Jesper Rye Andersen

Thyroid Gland Volume and Serum Concentrations of Thyroid Hormones in Chronic Renal Failure

Thyroid gland volume, ultrasonically determined, and thyroid function were investigated in 40 patients with chronic renal failure (33 of these on hemodialysis) and 40 sex-, age- and weight-matched healthy controls. None had thyroid autoantibodies or a clinically detectable goiter. The median thyroid gland volume was significantly elevated in the uremic patients: 24 ml (range 8-43 ml) compared with the healthy controls 17 ml (range 10-22 ml) (p less than 0.005). The serum concentrations of thyroxine (T4), triiodothyronine (T3), free thyroxine index (FT4I) and free triiodothyronine index (FT3I) were significantly decreased in uremic subjects compared with the controls. The serum concentration of thyrotropin did not differ significantly between patients and controls. None of the thyroid function variables correlated with thyroid gland volume. In conclusion, thyroid gland volume was increased in patients with chronic renal failure. The alterations in thyroid hormone concentrations could, however, not explain this finding.

Disturbances of ano-rectal function in multiple sclerosis.

Thirty patients with multiple sclerosis (MS) [18 men and 12 women, mean age 40 years (range 22–50), disease duration 12 years (range 0.5–34), Kurtzkes Expanded Disability Status Score 6.0 (range 4.0–7.5)] were interviewed about bowel symptoms and studied using ano-rectal manometry. The results were compared with findings in healthy controls. Twenty-eight had bowel symptoms: 8 constipation, 10 constipation and infrequent faecal urgency, 4 infrequent faecal incontinence and 6 frequent faecal incontinence. Anal sphincter pressure at rest was significantly reduced in MS patients 69 (SD 17) cm H2O, compared with 92 (SD 15) cm H2O in controls, and the external sphincter contraction force was also significantly reduced. Rectal sensation and rectal compliance were reduced and the ano-rectal inhibition reflex (defaecation reflex) required a higher rectal pressure to be elicited in the patients. Upon rectal filling, an early external sphincter excitation was seen. The presence of faecal incontinence correlated strongly with reduced rectal sensation. The findings suggest that faecal incontinence can at least partly be explained by low anal sphincter pressure and poor rectal sensation. The findings of early sphincter excitation and increased threshold of ano-rectal inhibition reflex may be an important pathophysiological factor for constipation in MS patients.

Case Reports: Implantation Metastasis After Laparoscopic Biopsy of Bladder Cancer

We report a case of tumor implantation in the abdominal wall following laparoscopic biopsy of a transitional cell tumor. Tumor seeding is a known risk in patients with transitional cell carcinoma and we recommend that laparoscopic biopsy of urothelial tumors be avoided.

Thyroid function and autoimmunity in pernicious anemia before and during cyanocobalamin treatment

Out of 35 consecutive patients with decreased plasma-cobalamin 22 had newly diagnosed overt pernicious anemia (PA) six of which had a known history of thyroid disease. At referral, 5 of these 6 were thyroid peroxidase antibody (TPOAb)-positive and 2 were thyroglobulin antibody (TgAb)-positive, while none were thyroid stimulating antibody (TSAb)-positive (an overall autoantibody appearance of 83.3%). Fifty percent of the 22 patients had TPOAb and 13.6% had TgAb compared to 18.2% and 4.5%, respectively in sex and age matched healthy controls. Six PA-patients without a history of thyroid disease had thyroid autoantibodies and another patient seroconverted within the first year during treatment with cyanocobalamin. Measurements of serum concentrations of thyroid hormones and thyroid stimulating hormone were performed during the first year of treatment with cyanocobalamin. Two cases of subclinical myxoedema were found among PA-patients and another case was found among patients with latent PA. The female:male ratio of thyroid disease among PA-patients and among thyroid autoantibody-positive PA-patients was interestingly found to be 1:1. Treatment with cyanocobalamin did not have any systematic effect on thyroid function. Routine screening for thyroid function and thyroid autoantibodies in patients with latent or overt PA is recommended.

Ureteroscopic Management of Transitional Cell Tumors

Eighty-nine ureteroscopies, comprising 102 renal units, were performed on 31 patients for diagnosis, treatment or follow-up of transitional cell tumors of the upper urinary tract. The indications were hematuria or filling defect (29 endoscopies), treatment of tumor (19) and follow-up (41), i.e. 33, 21 and 48 renal units. Ureteroscopy (including 2 peroperative) was satisfactorily completed in 93 units. Tumor was suspected or diagnosed in 57 units, but later disproved in 11. Two tumors were overlooked at endoscopy. Surgery was performed in 21 cases (bilateral in 3), with indications based on ureteroscopic findings in 58%. Electroresection, laser photocoagulation or fulguration was done on ten units (average treatment sessions 2.6). Inadequate ureteroscopic treatment led to surgery in two of these units, but in seven open surgery was avoided (follow-up 6-47, mean 25 months). One old patient had no further treatment. Follow-up ureteroscopy was planned for 48 units and completed in 42. Complications occurred after 11 of 89 endoscopies. Ureteroscopic management of upper-tract urothelial tumors can be satisfactory, with long freedom from recurrence.

