This book is the2nd improved and expanded edition of "Clinical Enzymology" (Lott/Wolf, 1987). It includes case studies and guidelines for specialists of laboratory medicine and clinicians, devotes each chapter to a specific enzyme or protein marker, contains case studies and guidelines, a section on marker biochemistry and physiology as well as a section on special pathology and analysis. The clear, didactic structure and the multiple choice questions also make the book valuable reading for graduate students in the fields of clinical pathology and laboratory medicine.

Breast and prostate cancers are both hormone-dependent, at least in some stages of their progression. Hormonal manipulation represents an important therapeutic approach. Although most of breast and prostate cancers initially respond to hormone therapy, most tumors reinitiate to growth. Finally, hormone-resistant and metastatic breast and prostate cancers may develop. Thus, the challenge is the dissection of mechanisms by which steroid receptor signaling pathways continue to influence cell growth and invasiveness. Compelling evidence indicates that steroid hormones elicit non-genomic responses in extra-nuclear compartment of target cells. In this cellular location, steroid-coupled receptors rapidly recruit signaling effectors or scaffold proteins and activate multiple pathways leading to proliferation, survival, migration and invasiveness. The immediate challenge is the dissection of key events regulating the steroid response of target tissues to prevent progression and improve treatment of breast and prostate cancers.

It has been known for over 150 years that hallmarks of inflammation can be observed in the wall of atherosclerotic vessels. It was, however, not clear if this inflammation is the cause or the consequence of atherogenesis. More recently, it has become evident that inflammation mediated both by innate and adaptive immunity is instrumental even in the earliest stages of the development of atherosclerotic lesions, i.e., that it plays an important pathogenetic role. In this volume, international experts in the field discuss the pathogenetic, diagnostic, preventive and possible therapeutic relevance of inflammation in atherogenesis. This book is intended for researchers and physicians in the fields of vascular biology, immunology and atherosclerosis.

Introduction Anthony J. Edis, Richard H. Egdahl, Tracy K. Mcintosh, Contents Lester F. Williams xi 1 Surgery of the Parathyroids General Introduction 1 SURGICAL ANATOMY Primary Hyperparathyroidism 7 PATHOLOGY 7 DIAGNOSIS 11 PREOPERATIVE LOCALIZATION STUDIES 22 TREATMENT 27 Secondary Hyperparathyroidism 35 SIGNS, SYMPTOMS, COMPLICATIONS 35 CLINICAL MANAGEMENT 36 Tertiary Hyperparathyroidism 37 Operative Technique 38 CERVICAL EXPLORATION WITH REMOVAL OF A PARATHYROID ADENOMA 46 SUBTOTAL PARATHYROIDECTOMY FOR HYPERPLASIA 59 PARATHYROIDECTOMY FOR CARCINOMA 60 MEDIASTINAL EXPLORATION FOR PARATHYROID TUMOR 61 References 66 2 Surgery of the Thyroid 71 General Introduction 71 SURGICAL ANATOMY 72 Nodular Goiter and Thyroid Carcinoma 79 PATHOLOGY 79 DIAGNOSIS 82 TREATMENT OF THYROID NODULES 94 TREATMENT OF THYROID CANCER RELATED TO PATHOLOGIC TYPE 97 Hyperthyroidism 110 Graves' Disease 111 PATHOLOGY 111 DIAGNOSIS 112 TREATMENT 115 Plummer's Disease 120 PATHOLOGY 120 DIAGNOSIS 120 TREATMENT 122 Complications of Thyroid Surgery 123 PREVENTION AND MANAGEMENT 123 viii CONTENTS 127 Operative Techniques TOTAL THYROID LOBECTOMY 127 REMOVAL OF A SUBSTERNAL GOITER 134 SUBTOTAL THYROID LOBECTOMY 136 MODIFIED NECK DISSECTION FOR PAPILLARY THYROID CARCINOMA 141 References 144 3 Surgery of the Adrenals 151 151 General Introduction SURGICAL ANATOMY 152 Pheochromocytoma 155 PATHOLOGY 155 156 DIAGNOSIS PREOPERATIVE 162 TREATMENT 166 172 Primary Aldosteronism PATHOLOGY 172 DIAGNOSIS 174 178 PREOPERATIVE LOCALIZATION STUDIES TREATMENT 180 Cushing's Syndrome 181 CLASSIFICATION 182 DIAGNOSIS 187 PREOPERATIVE LOCALIZATION STUDIES 192 TREATMENT 194 Adrenal Gland and Metastatic Breast Carcinoma 198 Adrenocortical Carcinoma 200 DIAGNOSIS 201 PREOPERATIVE LOCALIZATION STUDIES AND STAGING 201 TREATMENT 202 PROGNOSIS 203 Nonfunctioning Adrenal Tumors 203

