IA-2A positivity rate at manifestation of type 1 diabetes mellitus in Slovak children culminates in September.

BACKGROUND: New cases of type 1 diabetes mellitus (DM1) in Slovak children accumulate in late summer, autumn and winter. HYPOTHESES: Children manifesting the disease in these seasons have higher autoantibody positivity than those first diagnosed in spring or summer. PATIENTS AND METHODS: One hundred and fifty Slovak children (and adolescents), aged 1-14 (15-17) years at the manifestation of DM1, born 1978-2000, with the disease manifested 1989-2001, were investigated at diagnosis by IA-2A, GADA and IAA autoantibody positivity, using standard radioimmunoassay procedures. The resulting risk score values (0-1) were related to calendar days of diagnosis. Their annual, semi-annual and quarterly periodicity was tested using Halberg's cosinor regression. RESULTS: Only IA-2A positivity at the time of diagnosis showed significant seasonal cycling, with the acme around the autumn equinox and with the nadir in spring. There was no increase of this positivity in winter. CONCLUSION: The maximum autoantibody levels were found for those manifesting the disease in late summer and early autumn--the only time of year in Slovakia when both the numbers of births of future diabetic children as well as those of manifestation of new cases are significantly above average.

Thyroid hormone metabolism in pediatric cardiac patients treated by continuous povidone-iodine irrigation for deep sternal wound infection.

OBJECTIVE: The purpose of this study was to assess the influence of povidone-iodine mediastinal irrigation used for the treatment of deep sternal wound infection (DSWI) on thyroid function. METHODS: Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone-iodine irrigation for DSWI. The median age of patients was 8 months (18 days-5.3 years). Serum concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), reverse triiodothyronine (rT3) and thyroxine-binding globulin (TBG) were measured at three time points: (a) prior to mediastinal reexploration (before povidone-iodine exposure); (b) immediately after discontinuation of povidone-iodine irrigation; (c) 2 weeks after discontinuation of mediastinal irrigation. Urinary iodine excretion was examined on the last day of povidone-iodine exposure. RESULTS: Prior to the mediastinal reexploration, the median TT3 and TT4 levels were below the normal range, then increased significantly to concentrations within the normal range. The median serum FT3 levels were within the normal range throughout the observation period, though a significant increase of FT3 levels was observed after discontinuation of irrigation. The median serum FT4 concentrations were within the normal range prior to irrigation and did not change significantly. The median rT3 levels were within the normal range, close to upper normal limit. The median TBG levels were within the normal range throughout the observation period, though a significant increase of TBG levels was observed during the period of mediastinal irrigation. The median TSH level was within the normal range prior to mediastinal irrigation and did not change significantly. Urinary iodine concentrations in infants with povidone-iodine irrigation were significantly higher 6700 microg/l (range, 1600-15000 microg/l) than in the group of 53 healthy infants 200 microg/l (range, 20-780 microg/l, P<0,001). CONCLUSIONS: Our data showed that the use of povidone-iodine irrigation in the patients with DSWI has not lead to any significant alteration in thyroid function within the study period.

[Microalbuminuria and tubular reabsorption of minerals in children with type 1 diabetes mellitus]. / Mikroalbuminúria a tubulárna reabsorpcia minerálov u detí s diabetes mellitus 1. typu.

BACKGROUND: The most severe late complication of microangiopathic changes in diabetes mellitus type I (IDDM) is the diabetic nephropathy. The fully developed picture of diabetic nephropathy usually does not occur in children, however, original signs of altered renal functions may be present already. OBJECTIVES: The study is aimed firstly at the detection of microalbuminuria and the relation between the amount of albumin urinary excretion and individual clinical indices such as age, degree of metabolic compensation, blood pressure. Secondly, the study's objective is to evaluate alterations in tubular reabsorption of minerals. MATERIAL AND METHODS: 1.) The occurrence of microalbuminuria has been detected on the basis of a four-year longitudinal clinical follow-up of 134 children (81 boys and 53 girls) with IDDM. Examinations which took place in regular twelve-month intervals were aimed at the investigation of the amount of albumin urinary excretion by means of radioimmunoanalysis in the collected twelve-hour night fraction of urine, simultaneous level of HbA1C and blood pressure values. The degree of the evaluated metabolic compensation during the first 5 years of diabetes occurrence was evaluated retrospectively and expressed as its mean value. 2.) 18 randomly selected patients and 12 controls were subdued to an examination of alterations in tubular reabsorption of minerals--sodium, calcium and phosphorus. RESULTS: 1.) On the basis of the amount of excreted albumin the children were divided into 3 groups. The first group (n = 105) consisted of children with normal albumin excretion, the second group (n = 13) represented children with transitory microalbuminuria, and the third group 16 (11.9%) were patients with persistent microalbuminuria. There was no significant difference observed in the degree of metabolic compensation between individual groups. At the end of investigation the diastolic blood pressure was significantly higher in the third group of children (76.1 +/- 0.9 and 75 +/- 1.9 or 82.8 +/- 1.8 mmHg, 0.001). A significant correlation was found between HbA1c, systolic and diastolic blood pressure and the amount of urinary excretion of albumin (p < 0.001). 2.) The investigation of tubular balance of minerals led to the detection of a significantly increased tubular reabsorption of sodium and calcium in children with IDDM (p < 0.001), whilst the urinary excretion of these ions did not increase. However, there were found significantly increased values of urinary phosphorus excretion (p < 0.001) with its value of tubular reabsorption remaining unaltered. CONCLUSIONS: The alterations of glomerular functions is present already in the commencing stages of IDDM. The significance of examination of the amount of albumin urinary excretion augments after the twelfth year of age, during which the metabolic compensation becomes markedly deteriorated and the blood pressure elevates. Bad metabolic compensation with hyperglycaemia and glycosuria significantly influence tubular functions. This can represent the cause of the disturbed glomerulo-tubular balance which manifests itself by increased losses of phosphorus in children with IDDM. This fact can disturb osteogenesis in these patients. (Tab. 2, Fig. 3, Ref. 27.)

[Radical and selective removal of hyperfunctional hypophyseal adenomas using a transsphenoidal approach]. / Moznosti radikality a selektivity odstránenia hyperfunkcných adenómov hypofýzy transsfenoidálnym prístupom.

The authors investigated the possibility of radical removal of adenomas of the pituitary (AH), while preserving remnants of pituitary tissue, in 23 patients with primarily operated hyperfunctional AH producing PRL (14 patients), STH (8 patients) and ACTH (1 patient). Normalization of the pathologically elevated hormone level was achieved by the transsphenoid operation without supplementary treatment in 13 of 16 patients with defined and in 3 of 7 patients with invasively growing AH (PRL in 10, STH in 5 and ACTH in one patient), i.e. in 69.5% Identification and preservation of remnants of the pituitary was possible in 20 patients (in all 16 with defined and in 4 of 7 with invasive AH); 17 of them (73.9%) do not need hormonal substitution. Radical and at the same time selective adenomectomy was achieved in 14 patients (60.9%) incl. three patients with invasively growing tumours. The improved activity of the pituitary is manifested clinically after successful operation in particular in young patients by improved gonadal function.

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.