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Biomedical subjects

A Kreze

Publications and source records attributed to A Kreze.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Is the aldosterone-renin ratio useful in screening for primary aldosteronism?].

Despite improving laboratory and imaging methods the diagnosis of primary aldosteronism still remains a problem. One of the reasons is inadequate sensitivity of classical screening of this secondary arterial hypertension by hypokalemia. In the submitted paper the authors review data from the literature on more sensitive screening by means of the aldosterone-renin ratio. Its inclusion among basic examinations in patients with arterial hypertension seems fully justified.

Aldosterone↗
PubMed1995

[Successful treatment of agranulocytosis caused by carbimazole using recombinant granulocyte-macrophage colony stimulating factor].

The authors describe a patient with hyperthyroidism who developed after three weeks' treatment with carbimazole agranulocytosis and the condition was complicated by septic shock. The authors used for treatment in addition to antibiotics and corticoids, for the first time in their practice, human recombinant granulocyte macrophage colonies stimulating factor (rHuGM-CSF) which produced a very favourable effect. In the meantime the patient was prepared for goitrectomy, operated and discharged in a satisfactory condition to have ambulatory treatment.

Agranulocytosis↗
PubMed1995

[Cushing's syndrome in pregnancy].

Active Cushing's syndrome during pregnancy is a rare phenomenon which was so far described in the literature only in 85 women. The authors give an account of a patient who developed Cushing's syndrome during pregnancy and who was delivered during the eighth month of a healthy foetus by caesarean section, afterwards the hypercortisolism associated with hyperaldosteronism was treated by dextrolateral adrenalectomy. In the removed adrenal gland was a cortical adenoma made up of clear cells and cells reminding of the zona glomerulosa. Subsequently the authors summarize data from the literature on the prevalence of different pathogenetic forms of Cushing's syndrome in pregnant women, on the influence of hypercortisolism on mother and foetus, on the optimal diagnosis and therapy of this syndrome during pregnancy.

Adult↗
PubMed1995

[Microvascular angina pectoris and insulin resistance].

The authors examined 29 patients with the syndrome of microvascular angina pectoris. In 12 patients (41.4%) they recorded hyperinsulinaemia as a manifestation of insulin resistance. The body weight, HDL cholesterol level, LDL cholesterol and triglycerides did not differ significantly in the two groups and were at the upper borderline of the range of reference values. The authors analyze mechanisms common to the pathophysiology of the syndrome of microvascular angina pectoris and the syndrome of insulin resistance.

Adult↗
PubMed1995

[Hyperandrogenic states in women (polycystic ovary syndrome) and insulin resistance].

In the submitted paper the authors try to explain the relationship between hyperinsulinism as the cause and the polycystic ovary syndrome as the consequence of hyperinsulinism. This takes place via the insulin like growth factor I, the luteinizing hormone, sex binding hormone globulin, insulin like growth factor I binding protein and growth hormone. By varying interactions of the regulatory hormones gradually the granulosa cells are destroyed and replaced by androstendione producing thecal and stromal cells with impaired folliculogenesis. Chronic hyperestrogenism interferes also with hypothalamic regulation in the nucleus arcuatus. As almost identical changes are found in polycystic ovary syndrome and puberty, genetic and/or environmental factors certainly play a part. Their more detailed specification is a task for the future.

Female↗
PubMed1995

Daily variation of serum cortisol, 17-hydroxyprogesterone and five androgens in healthy women.

Serum cortisol, 17-hydroxyprogesterone and five androgens (androstenedione, 11-hydroxyandrostenedione, dehydroepiandrosterone and its sulphate, and testosterone) were measured by radioimmunoassay at 8:00, 16:00, 20:00 and 24:00 h and again at 8:00 h on the next day in eight healthy female subjects aged 16-40 years in the midfollicular phase of the menstrual cycle. Regression analysis revealed a significant (alpha = 0.05) circadian periodicity, with estimated peaks between 8:00 a.m. (testosterone) and 2:00 p.m. (dehydroepiandrosterone sulphate), and with estimated amplitudes between 76% (11-hydroxyandrostenedione) and 33% (17-hydroxyprogesterone, testosterone and dehydroepiandrosterone sulphate) of the rhythm adjusted mean. The inferential statistical approach illustrated here should contribute significantly to the diagnostic elucidation of adrenocortical disorders.

