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The CoPhyLab (Cometary Physics Laboratory) project is designed to study the physics of comets through a series of earth-based experiments. For these experiments, a dust analogue was created with physical properties comparable to those of the non-volatile dust found on comets. This ‘CoPhyLab dust’ is planned to be mixed with water and CO2 ice and placed under cometary conditions in vacuum chambers to study the physical processes taking place on the nuclei of comets. In order to develop this dust analogue, we mixed two components representative for the non-volatile materials present in cometary nuclei. We chose silica dust as a representative for the mineral phase and charcoal for the organic phase, which also acts as a darkening agent. In this paper, we provide an overview of known cometary analogues before presenting measurements of eight physical properties of different mixtures of the two materials and a comparison of these measurements with known cometary values. The physical properties of interest are particle size, density, gas permeability, spectrophotometry, and mechanical, thermal, and electrical properties. We found that the analogue dust that matches the highest number of physical properties of cometary materials consists of a mixture of either 60 per cent/40 per cent or 70 per cent/30 per cent of silica dust/charcoal by mass. These best-fit dust analogue will be used in future CoPhyLab experiments.

KALYPSO is a novel detector operating at line rates above 10 Mfps. The detector board holds a silicon or InGaAs linear array sensor with spectral sensitivity ranging from 400 nm to 2600 nm. The sensor is connected to a cutting-edge, custom designed, ASIC readout chip, which is responsible for the remarkable frame rate. The FPGA readout architecture enables continuous data acquisition and processing in real time. This detector is currently employed in many synchrotron facilities for beam diagnostics and for the characterization of self-built Ytterbium-doped fiber laser emitting around 1050 nm with a bandwidth of 40 nm.

Plasma concentrations of betamethasone, cortisol and corticosterone were measured before and after intraarticular injection of a betamethasone-depot preparation (Celestan-Depot) by radioimmuno-assay in 31 patients. Plasma concentration of betamethasone reached its maximum of between of 10 and 17 microgram/dl 30 min after injection. It had fallen to half after 2 hours, and practically to nil from the eighth day onwards. Lowest plasma levels of cortisol and corticosterone occurred after 6--24 hours, returning to the normal range after four days. In nine patients with knee-joint effusion and synovitis the plasma concentration of betamethasone was significantly higher after 24 hours, and cortisol and corticosterone values after 48 hours significantly more suppressed, than in patients without joint effusions and signs of inflammation. The results indicate that plasma concentration of betamethasone and the suppressant effect on the adrenal cortex after intra-articular injection is similar to that after intramuscular applications. Correspondingly, systemic application of the cortisol derivatives can cause significant side effects and be contra-indicated also after intra-articular injection.

A 21-year-old woman with weight loss, palpitations and facial flush was found to have hypertension (up to 200/130 mm Hg) and mild hyperkalaemia (3.4 mmol/l). Extensive diagnostic tests revealed hyperaldosteronism with contrast storing in the right adrenal gland on scintigraphy after injection of dexamethasone (2 mg daily for one week). The hyperaldosteronism could not be suppressed by dexamethasone. Analysis of venous blood separately from each side pointed to aldosterone production in the right adrenal (right renal vein: 80 ng/dl, drainage area of the right adrenal vein: 114 ng/dl, left renal vein: too low to measure). The right adrenal gland was removed. No adenoma was found histologically. After the operation the aldosterone level was reduced and the blood pressure transiently fell. But both had risen again after 3 months. Renewed tests revealed dexamethasone-remediable hyperaldosteronism. On treatment with hydrocortisone (15-5-5 mg) and 50 mg metoprolol the patient became normotensive without any other medication.

Die deutschen Durchgangsarzte arbeiten mit einer sowohl medizinisch als auch finanziell seit langem uberholten Gebuhrenordnung. Im vorliegenden Vortrag wird insbesondere Bezug auf ambulant durchgefuhrte Operationen genommen. Diese werden mit der gesetzlichen Gebuhrenordnung in Bezug gesetzt, die nach betriebswirtschaftlichen Aspekten mit einem Punktwert von 5,11 Cent kalkuliert ist. In allen Bereichen schneidet die UV-GOA schlechter ab als der EBM 2005. Auch unter dem Aspekt einer Mischkalkulation rechnet sich in weiten Bereichen das ambulante Operieren im Rahmen der UV-GOA nicht.

Adrenal insufficiency is suspected in some ill preterm infants. The aim of this prospective study was to compare serum cortisol concentrations during the first 2 wk of life of well preterm infants (group A) less than 30 wk of gestational age with the cortisol concentrations of ill preterm infants whose arterial hypotension-a potential sign of adrenal insufficiency-had been treated with catecholamine (group B), and the cortisol concentrations of ill preterm infants who had not been so treated (group C). Cortisol concentrations did not differ significantly between group A (240 nmol/l, 58-659; n = 46) (median, minimum-maximum) and group C (268 nmol/l, 58-1007; n = 25). Group B had a double-peaked distribution of cortisol. Two subgroups were formed by taking the highest cortisol level of group A as a threshold: group B1 (110 nmol/l, 41-378; n = 20) and group B2 (1200nmol/l, 764-1482; n = 8). The cortisol concentrations of group B1 were significantly lower (p = 0.00097) compared to the cortisol concentrations of the well preterm infants (group A). The severity of illness, which was quantified by two scoring systems, differed significantly among the groups (p < 0.003 for all comparisons) with the following sequence: A < C < B, but not between B1 and B2, as clinical variables were not different between the subgroups.

