Testosterone esters and oestradiol.
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Drug Administration Schedule↗
Biomedical subjects
A Luger
Publications and source records attributed to A Luger.
[Gas embolism with cardiac arrest during hysteroscopy. A case report on 3 patients].
Hysteroscopy and laparoscopy are relatively non-invasive methods routinely employed in the investigation of infertility. The danger of air embolism during these procedures was recognized early, and carbon dioxide was substituted for air since it is more readily soluble in blood. In this report we describe 3 cases of circulatory collapse and cardiac arrest in healthy young women during routine hysteroscopy (out of a total of 62 patients during the period 1989-1990) which were most probably caused by massive carbon dioxide embolism. Premedication was with oral diazepam 10 mg. Anesthesia was induced with 0.1 mg fentanyl, 2.5 mg droperidol and 100 mg methohexital (100 mg propofol in one case). Intubation was facilitated with 2 mg pancuronium and 50-100mg succinylcholine. Anesthesia was maintained with nitrous oxide 66% and halothane. Ventilation was controlled with a tidal volume of 10 ml per kilogram body weight at a rate of 10 per minute. Monitoring included ECG, automated non-invasive blood pressure, capnometry, pulse oximetry and body temperature. Anesthesia was uneventful prior to insufflation. In each case the signs and symptoms began approximately 5-8 minutes after the start of insufflation and consisted of an initial tachycardia rapidly followed by ventricular dysrhythmias, bradycardia and cardiac arrest. The end-tidal CO2 decreased during the tachycardic phase and prior to asystole. The patients were cyanotic with engorged jugular veins. Resuscitation with closed chest heart massage and intravenous epinephrine or orciprenaline was successful in every case. The typical "mill wheel phenomenon" of gas embolism was audible on auscultation after heart activity had returned, but disappeared after about 5 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Effect of recombinant human erythropoietin on anterior pituitary function in patients on chronic hemodialysis.
In 7 patients with end stage renal failure, anterior pituitary function was tested by simultaneous application of maximally effective doses of the hypothalamic releasing peptides, corticotropin-releasing hormone, growth hormone-releasing hormone, thyrotropin-releasing hormone and gonadotropin-releasing hormone, and compared to 8 normal controls. In addition to the pituitary hormones, plasma cortisol, thyroxine and testosterone concentrations were measured. To test for possible effects of treatment with recombinant human erythropoietin (rhu-EPO), all patients with chronic renal failure were studied again after partial correction of anemia by treatment with erythropoietin. Before initiation of rhu-EPO treatment, plasma concentrations of follicle-stimulating hormone were significantly elevated and the thyroid-stimulating hormone and prolactin responses to thyrotropin-releasing hormone blunted when compared to normal controls. Treatment with rhu-EPO induced a significant increase in plasma ACTH and follicle-stimulating hormone concentrations. All other pituitary functions remained unchanged. Thus, the general improvement in well-being, working capacity and sexual activity cannot be attributed to hormonal changes.
Adrenocorticotropic Hormone↗
Evaluation of somatostatin receptors in human cancer.
The binding of 123I-Tyr-3-octreotide (SDZ-204-090; specific activity 1 mCi/nmol), a new somatostatin-receptor binding radiopharmaceutical, to human tumour membrane fractions was evaluated in presence of unlabeled Tyr-3-octreotide and octreotide (SMS-201-995; Sandostatin). Tumour tissue was obtained intraoperatively from 15 patients with different endocrine tumours (insulinoma, carcinoide, phaechromocytoma, hypophysal adenoma) and breast cancer. In equilibrium experiments, membrane fractions (200 micrograms protein/ml) were incubated with increasing concentrations of 123I-Tyr-3-octreotide (0.03-30 nM) in presence or absence of 5 microM of unlabeled agonist. Binding capacities ranged from 1-20 pmol/mg protein (Kd 4-100 nM). The IC50 values (2.5-112 nM versus 0.02-69 nM) were different for the octreotide and Tyr-3-octreotide indicating that octreotide was the better competitor as Tyr-3-octreotide for 123I-Tyr-3-octreotide binding sites. In ductal breast cancer high numbers of in vitro binding sites for the radiolabel were found. In initial clinical studies 123I-Tyr-3-octreotide was i.v.-injected (3 mCi) to 5 acromegaly patients with hypophyseal adenomas. Following rapid uptake by the liver, positive tumour imaging was obtained in 3 patients which correlated to computer tomographic findings. Positive images were obtained just some minutes after injection. Our results support recent data suggesting that the 123I-Tyr-3-octreotide would be a suitable receptor-radiopharmaceutical for the localization of endocrine tumours.
