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I agree that Gooding should be revisited. I also think that the difficulty faced by a malpractice claimant in a Gooding-type case can be addressed by the doctrine of aggravation [...]

High blood insulin levels do not appear to blunt the adrenal gland's response to the pituitary gland hormone corticotropin in women who have excess levels of male hormones called androgens. Researchers gave a glucose tolerance test to seven women with high levels of androgens and insulin, eight women with excess androgens and normal insulin levels, and nine healthy women. Fasting blood samples were analyzed for insulin, glucose, and androgens. Hourly samples were analyzed for insulin and glucose. Women with excess androgens were also given corticotropin and its affect on adrenal production of cortisol and androgens was measured in blood samples taken at baseline and one hour later. No differences were found in cortisol response or in androgen production between women with chronic overproduction of insulin and women secreting normal amounts.

To determine the relative merits of primary percutaneous transluminal coronary angioplasty (PTCA) and intravenous thrombolytic therapy for acute myocardial infarction, 12 tertiary care hospitals entered patients who had [greater than or equal to]30 minutes of chest pain and were admitted to a cardiac intensive care unit within 12 hours of symptom onset into a prospective registry. Of 1,170 such patients, 118 (10%) underwent primary PTCA and 230 (19%) received intravenous thrombolytic therapy within 6 hours of registry hospital admission (144 at the registry hospital and 86 prior to arrival at the registry hospital). Baseline demographic characteristics of PTCA and thrombolytic subgroups were remarkably similar. The interval from initial evaluation at the registry hospital to treatment was shorter with intravenous thrombolytic therapy than with primary PTCA (64 vs 104 minutes, p

3-beta-hydroxysteroid dehydrogenase deficiency appears to be extremely rare among patients with hyperandrogenism. 3-beta-hydroxysteroid dehydrogenase deficiency is considered a sign of late-onset adrenal hyperplasia. Females with adrenal hyperplasia usually have hyperandrogenism, which is an excess of the male sex hormones, hirsutism, which is abnormal hairiness, or abnormal menstruation. 3-beta-hydroxysteroid dehydrogenase deficiency is usually defined as an abnormal 17-hydroxypregnenolone or dehydroepiandrosterone (DHEA) response following adrenal stimulation. Adrenal function was compared in 83 women with hyperandrogenism or abnormal hairiness and 26 healthy women. Following adrenal stimulation, 41% of the women with signs of hyperandrogenism had elevated blood levels of 17-hydroxypregnenolone, and 53% had elevated blood levels of DHEA. However, none of the women had levels high enough to be considered 3-beta-hydroxysteroid dehydrogenase deficient.

This study identifies factors that affect the death rate in patients who have had liver surgery to remove cancer which has spread (metastases) from colorectal cancer (cancer of the colon and rectum). The study also examines the variables that influence recurrence, survival time, and disease-free rates. Various statistical procedures were used to interpret and isolate these factors. Loss of more than 3.5 liters of blood during the operation was found to be a significant risk factor in complications after surgery. After two years, the disease recurred in three quarters of the cases. The following factors seemed to be reliable predictors of early recurrence: poor differentiation of the tumor; presence of multiple tumors which began to develop in the liver; male gender;and incomplete removal of the tumor. The liver was the most frequent site for recurrence of the disease. The various survival rates were discussed. The authors conclude that surgical removal of liver metastases in cases of colorectal cancer appears to offer a realistic option for selected patients, but only if the operation can be performed with a death rate of less than five percent.