Objectives: Testosterone formulations that have more steady-state pharmacokinetics, such as subcutaneously implanted testosterone pellets, may cause less erythrocytosis than i.m. injections of shorter acting androgen esters. We, therefore, sought to define the prevalence, predictors, and proximate basis (role of erythropoietin) for polycythemia (hematocrit O0.50) in hypogonadal men receiving testosterone implants long term. Design: A cross-sectional study was conducted in an academic andrology center with a longitudinal subgroup analysis. Patients: A total of 158 hypogonadal men aged 14-84 years (mean age 46.7 years) treated on average for 8 years (range 0-21 years). Measurements: Trough blood testosterone and hematocrit. Serial serum erythropoietin concentrations were measured in 16 volunteers. Results: Positive univariate associations between polycythemia (hematocrit O0.50) and log(testosterone) (odds ratio (OR) 24.7, 95% confidence interval (CI): 4.3, 141.2, P!0.01) and age (OR 1.1, 95% CI: 1.0, 1.1, PZ0.03) and a borderline relationship with current smoking (OR 4.2, 95% CI: 0.9, 20.0, PZ0.08) were unveiled. A sensitivity analysis using alternate definitions of polycythemia was performed to capture all potential covariants. Multivariate regression analysis incorporating all potential covariants disclosed the independent OR of developing polycythemia (after adjusting for smoking and age) for log(testosterone) to be 15.0 (95% CI: 2.5, 90.8). Duration of testosterone therapy did not alter the risk of polycythemia. A direct relationship between testosterone and erythropoietin was observed (PZ0.05). Conclusions: Higher trough serum testosterone concentrations but not duration of treatment predict the development of polycythemia in men receiving long-acting depot testosterone treatment.
We evaluated whether near-infrared spectroscopy (NIRS) measurement from the flank correlates with renal vein saturation in children undergoing cardiac catheterization. Thirty-seven patients <18 years of age were studied. A NIRS sensor was placed on the flank, and venous oxygen saturations were measured from the renal vein and the inferior vena cava (IVC). There was a strong correlation between flank NIRS values (rSO(2)) and renal vein saturation (r = 0.821, p = 0.002) and IVC saturation (r = 0.638, p = 0.004) in children weighing ≤ 10 kg. In children weighing > 10 kg, there was no correlation between rSO(2) and renal vein saturation (r = 0.158, p = 0.57) or IVC saturation (r = -0.107, p = 0.67). Regional tissue oxygenation as measured by flank NIRS correlates well with both renal vein and IVC oxygen saturations in children weighing <10 kg undergoing cardiac catheterization, but not in larger children.
The propositus, one of six family members with the ballooning posterior mitral leaflet syndrome, had experienced five syncopal episodes prior to initial presentation with cardiac arrest. Subsequent evaluation, after nearly complete recovery, revealed slight Q-Tc prolongation but no arrhythmia, despite extensive ECG monitoring and maximum exercise testing. Intravenous propranolol failed to alter the Q-Tc interval or the magnitude of ballooning of the posterior mitral leaflet at cardiac catheterization. Therapy with oral Dilantin to the point of clinical toxicity failed to significantly shorten the Q-Tc interval. While on oral propranolol, the patient, during a stressful argument, suffered her final cardiac arrest. Detailed post mortem studies were performed, with histochemical identification of the "myxomatous" material not previously reported.
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