Background The major aldosterone metabolite 3α,5β tetrahydroaldosterone reflects up to 45% of the aldosterone secretion. Its 24-h urinary excretion is likely to provide an accurate index of the daily aldosterone production and to be an indicator for primary aldosteronism (PA). Methods In a prospective study, the validity of tetrahydroaldosterone as a screening test for PA was evaluated in comparison to serum potassium, plasma aldosterone, plasma renin activity, plasma aldosterone/renin activity ratio (PARR), as well as 24-h urinary aldosterone-18-glucuronide and free aldosterone. A total of 111 normotensive individuals, 412 PA patients and 1453 essential hypertensive patients, were studied. The effect of blood sampling technique on potassium level was also investigated. Results Tetrahydroaldosterone differentiated PA from essential hypertension with a sensitivity of 96% and a specificity of 95%. The sensitivity was 89% for plasma aldosterone, 87% for free aldosterone, 85% for PARR, 71% for aldosterone-18-glucuronide and 51% for renin activity. Specificities varied between 91% and 85%. The combined use of the parameters plasma aldosterone ≥9.0 ng/dL and PARR ≥25 resulted in a sensitivity of 82% and specificity of 95%. Forearm exercise proved to be a source of erroneous elevations of potassium sufficient to obscure the suspicion of PA. Conclusion The data suggest that tetrahydroaldosterone is the most reliable screening test for PA. Tetrahydroaldosterone determination in combination with aldosterone-18-glucuronide and free aldosterone increases diagnostic specificity for PA. Potassium, renin, plasma aldosterone, and basal PARR are inadequate screening procedures because they are subject to high rates of false-positive and false-negative results.

Zusammenfassung: Fragestellung: In mehreren Untersuchungen konnte der Einfluss männlicher Steroidhormone auf die Entstehung und Ausprägung aggressiven Verhaltens sowohl im Tierexperiment als auch an Gruppen gewalttätiger Personen nachgewiesen werden. Die wenigen Studien mit Kindern und Jugendlichen zeigen inkonsistente Befunde. Die Bedeutung einer androgenvermittelten Verhaltensbeeinflussung bei Jugendlichen aus der Allgemeinbevölkerung, die ein höheres Risiko für die Entwicklung von Verhaltensstörungen tragen, wurde bislang nicht untersucht. Methodik: Im Rahmen einer prospektiven Längsschnittstudie von Risikokindern wurden bei 119 Jugendlichen (51 m, 68 w) im Alter von 14 Jahren Plasmakonzentrationen relevanter Androgenmetaboliten Testosteron (T) und Dihydrotestosteron (DHT) bestimmt und externalisierende Verhaltensauffälligkeiten mittels deutscher Versionen der Achenbach-Skalen durch Elternbefragung (CBCL) und Selbstbeurteilung der Jugendlichen (YSR) erfasst. Ergebnisse: Bei den Jungen fanden sich signifikante positive Korrelationen von DHT-Plasmakonzentrationen mit der Sekundärskala Externalisierendes Verhalten im CBCL sowie mit den Problemskalen Aggressives Verhalten und Dissoziales Verhalten. In der Selbsteinschätzung der Jugendlichen ergab sich lediglich eine marginal signifikante Beziehung zwischen DHT und dissozialem Verhalten. Bei den Mädchen fehlten entsprechende Zusammenhänge völlig. Schlussfolgerungen: Frühere Befunde von Androgeneffekten auf aggressives und antisoziales Verhalten bei Erwachsenen mit gewalttätigem Verhalten konnten nun auch für männliche Jugendliche mit externalisierenden Verhaltensauffälligkeiten aus der Allgemeinbevölkerung bestätigt werden. Eine besondere Bedeutung kommt dabei dem Androgenmetabolit DHT zu.

Die zweizeitige ileoanale Pouchanlage (IAP) ist Standardverfahren zur kurativen Therapie der familiaren Adenomatosis coli (FAP) sowie der chirurgisch therapiepflichtigen Colitis ulcerosa (CU). Neben den klassischen Komplikationen beeinflusst die Entfernung des Colorectums die Blut- und Volumenhomoostase. Patienten und Methoden: Aus einem Patientenpool von 320 Patienten mit J-Pouchanlage wurden uber einen Beobachtungszeitraum von 2 Jahren Patienten mit hohem facalen Verlustsyndrom ohne fassbare organische Ursache identifiziert. Der Ausschluss einer organischen Ursache erfolgte mittels Pouchoskopie, Pouchographie und ggf. mittels MRT-Untersuchung. Neben Messparameter der Routinediagnostik wurden der Saure-Basen-Haushalt analysiert, eine Urin-pH-Metrie durchgefuhrt sowie mittels Hormonanalysen die adrenale Kompensationsleistung erfasst. Sieben Patienten mit „High-Pouch-Output“-Syndrom konnten identifiziert werden. Das Kontrollkollektiv bildete eine Gruppe aus 14 beschwerdefreien, in der endoskopischen Routinediagnostik unauffalligen IAP-Patienten. Ergebnisse: Die Analyse der Routineparameter ergab bei beiden Patientengruppen keinerlei signifikante Unterschiede. Eine deutlich verminderte Urinnatriumkonzentration 40,5 ± 18,7 mmol/l (Kontrollgruppe 98 ± 43,4 mmol/l) bestand fur die Patientengruppe mit hohen facalen Verlusten. In dieser Gruppe waren mit 42,6 ± 28,9 ng/dl (Kontrollgruppe 13,2 ± 6,8 ng/dl) die Aldosteronspiegel sowie mit 153,7 ± 121,1 ng/dl (Kontrollgruppe 53 ± 23 ng/dl) die 18-OH-Corticosteronspiegel signifikant erhoht. Fur die Glucocorticoide, Corticosteron, Cortisol wurden bei beiden Gruppen keine erhohte Aktivitat festgestellt. Nur 11-Desoxycorticosteron war im Patientenkollektiv mit „High-Pouch-Output“-Syndrom erhoht. Schlussfolgerungen: Unsere Ergebnisse belegen, dass Hormone mit mineralocorticoider Wirkung eine zentrale Rolle bei der Aufrechterhaltung der Blut- und Volumenhomoostase spielen. Die niedrige Incidenz therapiepflichtiger Verlustsyndrome nach Abschluss der ileoanalen Pouchoperation belegt die hervorragende Kompensation des entfernten Colorectums. Mit Aldosteron scheint ferner ein Marker gefunden, der die intestinale Natriumresorptionsproblematik proktocolektomierter Patienten erfasst.

