Eighty percent to 90% of circulating cortisol is bound to cortisol-binding globulin (CBG) and albumin; only a small fraction is in the free, biologically active form. Traditionally, total serum cortisol measurements have been used to evaluate adrenal gland function. Accurate assessment, however, is difficult in severely ill patients because CBG falls rapidly and suum albumin levels are frequently low. Recently, direct measurements of free cortisol and a free cortisol index (FCI), derived by dividing the total cortisol by the CBG, have been shown to more accurately reflect adrenal gland function than the level of total cortisol in severely ill patients. Free cortisol levels are usually measured in reference laboratories and results arrive too late to be of practical value and CBG measurements are not generally available. In this Study, we compared an FCI index, derived by dividing the total cortisol by the serum albumin, with free cortisol measured by equilibrium dialysis in 11 women and 7 men before and 24 hours after surgery. Since the correlation of FCI (Alb) to free cortisol was good, our pilot study suggests that the total cholesterol/albumin ratio may provide a surrogate measure for free cortisol that is readily available in most clinical laboratories. Further studies in a larger number of patients, especially those with hypoalbuminemia, however, are needed before the FCI (Alb) can be used confidently in critically ill patients.

In an Endocrine Fellows Case Conference regarding metastatic Hürthle cell carcinoma (HCC) that was published in Endocrine Practice, Khan and coworkers ( 1. Khan S. Sharibi A. Neff R. Grace W. Young I.S. Metastatic Hürthle cell carcinoma: a unique case report and review of the literature. Endocr Pract. 2005; 11: 285-289 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ) put forward the often repeated but poorly documented proposition that radioactive iodine (RAI) scanning and treatment have limited value in the management of this malignant thyroid tumor.

OBJECTIVE:To describe a patient with papillary thyroid carcinoma who had measurable thyroglobulin (Tg) levels for 20 years without clinical or imaging evidence of a malignant lesion.METHODS:We reviewed the clinical course, pathologic findings, Tg measurements, and results of various imaging studies in our patient and reviewed the literature regarding Tg-positive, diagnostic total-body radioiodine scan-negative patients with thyroid cancer.RESULTS:Four months after a 3.5- by 3.5-cm follicular thyroid cancer was removed from the anterior neck area of a 5-year-old girl, a bilateral subtotal thyroidectomy was performed. At age 12 years, she presented with a 2-cm mass on the right side of the neck. After a completion thyroidectomy, recurrent mixed papillary-follicular thyroid cancer was found scattered throughout the remaining thyroid parenchyma. Although a postoperative diagnostic total-body radioiodine scan did not reveal uptake of (131)I, the Tg level was 58 ng/mL. Despite Tg levels as high as 2,528 ng/mL, the patient had no clinical evidence of thyroid cancer during a 20-year period of follow-up. Moreover, numerous imaging studies, including total-body scanning after the administration of 150 mCi of (131)I and [(18)F]fluorodeoxyglucose positron emission tomography, were negative. Review of pathologic specimens from both operations with use of updated diagnostic criteria indicated that the tumor was a papillary thyroid carcinoma.CONCLUSION:Our observations and the observations of other investigators indicate that some thyroid cancers produce Tg so efficiently that high levels of Tg may be associated with tumors that remain too small to be detected by imaging studies. The Tg levels may remain stable, decline, or even disappear over time without treatment.

Background The study was conducted to determine whether patients who are hospitalized for low-impact hip fractures at the Gundersen Lutheran Medical Center are investigated and treated for osteoporosis. Methods In a 1-year retrospective, we reviewed patient records of all patients older than 65 years who were hospitalized in 1999 for treatment of low-impact hip fractures. Risk factors for osteoporosis, the presence of previous fractures, the frequency of bone mineral density testing, and the frequency of osteoporotic treatment were tabulated. Results Of 162 patients, almost all had 1 or more risk factors for osteoporosis in addition to age, and 31% had a history of a previous fracture. None of the 42 men had bone mineral density testing and only 2 received calcium or vitamin D therapy prior to fracture. Of the 120 women, only 4 had bone mineral density testing. Prior to hip fracture, the following therapies were prescribed for female patients: estrogen therapy, 5 patients; alendronate, 6 patients; nasal calcitonin, 2 patients. Eighty-three percent of patients received no therapy. After hospital discharge, 2 additional women received estrogen therapy or nasal calcitonin, but 1 woman had alendronate discontinued. After the hip fracture, only 1 additional male was offered treatment (calcium carbonate). Comment