Correlations between PRL and Chloride, Sodium, Potassium and Calcium in Amniotic Fluid

Abstract. The concentration of prolactin in amniotic fluid from 91 pregnant women (Group I: 51 specimens obtained at 15th‐20th week of gestation; Group II: 40 specimens at term) has been correlated with the amniotic fluid concentrations of calcium, of the ions sodium, chloride, and potassium, and with the clinical data. When the week of gestation in multiple regression analyses was predetermined for inclusion in the first step, the amniotic prolactin concentration was found to be significantly correlated with sodium or chloride in both groups and the correlation coefficients in the two groups were alike. The correlation coefficients of potassium and of calcium differed between the two groups and no general pattern could be detected. The results indicate that the amniotic sodium and chloride concentrations could be of importance for the regulation of the amniotic prolactin concentration.

Decidual prolactin content and secretion at term: Correlations with the clinical data

This study was conducted to describe the distributions of the initial decidual PRL content (D‐PRL) and the decidual PRL secretion (D‐PRL‐s) in vitro at term and to ascertain whether the clinical data might influence these decidual PRL measures and their correlation with the amniotic fluid PRL concentration (A‐PRL). Decidual tissue was obtained after 134 normal pregnancies at term. D‐PRL and D‐PRL‐s into the medium after an 8 h incubation were determined. The distributions of D‐PRL and D‐PRL‐s were skewed to the right. A logarithmic transformation generated symmetric distibutions. Eight women who were delivered by vacuum extraction due to intra‐uterine asphyxia had D‐PRL values similar those in normal vaginal parturition, whereas D‐PRL‐s values were significantly reduced (p < 0.02). No significant difference (p>0.05) was found in the decidual PRL measures in the vaginal deliveries between those receiving labor stimulating medication and those without, or between women who gave birth vaginally and women undergoing elective cesarean section. Stepwise multiple regression analyses of data obtained from 30 women who gave birth after uncomplicated or various pathological pregnancies showed logarithmically transformed A‐PRL to be closely correlated with D‐PRL, and these correlations were improved by including the week of gestation as a second step (p < 0.00001). After normal pregnancy, D‐PRL‐s was significantly correlated with D‐PRL (p < 0.01), and D‐PRL was correlated with the week of gestation (p < 0.05). None of the remaining clinical data improved the correlations. The results indicate that a logarithmic transformation is appropriate when evaluating D‐PRL and D‐PRL‐s at term and that special attention should be paid to the differences in week of gestation and deliveries complicated with intra‐uterine as Dhvxia.

Serum thyroglobulin in chronic renal failure--effects of haemodialysis.

The influence of chronic renal failure (CRF) on serum thyroglobulin concentration (Tg) was investigated in 37 patients (29 on haemodialysis) and compared with results obtained from matched controls. Serum Tg did not differ significantly between CRF patients not on haemodialysis: median 24.1 micrograms/l, (range 2.5-47.0) and controls: median 23.6 micrograms/l, (range 2.1-53.0). Patients on haemodialysis had a significantly lower serum Tg level: median 11.4 micrograms/l (range 2.1-54.0) compared to controls (p less than 0.01) but no change in serum Tg level could be demonstrated after a single haemodialysis. A possible explanation for the low serum Tg level in patients with CRF on haemodialysis is decreased production parallelling the decreased production rate of T4 and T3. Since CRF patients not on haemodialysis had an unchanged serum Tg level compared to controls, haemodialysis was associated with small changes in serum Tg level, and since none of the patients had a serum Tg value above the upper reference limit we conclude that these changes were not of a magnitude likely to cause misinterpretation of results in routine clinical situations.

Effect of ouabain and bumetanide on the basal and the osmolality-affected prolactin secretion from human decidual cells in vitro

Human decidual explants were incubated in vitro in media containing 10(-5) mol/l ouabain or 10(-4) mol/l ouabain or 0.5 X 10(-4) mol/l bumetanide to change the intracellular ionic concentrations. In isosmotic incubations (osmolality 315 mmol/kg), no significant effect of either 10(-5) mol/l ouabain or 0.5 X 10(-4) mol/l bumetanide was found on the decidual prolactin secretion (D-PRL-s). 10(-4) mol/l ouabain significantly decreased both decidual prolactin production and D-PRL-s (P less than 0.05) and was therefore not used for the following cross-over experiments. Hyperosmotic media (387 mmol/kg) were produced by changing the concentration of either sodium chloride, potassium chloride, or mannitol. All increased D-PRL-s compared with the isosmotic media (315 mmol/kg). 10(-5) mol/l ouabain significantly diminished the increase otherwise elicited by the sodium chloride and the mannitol hyperosmotic media. However, in the hyperosmotic potassium chloride medium with 10(-5) mol/l ouabain, the D-PRL-s remained increased. The hyperosmotic medium (252 mmol/kg) reduced D-PRL-s compared with the isosmotic media (315 mmol/kg) and no significant effect of ouabain was found. Bumetanide did not change the D-PRL-s into any of the hypo- or hyperosmotic media compared with the secretion at 315 mmol/kg. Based on experience from other cell types, the results further indicate that the intracellular ionic concentrations could be of importance to the secretion of decidual prolactin in vitro.