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Adrenal insufficiency is the clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency also in mineralocorticoids and adrenal androgens. It is a life-threatening disorder that can result from primary adrenal failure or secondary adrenal disease due to impairment of the hypothalamic-pituitary axis. Prompt diagnosis and management are essential. The clinical manifestations of primary adrenal insufficiency result from deficiency of all adrenocortical hormones, but they can also include signs of other concurrent autoimmune conditions. In secondary or tertiary adrenal insufficiency, the clinical picture results from glucocorticoid deficiency only, but manifestations of the primary pathological disorder can also be present. The diagnostic investigation, although well established, can be challenging, especially in patients with secondary or tertiary adrenal insufficiency. We summarise knowledge at this time on the epidemiology, causal mechanisms, pathophysiology, clinical manifestations, diagnosis, and management of this disorder. INSET: Panel: Prevention and therapeutic management of adrenal.... [ABSTRACT FROM AUTHOR]

This article presents a seminar on sudden infant death syndrome (SIDS). While the rates of SIDS are declining, it is still the leading cause of death of very young infants age 1 month to 1 year in developed countries. Factors that are blamed for SIDS include the sleeping position of the baby, second hand smoke exposure, bedding that is too soft and overheating. Pacifiers and one child per bed appear to reduce the risk of sudden infant death. The exact cause of SIDS is still unknown though it is suspected that immature cardiorespiratory control and failure of arousal from sleep are causes in addition to possible genetic factors.

This article presents the results of a study looking into the risk of chronic obstructive pulmonary disease (COPD) in those exposed to second hand smoke in China. COPD is a leading cause of death in China where a large number of the population is exposed to second hand smoke. The study discovered that exposure to passive smoking is associated with an increased prevalence of COPD and respiratory symptoms. If the association is causal, the study authors' estimate that 1.9 million deaths from COPD among nonsmokers could be attributed to passive smoking in China.

Summary Alcohol abuse and dependence disorders are common in the 10% of hospitalised patients who need admission to the intensive care unit (ICU), but these disorders are often undiagnosed. The systemic effects from the excessive use of alcohol increase susceptibility to, or directly cause various important disorders in the critically ill. Early recognition of alcohol abuse and dependence is necessary and should prompt consideration of several alcohol-specific diagnoses that have important prognostic and therapeutic implications for these patients. We discuss the use of screening tests to improve the identification of alcohol abuse and dependence disorders, the epidemiology and pathogenesis of important alcohol-related disorders, differences in the presentation of several common alcohol-related diagnoses in the ICU, and important alcohol-specific therapies. [ABSTRACT FROM AUTHOR]

Summary Background: Vascular endothelial cells lost from the blood-vessel endothelium through necrosis or apoptosis must be replaced. We investigated in a leukaemia model whether bone-marrow-derived endothelial cells contribute to this maintenance angiogenesis.Methods: We studied six patients with chronic myelogenous leukaemia (CML) carrying the BCR/ABL fusion gene in their bone-marrow-derived cells. We screened endothelial cells generated in vitro from bone-marrow-derived progenitor cells and vascular endothelium in myocardial tissue for the BCR/ABL fusion gene by in-situ hybridisation. For detection of donor-type endothelial cells after transplantation of haemopoietic stem cells, recipient tissue was stained with monoclonal antibodies against donor-type HLA antigens.Findings: We identified the BCR/ABL fusion gene in variable proportions (0-56%) of endothelial cells generated in vitro. Endothelial cells expressing the fusion gene were found in the vascular endothelium of a patient. In a recipient of an allogeneic stem-cell transplant, normal donor-type endothelial cells were detected in the vascular endothelium.Interpretation: These findings suggest that CML is not solely a haematological disease but originates from a bone-marrow-derived haemangioblastic precursor cell that can give rise to both blood cells and endothelial cells. Moreover, normal bone-marrow-derived endothelial cells can contribute to the maintenance of the blood vascular endothelium. The integration of bone-marrow-derived endothelial cells into the vascular endothelium provides a rationale for developing vascular targeting strategies in vasculopathies, inflammatory diseases, and cancer. [ABSTRACT FROM AUTHOR]

Considers the reduced growth in utero associated with type 2 (non-insulin-dependent) diabetes and impaired glucose tolerance in adult life. The question of evidence in human beings that maternal nutrition during gestation affects insulin-glucose metabolism; The investigation of glucose tolerance in people born around the time of famine; The study, methods and findings.

