Comparison of efficacy of 2220 MBq versus 3700 MBq I-131 for ablation of thyroid remnant in patients with differentiated thyroid cancer.

AIM: We evaluated the efficacy of two doses of I-131 (2220 MBq versus 3700 MBq) after thyroid hormone withdrawal for thyroid remnant ablation postoperatively in patients with differentiated thyroid cancer (DTC). METHODS: A total of 133 patients with DTC were studied retrospectively. Group 1 (N.=48) included patients with a primary tumor less than 4 cm in mean diameter and confined to the thyroid gland that received an average ablation dose of 2220 MBq. Group 2 (N.=81) included patients with a primary tumor equal to or greater than 4 cm in mean diameter and/or with vascular invasion and/or intrathyroidal lymphovascular invasion and/or microscopic extrathyroidal extension that received an average ablation dose of 3700 MBq. There was no significant difference between the two groups in terms of demographic characteristics or the radioiodine uptake in the neck (2.86+2.31% versus 2.84+1.21%, P=0.97). The success of the remnant ablation was judged by the standard institutional protocol: I-123 whole body scan (WBS) and serum Thyroglobulin (Tg) level after thyroid hormone withdrawal or preparation with recombinant human TSH (rhTSH) 6-12 months after ablation. RESULTS: Overall, remnant ablation was successful in 121/133 (91%) patients. There was no statistically significant difference in the success of ablation between Group 1 and Group 2 (87.5% versus 93%, P=0.273). CONCLUSION: Therefore, for thyroid remnant ablation after thyroid hormone withdrawal, an administered I-131 dose of 2220 MBq is just as effective as 3700 MBq and has the potential for fewer longterm side effects.

Novel plasmids from alkaliphilic halomonads.

Seventeen alkaliphilic halomonads were examined for the presence of plasmids. Of these, eight strains harbored one or more from 5.3 to 33 kb in size, the first plasmids to be identified from an alkaliphilic halomonad source. Restriction and hybridization analysis revealed three strains that maintained an identical 5.9-kb plasmid which we named pAH1, two that had an identical 33-kb plasmid, and three others, of which one carried two plasmids of 5.3 and 15 kb, the former being designated pAH2. The two final strains maintained plasmids of 15 and 20.5 kb. Restriction mapping of both pAH1 and pAH2 indicated that they have a number of unique restriction sites and are of a small enough size to make them suitable for vector construction.

Structure-activity studies of tylosin-related macrolides.

The effects of tylosin-related macrolide antibiotics were examined in cell-free protein synthesis (using a coupled transcription-translation system derived from Streptomyces lividans) and against whole cells of that organism. Anti-ribosomal potency was determined primarily by the number and nature of the glycosyl substituents, and was not significantly influenced by lactone ring oxidation or sugar methylation. In contrast, uptake of the drugs into S. lividans was influenced, either positively or negatively, by each of these structural parameters. The presence of erm type I or erm type II resistance genes in S. lividans markedly affected the resistance phenotype and studies involving ribosomes from such strains revealed differences in macrolide activity that were not otherwise apparent.

Bioactive compound production by thermophilic and thermotolerant cyanobacteria (blue-green algae).

A thermotolerant species of Phormidium produced extracellular anti-microbial material during batch culture. Although this material was inactive when screened against a number of other cyanobacteria, it inhibited the growth of a wide range of Gram-positive and Gram-negative heterotrophic bacteria, Candida albicans and Cladosporium resinae.

Surgical repair of old fourth-degree perineal lacerations.

There are four basic surgical procedures for repair of old fourth-degree (complete) perineal lacerations: the layer closure, the Warren flap, Bowers' modification of the usual layer closure, and the Noble procedure. The Noble procedure avoids the deficiencies of the other procedures, and it is recommended as the best choice for this type of repair because it produces an intact rectal tube uncompromised by a suture line, is anatomically correct, is simple and easily mastered, and apparently has a near-zero failure rate.

The lecithin/sphingomyelin ratio in cases associated with fetomaternal disease.

