Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas

The recorded number of patients with central hyperthyroidism due to TSH-secreting pituitary adenoma doubled in the last few years after the introduction of ultrasensitive TSH assays in the assessment of thyroid function; however, information about the results and the criteria for cure after pituitary surgery is scanty. Seventeen patients with a TSH-secreting adenoma, diagnosed on the basis of detectable TSH levels in the face of high free thyroid hormone concentrations and pituitary lesion at neuroimaging, underwent pituitary surgery. Hypersecretion of other pituitary hormones was diagnosed in 5 of 17 patients. Four patients were initially misdiagnosed and treated with thyroid surgery or radioiodine therapy. The majority (86%) of hyperthyroid patients normalized thyroid hormone concentrations and regained euthyroidism, although pituitary imaging, alpha-subunit, and alpha-subunit/TSH molar ratio normalized in only 47%, 54%, and 58% of patients, respectively. Moreover, TSH secretion was normally suppressed by T3 in 40% of the patients. Interestingly, the finding of undetectable TSH levels 7 days after surgery was highly predictive of successful outcome. During long term follow-up, there was one relapse of hyperthyroidism. Early diagnosis of TSH-secreting adenomas permits a high rate of remission of hyperthyroidism after surgery. However, normalization of thyroid function alone does not necessarily reflect complete removal of the tumor, and more comprehensive criteria of cure based on pituitary imaging, hormone measurement, and suppression of TSH during T3 administration should be used. Lastly, all patients need an accurate long term follow-up to monitor the possible recurrence of the adenoma.     

Electro-optic sampling system for the testing of high-speedintegrated circuits using a free running solid-state laser

This paper deals with the indirect electro-optic sampling technique for the low-invasive detection of periodical voltage waveforms on lines in high-speed integrated circuits. The system introduced here is based on a passive mode-coupled Ti:Sapphire-Laser as light source for generating optical pulses in the subpicosecond regime. Therefore, we have to synchronize the resulting electric measurement signal and its external trigger onto the pulse repetition rate of this free running solid-state laser. The multi user function of the laser system forces us to transmit the pulses via a single-mode fiber into the measurement setup. For that purpose we developed a special optical arrangement to minimize the widening of the pulses in the time domain. The system's high-temporal resolution of nearly 10 ps in combination with its high-voltage sensitivity of about 800 μV/√(Hz) is demonstrated by measurements of an integrated microwave frequency divider     

Fetal survival in abdominal pregnancy: a review of 11 cases

PURPOSE: Little has been written regarding the ultrasound imaging features that might allow prediction of fetal viability in abdominal pregnancies. Toward this goal, we present our experience with a series of 11 abdominal pregnancies. MATERIALS AND METHODS: From 1981 to 1993, 11 patients presented to Universidad Catolica, Santiago, and Universidad de Austral, Valdivia, Chile, with third trimester abdominal pregnancies. Five had complete ultrasound examinations, and these five patients were managed expectantly. The other six women presented as acute abdominal emergencies and underwent emergent surgery. RESULTS: Four of five fetuses that survived had a complete placental attachment to the uterus, and one surviving neonate had a partial attachment of the placenta to the uterus. Three fetuses died prior to delivery, and all three had a complete mesenteric placental attachment. Two died in the early neonatal period. One had a complete uterine placental attachment, and the other had a partial attachment. CONCLUSIONS: The survival rate of abdominal pregnancies may be better than is generally believed. Placental attachment to the uterus appears to be a factor related to fetal survival and maternal morbidity. More cases are necessary to determine the feasibility of managing women with abdominal pregnancies expectantly.     

Bacteremia caused by the Bacteroides fragilis group in patients with hematologic diseases

During a 22-year period, 13 patients with hematologic diseases developed bacteremia caused by the Bacteroides fragilis group, with a frequency which remained almost unchanged. Nine patients (69%) had polymicrobial infections. Acute leukemia was the most common underlying disease. The lower intestinal tract (necrotizing enterocolitis and anorectal abscesses) was the most common source of infection. Prior antibiotic therapy was the most frequent host condition before bacteremia, followed by cancer chemotherapy, neutropenia, thrombocytopenia and hypoproteinemia. Septic shock occurred only in seven patients with polymicrobial infections. Six patients, including five with shock, died within a week of onset, while the other seven survived for at least three weeks. Despite its clinical similarity to aerobic gram-negative infection, bacteremia due to the B. fragilis group may well, therefore, be suspected particularly when neutropenic patients who present with lower intestinal symptomatology develop a persistent fever unresponsive to the initial empiric antibiotic therapy.     

Composition and thermodynamics of the surface layer of binary melts based on iron,cobalt, and nickel

The composition, thickness, thermodynamic activities of components, Gibbs energy and excess energy of formation of the surface layer on binary melts of iron, cobalt and nickel-based alloys with different interatomic interactions were evaluated with the aid of data from the literature and the authors measurements of the concentration dependence of the surface tension and molar volume.     

Performance evaluation of air-conditioning units

A limited selection of samples of small and medium size air-conditioning equipment being marketed or manufactured in Kuwait was tested in an internationally reputed laboratory. The actual performance results obtained from laboratory tests were analyzed and compared with the commercially available information from the manufacturers for the same selected units. The analysis indicated the quality of air-conditioning equipment available to the Kuwaiti user.     

Clinical applications of cytokines in pediatrics

The use of adjuvants for immunopotentiation has been investigated since the 1920s and a number of comprehensive reviews and monographs have been published on this subject. A recent trend in immunopotentiation has been the use of delivery systems which allow for sustained or controlled release of antigens and which induce prolonged immunity following a single dose. This concept has been termed either single-step or single-shot immunization. The delivery system has been modulated to potentiate the immune response either by delivering the antigen (and perhaps an adjuvant or adjuvants) either over a prolonged period of time or in a predetermined sequence or by incorporating substances with immunoadjuvant properties (e.g., lecithin and certain biodegradable polymers) as carriers within the delivery system. This Review focuses on the progress made in the design of delivery systems for immunopotentiation. Particular emphasis is given to delivery systems designed to achieve single-step immunization.