Angular distributions for photon scattering from C-12 and He-4 have been measured using continuous wave bremsstrahlung from the Saskatchewan Accelerator Laboratory pulse stretcher ring. Data for carbon were taken at 158.8, 195.2, 197.2, 247.2, and 290.2 MeV end-point energies, and for helium were taken at an end-point energy of 158.8 MeV. A large NaI(Tl) gamma ray spectrometer with 1.7% resolution was used to detect the scattered photons at laboratory scattering angles, ranging from 20 degrees to 150 degrees. The excellent energy resolution of the NaI detector allowed a separation of elastic from inelastic photon scattering for the first time at these energies. The angular distributions for elastic scattering are in only fair agreement with delta-hole theory and theory based on the optical theorem at forward angles, and completely disagree with theory at backward angles. Measured cross sections for inelastic scattering leading to the 4.43 MeV state in carbon are small compared to the elastic scattering at forward angles, but are dominant at backward angles. This experiment is the first to separate elastic from inelastic photon scattering at these energies.

The angular distributions for coherent photon scattering from He-4 were measured at average laboratory bremsstrahlung energies of 187, 235, and 280 MeV. The experiment was performed at the Saskatchewan Accelerator Laboratory using the new high duty factor electron beam. The scattered photons were observed with a high-resolution NaI(Tl) total absorption scintillation detector. These measurements are intended to investigate modification of the DELTA properties inside the nuclear medium and the treatment of nonresonant contributions to the scattering cross sections. The results are compared to theoretical calculations in the isobar-hole model. Clear deviations from the theory are evident at all energies, especially at 187 MeV.

The H3 and He3 charge and magnetic form factors have been extracted from cross-section measurements in the region 0.3≲Q≲2.9 fm−1. The measurements have random uncertainties of about 2% and systematic uncertainties of about 2% for H3 and 1.5% for He3. The small systematic uncertainties allow accurate determination of the isoscalar and isovector trinucleon form factors. The isoscalar charge and isovector magnetic form factors are in reasonable agreement with current theoretical models, whereas the isovector charge and isoscalar magnetic form factors show significant deviations from the models.Received 27 May 1987DOI:https://doi.org/10.1103/PhysRevLett.59.1537©1987 American Physical Society

A 13-year-old girl demonstrated abnormal I-131 uptake in the abdomen after total thyroidectomy for recurrent papillary-follicular thyroid carcinoma. Although a vertebral metastasis was suspected, a negative bone scan and normal computed tomography of the vertebra militated against this diagnosis. A Tc-99m abdominal scintigram and a small bowel roentgenogram revealed images typical of a Meckel's diverticulum. Exploratory laparotomy did not reveal metastases, and I-131 uptake was no longer demonstrated after operative removal of the Meckel's diverticulum. Uptake of I-131 by a Meckel's diverticulum can mimic metastatic thyroid cancer.

Cross sections have been measured for the elastic and inelastic scattering of electrons from 70Ge and 72Ge for momentum transfers from 0.65 to 1.14 fm−1. Values for the parameters of a Fermi type ground-state charge distribution were obtained from a phase shift analysis of the elastic cross sections. The rms charge radius corresponding to these parameters is 4.07±0.02 fm for 70Ge and 4.05±0.03 fm for 72Ge. Using DWBA analysis the reduced transition probabilities for the electroexcitation of the 21+ and 31− states were found to be: B(E2, ω)↑ = 19.7±1.2, 26.8±2.0 W.u.; B(E3, ω)↑ = 36±5, 37±7 W.u. for 70Ge and 72Ge respectively. The Jπ = 3− assignments for the state at 2.562 MeV in 70Ge and 2.515 MeV in 72Ge are confirmed.