The efficacy of correlating the L/S ratio in the amniotic fluid with fetal lung maturity has been substantiated in normal pregnancies. In gestations complicated by fetomaternal diseases, however, the assay is less reliable. This study involves 555 pregnancies in which there was a significant maternal, fetal, or placental disorder. The L/S ratio was related to fetal respiratory maturity as measured by Dubowitz criteria and the occurrence of RDS. The results show that pre-eclampsia, chronic hypertension, diabetes (Class D, E, F), significant cardiovascular disease, severe hemoglobinopathies, various congenital anomalies, chronic placental insufficiency, and prolonged ruptured membranes accelerated the L/S ration. Conversely, mild diabetes (Class B, C), intrinsic renal disease, hepatitis, collagen disease, hydrops fetalis, syphilis, and toxoplasmosis were associated with a delay in the L/S ratio. A significant increase in erroneous responses was noted in these patients when the L/S ratio was correlated to infant maturity and to the incidence of RDS. Possible mechanisms for these findings are discussed.

Amniotic fluid tests for fetal maturity in normal and abnormal pregnancies.

The lecithin-sphingomyelin (L/S) ratio is acknowledged to be superior to most procedures for predictinf fetal lung maturity in normal pregnancy. In complicated gestations, however, errors have been reported. This study involves 686 normal gestations and 389 pregnancies complicated by fetomaternal diseases. The L/S ratio, creatinine level, and percent of fat-staining cells were measured in samples of amniotic fluid from these patients. The results showed good correlation of all three tests with fetal maturity as measured by weight, Dubowitz criteria, and incidence of respiratory distress syndrome in the normal patients. In the complicated pregnancies, however, the creatinine was unacceptable in up to 30% of the cases. The L/S ratio likewise decreased in accuracy for all parameters of fetal maturity measured. The Nile blue staining of the fetal cells appeared to be the most consistent technic in these cases. A fetal maturity battery comprised of these three assays and other methods of assessing fetal health is advocated in pregnancies complicated by certain disease states.

Nile blue and fetal maturity. Further investigations.

The consistency of results using Nile blue staining of fetal cells in amniotic fluid to estimate fetal maturity has been demonstrated. Recently, evidence to support this method has been published from this laboratory. Several biochemical and technical factors were cited as important to the success of the method. This report deals with further testing of several Nile blue dyes (hydrochloride and sulfate) necessitated by changes in production and federal regulation of this compound. The results show Nile blue hydrochloride (HCl) to be the most superior dye regardless of color index. Buffered solutions (6.6) of Nile blue A (sulfate) improve its performance, but not to levels demonstrated by the HCl preparation. Storage at room temperature adversely affects each dye; however, the sulfate variety appears to be the most unreliable under these circumstances. For best results, it is recommended that Nile blue HCl be used and the solution (buffered or normal) be kept refrigerated.

Metabolites of meperidine in the fetal and maternal serum.

Although meperidine appears to be the safest obstetric analgesic agent, it has been associated with infant respiratory depression in certain situations. It would appear that the incidence of fetal depression related to meperidine is dependent on the time of injection prior to delivery, the quantity of drug administered, and the rate of maternal metabolism of the analgesic. Previous work showed that meperidine is metabolized in the maternal system by one of three patterns. The present study demonstrates that the particular maternal serum pattern is characteristic for the individual, regardless of whether the patient is pregnant or not, and that the fetal depression, although usually mild, can be correlated with fetal pH data as well as Apgar scores. In addition, this study supports indirectly the contention that metabolites of meperidine rather than the parent compound cause fetal depression. It would appear, therefore, that in certain obstetric cases with a higher probability for infant depression, other analgesic agents might be considered, especially if the serum pattern indicates meperidine is being metabolized.

Puerperal Weck clip sterilization: study I (first study of two consecutive studies).

One hundred and four puerperal applications have been performed using the (original) Weck pistol-grip applicator and applying the large Weck clip in the inverted V configuration. Follow-up varied from 37 to 42 months. The corrected failure rate was 8.7%. Mechanical difficulties were encountered with the jaws and metal sleeve of the (original) Weck pistol-grip applicator. Recovered clip configuration and tubal tissue histology are presented. Histologic changes suggest possible reversibility.

Puerperal weck clip sterilization: study II (second study of two consecutive studies).

