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To determine whether the time of day at which corticotropin stimulation testing is performed influences the steroid concentrations observed in persons with normal adrenal function.In this retrospective, secondary analysis, participants with normal adrenal function were studied to determine whether the time of corticotropin stimulation testing influenced results. Participants consisted of 2 groups: healthy volunteers who were not suspected of having adrenal insufficiency and patients being tested for adrenal insufficiency as part of their standard of care who were subsequently shown to have normal adrenal function on the basis of a peak cortisol value of at least 20 μg/dL. A high-dose corticotropin stimulation test was performed in all participants. Baseline, peak, and delta steroid concentrations were documented after corticotropin injection. Steroid concentrations were measured by tandem mass spectrometry. Multivariate analyses adjusted for patient age, sex, and baseline steroid concentrations.With progression through the day for the time of testing, the baseline cortisol concentration decreased, while the peak and delta cortisol concentration increased (P values:.001, .007, .007, respectively). For 11-deoxycortisol, the baseline decreased, while peak and delta values increased with later testing (P values: .017, .012, .02, respectively). Peak aldosterone concentrations increased according to their baseline values (P.001), but were unaffected by time. Peak and delta dehydroepiandrosterone concentrations increased with time (P = .015 and .021, respectively). Referring to the various criteria for adequate steroid responses to corticotropin available in the literature, the time-related differences in this small group of patients were insufficient to draw different conclusions about results of testing.Cortisol, 11-deoxycortisol, and dehydroepiandrosterone values were most influenced by testing times. In patients with borderline adrenal function who are tested at different times of the day, the modest differences we observed may be sufficient to affect conclusions about whether adrenal insufficiency is present.

Body weight (BW) and age have been shown to affect the dose of levothyroxine (LT(4)) that results in normalization of serum thyroid-stimulating hormone (TSH) in hypothyroid patients. Our objective was to determine whether gender, menstrual status, and ideal BW (IBW) also affect the LT(4) dose required to achieve a serum TSH within the normal range.We retrospectively reviewed the charts of patients being treated for primary hypothyroidism who had TSH values within a normal range. We selected patients aged 18-85 years who were taking LT(4) without any confounding medications, and who had no serious chronic conditions. Their LT(4) doses, referred to here as LT(4) dose requirements, based on both BW and IBW were documented. The relationship between gender, menstrual status, age, serum TSH concentrations, and the degree of overweight on LT(4) dose requirements were determined using multivariate analyses.Women were significantly more overweight than men (ratio of BW/IBW was 1.35 for women vs. 1.17 for men, p0.0001). LT(4) requirements based on BW did not differ by gender when age was included in the model. However, when degree of overweight was also included, men required lower LT(4) doses than both premenopausal women (1.34 μg/kg vs. 1.51 μg/kg, p = 0.038) and menopausal women (1.34 μg/kg vs. 1.49 μg/kg, p = 0.023). When examining IBW using a model incorporating age, men also required lower LT(4) doses than both premenopausal women (1.64 μg/kg vs. 1.92 μg/kg, p = 0.0033) and menopausal women (1.64 μg/kg vs. 1.90 μg/kg, p = 0.0024). Serum TSH concentrations were not significantly different in any of the gender groups. There was no relationship between serum TSH and either age or BW. The initial serum TSH concentration was by design with the normal range, but the concentration within that range was not a significant predictor of the LT(4) replacement dose in any of the models.In contrast to previous studies suggesting that age affects LT(4) replacement requirements, we found that age-based differences in doses are secondary to differences in BW and gender. In addition, in contrast to prior studies showing that lean body mass, but not gender, affected LT(4) dose, we instead found a significant impact of gender. Gender-based differences in dose requirement only became apparent either when IBW was used to correct for the dose or when degree of overweight was included in the model. Gender differences in LT(4) dose requirement exist, but are masked unless gender-based differences in degree of overweight are also considered.

