A case of cocaine-induced panhypopituitarism with human neutrophil elastase-specific anti-neutrophil cytoplasmic antibodies.

OBJECTIVE: To describe a patient with cocaine-induced panhypopituitarism associated with human neutrophil elastase-anti-neutrophil cytoplasmic antibodies (HNE-ANCA). CASE: A 41-year-old man presented with extreme fatigue, cold intolerance and anorexia with 20 kg weight loss in the last 6 months. His medical history was unremarkable. He snorted cocaine twice a week during the last 6 years. On examination, we saw a pale and skinny man, with a normal blood pressure. Because of the severity of symptoms central hypothyroidism was suspected and very low values of TSH, free thyroxine and free triiodothyronine were measured. His FSH, LH, ACTH, cortisol, prolactin and testosterone levels were also low. Magnetic resonance imaging and computed tomography scan showed a normal-sized pituitary gland entirely embedded in a dense, oedematous, contrast-enhancing mass, and a total destruction of the nasal septum with the absence of conchae and severely impaired sinus walls. A transnasal biopsy showed an acute necrotising, non-specific and non-granulomatous inflammation. Although cocaine-induced panhypopituitarism was suspected, Wegener's granulomatosis could not be excluded. Serology on ANCA showed a strongly positive C-ANCA titre (320 U/l) with specificity for HNE. A cocaine-induced HNE-ANCA-associated panhypopituitarism was diagnosed. Our patient was advised to quit using cocaine immediately and was initially treated with glucocorticoids and testosterone, followed by thyroxine. This led to a dramatic clinical response with an increase of appetite, weight gain and regained energy. After 2 years, the patient is well and his ANCA titre is no longer positive. CONCLUSION: We describe the first documented case of cocaine-induced panhypopituitarism associated with HNE-specific ANCA.

Accelerator mass spectrometry at Arizona: geochronology of the climate record and connections with the ocean.

There are many diverse uses of accelerator mass spectrometry (AMS). Carbon-14 studies at our laboratory include much research related to paleoclimate, both with 14C as a tracer of past changes in environmental conditions as observed in corals, marine sediments and many terrestrial records. Terrestrial records such as forest fires can also show the influence of oceanic oscillations, whether they are short-term such as ENSO, or on the millennial time scale. In tracer applications, we have developed the use of 129I as well as 14C as tracers for nuclear pollution studies around radioactive waste dump sites, in collaboration with IAEA. We discuss some applications carried out in Tucson for several of these fields and hope to give some idea of the breadth of these studies.

Accelerator mass spectrometry at Arizona: geochronology of the climatic record and connections with the ocean.

There are many diverse uses of accelerator mass spectrometry (AMS). 14C studies at our laboratory include much research related to paleoclimate, with 14C as a tracer of past changes in environmental conditions as observed in corals, marine sediments, and many terrestrial records. Terrestrial records can also show the influence of oceanic oscillations, whether they are short term, such as ENSO (El Niño/Southern Oscillation), or on the millennial time scale. In tracer applications, we have developed the use of 129I as well as 14C as tracers for nuclear pollution studies around radioactive waste dump sites, in collaboration with IAEA. We discuss some applications carried out in Tucson, AZ, for several of these fields and hope to give some idea of the breadth of these studies.

Remote analogical reminding.

Remote analogical reminding is hypothesized to occur when one episode is cued by another sharing similar themes but not similar object, character, or event descriptions. We report three experiments exploring this view. Subjects' remindings in Experiment 1 showed sensitivity to remote analogical similarity even though targets were encoded only briefly in an incidental learning paradigm. Experiment 2 subjects showed reliable remindings of remote analogs with study-test delays of up to 1 week. Experiment 3 demonstrated that remote analogical reminding effects are not an artifact of subjects' editing nonanalogical remindings. All experiments supported the hypothesis that human memory is sensitive to remote analogical similarity. We discuss the implications of these findings for memory models. Future progress requires the development of formal models that quantify factors relevant to reminding performance, such as reminding interference, transfer-appropriate processing, and domain expertise.