The form factor for the 19.08-MeV level in oxygen-16 has been measured for momentum transfers between 60 and $260 \frac{\mathrm{MeV}}{c}$. The results, when compared with particle-hole calculations, strongly support an assignment $J=2$. Since the transition is transverse, the parity is negative, and the assignment to the level is ${J}^{\ensuremath{\pi}}={2}^{\ensuremath{-}}$.

We have tried to present enough of the case and the therapeutic process to describe this boy. Mike was born blind and prematurely. In addition, his family was struggling with many tragedies. His mother was depressed, distant, and preoccupied with her own ‘bad’ self and the defective children she produced. She was not readily available for gratification and stimulation. We had no means of repairing his blindness or rectifying his birth history. We could deal with his denial mechanisms and those of his parents. We could work with Mike's inhibition of affect and inadequate object relationships. He could learn that there were many things he could do as well as things he could not do. We wish to underline that most of the psychotherapy was done with the boy and that the parents could begin to hope and do more for the boy only after he had made sufficient headway to pull them along with him. The study of this case brings up two basic questions: — 1) What are the indispensable factors for cognitive development? and, 2) What is the relationship between affect development and cognitive development? The recent literature bearing on this subject has been reviewed. Our tentative formulation is as follows: cognitive development depends essentially on a healthy ego apparatus and a stimulating environment. The stimulus is transmitted through the sensory modalities: as long as there is a sufficient sensory input the ego development will not be handicapped. The stimulus has two qualities: cognitive and affective. An important defect in either area will produce a distortion of the ego development generally. A sufficient sensory input does not necessarily require the intactness of all the sensory modalities: what matters is that enough information could be offered to the brain to allow concept formation and then abstract and creative, thinking. Mike suffered from a sensory deficit and emotional deprivation. In our work with him we acted mainly at the affect level, sensory deficit being irreversible. The result was a removal of symptoms at both the cognitive and the emotional level. This seems to support the theory that “interpersonal isolation without sensory interference can produce symptoms; sensory deficit by itself, without affective and interpersonal isolation, need not”. To quote G. Klein (1): “The sensory modalities are only carriers of input for high-order, integrative achievement, but they are only carriers, not the indispensable organizers of this input”. A ‘blind child will perhaps develop a different ‘cognitive style’, but “there is very little to support the idea that blindness imposes an upper limit on the potential development of the synthetic function of the ego”. The more, disabled the child is, the more important his world of people and early object relationships become. His dependency on ‘alter ego’ functioning and on stimulation of residual sensory capacity may have to go on for a much longer time than in the case of a normal child. Maternal care then becomes the crucial factor, mothering being defined as the source of a continual feed-back of reality at both the cognitive and the affective level.

The first study of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of social anxiety in autistic adults commenced in the spring of 2014. The search for psychotherapeutic options for autistic individuals is imperative considering the lack of effective conventional treatments for mental health diagnoses that are common in this population. Serious Adverse Events (SAEs) involving the administration of MDMA in clinical trials have been rare and non-life threatening. To date, MDMA has been administered to over 1133 individuals for research purposes without the occurrence of unexpected drug-related SAEs that require expedited reporting per FDA regulations. Now that safety parameters for limited use of MDMA in clinical settings have been established, a case can be made to further develop MDMA-assisted therapeutic interventions that could support autistic adults in increasing social adaptability among the typically developing population. As in the case with classic hallucinogens and other psychedelic drugs, MDMA catalyzes shifts toward openness and introspection that do not require ongoing administration to achieve lasting benefits. This infrequent dosing mitigates adverse event frequency and improves the risk/benefit ratio of MDMA, which may provide a significant advantage over medications that require daily dosing. Consequently, clinicians could employ new treatment models for social anxiety or similar types of distress administering MDMA on one to several occasions within the context of a supportive and integrative psychotherapy protocol.