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.     

Disappearing subdural hematomas in children

Serum glucose and plasma C-peptide response to i.v. glucagon administration was evaluated in 24 healthy dogs, 12 dogs with untreated diabetes mellitus, 30 dogs with insulin-treated diabetes mellitus, and 8 dogs with naturally acquired hyperadrenocorticism. Serum insulin response also was evaluated in all dogs, except 20 insulin-treated diabetic dogs. Blood samples for serum glucose, serum insulin, and plasma C-peptide determinations were collected immediately before and 5, 10, 20, 30, and (for healthy dogs) 60 minutes after i.v. administration of 1 mg glucagon per dog. In healthy dogs, the patterns of glucagon-stimulated changes in plasma C-peptide and serum insulin concentrations were identical, with single peaks in plasma C-peptide and serum insulin concentrations observed approximately 15 minutes after i.v. glucagon administration. Mean plasma C-peptide and serum insulin concentrations in untreated diabetic dogs, and mean plasma C-peptide concentration in insulin-treated diabetic dogs did not increase significantly after i.v. glucagon administration. The validity of serum insulin concentration results was questionable in 10 insulin-treated diabetic dogs, possibly because of anti-insulin antibody interference with the insulin radioimmunoassay. Plasma C-peptide and serum insulin concentrations were significantly increased (P < .001) at all blood sampling times after glucagon administration in dogs with hyperadrenocorticism, compared with healthy dogs, and untreated and insulin-treated diabetic dogs. Five-minute C-peptide increment, C-peptide peak response, total C-peptide secretion, and, for untreated diabetic dogs, insulin peak response and total insulin secretion were significantly lower (P < .00l) in diabetic dogs, compared with healthy dogs, whereas these same parameters were significantly increased (P < .01) in dogs with hyperadrenocorticism, compared with healthy dogs, and untreated and insulin-treated diabetic dogs. Although not statistically significant, there was a trend for higher plasma C-peptide concentrations in untreated diabetic dogs compared with insulin-treated diabetic dogs during the glucagon stimulation test. Baseline C-peptide concentrations also were significantly higher (P < .05) in diabetic dogs treated with insulin for less than 6 months, compared with diabetic dogs treated for longer than 1 year. Finally, 7 of 42 diabetic dogs had baseline plasma C-peptide concentrations greater than 2 SD (ie, > 0.29 pmol/mL) above the normal mean plasma C-peptide concentration; values that were significantly higher, compared with the results in healthy dogs (P < .001) and with the other 35 diabetic dogs (P < .001). In summary, measurement of plasma C-peptide concentration during glucagon stimulation testing allowed differentiation among healthy dogs, dogs with impaired beta-cell function (ie, diabetes mellitus), and dogs with increased beta-cell responsiveness to glucagon (ie, insulin resistance). Plasma C-peptide concentrations during glucagon stimulation testing were variable in diabetic dogs and may represent dogs with type-1 and type-2 diabetes or, more likely, differences in severity of beta-cell loss in dogs with type-1 diabetes.     

Calculation of optimum spacing for a three coil axially symmetric metal detector

When designing an in-line metal detector, a three coil axially symmetric design is often employed. For maximum sensitivity to small particles, the spacing of the coils is an important factor. A formula is derived which predicts the signal produced by a metal sphere when moved along the axis of such a detector and from this a graph is produced to determine the optimum coil spacing.<>     

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.     

Wigner-space synthesis of discrete-time periodic signals

A procedure that facilitates at least-squares synthesis of periodic, discrete-time signals from Wigner quasi-distributions is proposed. The scheme is based on expanding the desired time sequence on a generally nonorthogonal, Gabor-type basis whose associated biorthogonal function presumably exists. The specific basis selection may crucially affect the efficiency and quality of the ensuing synthesis procedure. The cited basis type constitutes a considerable generalization over the standardly used orthogonal variety, thus creating previously unavailable degrees of freedom. Of primary significance is the acquired capability of generating time-frequency basis functions that are well localized. Localization is a highly desirable property that can advantageously serve in various applications. It is shown and numerically demonstrated that benefits of localization as well as the fact that achieving effective time-frequency basis localization renders a certain degree of oversampling unavoidable     

The use of probability theory in fracture mechanics—A case study

A probabilistic approach to fracture mechanics in the form of a typical case study is described wherein the integrity of a high-pressure water pipeline is assessed. An analysis methodology is discussed incorporating the probability density functions of defect sizes, the statistics of defect occurrences and the statistical distribution of material properties. This method enables the analyst to supply a very simple assessment of safety, based on the probability of failure (a single number) which may be compared to accepted industrial standards (e.g. 10⁻⁶ for nuclear applications). It is argued that this method often offers the only way to scientifically and economically assess the integrity of fracture prone structures.