Ambulantes Operieren ist bei mindestens gleich hoher Qualitat kostengunstiger als eine stationare Behandlung und wird im niedergelassenen Bereich immer auf Facharztstandard durchgefuhrt. Es geht mit einer geringeren Infektionsrate, schnellerer Arbeitsfahigkeit, geringerem Medikamentenverbrauch und hoher Zufriedenheit der Patienten einher. Leider ist nach der derzeit moglichen Abrechnung keine Kostendeckung zu erreichen. Zudem stellen Krankenhauser und Operationszentren, die die Kosten durch Querfinanzierung decken konnen, eine massive Konkurrenz fur die niedergelassenen Arzte dar. Eine Verlagerung von stationaren Operationen in den ambulanten Bereich wird nur gelingen, wenn ambulant und stationar durchgefuhrte Operationen gleich bezahlt werden, weil dann kein Grund mehr besteht, auser aus medizinischen und sozialen Grunden, einen Patienten stationar aufzunehmen. Deshalb ist eine identische DRG-basierte (DRG: „diagnosis related groups“) Vergutung fur gleiche Operationen im ambulanten und stationaren Bereich zu fordern.

PURPOSE: Restorative proctocolectomy is a standard procedure in the surgical treatment of ulcerative colitis and familial adenomatous polyposis. The radical removal of the colorectum with construction of an ileostomy often results in high stoma losses. These may lead to changes in the electrolyte and acid-base balance and to alterations in renal and suprarenal gland function. METHODS: In this study 33 patients who received an ileoanal pouch before and after proctocolectomy were investigated at different time intervals for electrolyte changes, alteration of the acid-base balance, kidney function, and hormonal changes of the suprarenal glands. Measurements were performed before proctocolectomy, ten days after proctocolectomy with ileal pouch-anal anastomosis under protective loop ileostomy, before ileostomy closure, and 6 to 12 months after ileostomy closure. Neither acute renal failure nor other vital complications were observed. RESULTS: Statistical analysis showed a significant decrease of urine pH to 5.4±0.22 (before ileostomy closure) and metabolic acidosis (pH 7.32±0.04; base excess −1.3±5.6 (before ileostomy closure)). Likewise, we found a decrease in renal clearance to 86 ml/minute (before ileostomy closure) without signs of tubular damage. The most important change during the phase with ileostomy was a functional secondary hyperaldosteronism with aldosterone levels of 63.2±70.8 ng/dl (before ileostomy closure). In comparison with preoperative levels, there was a ten-fold increase in mineralocorticoid adrenal activity. Additionally, during the period with protective ileostomy, the hepatic synthesis of aldosterone-18-glucuronide was only slightly increased, and the cortisol/cortisone ratio was extremely decreased. CONCLUSIONS: These results show that restorative proctocolectomy with ileal pouch-anal anastomosis and protective loop ileostomy significantly influences fluid, electrolyte, and acid-base balance. Functional secondary hyperaldosteronism is of central importance for subsequent renal recompensation. Approximately one-half year after ileostomy closure, the endogenous hormones with mineralocorticoid effects returned to normal levels.

Auch seitens der gesetzlichen Unfallversicherungen wird uberlegt, wie die verfugbaren Mittel gezielter und effizienter eingesetzt werden konnen. Dies ist unter dem Eindruck rucklaufiger Beitrage, den hohen Arbeitslosenzahlen, der zunehmenden Zahl von Geschaftsaufgaben und den daraus resultierenden Mindereinnahmen zwingend geboten. Die Begriffe ausreichend, zweckmasig und wirtschaftlich werden in der Medizin immer mehr in den Vordergrund rucken, ihre Interpretation und die daraus resultierenden Begrenzungen werden die Unfallversicherungstrager fur die Zukunft festlegen mussen. Gegenuber den gesetzlichen Krankenkassen haben sie den Vorteil der weitergehenden physikalischen Masnahmen in der stationaren Rehabilitation, der unburokratischeren Wiedereingliederungsverfahren, dem Berufshelfersystem sowie dem Grundprinzip Heilung vor Rente. Nichtsdestotrotz wird auch im UV-System auf Dauer eine Mengenbegrenzung nicht zu umgehen sein.

Ten cases of adrenal adenomas, one case with unilateral adrenal hyperplasia, and another case with apparent bilateral are reported, in whom an alternative pathway of aldosterone via 21-deoxyaldosterone is operative. They all manifested hypertension, low renin activity, low normal potassium values, as well as high urinary excretion rates of 21-deoxyaldosterone and its related metabolite Kelly's-M1 steroid. In all cases, urinary aldosterone metabolites (aldosterone-18-glucuronide and tetrahydroaldosterone) and aldosterone precursor 18-hydroxycorticosterone levels were normal. Hence, the adrenal lesions give rise to hyper-21-deoxyaldosteronism. 21-Deoxyaldosterone is a weak mineralocorticoid, and its elevated production in the presence of normal aldosterone can induce a pathological state of hypermineralocorticoidism. Adrenalectomy resulted in normalization of hypertension in six of eight and amelioration in two of eight cases. Six of seven adenoma cases examined as well as the case of unilateral adrenal hyperplasia were sensitive to ACTH. One of the seven adenomas and, as expected, the case with apparent bilateral hyperplasia were angiotensin responsive. Histologically and electron microscopically, the operated adenomas consisted predominantly of clear cells, characterized by mitochondria with tubulo-vesicular internal structure similar to those of the zona fasciculata (in contrast, our classical Conn's adenoma with normal 21-deoxyaldosterone excretion exhibited a more heterogenous histological appearance and were, in terms of ultrastructure, more similar to cells of the zona glomerulosa). Ultrastructurally and immunocytochemically, the clear cells of 21-deoxyaldosterone adenomas showed features of both the zona glomerulosa and the zona fasciculata and are, hence, considered to be hybrid cells. We conclude that the determination of 21-deoxyaldosterone and Kelly's-M1 should be considered in the diagnosis of mineralocorticoid-induced forms of hypertension, especially when an adrenal adenoma has been detected with an imaging procedure.

