David Deam

Iodine-induced hyperthyroidism due to nonionic contrast radiography in the elderly

PURPOSE To identify the number of cases of hyperthyroidism that followed the performance of contrast radiography in elderly patients at a geriatric hospital in a non-iodine-deficient area and to determine the clinical course of the condition. PATIENTS AND METHODS All patients over a 20-month period with biochemical hyperthyroidism (plasma free thyroxine level greater than 25.0 pmol/L and thyroid-stimulating hormone level less than 0.10 IU/L) were identified. Clinical features of hyperthyroidism and exposure to nonionic contrast media radiographs within the previous 12 months were sought. Follow-up extended from 6 to 22 months. RESULTS A total of 28 patients with hyperthyroidism (aged 70 to 96 years) were identified. Seven patients (25%) had documented biochemical development of hyperthyroidism (five) or subsequent hyperthyroidism (two) 3 to 8 weeks after nonionic contrast media radiography. The four patients who underwent scanning had a multinodular thyroid, and thyroid antibodies were not detected in five of five patients. Although the condition appeared self-limited and six of six patients were euthyroid after 18 months, the condition was not benign; progress and recovery were adversely affected by hyperthyroidism. Four patients had a good response to treatment with an antithyroid drug (carbimazole). CONCLUSION Iodine-induced thyrotoxicosis following contrast radiography was found in 7 of 28 cases of hyperthyroidism seen at a geriatric hospital. Although the condition appears ultimately self-limited, pharmacologic control of severe clinical features may be required. The frequency of this condition in a non-iodine-deficient area appears related to the more common occurrence of autonomous thyroid nodules in the elderly. Because performance of contrast radiography is more common in this age group, the recognition and treatment of iodine-induced thyrotoxicosis are of increasing clinical importance.

A case–control study of the androgen receptor gene CAG repeat polymorphism in Australian prostate carcinoma subjects

The development of prostate carcinoma is androgen‐dependent. The coding sequence of the androgen receptor (AR) gene contains a CAG repeat polymorphism that has been shown to influence AR activity in vitro. Studies of this polymorphism as a prostate carcinoma risk factor have been conflicting.

ALPHA1-Antitrypsin phenotypes in homosexual men

&NA; The alpha1‐antitrypsin (AAT) phenotype was determined by isoelectric focusing in 215 male homosexuals and compared with those in 208 male heterosexuals. The incidence of abnormal phenotypes was 16.3% in the homosexual group which was significantly different (p<0.03) than the 8.7% in the heterosexual group. There was no difference in the phenotype distribution between homosexuals who were anti‐human immunodeficiency virus reactive and those who were non‐reactive. It suggests that investigation into the interplay of factors associated with homosexuality could include genetic as well as psychological and social factors.

Comparison of Two Commonly Used Standard IVGTTs

OBJECTIVE To compare the magnitude and reproducibility of the FPIR measured during two different IVGTT protocols in nondiabetic subjects. RESEARCH DESIGN AND METHODS Nine control subjects each had two pairs of IVGTTs with either a 4-min infusion of 0.5 g/kg glucose or a 1-min infusion of 0.3 g/kg glucose. Blood glucose and serum insulin were measured before and 1, 2, 3, 5, and 10 min after completion of the glucose infusion. The FPIR was measured with either 1 + 3−, 2 + 3 + 5−, or 1 + 3 + 5-min serum insulins, areas under the insulin curve (0–5 or 0–10 min), or the ratio of serum insulin to blood glucose area. RESULTS The FPIR was higher in eight of nine subjects with the short-infusion test, but the within-subject variation of the two methods was identical. Reproducibility was not significantly improved with an integrated insulin area or insulin-to-glucose ratio measurement. CONCLUSIONS Reproducibility of the FPIR measured during IVGTT is not significantly affected by the duration of the glucose infusion. However, the magnitude of the difference in FPIR observed between the two protocols highlights the need for standardization of the methodology if the IVGTT is to be used in studies of the preclinical stage of IDDM.

Four cases of IgD multiple myeloma

Summary The pathological and clinical findings in 4 cases of IgD multiple myeloma are presented. Two patients presented with renal failure and 2 with bone pain and weight loss. Three had IgD lambda paraproteins and 1 an IgD kappa paraprotein. One patient also developed hypercalcemia and extraosseous spread of tumor to pleura, skin, and palate. There were no distinctive bone marrow or histological findings which suggested this unusual type of myeloma.

Cerebrospinal fluid biochemistry in the diagnosis of multiple sclerosis.

The Poser criteria for diagnosing multiple sclerosis (MS) includes clinical, paraclinical and laboratory information.1 We studied the influence of cerebrospinal fluid (CSF) biochemistry results on the categorisation of patients with suspected MS. A retrospective study was made of 138 patients who had CSF samples sent over a 1 year period to the laboratory for examination for oligoclonal bands. Using the Poser criteria, 23 patients were diagnosed as having definite MS and one patient as probable MS. Cerebrospinal fluid biochemistry upgraded the categorisation from probable to definite MS in 16 of these 24 patients (66%). In this study, we found oligoclonal bands to be more sensitive in the diagnosis of MS (96%) than either the concentration of IgG in the CSF (43·5%) or the IgG expressed as a percentage of the total protein in the CSF (71%). We conclude that CSF biochemistry is a valuable investigation in the evaluation of patients with suspected MS.

Paraproteins associated with elevated immunoglobulins

The presence of a paraprotein is usually associated either with normal levels of immunoglobulins (Ig) or with suppressed Ig levels such as in multiple myeloma. Over a 10 year period we discovered paraprotein bands in 570 patients. Eighteen (3%), had elevated levels of Ig in association with their paraprotein. The features of these patients are shown in the table. HIV infection 4 Carcinoma 3 Liver Disease 3 B Cell neoplasia 2 Sjogrens Syndrome 2 Unknown 2 Inflammatory Conditions 2 Unavailable 1 HIV infection is known to be associated with both paraproteins and elevated Ig levels. Both liver disease and Sjogrens disease may be associated with elevated Ig. The inflammatory conditions included one patient who had a transient paraprotein band with a chest infection and another with active arthritis. Of the B cell neoplasias, one patient had myeloma and one had Waldenstroms macroglobulinaemia. An unexpected finding was three patients with malignancy. Two patients had carcinoma of the kidney and one a leiomyosarcoma of the stomach. One of the renal carcinoma patients was also infected with HIV. The finding of a paraprotein and raised Ig may be caused by a problem of B cell control with stimulated B cells producing excessive Ig and one done producing a paraprotein. Alternatively these patients may coincidentally have two separate conditions, a B cell disorder causing a paraprotein and a separate disorder stimulating generalised Ig production. Examples of both theories are probably present in our series. Our results suggest that if a paraprotein is found in association with raised Ig, the above conditions be searched for, especially HIV infection.