Looks at a study of the association between a first myocardial infarction and current oral contraceptive use in women from Africa, Asia, Europe, and Latin America. Methods of the study; Findings; Interpretation.

Analyzes a study that aimed to find out the proportion of cases of apparently non-syndromic coronal craniosynostosis that are attributable to the C749G (Pro250Arg) mutation in the gene for fibroblast growth factor receptor 3 (FGFR 3). Methods of the study; Findings of the study; Interpretation of the findings.

Assesses the distribution of neurovascular compression at the ventrolateral medulla in human beings with essential hypertension. Use of double-echo and magnetic-resonance angiography sequences to detect neurovascular compression; Differences in blood pressure control and duration; Essential hypertension patients with evidence of left-sided neurovascular compression at the ventrolateral medulla.

Presents research which developed a method for the identification of fragile X syndrome. The syndrome causing intellectual disability resulting from an absence of the protein FMR1; Populations affected by the condition; Cytogenic findings; Methods and results; Screening for male fragile X syndrome using Guthrie dried blood-spot samples.

Discusses research which studied the functions of Broca's area in the brain. Debate about whether the area is related to disturbances in articulation; Brief history of research; Research in this issue by Richard Wise et al regarding the brain areas involved in articulation; Use of positron-emission tomography (PET); Articulation in the insula; Details about Broca's aphasia; Tie between Broca's aphasia and Broca's area.

Presents research which concluded that protease inhibitors caused sexual dysfunction in HIV-1-infected men. Patients lacking any prior sexual dysfunction; Symptoms of the dysfunction; No organic causes of impotence present; Impact of the use of ketoconazole.

Focuses on a study that investigated 16 cases of major aphthous mouth ulcers after use of nicorandil, a cardiovascular drug. Patients; Duration of treatment; Study results; Conclusions.

Presents research which studied the incidence of herpes simplex virus 1 (HSV-1) in elderly persons with and without Alzheimer's disease (AD). Role of the epsilon-4 allele of apolipoprotein E (apoE); Previous research; Methods; Results; Suggestion that HSV-1 does not confer increased risk for AD when combined with the epsilon-4 allel of apoE; Additional conclusions.

Presents a case in which retrobulbar irradiation was used in the treatment of Graves' ophthalmopathy. Side-effect of retinal destruction; No prior evidence of effects on optic nerve; Case of 61-year-old woman who developed transient blindness following treatment; Explaining reduced vision; Normal vision returning after six months; Caution about use of this method as first treatment of choice.

Discusses relapses and occurrences of pityriasis rosea during states of altered immunity and that they suggest viral reactivation. Human herpesviruses as possible culprits; Details on blood samples from 12 patients with pityriasis rosea and 25 healthy people; Conclusions.

Presents a study that proposes application of capsaicin as the cause of causalgia. Depletion of neuropeptides which is attributed to `capsaicin causalgia'; Improvement in the means of diagnosing causalgic syndrome; Treatment of causalgic syndrome through modulating neuropeptide concentration or responsitivity and mitigating the consequences of neuropeptide depletion.

Reports on research which suggests that a decreased availability of nitric oxide (NO) during pregnancy could result in the complication known as pre-eclampsia. Finding that women with pre-eclampsia had higher levels of S-nitrosalbumin, a combination of NO and albumin; Speculation that the vitamin C deficiency that is usually associated with pre-eclampsia may result in less NO released from its protein-bound store in the blood; Directions for future studies.