The distribution (between adult workers and worker larvae) and storage of dyed foods (one protein, two lipids, and three carbohydrates) were investigated in standardized Pharaoh ant, Monomorium pharaonis (L.), colonies (n = 250 workers, 2 queens, and 25–30 mg worker brood) in the laboratory. Two foods were in liquid form (peanut oil and 1 M sucrose) and four were in solid form (egg yolk, beef fat, table sugar, and corn starch). Workers did not actively recruit to table sugar, but in a concurrent study it was used as building material to fill nest openings. Moistened corn starch was ignored by foraging workers with little storage. Workers became satiated on 1 M sucrose before any solution was given to larvae. Peanut oil, like the 1 M sucrose solution, was rapidly distributed among and stored internally by adult workers. Unlike the 1 M sucrose solution given primarily to older larvae, peanut oil was distributed rapidly to all larval stadia. Workers showed weak recruitment to beef fat even after 7 d of starvation. Only a few workers showed evidence of feeding on beef fat and none was distributed to larvae. Storage of solid lipid (beef fat) was variable. Workers in two of five colonies stored large quantities of beef fat in piles inside their nests. In three colonies only trace amounts of beef fat were stored after 24 h. In contrast, workers consistently stored large quantities of excess solid protein (moist egg yolk powder) in piles inside their nests. Solid protein was fed to and consumed primarily by older larvae, and none was detected in young larvae or adult workers. Workers actively recruited to liquid carbohydrate (1 M sucrose) and solid protein (moist egg yolk powder) foods after 2 d of starvation. A 7-d starvation period was necessary for active recruitment to lipids (peanut oil and beef fat), but caused extremely rapid recruitment (too fast for accurate observation) to carbohydrate and protein foods. Thus, colonies were starved for 2 d prior to the introduction of protein or carbohydrate foods, and 7 d prior to lipid foods. Our results suggest that lipids may not be rapidly depleted in the metabolism of the Pharaoh ant. Thus, protein and liquid carbohydrates (using simple sugars) may play a more important role as components of insecticidal baits that are important in Pharaoh ant management. However, in field colonies that may be stressed for lack of food (which may commonly occur), an insecticidal bait formulated from oil may be readily accepted and effective.

21-Deoxyaldosterone has been postulated to be a precursor of aldosterone in an altenative biosynthesis pathway and Kelly's-M1 is considered to be its metabolite. In healthy volunteers, the excretion rate of 21-deoxyaldosterone and of Kelly's-M1 are significantly lower than the aldosterone metabolites, aldosterone-18-glucuronide and tetrahydro-aldosterone and than the aldosterone precursor 18-OH-corticosterone. Essential hypertension patients (with low and normal renin) excrete comparable values of 21-deoxyaldosterone and Kelly's-M1 as normotensives. In 66% of aldosterone-producing adenoma cases (APA) and in 60% of idiopathic hyperaldosteronism (IHA) patients, significantly raised values of 21-deoxyaldosterone and Kelly's-M1 were found. The patients with the high excretion rates of both steroids showed only moderately increased values of the aldosterone metabolites, aldosterone-18-glucuronide and tetrahydro-aldosterone, as well as of the aldosterone precursor 18-OH-corticosterone. In contrast, the latter mentioned steroids were excreted in higher amounts in those patients with normal excretion of 21-deoxyaldosterone and Kelly's-M1. Hence, it is suggested that aldosterone is produced alternatively either via 18-OH-corticosterone alone or additionally via 21-deoxyaldosterone. Furthermore, in three cases of “incidentally” discovered adrenal adenomas, 21-deoxyaldosterone and Kelly's-M1 were the only elevated steroids. After adrenalectomy, excretion of 21-deoxyaldosterone and of Kelly's-M1 and blood pressure returned to normal, which proves that these steroids play a role in blood pressure regulation. In essential hypertension, ACTH infusion induced a significant increase of 21-deoxyaldosterone and Kelly's-M1. However, the increase after angiotensin II was 3- to 6-fold higher than after ACTH. IHA patients proved to be more responsive to angiotensin II; and, in contrast, APA cases proved to be more sensitive to ACTH. The data suggest that beside the main route of aldosterone biosynthesis via 11-deoxycorticosterone, corticosterone and 18-OH-corticosterone an alternative pathway exits via 21-deoxyaldosterone in healthy and in hypertensive patients. There are similarities between the regulation of 21-deoxyaldosterone and the regulation of aldosteorne. The determination of 21-deoxyaldosterone and its possible metabolite Kelly's-M1 might be appropriate in the diagnosis of mineralocorticoid-induced forms of hypertension, especially when an adrenal adenoma is discovered.

We report on three cases of Corticosterone Methyl Oxidase Typ II deficiency in two siblings and one boy. All three children were presented with typical symptoms of a saltlosing syndrome (vomiting, poor drinking, weight loss, hypotonia). Hyponatremia and hyperkalemia, low plasma aldosterone concentrations when related to high plasma-renin-activities suggested deficiency in the final steps of aldosterone biosynthesis. Variable degrees of enzyme deficiency and no relation of biochemical findings to the clinical symptoms were observed. Clinical symptoms became less severe with age. Diagnosis of CMO II-deficiency was established by an abnormal high ratio of 18-hydroxycorticosterone to aldosterone, by measurement of their precursors and metabolites in plasma and urine. In one sibling negative values may have been caused by suppression of the renin-angiotensin-system due to high sodium replacement therapy.

A midpubertal girl presented with secondary amenorrhea and a rapidly progressive deepening of her voice as the only signs of virilization. Diagnostic work-up yielded an extremely elevated plasma testosterone (289 ng/dl), low estradiol (29 pg/ml) levels and a large solitary cyst of the right ovary, which was totally removed. Pathohistology was in keeping with a granulosa cyst with mild luteinization. Normalization of testosterone (to 27.3 ng/dl) and estradiol (to 62 pg/ml) and resumption of regular menses after 2 months clearly indicated an autonomous function of the cyst. A malignant tumor was unequivocally excluded. Basal and ACTH stimulated levels of adrenal androgens pointed to a late-onset 3 beta-hydroxysteroid dehydrogenase deficiency, which per se is known to induce polycystic ovarian changes, but to date has never been described to be accompanied with a large and autonomous follicular cyst.

Background: While an association between androgens and different types of aggression has been well documented in male offenders, the influence of androgens on externalizing behavior in adolescents at risk for antisocial behavior has not been investigated so far. Methods: Plasma levels of the main androgen metabolites testosterone (T) and 5α-dihydrotestosterone (DHT) were measured in N =87 fourteen-year-old (36 boys, 51 girls) from a prospective longitudinal study of children at risk. Externalizing behavior at age 8, 11 and 14 was assessed using the Achenbach Child Behavior Checklist (CBCL) and Teacher Report Form (TRF). Results: Significant higher androgen levels (T, DHT) were found in male, but not in female adolescents with elevated scores of externalizing behavior. Moreover, boys with persistent externalizing behavior exhibited the highest levels of plasma androgens. Conclusions: There is a link between T, DHT and externalizing behavior in male adolescents at risk for psychopathology. Due to the findings of highest androgen levels in boys with persistent externalizing behavior, a role of androgens in the development of disruptive or later antisocial disorders can be hypothesized.

