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Fam Med. 2003 Jun;35(6):408-10.
Thyroid function testing in outpatients: are both sensitive thyrotropin (sTSH) and free thyroxine (FT4) necessary?

Viera AJ.

Department of Family Practice, Naval Hospital Jacksonville, FL 32214, USA. a_j_vierar.med.navy.mil

BACKGROUND AND OBJECTIVES: Despite improved thyroid function testing assays, appropriate use of these commonly ordered tests to detect thyroid dysfunction remains controversial. This study determined if a normal sensitive thyroid stimulating hormone (sTSH) test alone is sufficient to rule out thyroid dysfunction in outpatients. METHODS: This was a retrospective analysis of initial sTSH and free thyroxine index (FT4) tests ordered during a 26-month period. Test results were classified as concordant if both the sTSH and FT4 indicated the same findings (ie, euthyroid, hyperthyroid, or hypothyroid). The results were classified as discordant if the sTSH and FT4 did not indicate the same findings. RESULTS: There were 1,392 paired sTSH and FT4 results. Of 1,340 results classified as concordant (96.2%), 1,187 specimens were consistent with euthyroidism, 41 with hyperthyroidism, and 112 with hypothyroidism. Of the remaining 52 (3.8%) discordant results, 47 met the definition of subclinical thyroid dysfunction. Excluding these 47 results yielded a concordance rate of 99.6%. Of the 1,192 normal sTSH results, FT4 was low in two and high in three. If FT4 tests had not been ordered on the 1,192 specimens with normal sTSH levels, the savings over the study period would have been more than dollars 3,360. CONCLUSIONS: If the sTSH is normal, the likelihood of an abnormal FT4 is very small. sTSH alone is adequate to screen outpatients for thyroid dysfunction. Limiting FT4 tests to those with abnormal sTSH results will result in cost savings.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817866&dopt=Abstract [PubMed - in process]

Pharm Res. 2003 Jun;20(6):889-96.
Targeted proapoptotic LHRH-BH3 peptide.

Dharap SS, Minko T.

Department of Pharmaceutics, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, New Jersey, USA.

PURPOSE: The purpose of this work was to construct and evaluate a novel targeted proapoptotic peptide for cancer treatment. METHODS: The peptide consisted of luteinizing hormone-releasing hormone (LHRH) as a targeting moiety specific to LHRH receptors and a synthetic BCL-2 homology 3 (BH3) domain peptide as an apoptosis inducer and a suppressor of antiapoptotic cellular defense. Anticancer activity of the peptide was evaluated on different cancer cell lines. RESULTS: The targeting receptor to LHRH peptide is overexpressed in several cancer cell lines but is not expressed in healthy human visceral organs. LHRH and BH3 peptides when applied separately did not demonstrate cellular toxicity. In contrast, the LHRH-BH3 peptide was toxic in several cancer cell lines. Coincubation of LHRH and LHRH-BH3 peptides significantly decreased cytotoxicity of the latter. It was found that the LHRH-BH3 peptide induced apoptosis by simultaneous inhibition of the antiapoptotic function of BCL-2 protein family and activation of caspase-dependent signaling pathway. CONCLUSIONS: The proposed anticancer proapoptotic LHRH-BH3 peptide simultaneously affects two molecular targets: 1) extracellular cancer-specific LHRH receptors and 2) the intracellular controlling mechanisms of apoptosis. The results of this work may be used to design novel approaches for the treatment of various cancers.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817893&dopt=Abstract [PubMed - in process]

Scand J Clin Lab Invest. 2003;63(3):233-8.
Circulatory responses to hypoglycaemia in diabetic and non-diabetic children.

Bjorgaas M, Aasarod K.