17-alpha-Hydroxyprogesterone↗
PubMed1995

[The effect of long-term treatment of arterial hypertension with Ca antagonists on the renin-angiotensin-aldosterone system in diabetics. Hyporeninemic hypoaldosteronism].

During long-term treatment of arterial hypertension with calcium antagonists of the dihydropyridine type activation of the sympathetic nervous system and subsequently also of the renin-angiotensin-aldosterone system persists, while the haemodynamic reaction to vasodilatation, manifested by an elevated pulse rate and minute volume from the initial stage of therapy, recedes. In type II diabetics the basal and stimulated response of the renin-angiotensin-aldosterone system is reduced. The administration of calcium antagonists of the dihydropyridine type does not stimulate significantly the renin-angiotensin-aldosterone system as the starting function of the sympathetic nervous system is impaired within the framework of vegetative neuropathy. In almost 20% NIDDM plasma renin activity and aldosterone do not respond to furosemide administration and the vertical posture. In others the response is found but takes place at reduced levels. Hyporeninaemic hypoaldosteronism is thus manifested not so much by a drop of plasma renin and aldosterone beneath the lower range of reference values as by a reduced response to stimulation. Functional hyporeninaemic hypoaldosteronism is another, frequent late complication of diabetes. In advanced forms a further block of the renin-angiotensin-aldosterone system by ACE inhibitors can then produce, even in the absence of diabetic nephropathy, in the stage of chronic renal failure dangerous hyperkaliaemia which may threaten the patient. Dynamic examination of the sympathetic nerve and the renin-angiotensin-aldosterone system makes it possible to predict this condition. In practice it is necessary in diabetics with arterial hypertension after starting with ACE inhibitors during the first days to monitor repeatedly plasma potassium and creatinine. ACE inhibitors and calcium antagonists are otherwise for diabetics drugs of first choice which can arrest the progression of nephropathy, effectively reduced the blood pressure without causing deterioration of insulin resistance and hyperlipoproteinaemia and lead even to regression of hypertrophy of the vascular wall and left ventricle.

Aged↗
PubMed1995

[Cushing's syndrome is still a potentially fatal disease].

The paper summarizes the studies documenting the outlasting of increased cardiovascular mortality in patients with Cushing's syndrome even after the hypercortisolism resolution. Despite the hypercortisolism resolution the mortality during the subsequent period of life is up to four-fold higher than in the comparable population as a whole. The pathogenesis of this cardiovascular risk is based on arterial hypertension, steroid cardiomyopathy and hyperlipidaemia with subsequent atherosclerosis. The post mortem material bears a parallel of the extent of atheromatous changes and duration of hypercorticolism. The prevention has to its disposition two mutually complementing means. The first is represented by clinical screening of hypercorticolism which enables an early recognition and therapy of the Cushing's syndrome. The successive measure resides in increased attention to the cardiovascular system even after hypercorticolism resolution. (Tab. 1, Fig. 1, Ref. 25.).

Cardiovascular Diseases↗
PubMed1995

Factors influencing the development of glucose intolerance in Cushing syndrome.

BACKGROUND: Although the frequency of glucose intolerance in endogenous Cushing syndrome has been repeatedly evaluated, no attempt has been made so far at analyzing simple clinical factors in order to quantify their influence on the development of glucose intolerance. METHODS: The influence of 6 factors on the development of glucose intolerance (family history of diabetes, age and body mass index of patients, duration of hypercortisolism, its pathogenetic form, and the extent of its clinical manifestation) was evaluated by means of multiple regression in 74 patients with Cushing syndrome. RESULTS: The disappearance of a normal glucose tolerance in Cushing syndrome was a function of the time of duration of hypercortisolism. The emergence of diabetes mellitus, but not of impaired glucose tolerance, was supported by ageing. Surprisingly, the family history failed to have any predictive value. CONCLUSIONS: The results suggest that diabetes mellitus in endogenous Cushing syndrome is a disorder genetically different from primary diabetes mellitus.