The Ileo-Pouch-Anal-Anastomosis (IPAA) is the standard restorative procedure for Ulcerative Colitis and Familial Adenomatous Polyposis (FAP). IPAA may lead to considerable losses of fluids, especially in association with a protective loop ileostomy.The aim of this study was to investigate adrenal mechanisms in the regulation of volume homeostasis immediately after IPAA and protective ileostomy.For that purpose, 20 patients out of our patient population with elective IPAA with ileostomy participated in this study between 1993 and 1997. In all patients, routine laboratory tests and gluco- and minealocorticoid hormone measurements were performed preoperatively and 10 days after operation.These blood analyses indicated functional hyperaldosteronism immediately after IPAA. Significantly elevated levels of Aldosterone (36.4 +/- 25.1 ng/dl) and 18-OH-Corticosterone ( 173 +/- 11.3 ng/dl) were found. Among hormones with glucocorticoid effects, blood levels of Cortisol (10.4 +/- 4.8 microg/dl) were significantly elevated, while 11-Desoxycortiosterone (13.9 +/- 8.4 ng/dl) and Corticosterone (0.8 +/- 0.6 microg/dl) were not significantly elevated. Serum electrolytes remained unchanged.Our results indicate that hormones with mineralocorticoid effects play a predominant role in the compensation of ileostomy losses after IPAA.

While an association between androgens and different types of aggression has been well documented in male offenders, the influence of androgens on externalizing behavior in adolescents at risk for antisocial behavior has not been investigated so far.Plasma levels of the main androgen metabolites testosterone (T) and 5a-dihydrotestosterone (DHT) were measured in N = 119 14-year-olds (51 boys, 68 girls) from a prospective longitudinal study of children at risk. The Achenbach Child Behavior Checklist (CBCL) and the Youth Self Report Form (YSR) were used to assess externalizing behavior at age 14.The CBCL revealed significant positive correlations between DHT levels and the subscales "externalizing problems" and the problem scales "aggressive behavior" and "delinquent behavior" in male adolescents. Only the YSR subscale "delinquent behavior" exhibited a marginally significant association with DHT. Neither scale showed any significant correlations between androgen levels and externalizing behavior in female adolescents.Earlier findings of androgen effects on aggressive and antisocial behavior in male offenders were confirmed for male adolescents from a general population sample. The results stress the importance of the androgen metabolite DHT.

The two-phase restorative proctocolectomy is the treatment of choice for surgical therapy of the familial adenomatous polyposis (FAP) and also for the ulcerative colitis (UC). Besides the well-known complications the entire removal of the colorectum leads to an impairment of fluid and electrolyte resorption.Over a time period of two years we observed 320 proctocolectomized patients with ileal pouch-anal anastomosis (IPAA). All patients with high pouch output but without organic malfunction were identified. The organic reasons were excluded with the help of pouchoscopy, radiography or MR imaging. We evaluated routine parameters, the kidney function, the electrolyte changes, the acid-base balance and the urine pH, as well as the hormonal changes of the suprarenal glands. We identified seven patients with 'high pouch output' out of 320 patients observed. The control group consisted of 14 proctocolectomized patients without hints of complications in the endoscopic, radiographic and routine laboratory diagnostics.Neither group showed any significant differences in the analysis of the routine parameters. A significant drop of the urine sodium concentration of 40.5 +/- 18.7 mmol/l (control group 98 +/- 43.4 mmol/l) was observed in the group with 'high pouch output'. In this group the plasma aldosterone values were strongly increased with an average of 42.6 +/- 28.9 ng/dl (control group 13.2 +/- 6.8 ng/dl) as well as the plasma 18-hydroxycorticosterone with an average of 153.7 +/- 121.1 ng/dl (control group 153.7 +/- 121.1 ng/dl). Neither group of patients showed increased activity of free corticosterone and free cortisol. Only free 11-desoxycorticosterone was elevated in the group with 'high pouch output'.Our results prove that the mineralocorticoid adrenal activity plays a central role in order to preserve the volume and electrolyte homeostasis. The low frequency of 'high-pouch-output'-complications in realms of the restorative proctocolectomy proves the excellent compensation of the removal of the colon mucosa. Plasma aldosterone seems to be a diagnostic marker encapsulating the reabsorption problems of intestinal salt and volume losses after proctocolectomy.

Adrenal insufficiency is suspected in some ill preterm infants. The aim of this prospective study was to compare serum cortisol concentrations during the first 2 wk of life of well preterm infants (group A) less than 30 wk of gestational age with the cortisol concentrations of ill preterm infants whose arterial hypotension-a potential sign of adrenal insufficiency-had been treated with catecholamine (group B), and the cortisol concentrations of ill preterm infants who had not been so treated (group C). Cortisol concentrations did not differ significantly between group A (240 nmol/l, 58-659; n = 46) (median, minimum-maximum) and group C (268 nmol/l, 58-1007; n = 25). Group B had a double-peaked distribution of cortisol. Two subgroups were formed by taking the highest cortisol level of group A as a threshold: group B1 (110 nmol/l, 41-378; n = 20) and group B2 (1200nmol/l, 764-1482; n = 8). The cortisol concentrations of group B1 were significantly lower (p = 0.00097) compared to the cortisol concentrations of the well preterm infants (group A). The severity of illness, which was quantified by two scoring systems, differed significantly among the groups (p0.003 for all comparisons) with the following sequence: ACB, but not between B1 and B2, as clinical variables were not different between the subgroups.