Adenoma↗
[The significance of Karl Landsteiner's works for syphilis research].
On January 7th 1905, more than five months before the detection of T. pallidum, Karl Landsteiner began his work on syphilis research together with notable members of the Viennese School of Medicine, namely Ernest Finger, Rudolf Müller, Viktor Mucha, Otto Pötzl and others. Extensive animal experiments led to the formulation of the Finger-Landsteiner Law and provided the basic facts for the Jadasson-Lewandowsky Law. Attempts of active or passive immunization were unsuccessful and, indeed, were still a failure in 1990 after implementation of the latest tools of modern research, including gene technology. Dark-field microscopy was introduced for the detection of T. pallidum by Landsteiner and Mucha. These authors noted that serum of syphilitic patients inhibited the movements of T. pallidum and, thus, observed the basic principle underlying the T. pallidum immobilization test (= TPI = Nelson-Mayer test). Finally, Landsteiner, Müller and Pötzl discovered that it was not an antibody specific to T. pallidum that reacted in the Wassermann reaction, but "autotoxic" substances, which they called reagines. During the 1970's and 1980's it was discovered that these reagines are autoantibodies directed against parts of the inner envelope of the mitochondria.
Animals↗
[The significance of erythropoietin for nephrology].
The analysis of the structure of erythropoietin and the subsequent production of recombinant human erythropoietin opened a new era in the understanding of the pathogenesis and therapy of renal anaemia. From the diagnostic point of view sufficiently accurate radioimmunoassays are currently available to throw new light on the pathogenesis of renal anaemia, and enable pharmacokinetic studies of the recombinant hormone to be carried on. For the first time a causal therapy is available for renal anaemia. The following review summarizes the consequences of these innovations on the different aspects of nephrology.
Anemia↗
Decreased peripheral insulin sensitivity in acromegalic patients.
In 13 nondiabetic acromegalic patients glucose homeostasis was studied by use of the hyperglycaemic clamp technique and compared to a group of sex and age matched and a group of sex, age and weight matched controls. When compared to a control group of normal weight glucose stimulated insulin release (I) was significantly increased and tissue sensitivity to insulin (M/I) significantly decreased. However, no significant differences were observed when the parameters were compared with a weight matched group. Glucose stimulated insulin release correlated positively with growth hormone (GH) and somatomedin-C levels, whereas no such a correlation could be obtained for M/I. Thus, chronic growth hormone excess seems to induce hyperinsulinaemia which in turn leads to obesity and metabolic changes comparable to those of obesity.
Acromegaly↗
Hormonal and metabolic responses of untrained, moderately trained, and highly trained men to three exercise intensities.
Untrained, moderately trained (runners, 15 to 25 mi/wk), and highly trained (runners, greater than 45 mi/wk) men participated in graded treadmill exercise at 50%, 70%, and 90% of their maximal oxygen consumption to quantify the relation between intensity of exercise and sympathetic nervous system and metabolic responses. Sympathetic system activation was noted at all intensities tested and was proportional to the relative exercise intensity. The magnitudes of the norepinephrine (NE) and epinephrine (E) responses were similar in all three groups of men at each relative exercise intensity and correlated with the magnitudes of change in levels of circulating plasma adrenocorticotropin hormone, cortisol, lactate (La), phosphate (Pi), and glucose (GI). The magnitudes of change in concentrations of La, Pi, and GI were also similar for the three groups at each relative exercise intensity. In contrast, a lower degree of sympathetic system activation in response to a given absolute workload was noted in the moderately and highly trained men as compared to that of the untrained men. Sympathetic and metabolic responses to exercise are similar under conditions of comparable relative exercise intensities, regardless of conditioning level. The sympathetic-adrenal medullary system is more sensitive to exercise than the hypothalamic-pituitary-adrenal axis. For a given absolute workload, the degree of activation significantly lower in trained individuals.
Adrenocorticotropic Hormone↗
Phrenic nerve block as a complication of local anesthetic. Infiltration for internal jugular vein catheterization.