Reports on the publishing of research papers which provide support to the evidence that the accumulation of beta-amyloid peptide causes dementia in Alzheimer's disease. How apolipoprotein E4 gene (APOE4) is the only known genetic risk factor for late-onset Alzheimer's disease (AD); Discovery that chromosome-10 probably contains one or more genes that increase the susceptibility to late onset AD; Discussion of the problems with the study.

Reports that ghrelin has been implicated in obesity and wasting syndromes. How little is known about ghrelin, a peptide hormone acting at the growth hormone secretagogue receptor; Research by Matthias Tschop at Lilly Research Laboratories which describes the metabolic effects of ghrelin in rats and mice which, when administered peripherally or centrally, caused an increase in food intake and weight gain.

Discusses a study which shows that people with active multiple sclerosis (MS) have higher concentrations of certain chemokines in their cerebrospinal fluid. Finding that lymphocytes in the central nervous system of these patients express higher concentrations of specific chemokine receptors than people without MS; Identification of chemicals and receptors involved in the inflammatory process of MS which suggest potential for new treatments; Comments by study author Richard Ransohoff.

Presents research which studied whether an association existed between the angiotensin converting enzyme (ACE) I/D gene polymorphism and susceptibility to high altitude pulmonary hypertension (HAPH) in highlanders of the Kyrghyz Republic. Individual variations in susceptibility to HAPH; Altitudes in the Kyrghyz Republic; Role of ACE in the etiology of hypertension; Measurements of pulmonary hemodynamics; Conclusions.

Reports on the findings of a small trial which showed that a synthetic peptide that mimics the adhesion epitope of streptococcal adhesion antigen I/II can prevent oral recolonization by Streptococcus mutans, the main aetiological agent of dental caries. Details of the studies conducted.

Reports that a gene that encodes a subunit of phosphatidylinositol 3-kinase (PI3-kinase), a cell-signalling protein has been implicated as an oncogene in ovarian cancer. Findings that PIK3CA on chromosome 3q26 is amplified in 40 percent of ovarian and other cancers; Indications that tumor cells loose their heterozygosity.

Reports a study which described the first direct evidence that residential radon can cause lung cancer. Research by Darby et al in the `British Journal of Cancer,' June, 1998; Previous studies on miners; Methods used in this study; Future research planned.

Looks at the evidence that intranuclear inclusions could be a key to the pathology of several inherited neurodegenerative diseases. The idea suggesting that these diseases could be prevented or cured by blocking mutant-protein aggregation; The presence of intranuclear inclusion in brain regions, such as Huntington's disease, revealed with the use of antibodies; Comments of Christopher Ross of Johns Hopkins University, Baltimore, Maryland.

Reports on research that indicates that two cytokines are responsible for acute flu symptoms that are common during the 1998 flu season. The cytokines, interleukin-6 (IL-6) and interferon-alpha (IFN-alpha); The incomplete knowledge of the cause of flu; The probable cause of cytopathic viral effects on the respiratory system.

Reports on protein found in plaque-like lesions in the brains of people with Alzheimer's disease and the role it plays in the development and progression of the illness. Discovery of the protein.

Discusses the physiological effect of the chewing of betel nuts. The linking of chewing areca nuts to the development of oral submucous fibrosis; Attempts to determine the agents in areca nuts that induce fibrosis.

Reports that clinical trial and postmarking data show that lamotrigine, an antiepileptic, is more likely to produce dangerous skin rashes in children than previously suspected. Letters from GlaxoWellcome, manufacturer of the lamotrigne, Lamictal, to physicians in the United Kingdom and the United States; The risk levels for use of Lamictal by children and adults; When most life-threatening reactions occur; Number of countries in which lamotrigine is approved.

Presents medical news briefs for November 1996. The drop in the percentage of AIDS-related deaths in Australia in 1995; Report from United States scientists that smoking may more than quadruple the risk of a subset of postmenopausal women developing breast cancer.