Aim—To establish a reference range for serum cortisol concentrations in preterm infants with a gestational age of less than 30 weeks during the first two weeks of life. Methods—Infants were prospectively classified by the following exclusion criteria: surfactant administration, arterial hypotension, acute or uncontrolled infection, ventricular haemorrhage II° or above, serum glucose < 2.2 mmol/l, exchange transfusion, stress as a result of any kind of examination or nursing for at least 4 hours before blood sampling. The cortisol value was measured once using radioimmunoassay in each infant. Results—In appropriate for gestational age (AGA) infants (n = 37, median gestational age 27.7 weeks, median birthweight 1030 g) the distribution of the cortisol concentrations was non-Gaussian. These had a nearly normal distribution, when log10 values of the data were used. The points determined by mean (2 SD) on the logarithmic scale were transformed back to the original units to provide a reference range: 73‐562 nmol/l. Gestational age was significantly (p = 0.033) associated with cortisol values (log10) with a regression coeYcient (standard error) of ˛0.045 (0.020). Small for gestational age (SGA) infants (n = 8) had significantly higher cortisol values (median 357 nmol/l) than AGA infants (median 199 nmol/l) (p=0.028). Conclusions—There is a strictly defined reference range of serum cortisol concentrations in AGA preterm infants. (Arch Dis Child Fetal Neonatal Ed 1999;81:F171‐F174)

The variable response of patients with idiopathic nephrotic syndrome (NS) to glucocorticoid (GC) treatment has not been explained. Earlier studies indicated that the response is limited by cellular GC receptors. We investigated these receptors in mononuclear leukocytes of 28 pediatric patients with NS divided into three groups: steroid-sensitive in relapse, steroid-sensitive in remission, and steroid-resistant. Density and binding affinity of GC receptors were determined by a dexamethasone binding assay; no significant differences were found between the three patient groups and between these and healthy controls, although a few patient values fell outside the range of controls. Total and free plasma concentrations of cortisol were low in all three patient groups. A weak positive correlation was found between the number of GC receptors and total plasma cortisol (r=0.36, P=0.03). The results suggest that factors other than GC receptors that mediate the cellular effects of GC are involved in the variable response of NS patients to GC.

There is a large body of evidence that points to a systemic link between the somatotropic axis and sex hormones, but epidemiologic data on the interactions between the two hormonal systems are still missing. We examined here the associations between the plasma levels of insulin-like growth factor (IGF) I, IGF-II, IGF-binding protein 3 (IGFBP-3), and sex hormones in a population-based sample of 486 men and women, aged 50-80 yr. The strongest association was an age-independent inverse correlation between all three circulating IGF components and sex hormone-binding globulin (SHBG), the major testosterone-binding protein in plasma. Consistent with this, bio-available (non-SHBG-bound) but not total testosterone levels were positively associated with the IGF system in men, and 3 alpha-androstanediol glucuronide was positively correlated with circulating IGFs in women. Moreover, part of the correlation between the circulating IGF system and bone mineral density at the femur and the calcaneus could be accounted for by SHBG. Our data suggest that sex hormones and the GH/IGF system are significantly interrelated in the elderly population. These hormonal interactions may play an important role in human aging and the pathogenesis of age-related diseases.

In order to assess hypothalamic-pituitary-adrenocortical axis function, we conducted low and single oral dose metyrapone tests (35 mg/kg) in dexamethasone treated very low birth weight infants with bronchopulmonary dysplasia (n = 12). The responses to metyrapone of tetrahydro-11-deoxycortisol (THS) and cortisol metabolites were analyzed by gas chromatography and mass spectrometry in 24-h urinary specimens. For comparative reasons, morning plasma 11-deoxy-cortisol and cortisol were measured by radioimmunoassay before and after metyrapone. No side effects of metyrapone were observed in our patients. In 5 of 12 patients, no urinary THS could be stimulated after metyrapone and most of the other patients had small increases in urinary THS. These findings suggest suppressed or strongly impaired hypothalamic-pituitary-adrenocortical axis function in most patients. While the concentrations of plasma 11-deoxycortisol showed little variation, those of plasma cortisol were grossly different from the respective urinary values. We recommend steroid analysis in 24-h urinary specimens by gas chromatography and mass spectrometry, because urinary steroids provide more information and the highly specific analytical technique is independent of phenomena such as cross reactivity or matrix effects. The low and single oral dose metyrapone test in combination with urinary steroid analysis by gas chromatography and mass spectrometry therefore provides a noninvasive, convenient and safe means of evaluating the integrity of the hypothalamic-pituitary-adrenocortical axis in very low birth weight infants.

In the present study the aldosterone-18-glucuronide and tetrahydroaldosterone values in 24 hour urine collections of healthy nonpregnant women, women with normal pregnancies and women with pregnancy induced hypertension (PIH) were compared. In pregnancy an elevated excretion of both aldosterone metabolites was found. The Q-ratio (aldosterone-18-glucuronide / tetrahydro-aldosterone + aldosterone-18-glucuronide) was also increased compared to healthy nonpregnant women. The elevated Q-ratios point out to increased formation of aldosterone-18-glucuronide. This predominantly renal metabolite may reflect greater availability of aldosterone molecules for interaction with mineralocorticoid receptor in the kidney.

A 21-year-old woman with weight loss, palpitations and facial flush was found to have hypertension (up to 200/130 mm Hg) and mild hyperkalaemia (3.4 mmol/l). Extensive diagnostic tests revealed hyperaldosteronism with contrast storing in the right adrenal gland on scintigraphy after injection of dexamethasone (2 mg daily for one week). The hyperaldosteronism could not be suppressed by dexamethasone. Analysis of venous blood separately from each side pointed to aldosterone production in the right adrenal (right renal vein: 80 ng/dl, drainage area of the right adrenal vein: 114 ng/dl, left renal vein: too low to measure). The right adrenal gland was removed. No adenoma was found histologically. After the operation the aldosterone level was reduced and the blood pressure transiently fell. But both had risen again after 3 months. Renewed tests revealed dexamethasone-remediable hyperaldosteronism. On treatment with hydrocortisone (15-5-5 mg) and 50 mg metoprolol the patient became normotensive without any other medication.

We report on three cases of Corticosterone Methyl Oxidase Typ II deficiency in two siblings and one boy. All three children were presented with typical symptoms of a saltlosing syndrome (vomiting, poor drinking, weight loss, hypotonia). Hyponatremia and hyperkalemia, low plasma aldosterone concentrations when related to high plasma-renin-activities suggested deficiency in the final steps of aldosterone biosynthesis. Variable degrees of enzyme deficiency and no relation of biochemical findings to the clinical symptoms were observed. Clinical symptoms became less severe with age. Diagnosis of CMO II-deficiency was established by an abnormal high ratio of 18-hydroxycorticosterone to aldosterone, by measurement of their precursors and metabolites in plasma and urine. In one sibling negative values may have been caused by suppression of the renin-angiotensin-system due to high sodium replacement therapy.