Endocrine disruption represents one of the most controversial environmental issues of our time. Mounting evidence stemming from more than 10 years of experimental, epidemiological and clinical studies has transformed the once generally discounted subject of endocrine disruptors into an issue of tremendous concern not only within the scientific community but among society as a whole. Following initial evidence from basic research, endocrine disruption in humans has now emerged as a major medical challenge. In this respect, puberty, a crucial developmental stage, has been definitively identified as a key window of vulnerability with regard to endocrine disruptors. Written by leading authorities in the field, Endocrine Disruptors and Puberty offers an engaging and comprehensive overview of this fascinating and rapidly growing problem. An indispensable resource for all clinicians and scientists interested in this challenging endocrinologic topic, Endocrine Disruptors and Puberty is a timely contribution that will help navigate a path toward understanding the problem and developing solutions.

The volume Appetite Control provides a comprehensive description of the mechanisms controlling food intake, and thereby energy balance, in the mammalian organism. During the last decade, research in this area has produced a remarkable wealth of information and has characterized the function of numerous peptides, transmitters, and receptors in appetite control. Dysfunction of these circuits leads to obesity, a growing health concern. However, the plethora of mechanistic information is in marked contrasts to an almost complete lack of anti-obesity drugs that meet the safety standards required for the chronic therapy of morbid obesity. Consequently, ongoing research aims to identify additional targets and agents for a pharmacological intervention. Thus, the mechanisms of appetite control as well as all agents interfering with its control are of considerable practical interest.

The authors of the volume are distinguished scientists who are leading experts in the field, and who have contributed important, original data to our understanding of the mechanisms of appetite control. They have quite different scientific backgrounds and, together, they represent all relevant disciplines. Thereby, the topics are presented from different points of view, not exclusively from that of pharmacology and neuroendocrinology. Thus, the volume addresses all scientists who are interested in the field of obesity research and the pathophysiology of appetite control."

Muscarinic acetylcholine receptors have played a key role in the advancement of knowledge of pharmacology and neurotransmission since the inception of studies in these fields, and the effects of naturally occurring drugs acting on muscarinic receptors were known and exploited for both therapeutic and non-therapeutic purposes for hundreds of years before the existence of the receptors themselves was recognized. This volume presents a broad yet detailed review of current knowledge of muscarinic receptors that will be valuable both to long-time muscarinic investigators and to those new to the field. It describes the detailed insights that have been obtained on the structure, function, and cell biology of muscarinic receptors. This volume also describes physiological analyses of muscarinic receptors and their roles in regulating the function of the brain and of a variety of peripheral tissues. This volume shows how the study of muscarinic receptors continues to provide new and surprising insights not just to the cholinergic system but to the broad areas of neurobiology, cell biology, pharmacology, and therapeutics.

More than just coincidence connects a Tate & Lyle lawsuit and artificial sweetener to Jamaican-born Chemist Bert Fraser-Reid. From his first experience of Chemistry through his diabetic father, to his determination and drive as a Chemistry student in Canada, Fraser-Reid weaves a remarkable tale integrating science, law and autobiographical anecdotes. This book arises from the lawsuit brought by Tate & Lyle against companies accused of infringing its patents for sucralose, the sweet ingredient in the artificial sweetener SPLENDA which is made by chlorinating sugar. From a 1958 undergraduate intern witnessing the pioneering experiments on sugar chlorination, to being the 1991 recipient of the world's premiere prize for carbohydrate chemistry, Fraser-Reid was groomed for his role as expert witness in the mentioned lawsuit. Nevertheless, it seems more than his career links Fraser-Reid to the case.