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Catheterization↗
[The AIDS pandemic].
An analysis of the distribution of HIV-infections in different countries permits to distinguish 3 different patterns. Type 1 occurs in North America, Western Europe, parts of South America, Australia and New Zealand. Type 2 is found in Africa, in sub-Saharan regions and in the Caribbean sea. Type 3 prevails in Eastern Europe, in North Africa, in the Middle East, in Asia, in most of the Pacific and in many parts of Latin America. 138 countries have reported 100.410 AIDS-cases until June 30, 1988. Actually, it can be assumed, that by now approximately 5 million people are infected with HIV, of these about 1.5 million are women. As of mid 1988 over 200.000 persons have clinically manifested AIDS, in addition, 150.000 more cases are expected to occur in the remainder of 1988 and this figure will grow to over a million cases by the early 1990ies. The impact of the AIDS-pandemic on the social and economic structures will grow to very large dimensions in some countries.
AIDS Serodiagnosis↗
[Drastic spread of endemic treponematoses].
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Cross-Sectional Studies↗
Hormonal responses to the stress of exercise.
Exercise stimulates the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axes and causes growth hormone and prolactin release in an intensity-dependent fashion. Activation of the different endocrine responses examined occur at different exercise intensities. Subjects of differing training status respond similarly to matched exercise intensities. Highly trained subjects have elevated basal concentrations of ACTH and cortisol and a blunted response to exogenous corticotropin releasing hormone. These data are compatible with mild sustained hypercortisolism in highly trained runners.
Adrenocorticotropic Hormone↗
Diagnosis of Chlamydia trachomatis infection--culture versus serology.
The diagnostic value of different laboratory methods in detecting Chlamydia trachomatis infections in high risk groups was analysed. The efficiency of a direct specimen test was compared with serology (IgG and IgM ELISA) and culture in L929 cells, stained either with fluorescein conjugated monoclonal antibodies or with iodine. Patients (no. = 1041) with localized genital infections attending a STD clinic, sexual contacts and patients with ascending infections from urological and gynecological clinics were examined. Chlamydia trachomatis was detected in 225 patients: 210 (93.3%) were reactive in the direct test (smears stained with monoclonal antibodies), whereas culture missed only 5 (sensitivity 97.8%) when stained by the same method. Cultures stained with iodine produced the lowest recovery rate (73.8%), but this rate increased to 80.9% when a second passage was performed. In addition the prevalence of Neisseria gonorrhoeae, Mycoplasma hominis, Ureaplasma urealyticum, Candida albicans and Trichomonas vaginalis was investigated. In patients with non-gonococcal urethritis (no. = 331) and cervicitis (no. = 353), Chlamydia trachomatis was isolated in 32.3% and 12.8% respectively. However, this pathogen could be isolated in only 3 (15.8%) out of 19 patients with epididymitis and 15 (14%) out of 107 patients with adnexitis, although 66.7% and 93.3% respectively had specific IgG antibodies. Specific IgM could by detected with a sandwich ELISA in patients with adnexitis (46.7%), epididymitis (33.3%), cervicitis (22.2%), non-gonococcal urethritis (14%) and in the sexual partners of patients with genital infections (35.7%). The direct specimen test with monoclonal antibodies is the method of choice for the diagnosis of a C. trachomatis infection in patients with urethritis and cervicitis.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies, Monoclonal↗
Diabetic glomerulosclerosis without concurrent diabetes mellitus.
In four adults with idiopathic nephrotic syndrome and azotemia, percutaneous renal biopsy showed diabetic glomerulosclerosis, yet none had oral glucose tolerance tests diagnostic of diabetes mellitus or funduscopic evidence of diabetic retinopathy. Possible concomitant glomerular disease that may have produced proteinuria was excluded. Well documented cases of diabetic glomerulosclerosis without concurrent glucose intolerance are uncommon, and almost 30% of such patients have a past history of diabetes. Despite the absence of overt diabetes at onset of diabetic glomerulosclerosis, these patients warrant careful monitoring of plasma glucose levels and strict control of systemic hypertension.
Aged↗
Cytokine production in patients with newly diagnosed insulin-dependent (type I) diabetes mellitus.