Forty-five puerperal inverted V Weck clip applications have been completed with either the Samuel's or (modified) Weck pistol-grip applicator. Of the 45 applications, 31 have been followed for 25 to 36 months (69%), 12 have been followed for 13 to 25 months (27%), and 2 have been followed for 9 to 12 months (4%). The failure rate thus far is 2.2%. No mechanical difficulties were encountered with the Samuel's or the (modified) Weck pistol-grip applicator. Reversibility has been observed in one interval patient, while pre-admission evaluation of a puerperal patient suggests postremoval tubal patency.

PIP: A 2ndary study was initiated following the completion of the 1st puerperal Weck clip sterilization study in April 1973. Patient motivation, minimal tubal anatomical distortion, either permanent or semipermanent fertility control, and reversibility continued as features in this study. 45 transabdominal inverted V applications were made in the immediate puerperal period, usually within 24 hours. Resident operative time was consistent with the 1st series. Routine postoperative hysterosalpingograms were not obtained for verification. The longest follow-up period was 36 months and the shortest was 9 months. Of the 45 cases, 31 (69%) were followed for 25-36 months; 12 (27%) were followed for 13-25 months; and 2 were followed from 9-12 months (4%). The failure rate of 2.2% represents 1 failure in the entire group of 45. No mechanical problems were encountered with the Samuel's or the (modified) Weck pistol-grip applicator. Reversibility was observed in 1 interval patient, whereas preadmission evaluation of a puerperal patient suggested postremoval tubal patency.

Adolescent genital dermatoses.

The female adolescent period rivals the menopausal years as a most tumultuous interval. Hormonal changes account for many dermatoses not seen in older women. Vulvar problems that commonly affect the adolescent are discussed in reference to the pathophysiology which may induce these changes. The hormonal milium at this time period is emphasized. A concise grouping of disease processes, as well as a description, clue to diagnosis, and treatment of each entity is presented.

The effectiveness of two oral contraceptives in suppressing plasma androstenedione, testosterone, LH, and FSH, and in stimulating plasma testosterone-binding capacity in hirsute women.

The effectiveness of two oral contraceptives in suppressing plasma androstenedione (A), testosterone (T), LH, and FSH and in stimulating testosterone-estradiol-binding globulin (TeBG) was evaluated in 39 hirsute women. Twenty-seven hirsute women received norethindrone 2 mg.-mestranol 0.1 mg. (Group I) and 12 received norgestrel 0.5 mg.-ethinyl estradiol 0.05 mg. (Group II). Hormone assays were performed before treatment and at the end of 3 weeks of therapy. Ninety percent of the women in both groups had an elevated plasma A and/or T. During treatment, plasma A,T, LH, and FSH were significantly reduced in both groups (p less than 0.01). In Group I, 78% of the women had a normal plasma A and T during treatment. In Group II, 83% of the women had a normal A and T during treatment. There was a greater increase in TeBG in Group I (p less than 0.01). It is concluded that these two oral contraceptives effectively suppressed the hyperandrogenism of most of the hirsute women.

Mumps oophoritis: a cause of premature menopause.

One cause of secondary oligomenorrhea is ovarian infection. A rare type of infection related to the disturbance of menstrual function is mumps oophoritis. Three patients with premature menopause presumably caused by this agent were described. In one patient the symptoms coincided with a subclinical infection during the perinatal period, with subsequent infertility. Another patient seemed to have had a clinically mild oophoritis during the pubertal period, and the third patient became symptomatic following parturition. It appears that this aberration in menstrual function and fertility may be related to the time during which the infection occurs as well as to the severity of the infection. In addition, it is apparent that mumps oophoritis may be a more frequent cause of premature menopause than has heen previously suspected.

Features of Turner's syndrome in women with polycystic ovaries.

Four women with phenotypic features of Turner's syndrome and with poly cystic ovaries (PCO) are describe. In addition to the phenotypic features, Case 1 had primary amenorrhea and small PCO, Case 2 had a 46, XX/45, X karyotype (lumphocytes), Case 3 had enlarged PCO which contained a decreased number of oocytes, and Case 4 had enlarged PCO and was short in statute. These cases support the concept of a relation between PCO and the X chromosome. Some PCO may represent an intermediate condition in a spectrum that extends from the streak gonad of Turners syndrome to the normal ovary. Evidience for X chromosome involvement in PCO is summarized. The concept is advanced that at least some cases of OCO may be due to X chromosomal factors causing an abnormal follicular appartus.