Western knowledge of progress in biomedical research in Russia is severely limited by the scarcity of Russian journals available to us as well as the fact that few of us can read Russian. Therefore, it is of special significance that this recent contribution to the Russian scientific literature has been trans lated into English. This publication, Thyroid Hormones, brings to us a detailed analysis of recent work in Russia, and in particular in the Laboratory of Hormone Biochemistry, Institute of Biochemistry, Academy of Science of the Uzbek SSR and the Laboratory of Pathological Physiology, Institute of Experi mental Endocrinology and Hormone Chemistry, Academy Medical of Science of the USSR. The review illustrates the parallel pathways of inves tigation taken by investigators in Russia and in the West, indicating where the results have complemented each other or stimulated new questions and approaches. Consequently, the book provides an excellent review of the contributions made by Russian scientists in thyroid research and couples it with Western thought on these subjects to produce a complete review of the thyroid hormones. The large amount of data provided and the inclusion of multiple view points toward specific problems provides an excellent survey of the mecha nisms of biosynthesis and control of hormone formation, physiological effects of the hormones, and the molecular mechanisms involved in thyroid hormone action."

The Eleventh Midwest Conference on Endocrinology and Metabol ism in September 1975 brought together a number of leading invest igators in the areas of steroid, peptide, acetylcholine, and cate cholamine hormone receptor studies. This book is based upon the reports of investigations into hormone receptor biochemistry and physiology presented at the Conference as well as on the ensuing discussions. However, many of the manuscripts were written after the Conference. Because of this, the reader will find that some literature references and results of i vestigations are more up to-date than the Conference date would suggest. Perusal of this and previous volumes will attest to the high quality of this annual conference, due primarily to the efforts of the Planning Committee. We also acknowledge the superb efforts of the staff of Conferences and Short Courses for their assistance in organizing the Conference, and Mrs. Linda Bennett for expert sec retarial assistance in the typing of the book. Last, but certain ly not least, we express our appreciation to the various organiza tions that provided the necessary financial assistance. Leonard R. Forte John M. Franz David M. Klachko vii Contents The Receptor Concept: Prejudice, Prediction, and Paradox. . . . . Oscar M. Hechter Discussion. . . . . . . . . . . . . . 41 DeGroot, Hechter, Campbell, Freed, Barnawell, Morgan, Siegel Nuclear Receptors for Thyroid Hormone . 45 Leslie J. DeGroot 69 Discussion ............ ."

Gastroparesis is an increasingly recognized disorder. Treatment can be difficult due to the several mechanisms for symptom production. Gastroparesis: Pathophysiology, Presentation and Treatment serves as a concise reference on this disorder that allows clinicians to quickly access and evaluate the necessary information for treating and managing patients with gastroparesis. Each chapter is written byexperts in their respective area. The volume will enable the reader to better understand all aspects of this disorder. The book presents current concepts in a variety of areas opening with the epidemiology, clinical presentation and pathophysiology of gastroparesis. The natural history of patients is explored as well as evaluation of patients with suspected gastroparesis. This section includes chapters on Wireless Capsule Motility, Electrogastrography and Antroduodenal Manometry. This important resource concludes with a full section on treatment including dietary, prokinetic, antiemetic, sensory, electric stimulation, and surgical methods. New developments include the use of gastric electric stimulation for treatment, the use of SmartPill for diagnosis, and a number of new agents in development for this disorder. Gastroparesis: Pathophysiology, Presentation and Treatment is the ideal reference for gastroenterologists, and also for surgeons, endocrinologists, primary care physicians and nutritionists looking to keep pace with the latest information treatment options for their patients. "

Endocrine disruption is an expanding field due to the numerous chemicals involved and, as evidenced more recently, the variety of homeostatic systems that they can alter throughout life. Also, this field is at the edge of several disciplines with implications of both laboratory scientists and clinicians. This symposium aims at updating mechanisms and consequences of endocrine disruption in three perspectives: neural, metabolic and reproductive. The gathering of experts from all over the world should help the participants to identify health disorders that are possibly or likely related to exposure to endocrine disrupters. The research needs will be discussed as well as recommendations prioritizing target groups and following the precautionary principle.

