Cushingoid

Abstract: with Hypaque was performed before the expected date of ovulation, and laparoscopy before menstruation.' All but one of the laparoscopies were performed under local anaesthesia2 with about 30 ml aqueous methylene blue injected under low pressure into the uterine cavity. On laparoscopy the dye could be seen traversing patent tubes and spilling into the pouch of Douglas. Bilateral tubal patency was shown in 27 patients by hysterosalpingography and 33 by laparoscopy (see table). In 700Z of the patients known to have some degree of tubal occlusion the two methods gave closely similar results, whereas periadnexal adhesions were detected in 57 patients (66 %) by laparoscopy but in only four patients (47 %0) by hysterosalpingography. Laparoscopy also permitted an assessment of the severity of the adhesions and the degree to which other organs were affected. Thirteen patients who appeared to have either bilateral or unilateral patent tubes on their hysterosalpingograms were shown by laparoscopy to have fimbrial phimosis.

Abstract: Equine pituitary pars intermedia dysfunction (PPID) is a common and serious condition that gives rise to Cushing's disease. In the older horse, it results in hyperadrenocorticism and disrupted energy metabolism, the severity of which varies with the time of year. To gain insight into the mechanism of its pathogenesis, 24-h profiles for peripheral plasma melatonin, serotonin, dopamine and cortisol concentrations were determined at the winter and summer solstices, and the autumn and spring equinoxes in six horses diagnosed with Cushing's disease and six matched controls. The nocturnal rises in plasma melatonin concentrations, although different across seasons, were broadly of the same duration and similar amplitude in both groups of animals (P > 0.05). The plasma concentrations of cortisol did not show seasonal variation and were different in diseased horses only in the summer when they were higher across the entire 24-h period (P < 0.05). Serotonin concentrations were not significantly affected by time of year but tended to be lower in Cushingoid horses (P = 0.07). By contrast, dopamine output showed seasonal variation and was significantly lower in the Cushing's group in the summer and autumn (P < 0.05). The finding that the profiles of circulating melatonin are similar in Cushingoid and control horses reveals that the inability to read time of year by animals suffering from Cushing's syndrome is an unlikely reason for the disease. In addition, the results provide evidence that alterations in the dopaminergic and serotoninergic systems may participate in the pathogenesis of PPID.

Abstract: THE INTRODUCTION into clinical use of adrenocorticotropic hormone (ACTH) and later of cortisone and its analogues caused a marked change in prognosis for children affected with the nephrotic syndrome. Initial enthusiasm was somewhat dampened by subsequent observations that the diuresis achieved was often temporary and proteinuria frequently persisted. These deficiencies were largely controlled by prolonging therapy beyond initial diuresis. Recent reports1-4of studies from a number of centers treating with various ACTH and long-term steroid regimens uniformly substantiate their therapeutic efficacy in producing and maintaining remissions, thus reducing morbidity and mortality. The untoward effects of high-dosage, long-term steroid therapy are generally recognized.5The Cushingoid appearance of such children commonly results in adverse behavioral manifestations such as depression, withdrawal, and aggressiveness, which in turn lead to decreased school attendance and poor intellectual performance. Moreover, a number of serious and at times life-threatening pathophysiologic effects frequently are produced, such as