There is ample evidence that cell-mediated immune mechanisms are crucial in the initiation of insulin-dependent diabetes mellitus (IDDM). Therefore, the role of cytokines in the pathogenesis of IDDM was investigated in 51 patients with IDDM, in comparison with 20 normal controls. The patients were divided into three groups, group 1 consisting of 31 newly diagnosed type 1 diabetics, in group 2 IDDM had been diagnosed for between 2 months and 2 years, and in group 3 onset had occurred 2-20 years before. Interleukin 1 (IL 1) activity was measured by the thymocyte co-stimulator assay, and interleukin 2 (IL 2) using IL 2 dependent cell lines. Peripheral blood monocyte IL 1 production was not altered under basal conditions. However, silica-stimulated IL 1 release was normal in patients with newly diagnosed or short-term disease, but was significantly decreased in long-term diabetics. Peripheral blood T-lymphocyte IL 2 production at onset of IDDM was normal under basal conditions, and upon optimal stimulation with concanavalin A (ConA) and phorbol myristate acetate (PMA). However, in the two groups with longer standing diabetes, basal and stimulated IL 2 release was decreased. We conclude that monocytes and T-lymphocytes from patients with diabetes mellitus have a diminished capacity to release IL 1 and IL 2 only later in the course of the disease. At the time of manifestation of disease, IL 1 and IL 2 production is normal in type-I diabetes mellitus.
Diabetes Mellitus, Type 1↗
Acute exercise stimulates the renin-angiotensin-aldosterone axis: adaptive changes in runners.
The plasma concentrations of aldosterone and its known regulators, plasma renin, potassium and ACTH, were examined during graded intensities of treadmill exercise (50, 70 and 90% of maximal oxygen uptake, VO2max). Sedentary men (n = 7) and two groups of runners of different training status (moderately trained, 15-25 miles/week, n = 7; highly trained, greater than 45 miles/week, n = 7) were studied in an attempt to define whether physical training causes changes in aldosterone homeostasis. Acute exercise was associated with elevations in plasma aldosterone, renin activity, potassium and ACTH in all three groups of subjects at exercise intensities of 70 and 90% VO2max. There were no differences in any of the responses among the three groups except for a blunted response of PRA at 90% VO2max in highly trained athletes. The exercise-induced rise of plasma aldosterone concentration did not correlate with changes in the concentration of its regulatory substances. We conclude that exercise stimulates the renin-angiotensin-aldosterone axis in an intensity-dependent fashion. With increased physical training identical hormonal and metabolic responses result at increased absolute workloads.
Adrenocorticotropic Hormone↗
Interaction of epidermal growth factor with the hypothalamic-pituitary-adrenal axis: potential physiologic relevance.
Epidermal growth factor (EGF), a polypeptide mitogen that participates in wound healing, has ACTH-like activity in ewes. We examined its effects on the primate hypothalamic-pituitary-adrenal (HPA) axis by administering mouse EGF (mEGF) iv (0-100 micrograms/kg) to rhesus monkeys. mEGF caused dose-dependent elevations of plasma ACTH and cortisol in these animals. To define whether the locus of stimulation was the hypothalamus and/or the pituitary gland we examined the capacity of mEGF to directly stimulate hypothalamic CRH or pituitary ACTH secretion in a rat hypothalamic organ culture system and a rat pituitary cell system, respectively. mEGF stimulated hypothalamic CRH release in a dose-dependent manner, but failed to cause pituitary ACTH release. We conclude that EGF is a stimulator of the HPA axis in primates. Thus, EGF, and/or one of its naturally occurring analogs, may participate in the physiological activation of the HPA axis at times during which the concentrations of these factors are raised in the systemic circulation and/or locally in the hypothalamus. Such states may include trauma, surgery, and possibly emotional stress.
Adrenocorticotropic Hormone↗
[Economic aspects of serologic syphilis tests in routine screening in Viennese hospital facilities].
971, 786 patients in Viennese municipal hospitals were routinely screened by serological testing for syphilis between January 1980 and December 1984, leading to the detection of 28,090 cases of untreated latent infection. The annual incidence varied between 7463 and 4623 cases. Roughly one third of patients with untreated syphilis develop severe late manifestations: 10.4% show cardiovascular involvement, 6.5% get neurosyphilis and 15.8% have a gumma. The mortality rate is 85% in cardiovascular disease and 64% in neurosyphilis, whilst irreversible incapacity is the fate of the remaining 15% and 36% of these patients, respectively. