RESUMO
Two hundred one deaf adolescents with congenital rubella syndrome and 83 age-matched deaf control subjects were evaluated for the presence of organ-specific antibodies directed against thyroid microsomes, thyroglobulin, pancreatic islets, adrenal cortex, and gastric parietal cells. Positive thyroid microsomal or thyroglobulin antibodies were found in 23.3% (47/201) of the rubella group and in 12.0% (10/83) of control subjects. Nine of 46 (19.6%) in the rubella group and two of nine (22.2%) control subjects with thyroid autoimmunity had thyroid gland dysfunction as indicated by elevated serum TSH concentrations. Neither islet cell nor adrenal cortical antibodies were detected in any subject tested; parietal cell antibodies were detected in 5.5% (8/146) of those in the rubella group and 8.8% (6/68) of control subjects tested, but occurred most frequently in subjects with thyroid autoimmunity (6/36, 16.7% vs 8/178, 4.5%; P less than 0.05). It is recommended that all patients with congenital rubella syndrome be screened for thyroid autoimmunity and that those with positive antibody titers be evaluated for the presence of thyroid dysfunction.
Assuntos
Autoanticorpos/análise , Complicações Infecciosas na Gravidez , Rubéola (Sarampo Alemão)/imunologia , Glândula Tireoide/imunologia , Adolescente , Córtex Suprarrenal/imunologia , Surdez/imunologia , Feminino , Humanos , Ilhotas Pancreáticas/imunologia , Masculino , Gravidez , Rubéola (Sarampo Alemão)/congênito , Rubéola (Sarampo Alemão)/fisiopatologia , Testes de Função Tireóidea , Glândula Tireoide/fisiopatologia , Tireotropina/sangueRESUMO
Sera from 438 children were examined for autoantibodies to thyroid microsomes, thyroglobulin, pancreatic islet cells, gastric parietal cells, and adrenocortical cells by indirect hemagglutination and immunofluorescence techniques. A modification of the indirect hemagglutination technique allowed specific detection of low titers of antithyroidal antibodies. The subjects included a control group (117) with no known autoimmune disease, and children with disorders of the thyroid (88), insulin-dependent diabetes mellitus (201), Turner's Syndrome (24), and Addison disease (8). A subject's age at the time of disease onset and the race and sex were correlated with the prevalence of autoantibodies. The coincidence of autoantibodies to components of the thyroid with autoantibodies to gastric parietal cells was increased in children with disorders of the thyroid (94%, 18/19) over that observed in diabetes (29%, 4/14), Turner syndrome (0%), or Addison disease (0%), perhaps indicating different genetic propensities for the development of parietal cell antibodies in these groups. Islet cell antibodies were not found in subjects with Turner syndrome, nor were they more prevalent in white or black subjects with diabetes. The incidence of organ-specific autoantibodies in individuals without overt clinical disease may reflect an altered immunologic state that will lead eventually to autoimmune disease. Islet cell antibodies decline in prevalence in diabetes, whereas thyroid antibodies in disorders of the thyroid do not; this may reflect differences in the pathogenesis of these common autoimmune endocrine disorders in children.
Assuntos
Autoanticorpos/análise , Doenças do Sistema Endócrino/imunologia , Especificidade de Órgãos , Doença de Addison/imunologia , Adolescente , Glândulas Suprarrenais/imunologia , Adulto , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/imunologia , Feminino , Imunofluorescência , Mucosa Gástrica/imunologia , Testes de Hemaglutinação , Humanos , Lactente , Ilhotas Pancreáticas/imunologia , Masculino , Doenças da Glândula Tireoide/imunologia , Glândula Tireoide/imunologia , Síndrome de Turner/imunologiaRESUMO
A newly developed artificial pancreatic beta cell is described and its use in five children with diabetes mellitus is evaluated. This device can be programmed to bring the blood glucose concentration rapidly to a preselected level and normalize glucose tolerance in juvenile diabetic patients with markedly different insulin requirements. It is portable, can be operated by one person, and has been used to regulate the blood glucose concentration before, during, and after surgery requiring general anesthesia. The potential value of the device as an investigational tool is shown by demonstrating that regulation of the blood glucose concentration with insulin for seven to 24 hours does not alter circulating glucagon concentrations in the juvenile diabetic patients studied.
Assuntos
Órgãos Artificiais , Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina/administração & dosagem , Adolescente , Animais , Glicemia/análise , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Operatórios , Suínos , Fatores de TempoRESUMO
L-Dopa in a dose ranging from 125-500 mg and arginine monochloride in a dose of 0.5 gm/kg were given simultaneously to 56 children with short stature (height less than third percentile). Sixteen of these children were subsequently diagnosed as having growth hormone deficiency. The diagnosis of hyposomatotropism was based on clinical findings and on responses to the combination test and to arginine and L-dopa administered as separate tests. All of the remaining 40 children had a normal GH response of greater than 6 ng/ml to the combination test. However, in this group, nine children were identified who responded to the combination test but who failed to respond to arginine and L-dopa in individual tests. The data suggest that a positive response to arginine and L-dopa in combination in children, who do not respond to the usual provocative tests when administered individually, may fail to identify children with partial GH deficiency who would benefit from treatment. The integrated stimulated GH response in the 31 children in whom a normal GH response to all three tests occurred suggests that the effects of L-dopa and arginine are additive.