Differences in corticotropin-releasing hormone-stimulated adrenocorticotropin and cortisol before and after weight loss

Little is known about the effects of intentional weight loss on the function of the hypothalamic-pituitary-adrenal (HPA) axis of obese individuals. We studied the HPA axis of 34 healthy obese women (body mass index, 40.2 +/- 7.9 kg/m2) before and after a 21.0 +/- 7.9-kg weight loss induced by a 26-week weight loss program that included 12 weeks of a 3350 kJ/day (800 Cal/day) liquid formula diet, 6 weeks of gradual refeeding, and 6 weeks of caloric stabilization at 5020-6280 kJ/day (1200-1500 Cal/day). Obese subjects were evaluated twice: before caloric restriction and during the last 3 weeks of caloric stabilization with a 3-h evening 1 microg/kg ovine CRH (oCRH) stimulation test. CRH-stimulated ACTH and cortisol values were compared to those of a control group of 12 normal weight women. Before caloric restriction, both ACTH and cortisol responses to oCRH were similar in obese women and normal weight controls. Weight loss did not significantly alter the ACTH response to oCRH; however, the total plasma cortisol response to oCRH decreased significantly with weight loss (area under the curve, 96,320 +/- 21,040 nmol/L x min before weight loss; 82,450 +/- 22,460 nmol/L x min after weight loss; P < 0.001). Cortisol-binding globulin also decreased significantly after weight loss (2,270 +/- 1,050 nmol/L) compared either to values obtained before weight loss (3,590 +/- 1,360 nmol/L; P < 0.001) or to those of normal weight controls (3,910 +/- 1,400 nmol/L; P < 0.001). Assay for plasma free cortisol, either before or 180 min after oCRH treatment, showed no significant changes in cortisol responses resulting from weight loss. As plasma free cortisol was not altered by weight reduction, the decrease in the total cortisol response to oCRH after weight loss appears to be secondary to significant decreases in cortisol-binding globulin. We conclude that when obese women lose large amounts of weight with a 3350 kJ/day, very low energy diet, such weight reduction does not significantly affect the HPA axis.     

Investigations of anti-inflammatory activity of Jigrine

We report our experience with five lesions exclusively involving the entire cavernous sinus in which an essentially extradural surgical approach was used. There were two cases of cavernous haemangioma, two cases of meningioma and one case of fungal granuloma. The dural cover of the superior orbital fissure, and mandibular and maxillary divisions of the fifth nerve was dissected along with the dura of the lateral wall of the cavernous sinus. The presence of a relatively large intracavernous bulge due to the tumour assisted in this dissection. The contents of the cavernous sinus were exposed from an anterolateral, lateral and inferior approach. Through the corridor available between the splayed out cranial nerves, a radical resection of the tumour was accomplished in each case. The technical advantages of this approach are discussed in light of the anatomy of the dural configuration of the lateral wall of the cavernous sinus.     

Synthesis and in vivo evaluation of a 99m/99Tc-DADT-benzovesamicol: a potential marker for cholinergic neurons

Fifty-six asthmatics from an asthma ward or from an asthma out-patient clinic were challenged with two low concentrations (0.03 and 0.012 mg) of metacholine chloride in order to assess the relationship between pronounced hyper-responsiveness and asthma severity in a clinical setting. Only inhaled bronchodilators were stopped before challenge. Asthma severity was assessed retrospectively and prospectively on the basis of treatment, number of days in hospital, intensive care, number of emergency visits and days on sick-leave. The results show that pronounced hyper-responsiveness (n = 28) is not associated with asthma severity. It is concluded that a single simplified test of pronounced bronchial hyper-responsiveness, performed without taking into consideration the actual state of the disease and without stopping all medication, is of no help in identifying the patients with the clinically most severe asthma and worst prognosis.     

Complications of renal cyst puncture

One hundred nineteen renal cyst punctures have been reviewed. There have been four complications (3.4 per cent), three requiring surgery. This should be expected, as all invasive diagnostic procedures are accompanied by some morbidity. The relative benefit of nonoperative diagnostic procedures in differentiating benign renal cyst from adenocarcinoma is discussed.