Department of Medicine, Division of Endocrinology, St. Olavs Hospital, Norway. marit.bjorgaaedisin.ntnu.no

The purpose of this study was to investigate the circulatory responses to hypoglycaemia in diabetic and non-diabetic children and to determine whether these changes were associated with hormone levels or clinical variables. Plasma glucose levels in 18 diabetic and 15 control children were gradually lowered to 2.5 (0.3) mmol/L (mean (SD)) and 2.9 (0.2) mmol/L, respectively. Blood pressure and heart rate were recorded at 10-min intervals, and blood samples were taken for hormone analysis. Systolic pressure increased from 110.1 (10.0) to 115.0 (11.2) mmHg (p = 0.008) in the diabetic children and from 116.9 (12.0) to 121.6 (12.7) mmHg (p = 0.049) in the controls. Diastolic pressure decreased from 61.9 (6.7) to 55.5 (7.6) mmHg (p < 0.001) in the diabetic children and from 66.5 (6.3) to 55.1 (5.1) mmHg (p < 0.001) in the controls. The increase in pulse pressure during hypoglycaemia was significantly smaller in the diabetic children (10.6 (5.5) vs. 15.7 (7.7) mmHg, p = 0.04). The final systolic and pulse pressure correlated with the final adrenaline level in the controls (r = 0.66, p = 0.008 and r = 0.70, p = 0.003, respectively). In the non-diabetic as well as the diabetic group, the increase in pulse pressure correlated with the increase in adrenaline (r = 0.66, p = 0.008 and r = 0.50, p = 0.03, respectively). It is concluded that systolic pressure increases and diastolic pressure decreases during hypoglycaemia in children. The smaller increase in pulse pressure observed in the diabetic children is probably related to a significantly smaller increase in adrenaline in this group.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817910&dopt=Abstract [PubMed - in process]

Breast Cancer Res. 2003;5(4):R88-102. Epub 2003 Apr 29.
Risk factors for breast cancer in a population with high incidence rates.

Wrensch M, Chew T, Farren G, Barlow J, Belli F, Clarke C, Erdmann CA, Lee M, Moghadassi M, Peskin-Mentzer R, Quesenberry CP Jr, Souders-Mason V, Spence L, Suzuki M, Gould M.

University of California, San Francisco, California, USA. wrensctsa.ucsf.edu

BACKGROUND: This report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates. METHODS: Eligible women who were residents of Marin County diagnosed with breast cancer in 1997-99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews. RESULTS: In multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990-94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over. CONCLUSIONS: Despite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817999&dopt=Abstract

J Am Med Dir Assoc. 2000 May-Jun;1(3):117-21.
Hormone Replacement Therapy in Prevention of Morbidity and Mortality in the Older Woman: Part III: Potential Adverse Effects of Hormone Replacement Therapy.

Steffen KA, Carnes M.

University of Wisconsin Department of Medicine, Section of Geriatrics and Gerontology, and the Department of Veterans Affairs Geriatric Research and Clinical Center, Madison, WI.

OBJECTIVES: The objective of this four part series is to review for the practicing clinician the extensive and sometimes contradictory literature on the effects of estrogen replacement therapy (ERT) and hormone replacement therapy (HRT) in the postmenopausal woman. This third article reviews HRT and the potential excess morbidity from breast cancer, endometrial cancer, venous thromboembolism (VTE), and coronary heart disease (CHD). DESIGN: Studies reviewed were obtained through Medline searches, examination of citations in the articles reviewed from those searches,interviews with local experts in geriatrics, cardiology, and women's health. CONCLUSIONS: Long-term HRT seems to be associated with a small increased risk for breast cancer. The risk of endometrial cancer in women with a uterus using ERT can be eliminated completely with the use of combination estrogen and progestin. HRT may be associated with a small increased risk for VTE; however, the absolute morbidity and mortality attributable to VTE is small and unlikely to impact the net benefit of HRT significantly. Although there is considerable data favoring a beneficial effect of HRT on CHD, initiation of HRT in women with established CHD may be associated with increased risk of adverse cardiac events in the first year after initiation. In counseling patients about the use of long-term HRT, the balance of these risks and the effect of co-morbid illness in the geriatric population should be addressed. Discussion of HRT and the aging brain (stroke, dementia), the net benefit of long-term HRT, and decision-making for the individual patient is forthcoming in the final article of this four-part series.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12818024&dopt=Abstract [PubMed]

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