Early and late postnatal identification of isolated lenticulostriate vasculopathy in preterm infants: associated findings.

OBJECTIVES: To determine the incidence, possible etiologies, and neurodevelopmental outcome of premature infants (<35 weeks) with isolated lenticulostriate vasculopathy (LSV). STUDY DESIGN: In a retrospective case-control design, we reviewed the medical records of all premature infants who were admitted to our neonatal intensive care unit between 1996 and 2000. RESULTS: The prevalence of LSV was 4.6% (21 of 453). Patients with late LSV (detected after 10 days of age) had less exposure than controls to prenatal steroids [42.8% (6 of 14) vs. 92.8% (13 of 14), respectively; p<0.01], and prenatal antibiotics [42.8% (6 of 14) vs. 85.7% (12 of 14), respectively; p=0.01]. Fifty-seven percent (8 of 14) of patients with late LSV had a low Apgar score vs. 14.2% (2 of 14) of the control group (p=0.01). Patients with LSV also had more muscle tone abnormalities than controls at 6 months of age [33.3% (5 of 15) vs. 5.2% (1 of 19), respectively; p=0.03]. CONCLUSION: Patients with late LSV have less exposure to antenatal steroids and antibiotics, lower Apgar scores, and abnormal muscle tone at 6 months of age.

[Lipoprotein(a)--a risk factor for coronary sclerosis in patients with hypothyroidism]. / Lipoproteín(a)--rizikový faktor koronárnej sklerózy u pacientov s hypotyreózou.

In a group of patients with developed primary hypothyroidism the authors investigated in a longitudinal eight-month trial the effect of hormonal substitution therapy with thyroxine (T4) on the serum concentration of lipids, apolipoprotein B and lipoprotein (a)--risk factors for the development of early coronary sclerosis. In some patients--"responders"--gradually euhormonosis, normolipaemia are induced and clinical symptoms of hypothyroidism receded. In the second group of patients with hypothyroidism, so-called "non-responders" (n = 5) after eight months substitution treatment with thyroxine the anticipated effect does not occur and the investigated serum parameters improve only partially. The thyroxine, TSH levels and those of lipid parameters and apolipoprotein B persist in the zone of pathological values. The lipoprotein (a) concentration in both groups of patients with hypothyroidism does not change during thyroxine substitution and varies near baseline values. From the submitted observations the authors of the present work do not assume that thyroxine plays a part in the catabolism of lipoprotein (a) via LDL receptors, the activity and number of which increases along with the effect of thyroxine.

[Serum apolipoprotein B (apoB) in patients with hypothyroidism]. / Apolipoproteín B (apoB) v sére pacientov s hypotyreózou.

The concentrations of serum lipids (total cholesterol, triacylglycerols), apolipoprotein B and thyroid hormones (thyroxine, triiodthyronine) were observed before and during hormone replacement therapy by thyroid hormones in 24 hypothyroid patients (18 women and 6 men) until the state of euthyroidism was reached. The observed parameters regained standard values gradually, while the concentration of apolipoprotein B recovered to normal as the last among them. Therefore the authors recommend to consider apolipoprotein B concentration in serum as a risk factor of the development of arteriosclerosis in hypothyroid patients, the value of apolipoprotein B concentration can serve as a guideline in choosing the optimal hormone substitution therapy. (Tab. 1, Fig. 1, Ref. 5.).

Value of increasing film processing time to reduce radiation dose during mammography.

We systematically tested the effects on radiation dose and image quality of increasing the mammographic film processing time from the standard 90 sec to 3 min. Hurter and Driffield curves were obtained for a Kodak Min-R-OM1-SO177 screen-film combination processed with Kodak chemistry. Image contrast and radiation dose were measured for two tissue-equivalent breast phantoms. We also compared sequential pairs of mammograms, one processed at 90 sec and one at 3 min, from 44 patients on the basis of nine categories of image quality. Increased processing time reduced breast radiation dose by 30%, increased contrast by 11%, and produced slight overall gains in image quality. Simple modifications can convert a 90-sec processor to a 3-min unit. We recommend that implementation of extended processing be considered, especially by those centers that obtain a large number of screening mammograms. Three-minute film processing can reduce breast radiation dose by 30% and increase contrast by 11% without compromising image quality.

[Forms of the compression syndrome in nodular and retrosternal struma in advanced age]. / Formen des Kompressionssyndroms bei Knoten- bzw. Retrosternalstruma im fortgeschrittenen Alter.

65 cases with a partially retrosternally localized nodular goitre and with compression syndrome (CS) are discussed. The most often (45 patients) registered complaints are breathing difficulties because of tracheal compression, in 8 further patients bad deglutination prevailed over dyspnoe, 3 patients with a compression of the jugular veins showed oedematous face, cyanosis and other signs testifying for stasis of the superior vena cava. Compression of the cervical truncus sympathicus was the cause of Horner's syndrome in 5 patients, in one person thyroid malignancy led to a coarse voice via infiltration of the recurrent nerve. In an additional group were 10 persons with a partially retrosternally localized recurrent nodular goitre, they were subjected to reoperation. In conclusion, 1. the therapy of choice of a CS is strumectomy 2. a consequent postoperative therapy with thyroid preparations is postulated.

Decreased apolipoprotein levels in women with hyperprolactinemia related to increased estradiol level: effect of hepatic lesion?

In 3 groups of women (1. with pathological hyperprolactinemia, but low estradiol level--19 patients; 2. with pathological hyperprolactinemia, but high estradiol level--17 patients; 3. 16 healthy control women) the level of prolactin, estradiol, cortisol, total cholesterol, triglycerides and apolipoproteins A-I, A-II and B in serum was estimated together with routine clinical examination. In both hyperprolactinemic groups a significant decrease of apolipoprotein A-I and A-II was found, while in the group with high estradiol also a significant decrease of apolipoprotein B was observed. It is suggested that the increased level of prolactin results in an impairment of apolipoprotein biosynthesis and, in addition, in a group with high estradiol level also a lesion of liver function might occur which results in its decreased degradation.

[Hyperparathyroidism--complications and prevention]. / Hyperparathyreoidismus - Komplikationen und deren Prävention.

The diagnosis of the primary hyperparathyroidism is, as it is demonstrated at the example of a female patient, up to now always made very late. It is referred to the importance of modern screening methods which are suitable to improve the early diagnosis and to reduce the still high rate of complications.

[Clinical aspects and therapy of Sheehan's syndrome and its special forms]. / Klinik und Therapie des Sheehan-Syndroms und seiner Sonderformen

Sometimes the Sheehan-syndrome appears in form of a partial insufficiency and sometimes also with atypical symptomatology. From this result diagnostic and therapeutic consequences, the peculiarities of which are exhibited. The acute form of the course is dangerous. It makes necessary the use of a specific emergency treatment, whereby the result of the highly threatening condition depends on its consequent application. When a competent therapy is carried out the life expectancy of female patients suffering from the Sheehan-syndrome is no more to be regarded as reduced.