Adult↗
PubMed1994

[Primary aldosteronism--personal experience with diagnosis and surgical treatment of adenomatous forms].

Primary aldosteronism (Conn's syndrome) forms about 2% of disease in patients with arterial hypertension. Primary aldosteronism is in 50% of patients caused by aldosteron producing adenoma. Surgical treatment of these adenomas is excellent, or with complete disappearance of the disease, or with simple drug control of the symptoms after adrenalectomy. In the diagnostic process we can meet also seemingly divergent results of investigations. In these cases diagnosis usually requires the catheterization of adrenal veins with selected sampling of aldosteron level and thus determines the localisation of the tumor. Localised adenomas are indicated for surgical treatment. The best approach seems to be the abdominal transperitoneal incision with removal the whole adrenal gland. In this paper authors describe their experience with 5 patients treated at the F.D. Roosevelt Hospital in Banská Bystrica. (Tab. 1, Fig. 2, Ref. 25.)

Adrenal Cortex Neoplasms↗
PubMed1994

[The importance of studying the renin-angiotensin-aldosterone system in essential arterial hypertension in clinical practice. Activity of the renin-angiotensin-aldosterone system during treatment of hypertension with ACE-inhibitors and beta blockers].

The authors assessed in 20 subjects with mild or medium severe arterial hypertension basal and stimulated values of plasma renin activity (PRA) and aldosterone before onset of treatment and after 6-week therapy with enalapril (ENAP KRKA) or metoprolol (Vasocardin Slovakofarma). PRA and aldosterone secretion was stimulated by a vertical position and by administration of 40 mg furosemide by the i.v. This test proved suitable for assessment of secondary arterial hypertension in different forms of primary hyperaldosteronism and for expressing suspicion of renovascular hypertension and hypertension with affection of the renal arteries resp. Based on PRA levels, arterial hypertension can be divided into normorenin, high-renin and low-renin hypertension. This classification is, however, of no value for selection of treatment and the prognosis of hypertension. Each level of PRA can be associated with three different aldosterone levels. PRA and aldosterone did not correlate with urinary K, Na excretion nor with blood pressure. During treatment with ACE inhibitor PRA rose while basal as well as stimulated aldosterone levels declined. After administration of betablockers basal as well as stimulated PRA and aldosterone levels declined.

Adult↗
PubMed1992

[Primary hyperaldosteronism, problems in diagnosis and therapy in clinical practice].

The paper summarizes data from the recent literature on pathogenetic variants of primary hyperaldosteronism, screening, diagnosis and therapy of this secondary form of arterial hypertension. On examples from their own practice the authors draw attention to the that the diagnosis and treatment of this disease is not always as straightforward as might appear from the literature. The solution is simple, effective screening in every hypertensive patient by examination of the kalaemia before treatment of arterial hypertension is started. In case of hypokalaemia the subsequent procedure should be the concern of specialized departments.

Aged↗
PubMed1990

[Present state and perspectives of endocrinology in Czechoslovakia].

The contemporary state of the sub-discipline of endocrinology within the framework of internal medicine is generally considered rather desolate, but so far actual data were lacking. Based on an analysis of data provided by regional specialists in the Czech Republic and by regional (district) specialists in internal medicine in Slovak republic it may be said that in the majority of health institutions the number of endocrinologists does not reach even the unsatisfactory standard (i. e. 1 endocrinologist per 150 to 250,000 population), that specialized training of endocrinologists, specialists in internal medicine and other specialist is not ensured, that there are not adequate numbers of community doctors and factory medical officers, that there are not adequate capacities of specialized laboratory examinations and that adequate collaboration with other disciplines is not ensured (the position is in particular alarming as regards immunological methods and cytological processing of specimens obtained by aspiration biopsy from the thyroid gland. With regard to these data the authors recommend to raise the numbers of endocrinologists so that in institutions corresponding to hospitals with policlinics type II there will be one endocrinologist per 50-100,000 population, to improve the standard and availability of auxiliary examinations, to ensure endocrinological in-patient care at the level of hospitals with policlinics type III and to create specialized centres within the framework of the research base or university hospitals. It is important to resolve the link between endocrinology and other disciplines (paediatrics, gynaecology etc). It is also essential to coordinate closely therapy, education and research, Federal coordination is essential.

