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Iatrogenic thyrotoxicosis. Causal circumstances, pathophysiology and principles of treatment. Review of the literature.

Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. In most instances, thyrotoxicosis is due to hyperthyroidism, a term reserved for disorders characterized by overproduction of thyroid hormones by the thyroid gland. Nevertheless, thyrotoxicosis may also result from a variety of conditions other than thyroid hyperfunction. The present report focuses on the etiologies, pathophysiology and treatment of iatrogenic thyrotoxicosis. Iatrogenic thyrotoxicosis may be caused by 1) subacute thyroiditis (a result of lymphocytic infiltration, cellular injury, trauma or radiation) with release of preformed hormones into circulation, 2) excessive ingestion of thyroid hormones ("thyrotoxicosis factitia"), 3) iodine-induced hyperthyroidism (radiological contrast agents, topical antiseptics or other medications). Among these causes of iatrogenic thyrotoxicosis, that induced by the iodine overload and cytotoxicity associated with amiodarone represents a significant challenge. Successful management of amiodarone-induced thyrotoxicosis requires close cooperation between endocrinologists and endocrine surgeons. Surgical treatment may have a leading yet often underestimated role in view of the potential life-threatening severity of this disease, whereas others kinds of iatrogenic thyrotoxicosis are usually treated conservatively.

Amiodarone↗

[Serum cholesterol and cancer. Is there a causal relationship?].

Several studies have reported an inverse relationship between serum cholesterol levels and the risk of cancer, especially of the colon (Seven Countries, Framingham, Chicago studies, London Whitehall Study, Paris prospective study, New Zealand Maori, Honolulu Heart Study, Hypertension Detection and Follow-Up Program, ...). For example, in the Multiple Risk Factor Intervention Trial (361 662 men), the global mortality graph was J-shaped, higher at either side of the 4.6-5.1 mmol/l value of serum cholesterol. This increased mortality with lower serum cholesterol levels was due to increased numbers of death from cancer. However, when the relationship is studied with respect to the time elapsed between the cholesterol measurement and death from cancer, the relative risk of death in the lowest decile with respect to the average of the following deciles, decreases with the period between measurement of the serum cholesterol and time of death. The negative relationship between serum cholesterol and death by cancer, very significant for deaths occurring within the first 5 years, disappeared almost completely for deaths occurring after 5 years. Other trials designed mainly to examine cardiovascular risk, and concerning smaller numbers, have not demonstrated this inverse relationship between serum cholesterol and cancer. This negative relationship between serum cholesterol and cancer must be acknowledged. It is weak and concerns mainly colonic cancer, especially in men in the elderly age groups. Several explanations have been put forward: influence of the combination of factors, competition of risk of death by other causes, chance, alteration of normal biological function of the cell membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The relationship between cohabitation and divorce: selectivity or causal influence?

Recent evidence linking premarital cohabitation to high rates of divorce poses a complex theoretical and empirical puzzle. We develop hypotheses predicting that premarital cohabitation is selective of those who are prone to divorce as well as hypotheses predicting that the experience of premarital cohabitation produces attitudes and values which increase the probability of divorce. Using multiwave panel data from a recent cohort of young men and women in the United States, we specify and test models of these predictions. The results are consistent with hypotheses suggesting that cohabitation is selective of men and women who are less committed to marriage and more approving of divorce. The results also are consistent with the conclusion that cohabiting experiences significantly increase young people's acceptance of divorce.

Adolescent↗

Mesothelioma trends in the Republic of Ireland: an epidemiologic study in the context of the causal pathway.

This study utilized pleural cancer deaths (n = 125) as a surrogate measure for mesothelioma. The existing mesothelioma incidence data (n = 77) were also analysed. Annual-Percent-Change (APC) in age-adjusted rates (European standard population) was estimated. The pleural cancer mortality rates showed an annual rise of 8.9% (95% CI: 7.1%, 10.8%) from 1979 to 1998 (p < 0.0001), and this was steeper from 1990 onwards, especially among the older cohorts (10.9%). The birth-cohorts of 1925-1935 appear to be suffering the highest risk of pleural cancer deaths. The mesothelioma incidence also showed an annual increase of 14.4% (95% CI: -22.7%, 51.4%) from 1994 to 1998 (p = 0.08). The majority of the mesothelioma cases were involved in asbestos-related trades. Seventy (95% CI: 49,101) cases of pleural cancer deaths are predicted for the years 2007-2008, as opposed to 29 cases observed a decade ago in the years 1997-1998. The current APC (8.9%) is also predicted to rise to 10.5% (95% CI: 7.3%, 15.0%) in 2007-2008. These findings merit close attention for future public-health policies in line with EC directive of banning the indiscriminate use of 'all' forms of asbestos in the Republic of Ireland as early as possible.

Causality↗

Obstructive sleep apnea and cardiovascular disease and mortality: the argument for causality.

There is solid evidence linking obstructive sleep apnea (OSA) to cardiovascular mortality. Although it has yet to be scientifically proven that OSA causes cardiovascular disease, many investigators consider it an independent cardiovascular risk factor. Its impact on the cardiovascular mortality risk of a given applicant varies depending upon the severity of the condition, compliance with treatment, and the applicant's specific cardiovascular milieu. This review is aimed at making mortality risk assessment more accurate by describing what is known of the physiologic mechanisms by which OSA may influence cardiovascular mortality and providing an appreciation for the magnitude of this risk. In doing so, an argument supporting OSA as a cause for cardiovascular disease and mortality emerges.

Cardiovascular Diseases↗

[Cigarette smoking and ulcerative colitis--is there a causal relationship?].

The relation between cigarette smoking and ulcerative colitis was assessed in a case-control study of 235 cases of ulcerative colitis and 311 age- and sex-matched control subjects admitted to the hospital for conditions unrelated to smoking. Smoking habits and daily number of cigarettes smoked were analysed. We found significantly less number of smokers and more ex-smokers in the ulcerative colitis group. The intensity of smoking was equal in both groups. It was noted that pancolitis occurred more frequently in the ex-smokers group. The intensity of smoking did not influence the extension and clinical course of ulcerative colitis. For ulcerative colitis, the relative risk for nonsmokers was 7.4. The study revealed a positive correlation between nonsmoking and ulcerative colitis, higher incidence of pancolitis among ex-smokers and higher relative risk of ulcerative colitis for never-smokers. Various possible causes of influence of smoking on ulcerative colitis are discussed.

Adolescent↗