects were matched by age and locality with controls, all of whom had a serum prostate specific antigen (PSA) level of less than 4 mg/L. Conditional logistic regression was used to determine the relative risk of prostate carcinoma dependent on AR gene CAG number. The association of disease characteristics at diagnosis with the polymorphism also was assessed. RESULTS: Five hundred forty-five cases of prostate carcinoma and 456 matched case-control pairs were recruited. Association studies of disease characteristics at diagnosis showed age at diagnosis to be associated with AR CAG number by univariate (P = 0.004) and multivariate (adjusting for PSA, stage, and grade) linear regression (P = 0.018). No association was observed between the polymorphism and disease stage (TNM-based categories; P = 0.277), histologic grade (P = 0.41), or PSA level at diagnosis (P = 0.48). In the pairwise case-control analysis, the odds ratio of prostate carcinoma for a change of 5 CAG repeats gave an odds ratio of 0.9821 (95% confidence interval, 0.84-1.15). CONCLUSIONS: In this Australian study population, the AR CAG repeat polymorphism was not a risk factor for prostate carcinoma, but a shorter repeat sequence was associated with earlier age at diagnosis.

Hyperthyroidism in elderly hospitalised patients. Clinical features and treatment outcomes.

OBJECTIVE: To review the clinical features and response to treatment of hyperthyroidism in elderly hospitalised patients. PARTICIPANTS AND SETTING: Sixty patients over the age of 70: 41 admitted to a geriatric hospital and 19 to an acute-care hospital, 1990-1993. METHODS: Thyroid function tests were performed routinely in the geriatric hospital but only on demand at the acute-care hospital. Hyperthyroidism was defined as elevation of plasma free thyroxine (FT4) or total tri-iodothyronine (T3) level and suppression of thyroid-stimulating hormone (TSH) level. Seventy-seven per cent of patients were seen personally; in the remainder details were obtained from their hospital records. Outcome was assessed by clinical and biochemical improvement. RESULTS: Clinical features - Fifty-two women and eight men with hyperthyroidism were identified. Their average age was 80.2 years (range, 70-101; median, 80.0). The most common clinical features were weight loss (83%) and atrial fibrillation (60%); 58% were agitated and 15% apathetic. Fifty-two per cent had cognitive impairment with either dementia or confusion. The diagnosis was not initially suspected in 62%. Thyroid antibodies were absent in 35/40 and an isotope scan showed a nodular thyroid in 27/29. Contrast radiography with iodine-containing media had been performed within the preceding six months in 23% of patients. Treatment and outcome - Forty-seven patients were treated with antithyroid drugs in standard doses and 21 received radioactive iodine. In 35 adequately assessed patients, including 21 with dementia, clinical improvement and normal results of thyroid function tests were achieved, but five patients died with uncontrolled hyperthyroidism. CONCLUSIONS: Hyperthyroidism in the elderly is usually due to autonomous thyroid nodules, and in about 20% of hospitalised patients may follow a contrast radiography procedure. The more common clinical features of hyperthyroidism occur frequently as unrelated symptoms in the elderly so that the diagnosis is often not apparent, particularly in the presence of cognitive impairment. As the response to standard biochemical treatment is rewarding, screening of the elderly with thyroid function tests should be done routinely.

Behavior of sheep drinking ethanol solution.

Sheep that were habituated to drinking 10% (vol/vol) ethanol solution instead of water were subjected to proven thirst stimuli to study the effect of chronic ethanol intake on brain mechanisms subserving thirst. Sheep that had not previously drunk 10% ethanol were also tested. All sheep were trained to press a pedal that delivered 50 ml/press of fluid (either 10% ethanol or water) into a drinking cup. In some experiments, fluids were presented in bins. All animals had access to only one fluid at a time. Five ethanol-drinking sheep appeared healthy and maintained body weight over 18 mo. They always preferred water to 10% ethanol. The intracerebroventricular (icv) infusion of angiotensin II (ANG II) at 3.8 micrograms/h for 2 h increased ethanol intake from 15 +/- 10 to 200 +/- 55 ml in the 1st h, but 2,850 +/- 320 ml of water was drunk in the 2nd h. The icv infusion of 500 mM NaCl had a similar effect. After fluid deprivation for 22 or 46 h, ethanol intake in 1 h of access was only 280 +/- 40 and 400 +/- 90 ml, respectively, and 24-h intake was not increased. Water-drinking sheep drank 1,300 +/- 195 ml of water in 1 h after 22-h water deprivation, and 24-h intake was 1.5 times normal. The icv infusion of ANG II in these sheep increased water intake in 1 h from 10 +/- 10 to 1,630 +/- 250 ml and intake of 10% ethanol to only 310 +/- 60 ml. In conclusion, sheep accept 10% ethanol as a substitute for water for daily drinking.(ABSTRACT TRUNCATED AT 250 WORDS)

Iodine-induced hyperthyroidism due to nonionic contrast radiography in the elderly.