Czechoslovakia↗
PubMed1990

[Diagnosis of diabetic macroangiopathy of the lower extremities using rheography].

Rheography (impedance plethysmography) makes it possible to differentiate the normal condition of arteries of the lower extremity from functional and organic affections. The examination of a group of 325 patients with diabetes mellitus revealed that without the use of rheography, i.e. when relying only on examination of the lower extremities by palpation, the presence of macroangiopathy would escape attention in 46% of the affected subjects. Macroangiopathy of an organic character was found significantly more frequently in type 2 (NIDDM) (35%) than in type 1 (IDDM) (9%; p less than 0.03). Its incidence increased in both types of diabetes with the duration of the disease. Moreover it was significantly associated with hyperlipoproteinaemia. The assembled results drew attention to the great diagnostic value of rheography. It permits also to document objectively the effect of treatment focused on macroangiopathy.

Adolescent↗
PubMed1990

[Diagnosis of acute dissection of the aorta].

The authors present a group of 14 patients (9 men and 5 women) aged 38-76 years (mean age 59 years) who were hospitalized during the five-year period between 1984 and 1988 at the medical department A of the Regional Institute of National Health in Banská Bystrica on account of acute dissection of the aorta. The authors describe clinical manifestations which can lead to suspicion of this serious disease. They make the readers familiar with their experience with ultrasonic and X-ray examination (in particular aortography and computed tomography). They analyze their contribution to the diagnosis of acute dissection of the aorta.

Acute Disease↗
PubMed1990

[Microcirculation in the subcutaneous layer and in muscles in diabetes mellitus].

The work is focused on the possibility of early diagnosis of diabetic microangiopathy. The authors used examination of microcirculation by the method of tissue clearance of Na 131I. In a group of 106 patients with diabetes thus the microcirculation of the lower extremities in the subcutaneous layer and the calf muscle was examined. A group of 36 healthy subjects served as control. An altered microcirculation was found in 75% type 1 diabetics and in all type 2 diabetics. In those with an altered microcirculation only in 23% type 1 diabetics and in 17% type 2 diabetics organ manifestations of diabetic microangiopathy (i.e. retinopathy and nephropathy) were lacking. It seems thus that altered Na 131I absorption in the lower extremities is an earlier sign of microangiopathic affection than identifiable organ changes. Examination of tissue clearance of Na 131I thus could reveal in time individuals threatened by this complication of diabetes.

Adult↗
PubMed1987

Radioimmunoassay of 11 beta-hydroxyandrostenedione in laboratory diagnostics of selected endocrine disorders.

A specific radioimmunoassay of 11 beta-hydroxy-4-androstene-3,17-dione, an androgen of exclusively adrenal origin, is described and evaluated. The antiserum was raised in rabbits using 6 beta,11 beta-dihydroxy-4-androstene-3,17-dione-6 beta-hemisuccinate:bovine serumalbumin conjugate as an immunogen. The method has been used for determination of the plasma levels of the hormone in healthy subjects, including children, with regard to the possibility its use as a laboratory marker for monitoring corticoid therapy in patients with congenital adrenal hyperplasia and in patients with various endocrine disorders, under basal conditions and after dynamic tests. The plasma levels of 11 beta-hydroxyandrostenedione (means +/- s.d.) in healthy persons at 8 a.m. were 8.69 +/- 2.88 (men), 7.72 +/- 2.85 (women), 8.73 +/- 5.13 (boys) and 7.88 +/- 5.23 (girls) nmol/l, respectively. The hormone concentrations followed the pattern of circadian rhythm of cortisol, they were increased markedly after corticotropin and suppressed by dexamethasone.

Adolescent↗