We studied glucocorticoid receptor autoregulation and corticotropin response to dexamethasone in depressed patients and controls, attempting to control for the confounding effect of endogenous glucocorticoids. After depletion of endogenous cortisol, depressed patients showed an attenuated suppressibility of corticotropin by dexamethasone in the face of unchanged dexamethasone plasma levels. Beta-endorphin levels were strongly correlated with adrenocorticotropic hormone (ACTH) concentrations. Although metyrapone administration resulted in a marked rise of glucocorticoid receptor sites per cell in controls, this effect was not present in depressives. These data support the hypothesis of a decreased glucocorticoid receptor plasticity and a partial steroid resistance in depression.

Although treatment comprising a combination of methylprednisolone (MP) and troleandomycin (TAO) has been employed to treat cases of severe bronchial asthma requiring high doses of corticosteroids, for about 20 years, now, it has always been associated with major adverse reactions (1). A new protocol avoids these adverse effects by a rapid reduction in the dose of MP to alternating administrations and low TAO dosage (250 mg). Nineteen patients were treated using this protocol, 16 of whom for more than two months (maximum 21, minimum 4 months). Three patients were taken out of the study as early non-responders in the initial phase. Five patients must be considered to be late non-responders, or were discharged from the study on account of pathological liver parameters. In 8 patients who showed good tolerance, an appreciable reduction in the dose of steroids, with stabilisation of the asthma, was observed.

Serum Cortisol Levels of Well, Ill and Preterm Infants treated with Catecholamines < 30 Weeks of Gestational Age † 1528

Aldosterone-18-glucuronide, free aldosterone, free 18-OH-deoxycorticosterone, and tetrahydroaldosterone radioimmunoassays were performed in urine samples from normal subjects, as well as from patients with essential hypertension and primary hyperaldosteronism. The aldosterone-18-glucuronide measurements were made on 1119 urine samples, with and without chromatographic separation, with antisera raised against 3 different types of aldosterone antigens. Good correlations were found between the values obtained with the different methods. However, the values measured without chromatography were usually higher and individual discrepancies between results obtained with and without chromatography were observed. The antiserum raised against an aldosterone-3-oxime antigen produced the most reliable results without prior chromatography, but the values were still higher than after chromatography in 4.33% of 854 cases. These values may be clinically misleading, and we therefore recommend the aldosterone-18-glucuronide estimation without chromatography as a screening method only. When the results of the aldosterone-18-glucuronide, free aldosterone, free 18-OH-deoxycorticosterone, and tetrahydroaldosterone assays were compared, free aldosterone was found to correlate the best with the results of all other assays. There were also correlations among the other assays. The aldosterone-18-glucuronide estimation is currently the most frequently used assay. This study revealed, however, that in patients with essential hypertension and primary aldosteronism, normal aldosterone-18-glucuronide levels can be accompanied by high free aldosterone and tetrahydroaldosterone levels. We conclude, therefore, that the aldosterone-18-glucuronide assay may not be sufficient to select all patients with hyperaldosteronism. Additionally, a radioimmunoassay of urinary free 18-OH-corticosterone was developed and used as an aid in the aldosterone diagnosis. The excretion levels were 1.5–6.5, with a mean value (± SD) of 4.0±1.44 µg/24 h. These values also correlated with the different aldosterone measurements, and correlated best with the free aldosterone values.

Specific 21-deoxycortisol (21-DF) antiserum was raised in New Zealand white rabbits using a 21-DF-3,20-oxime-bovine serum albumin complex. Plasma radioimmunoassay of 21-DF was developed and used together with a radioimmunoassay of 17-hydroxyprogesterone (17-OH-P) for diagnosis of patients with 21-hydroxylase deficiency of congenital and postpubertal forms. The assays were performed in plasma extracts after isolation by paper chromatography. The response of plasma 21-DF and 17-OH-P to i.v. ACTH (25 IU) was studied in 15 adult controls and compared to 8 women with the late onset form of 21-hydroxylase deficiency and 23 women with idiopathic hirsutism. Normal 21-DF values for women were 6.9 +/- 3.6 ng/dl and for men 9.71 +/- 2.73 ng/dl. Newborn children (age: 3-10 days) had a value of 8.3 +/- 4.8 ng/dl. These values are definitely lower than the lowest value ever published. This is possibly due to the specificity of the antibody. During the menstrual cycle the 21-DF values did not change. The baseline and post-stimulated concentrations of hormone were similar in controls and women with hirsutism but were significantly higher in women with the late onset form of 21-hydroxylase deficiency. In the congenital form of 21-hydroxylase deficiency the 21-DF values (baseline) were high. In general, the 21-DF and 17-OH-P values have shown parallel changes. However, one case of 21-hydroxylase deficiency with elevated 21-DF but normal 17-OH-P was observed. The use of 21-DF for the diagnosis of 21-hydroxylase deficiency is suggested.

