[An endemic area of goiter in the Northern Golan Heights].
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Biomedical subjects
Publications and source records attributed to T Horne.
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A case is reported in which obstructed gallbladder resulted in a large defect in the liver scan. Causes of false positive liver scans are discussed.
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In 38 subjects, 24-h food-and-water deprivation during the Jewish fast day, Tisha b'Av, led to a 2.5-fold increase in plasma free fatty acids and to a doubling of the bilirubin concentration. There were also significant increases in serum sodium, chloride, total proteins, albumin, uric acid, phosphorus and alkaline phosphatase and aspartate aminotransferase activity. Serum glucose and triglycerides decreased in concentration. There were no changes in concentrations of urea, potassium, cholesterol or calcium. The marked increases in free fatty acids might constitute a hazard for those with impaired myocardial function.
In 55 Israeli Beduin Arabs the ratio of polyunsaturated to saturated fatty acids in subcutaneous fat (which reflects the degree of unsaturation of dietary fat) and serum cholesterol and triglyceride concentrations were all significantly lower in men and women leading the typical seminomadic Beduin life than in men doing western-type work and in housewives of a fixed Beduin settlement. The values were 0.76, and 159 and 72 mg/dl, respectively, compared with 0.93, 187 and 108; P less than 0.001, less than 0.01 and less than 0.02, respectively. In the group as a whole there was a paradoxically positive correlation between P/S ratio and cholesterol (r = 0.37, Pr = 0.025) and P/S ratio and triglycerides (r = 0.46, Pr less than 0.01). The expected cholesterol-lowering effect of the polyunsaturated Israeli diet (P/S ratio about 1.0) was apparently swamped by other factors, dietary and/or non-dietary, involved in acculturation to a western life style of Beduin, among whom coronary heart disease has only recently begun to appear.
Conventional food diets of 300-600 kcal (14-20 days) were not as efficient as anticipated in increasing the rate of weight loss in ten obese patients previously given diets of 800-1200 kcal (13-30 days). The greatest efficiency was 76 per cent of the theoretical. The final weights after refeeding the 800-1200 kcal diets (9-14 days) were 0.5-2.0 kg greater than expected to result from the increased caloric deficit, and close to the weights that would have been reached had the 800-1200 kcal diets been continued without increased reduction in caloric intake.
A 12-hour overnight fast in 17 subjects did not result in a significant increase in blood viscosity, as occurs after a 24-hour fast. The usual preoperative fast does not therefore appear to have any adverse rheological effect. However, when it is necessary to prolong the fast, intravenous fluids should be given to prevent the expected increase in blood viscosity which then might have clinical effects as a result of decreased organ perfusion.
Two patients with sublingual thyroid glands and hypothyroidism since childhood are described. Because of enlargement of the sella turcica both were erroneously diagnosed as having primary pituitary tumors resulting in secondary hypothyroidism. One of the patients was even treated with pituitary gland irradiation. Following substitution thyroid therapy, thyroid-stimulating hormone (TSH) levels promptly returned to normal. Ectopic thyroid glands, which are often incapable of adequate hormonogenesis, may cause secondary pituitary enlargement and lead to the suspicion of a pituitary adenoma. The correct diagnosis can easily be established by measuring serum TSH levels, which are elevated in the former condition.
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As a result of abstaining from food and water for 24 h during the midsummer Tishah-b'Ab fast, blood viscosity increased by 16.5% in 27 subjects studied; plasma viscosity increased by 10.3% in nine; hematocrit, by 3.1% in 27; serum total protein, by 6.3% and albumin, by 7.7%, both in 29 subjects. These changes were statistically significant. Plasma fibrinogen did not increase significantly. Fasting-induced changes could impair blood supply to vital organs in patients with vascular insufficiency.
The ratio of polyunsaturated to saturated fatty acids in the adipose tissue of Israelis was found to be 0.88 for Ashkenazic Jews and 1.13 for non-Ashkenazic Jews, the highest reported for any population on a free-choice diet. Despite the unusually high ratios, indicating a high consumption of polyunsaturated fat, there is nevertheless, a relatively high incidence of ischemic heart disease among Israelis.
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Thyrotropin (TSH)-stimulation tests were performed on 21 patients with solitary hot nodules in the thyroid gland. Twelve of the patients were euthyroid and nine were hyperthyroid. The average age of the euthyroid patients was 38 +/- 14 (SD) years, and that of the hyperthyroid patients, 55 +/- 8 years. Prior to TSH stimulation, the scanograms of the euthyroid patients showed 131I uptake only in the nodules, while after the TSH test, almost equal uptake was observed in both lobes. The scanograms of the hyperthyroid patients that showed 131I uptake only in the area of the nodules prior to the TSH test showed no appreciable change after TSH stimulation.
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A patient with histologically proven coexistent Paget's disease of the bone and parathyroid adenomatosis is described. She developed coma associated with hypercalcemia and underwent successfully surgical removal of two parathyroid adenomata. The differential diagnosis of hypercalcemia in patients with this rare association is discussed and the importance of early surgical treatment is stressed. A review of similar reported case is presented.
Solitary parathyroid adenoma is the most common cause of primary hyperparathyroidism. It can be removed surgically with a 92-96% success rate without any pre-operative imaging procedures. However, imaging procedures may be of help in localization, thereby reducing operative morbidity, and in the detection of ectopic adenomas. The decision to undertake surgical exploration should not be based on these procedures because of their low sensitivity and limited specificity when used alone, but rather on an established biochemical diagnosis of hyperparathyroidism.