PURPOSE: To identify the number of cases of hyperthyroidism that followed the performance of contrast radiography in elderly patients at a geriatric hospital in a non-iodine-deficient area and to determine the clinical course of the condition. PATIENTS AND METHODS: All patients over a 20-month period with biochemical hyperthyroidism (plasma free thyroxine level greater than 25.0 pmol/L and thyroid-stimulating hormone level less than 0.10 IU/L) were identified. Clinical features of hyperthyroidism and exposure to nonionic contrast media radiographs within the previous 12 months were sought. Follow-up extended from 6 to 22 months. RESULTS: A total of 28 patients with hyperthyroidism (aged 70 to 96 years) were identified. Seven patients (25%) had documented biochemical development of hyperthyroidism (five) or subsequent hyperthyroidism (two) 3 to 8 weeks after nonionic contrast media radiography. The four patients who underwent scanning had a multinodular thyroid, and thyroid antibodies were not detected in five of five patients. Although the condition appeared self-limited and six of six patients were euthyroid after 18 months, the condition was not benign; progress and recovery were adversely affected by hyperthyroidism. Four patients had a good response to treatment with an antithyroid drug (carbimazole). CONCLUSION: Iodine-induced thyrotoxicosis following contrast radiography was found in 7 of 28 cases of hyperthyroidism seen at a geriatric hospital. Although the condition appears ultimately self-limited, pharmacologic control of severe clinical features may be required. The frequency of this condition in a non-iodine-deficient area appears related to the more common occurrence of autonomous thyroid nodules in the elderly. Because performance of contrast radiography is more common in this age group, the recognition and treatment of iodine-induced thyrotoxicosis are of increasing clinical importance.

Four cases of IgD multiple myeloma.

The pathological and clinical findings in 4 cases of IgD multiple myeloma are presented. Two patients presented with renal failure and 2 with bone pain and weight loss. Three had IgD lambda paraproteins and 1 an IgD kappa paraprotein. One patient also developed hypercalcemia and extraosseous spread of tumor to pleura, skin, and palate. There were no distinctive bone marrow or histological findings which suggested this unusual type of myeloma.

Alpha 1-antitrypsin phenotypes in homosexual men.

The alpha 1-antitrypsin (AAT) phenotype was determined by isoelectric focusing in 215 male homosexuals and compared with those in 208 male heterosexuals. The incidence of abnormal phenotypes was 16.3% in the homosexual group which was significantly different (p less than 0.03) than the 8.7% in the heterosexual group. There was no difference in the phenotype distribution between homosexuals who were anti-human immunodeficiency virus reactive and those who were non-reactive. It suggests that investigation into the interplay of factors associated with homosexuality could include genetic as well as psychological and social factors.

Paraproteinemias in homosexual men with HIV infection. Lack of association with abnormal clinical or immunologic findings.

During a prospective immunologic study of 130 homosexual men, the authors looked for the presence of paraprotein bands in serum by electrophoresis. Antibody to the human immunodeficiency virus (HIV) was present in 65 of the 130 men, the lymphadenopathy syndrome (LAS) in 26, and the acquired immune deficiency syndrome (AIDS) in 3. Abnormal bands were detected in the serum of six men, as single paraproteins in four and as oligoclonal bands in two. All six were seropositive for anti-HIV; one has LAS, two had persistent but minor lymphadenopathy, and three were apparently normal. There was no significant difference between the T-cell subsets or ratios between those seropositive men with or without paraproteins. This high incidence of paraproteins is another accompaniment of B-cell hyperactivation in persons infected with HIV.

Effect of oral intake of thyroxine on results of thyroid function tests in patients receiving thyroid replacement therapy.

To investigate the effect of orally administered thyroxine on thyroid function tests, serial thyroid function tests were performed in 29 patients receiving maintenance thyroxine replacement therapy. The results showed that plasma thyroxine levels rose significantly in most subjects after an oral dose of thyroxine. The patients who had the largest rise had high basal levels and were taking a higher mean replacement dose of thyroxine. This increase may move a patient's thyroxine level from within the reference range to the abnormal range if blood is taken soon after thyroxine ingestion.