Electrical transport properties of pure and phosphorus-implanted SiO2 layers on n-Si substrate are investigated. By means of multiple implantations and final etching-off of the inhomogeneous top layer, uniformly doped SiO2 layers (L = 800 to 2400 A) are achieved. Measurements of I–U-characteristics reveal several different conductivity states of the samples referring to previous thermal annealing and electrical forming of unimplanted or implanted samples. For electrically unformed samples Fowler-Nordheim tunneling across the interfaces prevailes (samples unimplanted) which changes to a bulk-limited Pool-Frenkel mechanism after implantation. The inherent trap density reaches between 5 × 1019 and 10 × 1020 cm−3 with respect to annealing. Electrically formed samples show SCL current behaviour of single- and double-injection type with respect to carrier density electrically activated. Typically the mobility of carriers increases by a factor of 105 after implantation which leads to conductivity switching of samples at low voltages (UB = 2 to 20 V) as a consequence of double injection. The inherent trap density is lowered down to values of 1017 cm−3. Die Transporteigenschaften der elektrischen Ladung in reinen und mit implantierten Phosphoratomen dotierten SiO2-Schichten auf n-Silizium-Substraten werden untersucht. Als Proben standen gleichmasig dotierte SiO2-Schichten (Dicke = 800 bis 2400 A) zur Verfugung, deren homogene Dotierung mit Hilfe von Mehrfach-Implantationen und anschliesender Abatzung der inhomogen dotierten Oberflachenschicht eingestellt wurde. Die Messungen der Strom-Spannungs-Kennlinien ergeben mehrere unterschiedliche Leitfahigkeitszustande unter Berucksichtigung vorhergehender thermischer und elektrischer Behandlung der unimplantierten und implantierten Proben. Bei Proben, die keinem elektrischen Formierungsprozes unterworfen werden, herrschen fur den Fall fehlender Implantation Fowler-Nordheim-Tunnel-Prozesse uber die Phasengrenzen vor. Nach Implantation zeigt sich ein volumenbegrenzter Pool-Frenkel-Mechanismus. Die damit verknupfte Trap-Dichte liegt zwischen 5 × 1019 und 10 × 1020 cm−3 entsprechend der thermischen Behandlung. Proben, die einem elektrischen Formierungs-Prozes unterzogen werden, zeigen raumladungsbegrenzte (SCL) Strome, vom Einfach- oder Doppel-Injektionstyp, je nachdem, welche Ladungstragerdichte elektrisch aktiviert worden ist. Typisches Verhalten ist der Beweglichkeitsanstieg der Ladungstrager nach der Implantation um den Faktor 105. Dies fuhrt zu Leitfahigkeits-Schaltvorgangen bei niedriger Probenspannung von 2 bis 20 V als Folge von Doppel-Injektion. Die entsprechende Trap-Dichte sinkt dann bis zu Werten von 1017 cm−3.

The effects of different intervening variables on dexamethasone suppression test (DST) results were evaluated in depressed, schizophrenic, and manic pstients. There was a significant correlation between age and DST results in major depression. Some “isolated peaks” of DST nonsuppression were explained by low dexamethasone serum levels. In schizophrenic and manic patients, the dexamethasone concentrations increased to above the normal range during the study period. A significant negative correlation between dexamethasone concentrations and DST results was found in schizophrenia and mania, but not in depression. Dexamethasone levels were generally higher in men than in women. Weight loss and hospital admission affected the DST in individual cases, whereas length of episode and drug withdrawal did not. Thus, the intervening variables accounted for some of the abnormal DST results, but other factors such as severity of illness, nonspecific stress, or possibly depression itself emerged as the main causes of abnormal DST results.

Urinary “free” (unconjugated) 18-hydroxy-corticosterone (18-OH-B), together with aldosterone-18-glu-curonide, “free” aldosterone and tetrahydroaldosterone were determined in 20 patients with primary aldosteronism. In 19 out of 20 cases (both in adenoma and hyperplasia) the 18-OH-B excretion was at least temporarily increased. On the basis the measurement of the 18-OH-B excretion was applied-in addition to determinations of aldosterone and aldosterone-metabolites-to search for cases of primary aldosteronism. Increased 18-OH-B excretion was found in 20 of 165 pre-selected patients with essential hypertension. In 11 of them, at least one of the urinary aldosterone values was concomitantly elevated. In 9 patients the aldosterone values were found to be within normal ranges. Follow-up studies have shown elevated aldosterone values in some members of the latter group, and in 3 patients first believed to have essential hypertension adrenal adenomas were established. In 2 patients the adenoma was removed.

Two female patients, 54 and 34 years old, each presented with an adrenal adenoma and hypertension. Blood pressure fell after removal of the tumors. The first patient had high urinary 18-hydroxycorticosterone and periodically elevated 18-hydroxy-deoxycorticosterone excretions. The second patient had elevated 18-hydroxycorticosterone and free cortisol excretions. Urinary aldosterone, aldosterone metabolites and plasma aldosterone were not increased. Plasma renin activity was suppressed and serum potassium levels were normal. After surgery, no elevated steroid values were found. Elevated 18-hydroxycorticosterone excretion may be an indicator of yet unknown hypertensinogenic mechanisms. The role of 18-hydroxycorticosterone in the etiology of hypertension is still unknown.

The value of the urine tests: free aldosterone, aldosterone-18-glucuronide, tetrahydroaldosterone 18-hydroxycorticosterone and 18-hydroxydeoxycorticosterone in distinguishing primary aldosteronism from essential hypertension was studied in patients with typical and atypical primary aldosteronism and in patients with essential hypertension. The discriminating function of the tetrahydroaldosterone determination was the best, followed by 18-hydroxycorticosterone, free aldosterone and aldosterone-18-glucuronide. The measurement of 18-hydroxydeoxycorticosterone was without distinguishing value. Three cases with hypertension, adrenal adenoma, elevated 18-hydroxycorticosterone but normal aldosterone values were observed. In longitudinal studies the excretions of aldosterone, aldosterone metabolites and possible precursors periodically varied independently of each other. Determinations of urine aldosterone, aldosterone metabolites, 18-hydroxycorticosterone and 18-hydroxydeoxycorticosterone were not applicable for differential diagnosis of the adenoma and hyperplasia forms of primary aldosteronism.

1. The determination of aldosterone-18-glucuronide (pH 1-labile aldosterone) was complemented by concomitant measurements of free urinary aldosterone and tetrahydroaldosterone in 307 patients, most of whom were hypertensive. In 38 cases (12·3%) the normal, aldosterone-18-glucuronide concentration was clinically misleading, but increased free aldosterone and/or tetrahydroaldosterone values suggested the presence of hyperaldosteronism, which in many of these cases was confirmed by elevated excretion of the possible major aldosterone precursor 18-hydroxycorticosterone (18-OH-B). 2. Of 224 patients with essential hypertension and normal or low plasma renin activity 18 had an elevated free aldosterone and/or tetrahydroaldosterone excretion without increased aldosterone-18-glucuronide. These cases may represent early or pre-symptomatic forms of primary hyperaldosteronism. In other cases, particularly when tetrahydroaldosterone was increased alone, abnormalities of aldosterone metabolism were suspected. 3. In two out of 15 patients with primary hyperaldosteronism, aldosterone-18-glucuronide values were frequently found to be normal, although elevations were noted in other variables. However, no relation to the morphological abnormality (adenoma versus hyperplasia) was seen.