Some studies on the natural history of Graves' orbitopathy: increase in orbital fat is a rather late phenomenon

AimTo describe volumes of orbital fat (FV) and extraocular muscles (MV) in Graves' orbitopathy (GO) as a function of the duration of GO.Patientsi) Cross-sectional survey among 95 consecutive patients with untreated GO who had been referred to the combined thyroid–eye clinics of our university hospital. ii) Longitudinal survey among 39 of the 95 patients who did not receive any therapeutic intervention and were followed for 1 year.MethodsA computed tomography (CT)-based and well-validated method for calculating orbital soft tissues. In order to neutralize sex differences, results are expressed as ratios of FV:orbital volume (OV) and MV:OV.Resultsi) Patients with GO duration of >1 year had greater FV:OV (0.65 vs 0.55, P=0.004), similar MV:OV (0.22 vs 0.21, not significant (NS)), and more proptosis (22 mm vs 21 mm, P=0.03) as compared to those with shorter duration. ii) As compared to baseline, after 1 year, FV:OV had increased (0.56 vs 0.63, P=0.000), MV:OV had not changed (0.19 vs 0.19, NS), proptosis was higher (20 mm vs 21 mm, P=0.003), and clinical activity scores had become lower (2 vs 1, P=0.02) (median values).ConclusionCT images show that a longer duration of GO is associated with a higher orbital FV. Extraocular MV, however, is not associated with GO duration; rather, it is related to the severity of GO.

Mound Building and Prestige Goods Exchange: Changing Strategies in the Cahokia Chiefdom

I examine the shift, at about A.D. 1200 in the Mississippi River Valley Cahokia polity, from emphasizing the status and prestige of communal groups through monumental constructions to displaying and maintaining the status and prestige of individual elites using prestige goods. I interpret this transformation as a change from a “corporate” to a “network” leadership strategy. Archaeologically, these alternative strategies show up as differences in monumental construction, wealth differentiation, craft production, and exchange networks. The Moorehead phase (A.D. 1200-1275) is typically characterized as the time of Cahokia’s decline because of decreased mound building and population levels. My examination of archaeological indicators of household status and craft production reveals maximal differences between household units in status and marine shell working after A.D. 1200, with increased centralization of shell working and more intensive production by higher-status households. I argue that elite control of craft production, if present, was a late phenomenon. Rather than a decline at A.D. 1200, changes in the archaeological indicators of complexity reflect changes in the ways that power was expressed and maintained by elites in Cahokian society.

Settlement mobility and the ‘Middle Saxon Shift’: rural settlements and settlement patterns in Anglo-Saxon England

The traditional image of the stable Anglo-Saxon village as the direct ancestor of the medieval village is no longer tenable in view of growing evidence for settlement mobility in the early and middle Saxon periods. Indeed, it now appears that most ‘nucleated’ medieval villages are not the direct successors of early, or even middle Saxon settlements, and that nucleation itself appears to be a remarkably late phenomenon.

Early inappropriate secretion of antidiuretic hormone after trans-sphenoidal pituitary adenomectomy

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a rare but life-threatening complication of trans-sphenoidal pituitary adenomectomy. It has previously only been described as a late phenomenon. We report an early presentation within the first week. The pathophysiology, clinical features and treatment are discussed.