Endocrinology, as a discipline, was a late arrival in the corpus of established subjects. Its growth in recent years has been prodigious, extending from mor phology to molecular levels. Most of the major endocrine glands were noted by the early anatomists, although the adrenal glands were not described until 1563 by Bartholomaeus Eustachius (1520-1574). On the other hand, elucidation of the function of these glands was extremely slow. Key work by A. A. Berthold (1849), although overlooked at the time, showed that comb atrophy in castrated fowl was prevented by testis transplantation. The idea that glands produced substances reach ing the bloodstream directly and not via excretory ducts stemmed from Claude Bernard, who first used the term internal secretion in 1855. The clinical observa tions of Thomas Addison at Guy's Hospital-published as a monograph in 1855 entitled The Constitutional and Local Effects of Disease of the Suprarenal Capsules -were seminal. However, the stimulus of this early research did not bring imme diate widespread further investigations. Upon the discovery of secretin in 1902, Bayliss and Starling considered the term "internal secretion" to be clumsy, and the term "hormone" was coined (from OQ UW-1 excite or arouse) and it was first used by Starling in his Croonian of 1905."

Sugar consumption is suspected to play an important role in the pathogenesis of diabetes, cardiovascular disorders, fatty liver disease, and some forms of cancers. Dietary sugars-fructose in particular-also have a potential role in obesity and metabolic diseases. Dietary Sugars and Health presents all aspects of dietary sugars as they relate to health and disease. It provides a review of the current science related to dietary sugars, ranging from historical and cultural perspectives to food science and production to basic research, animal trials, human pathophysiology, epidemiology, and public health policy implications. Each chapter features a concise, thorough summary of the current knowledge, including an overview of cutting-edge research, controversies, and future perspectives. The book provides a balanced approach through global and multidisciplinary contributions as well as input from various sectors, from academia to the food and beverage industry. The overall collection provides readers with a balanced and complete view of the science related to dietary sugars and health. This book is an invaluable reference for food scientists, nutrition scientists, clinical and translational researchers, obesity researchers, physiologists, public health scientists, and policy makers.

A number of chapters present the most novel research on testicular and epididymal functions or on more general fields of hormone action and molecular cell biology as it is now a tradition. However, exceptionally, the book also contains several chapters dealing with the "Approaches and Tools in the Third Millenium." The unusual inclusion of technologies as such in the 2000 edition of the workshop was an absolute necessity, as these technologies are revolutionizing the fields of biology and medicine and, in many instances, how to do research. This volume gives the scientific community essential information about the very latest technical developments and their potential for future progress.

Readers of this book can update their knowledge in the fast-moving field of endocrinology and neurobiology. Topics concerning growth and development are extensively reviewed from both basic science and clinical viewpoints. Aspects related to growth development and to the control of cellular differentiation and multiplication are discussed. Further new information is provided on: synthetic recombinant human growth hormone (rHGH); potential diagnostic and therapeutic applications of the neuropeptide, growth hormone releasing hormone (GHRH); the physiology and physiopathology of the neural control of growth hormone secretion; the diagnosis and therapy of growth hormone deficiency or excess states; and the biology, function and possible utilization of growth factors. These important new findings are relevant to progress in pediatrics, pediatric and clinical endocrinology, neuroendocrinology and physiology.

The rapid developments in molecular genetics have clarified many of the muta tions in monogenic thyroid diseases over the last two decades; now the target of molecular thyroid genetics has become the oligogenic thyroid diseases. These include the autoimmune thyroid diseases and familial thyroid cancers, both of which are much commoner than the monogenic diseases. However, the method ological approach to the genetics of these more complex diseases is still far from being well established. Although the discovery of susceptibility genes has been partially accomplished in complex diseases such as asthma, Crohn's dis ease, and types I and II diabetes mellitus, the elucidation of susceptibility genes in complex diseases remains a major challenge. This volume contains papers presented at the International Symposium on the Genetics of Complex Thyroid Diseases. This meeting was held in association with the International Thyroid Congress in Kyoto in October 2000 and sup ported in part by the Japan Intractable Diseases Research Foundation and Knoll Pharmaceuticals Inc. The symposium was the first international symposium con cerning the genetics of complex thyroid diseases and was restricted to the study of the autoimmune thyroid diseases and familial thyroid cancer. Twenty distin guished researchers from the United States, the United Kingdom, France, Ger many, Italy, and Japan were invited. Each presentation precipitated intense dis cussion and there was much consensus during the meeting. Nevertheless, this volume will leave the reader with a clear understanding of how little we still know.

This book provides a concise summary across all aspects of endocrine surgery, covering the major endocrine organs and discussing aspects of surgical care. It comprises five sections covering the major endocrine organs/systems, each with a specialist section editor. Within each section there are a number of brief (2-3 page) chapters, written in a combination of prose and bullet points, a format that is conducive to both detailed reading and quicker, "dipping in", review. Each chapter contains a "Pearls and Pitfalls" summary box. The text takes into account the latest evidence and current expert opinion from an internationally renowned list of authors.

Sex matters! Are there differences between the sexes when it comes to brain function and the behaviours that result? This volume attempts to answer this fundamental question. If the answer is 'yes' then this should impact upon our approach to treating mental illness in humans, and to modelling it in animals, as we look for aetiological and pharmacological solutions.

In mammals, a robust physiologic system acts to maintain relative constancy of weight. A key element of this system is leptin. The nature of this "brain-somatic" cross talk is as yet poorly understood, but it is likely to have important implications for the pathophysiology and treatment of obesity, diabetes and other metabolic disorders.

Professor Egon Diczfalusy, a pioneer in gynaecological endocrinology and in particular female contraception, celebrated his 80th birthday with a scientific symposium. The participants were scientists from all over the world who had been scholars and close collaborators at different points in time. The interdisciplinary meeting consisted of lectures on the epidemiological impacts of ageing, its challenge for the pharmaceutical industry, philosophical aspects of the future of mankind, and the history and future of contraception. Three round table discussions addressed the hormonal control of reproduction and ageing, new approaches and future perspectives of contraception for women and men, and hormone replacement in the elderly.

Autoimmunity is the most common cause of endocrine disorders. This volume provides an up-to-date summary of recent advances in this important field. In addition, it describes developments in our understanding of conditions such as vitiligo and pernicious anaemia which are frequently associated with autoimmune endocrinopathies. There is a detailed review of animal models of endocrine disease which have contributed greatly to current knowledge. Furthermore, the aetiology, pathogenesis and treatment of the clinical disorders are discussed in depth. The book will be of interest to anyone working in the areas of endocrinology and immunology.

The study of prenatal development provides many clues for understanding the physiology as well as the pathogeny of malformations and many diseases. I became interested in the analysis of human development as a young medical student more than 30 years ago, and I have stayed in this field all my life. In my studies, I always tried to compare the events of different disciplines such as genetics, anatomy, bio chemistry and physiology. I learned that the development of a structure is, under normal circumstances, strictly determined and that the development of structures always precedes their proper function. There are no changes in function without changes in structure. The life of every cell is genetically preprogrammed and the program may be modified by complicated interactions with environment. Recent progress in our knowledge is basicly related to technology. However, using all the tools of today's technology, we are still unable to understand the basic normal development. After almost thirty years of work, I am trying to present a subjective review of the development of the human endocrine glands. I am presenting an image emerging from my experience. I personally studied several hundred human embryos using mostly anatomical, histochemical and some biochemical techniques. I found much additional information in the literature."

This book provides a complete review of multiple metabolic disorders and the use of phytochemicals for their prevention and treatment. When describing each metabolic disorder, all authors describe the main health alterations, providing the most current figures and statistics worldwide; medicinal plants used in traditional medicine for its treatment and scientific information related to their potential to prevent or treat each condition. Authors also include a complete scientific background check, comprehensive analysis of all phytochemicals recommended for each disorder, a description of the mechanism(s) of action and in vivo and/or in vitro studies. Within this volume, a series of 7 plant species, recommended to treat or prevent the previously described disorders, are presented with their botanical information, traditional use in different cultures and countries, and the available scientific information validating their health benefits. Besides, six main metabolic disorders are described, providing a full scientific background for its general understanding, and three study cases are presented, where metabolic disorders are analyzed and approached from different medical and pharmaceutical angles. Chapter 1 a Soybean contains a great nutritional value, which makes it an excellent food for the human diet. It has large amounts of protein and lipids and also provides fiber, calcium, iron, zinc, and several vitamins. For these reasons, the possible benefits of soy consumption for human health have been studied. Although the results obtained to date have not been conclusive, thanks to its high content of isoflavones (phytochemicals with estrogenic activity), soy is attributed with anti-inflammatory, antioxidants and antifungals properties. Moreover, soybeans could provide significant benefits to patients with cardiovascular diseases, cancer, or diabetes. Chapter 2 a Oil, proteins, vitamins, fibers, and phytochemicals present in the avocado plant have shown the excellent capability of not only addressing the prevalence of these metabolic diseases but also being safe and having minimal side effects. The general objective of this book chapter is to review the bioactive compounds and their action to promote health benefits in the prevention and management of metabolic disorders. Chapter 3 a Heliopsis longipes roots, which contain affinin, has been used in traditional cuisine as a spice for its pungent. Due to its tingling and numbing properties, it is frequently applied to heal diverse pains such as toothache, earache, and headache. Within this chapter, its applications on anti-inflammatory activity, local anesthetic, analgesic, anti-mutagenic, and antioxidant activity, will be reviewed. Chapter 4 a The species Opuntia ficus-indica (L.) Mill., represents a good source of nutrients and antioxidants in the diet of consumers. This chapter aims to offer a simple and economical alternative formulation of artisan conserves prepared with nopal, in which the antioxidant activity was evaluated. Chapter 5 a Metabolic syndrome is known as a group of metabolic abnormalities that increase the risk of developing cardiovascular diseases and type 2 diabetes. The cost of health for companies is very high for workers who have obesity or metabolic syndrome compared to healthy workers. Metabolic syndrome is closely related to obesity, and this, in turn, is associated with a poor diet (high intake of carbohydrates and fats). This chapter explains the decrement of risk factors in workers of Young Living Ecuador Farm based on the Health Belief Model. Chapter 6 a The objective of this chapter book was to analyze the evidence obtained by clinical studies reported by scientific literature. Clinical studies have employed different components or products of grapes, such as pulp, freeze-dried grape, extracts, wine, and a distinct dose of resveratrol, to demonstrate their biological properties against diabetes mellitus, hypertension, and obesity. Chapter 7 a The main purpose of this chapter is to describe the analysis of whether glycated hemoglobin values could be used as a limit marker for earlier diagnosis of type 2 DM in overweight patients. This was a nonexperimental, analytical, retrospective, longitudinal study of 100 overweight patients diagnosed with type 2 DM. The study was carried out in 2014 at Teodoro Maldonado Carbo Hospital, Guayaquil, Ecuador. Chapter 8 a Rosemary is classified not only as spice or ornamental but also as a medicinal plant. It is an important source of volatile and non-volatile compounds. The proportion of them varies in function of diverse factors as a region of growth, environment, extraction treatment, and others. Thanks to its composition, rosemary owners several properties such as anti-obesity, anti-diabetes, anti-cancer, among others, thus the importance of this plant over metabolic diseases is presented in this chapter. Chapter 9 a Agave has been used in traditional medicine as an anesthetic, anticonvulsant, antipyretic, urinary antiseptic, cathartic, cicatricial, and regenerative, diuretic, emmenagogue, and eupeptic. Agave extracts and derived agave products have been used to prevent several metabolic diseases, such as diabetes and cancer. However, more studies are needed to support these effects.

This volume contains the proceedings of the third in a series of conferences entitled, The International Symposium on Biological Reactive Intermediates. The first was held at the University of Turku in Finland, in 1975, the second at the University of Surrey in the United Kingdom, in 1980 and the most recent at the University of Maryland in the United States, in 1985. The significance of these conferences has been emphasized by the rapid growth of mechanistic toxicology over the last decade. These conferences were initially stimulated by the attempt to uncover the significance behind the observations that the toxicity of carcinogenic responses produced by many chemicals was associated with the observation that their metabolism led to the formation of chemcially reactive electrophiles which covalently bound to nucleophilic sites in cells such as proteins, nucleic acid or fats. Recently, newer concepts have arisen which have necessitated the expansion of subjects covered by the conference. For example, the application of newer knowledge of the role of active oxygen species in reactive metabolite formation, the concept of suicide substrates, examination of the function of glutathione in cells, application of immunological techniques and molecular biological probes to the solution of toxicological problems all had an impact on the study of the biological reactive intermediates.