Objective: To standardize the intravascular ultrasound (IVUS) analysis of coronary bifurcations. Background: Percutaneous treatment of bifurcation lesions is difficult particularly at the side branch ostium. Imaging techniques may improve our understanding of treatment options. There is no established IVUS methodology to assess the bifurcation. The present study aims to develop standards for bifurcation imaging. Methods: Quantitative IVUS analysis and 3D bifurcation angle measurements were performed in 34 patients who were selected from the Washington Hospital Center Database. Patients were included if both left anterior descending (LAD) and first diagonal (DX) pullbacks in the same procedure were done. Angiograms were available in 27 patients to measure the 3D bifurcation angle using specialized software. Pullbacks were analyzed proximal and distal to the bifurcation, and at the bifurcation. Results: PROXLAD versus PROXLAD(DX) were similar for vessel area (15.5 +/- 4.6 mm(2) vs. 15.9 +/- 4.0 mm(2), P = 0.19), lumen area (8.3 +/- 3.6 mm(2) vs. 8.6 +/- 3.3 mm(2), P = 0.25), and plaque area (7.2 +/- 2.0 mm(2) vs. 7.3 +/- 1.9 mm(2), P = 0.55). However, Bifurcation(LAD) was larger than Bifurcation(DX) for vessel area (17.3 +/- 4.0 mm(2) vs. 16.6 +/- 3.9 mm(2), P = 0.0083). The 3D angiographic bifurcation angle was 50 degrees +/- 13 degrees (range of 26 degrees-84 degrees), and did not affect the IVUS measurements. IVUS analysis showed that bifurcation lesions did obey Murray's Law, as PROXLAD lumen area measured 36.7 +/- 25.1 mm(3) versus Dist(LAD)/Dist(DX) measured 38.0 +/- 29.1 mm(3), P = 0.56. Conclusions: Two IVUS pullbacks should be performed for a complete assessment of the bifurcation and comparison with Murray's Law. The proposed IVUS analysis was not influenced by the bifurcation angle. (C) 2009 Wiley-Liss, Inc.

Improved accuracy in predicting coronary heart disease (CHD) risk in patients with diabetes and kidney disease is needed. The addition of albuminuria to established methods of CHD risk calculation was reported in the Strong Heart Study (SHS) cohort. In this study, the addition of estimated glomerular filtration rate (eGFR) was evaluated using data from 4,549 American Indian SHS participants aged 45 to 74 years. After adjustment for Framingham CHD risk factors, hazard ratios for eGFR as a predictor of CHD were 1.69 (95% confidence interval 1.34 to 2.13) in women and 1.41 (95% confidence interval 0.94 to 2.13) in men. Models including albuminuria, eGFR, or both scored higher in discriminatory power than models using conventional risk factors alone in women; in men, the improvement was seen only for albuminuria and the combination of albuminuria and eGFR. Hosmer-Lemeshow assessments showed good calibration for the models using eGFR alone in both genders, followed by models including albuminuria alone in both genders. Adding eGFR improved the net reclassification improvement (NRI) in women (0.085, p = 0.0004) but not in men (0.010, p = 0.1967). NRI and integrated discrimination improvement (IDI) were improved in both genders using albuminuria and eGFR (NRI 0.135, p

Objectives To test the hypothesis that early trends in common blood tests may delineate risks of liver failure (LF) in infants with parenteral nutrition-associated liver disease (PNALD) from short bowel syndrome and suggest criteria for transplant referral. Study design Total levels of bilirubin, gamma-glutamyl transferase, albumin, alanine aminotransferase, platelet count, and absolute neutrophil count were recorded every 3 months for 61 infants with PNALD who were being considered for intestinal transplant starting at age 3 months until death without transplant (n = 12), LF with transplant (n = 35), or liver recovery without transplant (n = 14). Probabilities of LF were determined with logistic regression. Results Independent predictors of LF were, in descending order, total bilirubin level (odds ratio [OR] = 1.195), platelet count (OR = 0.992), and albumin level (OR = 0.248). Predicted probabilities of eventual LF varied from 36% to 38% at ages 3 to 6 months when the total bilirubin level was 6.0 mg/dL, platelet count was 220 x 103/μL, and albumin level was 3.5 g/dL to 83% to 84% when the total bilirubin level was 11.7 mg/dL, platelet count was 168 x 103/μL, and albumin level was 3.0 g/dL. Conclusions Transplant referral for a total bilirubin level of 6 mg/dL between 3 to 6 months of age is appropriate, because the probability of LF is at least 36%.

As a result of therapeutic advances, survivors of lymphoma are now living longer. However, their mortality is higher when compared to the general population, probably due to multiple factors. Survivors of childhood leukemia and lymphoma appear to have an increased prevalence of obesity. The objectives of this retrospective study were to analyze weight change after lymphoma treatment in an adult population and determine factors predictive of weight gain. Data were collected from 219 patients and analyzed sequentially at the initial visit and at 6, 12 and 18 months. There was a progressive increase in weight from the initial visit to 6 months (1.5% increase of initial body weight), 12 months (4.5%) and 18 months (6.4%). More than 9% of patients experienced weight gain greater than 20% during follow-up. There was a statistically significant association between the percentage of increase in weight and age, B symptoms and body mass index (BMI) at presentation. Younger patients, those with B symptoms or those with lower BMI manifested more weight gain (p = 0.0008, p = 0.0440 and p = 0.0009, respectively). Other assessed factors had no effect on weight gain including sex, race, lymphoma histology, disease outcome, radiation therapy, number of treatment regimens and use of steroids. Further studies are needed to explore long-term weight trends and their impact on the health of lymphoma survivors.