Folate levels in psychiatric outpatients.

This study examines folate in psychiatric outpatients. Fifty-three outpatients with schizophrenia and 24 outpatients with depressive disorder assessed with the Schedules for Clinical Assessment in Neuropsychiatry interview are included. Patients with schizophrenia had lower serum folate levels than age- and sex-matched controls, while red cell folate levels did not differ. Serum folate levels showed a negative correlation with the Clinical Global Impression, disorganized dimension, and total Positive and Negative Syndrome Scale score. Patients with depressive disorder had lower serum folate levels than healthy controls, but showed no differences in red cell folate levels. Only two patients with schizophrenia had red cell folate levels below the normal range.

Blood levels of cytokines in brain-dead patients: relationship with circulating hormones and acute-phase reactants.

We hypothesized that increased levels of blood cytokines occur in brain-dead patients, and that these cytokines are responsible for some of the endocrine and/or acute-phase reactant abnormalities found in these patients. We measured blood levels of cytokines, hormones, and acute-phase reactants in 18 brain-dead potential organ donors at the moment of establishing the legal diagnosis of brain death and compared them with levels found in a control group. Although interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) levels were within the normal range, interleukin-6 (IL-6) levels were clearly above the normal range in all patients (median, 1,444 pg/mL; range, 75 to 11,780). In the brain-dead group, total thyroxine (tT4), free T4 (fT4), triiodothyronine (T3), thyrotropin (TSH), dehydroepiandrosterone sulfate (DHEA-S), testosterone, albumin, Zn, and osteocalcin levels were decreased, T3 resin uptake index (T3 RUI), corticotropin (ACTH), cortisol, 11-deoxycortisol (11-DOC), 17-hydroxyprogesterone (17-OHPr), aldosterone, luteinizing hormone, and follicle-stimulating hormone levels were normal, and reverse T3 (rT3), renin, and C-reactive protein (CRP) levels were increased. Multiple regression analysis demonstrated significant interrelations between IL-6 and T4, T3, testosterone, and CRP. We also studied the evolution of some of these parameters in four patients with severe head injury who finally developed brain death. IL-6 levels on admission to the intensive care unit (ICU) were above the normal limits, as in other patients with cranial trauma, but when the patients developed brain death, there was a pronounced increase in IL-6 levels.(ABSTRACT TRUNCATED AT 250 WORDS)

[Regulation of the response of the hypothalamo-hypophyseal-adrenal axis during anesthesia with diazepam-fentanyl in heart surgery]. / Regulación de la respuesta del eje hipotálamo-hipofisario-adrenal durante la anestesia con diazepam-fentanilo en cirugía cardíaca.

OBJECTIVES: To study the response of the hypothalamic-hypophysial-adrenal axis during heart surgery under anesthesia with diazepam-fentanyl (D-F) at high doses. MATERIAL AND METHODS: We studied the intraoperative response of cortisol, ACTH, and 11-deoxycortisol and aldosterone (RIA) to heart surgery under anesthesia with 0.5 mg/kg diazepam and 0.1 mg/kg fentanyl in 12 patients (group D-F) and the effect on that response of blocking peripheral cortisol production with etomidate (0.15 mg/kg bolus) (group D-F-E, n = 12). RESULTS: Sharp drops in cortisol, ACTH and 11-deoxycortisol levels were observed in group D-F before the start of extracorporeal circulation (ECC). Albumin and red blood cell counts fell less sharply than did hormone levels. ACTH levels increased after ECC. Throughout surgery, ACTH and cortisol never rose over preanesthetic levels. The response in group D-F-E was similar, with a clear early rise in 11-deoxycortisol and a later rise in ACTH. CONCLUSIONS: Anesthesia with D-F lowers levels in the hypothalamic-hypophysial-adrenal axis below baseline in the phase before ECC, despite the stimulus of surgery and the effect of hemodilution. After ECC, ACTH levels rise. The response seen in group D-F-E suggests that levels in the hypothalamic-hypophysial-adrenal axis are below normal, but that the mechanism is functioning appropriately.

Assessment of the hypothalamic-pituitary-adrenal axis function after corticosteroid therapy for MS relapses.

Doses of corticosteroids usually given for relapses of MS are able to suppress the hypothalamic-pituitary-adrenal (HPA) axis. We evaluated HPA axis function using rapid ACTH stimulation and rapid overnight metyrapone tests, just after cessation of regular oral prednisone therapy for relapses in 14 MS patients. Nine additional patients treated with i.v. boluses of methylprednisolone before beginning conventional oral therapy were also evaluated. Sixteen patients had normal response to both tests and 6 patients had only a discordant response to one test. These data indicate that most patients had normal HPA axis function, which make corticosteroid replacement unnecessary after cessation of therapy for relapses.

Anti-adrenal action of a subanaesthetic dose of etomidate.

The effects of subanaesthetic doses of etomidate on corticosteroid synthesis have been studied in vivo. In the group of patients who received etomidate (n = 10), cortisol and aldosterone responses to adrenocorticotrophic hormone were blunted, while 11-de-oxycortisol response was increased, as compared to a control group (n = 10). These results suggest that a single bolus of 0.04 mg/kg etomidate, which produces sedation, without loss of consciousness, is able to block adrenal 11 hydroxylase.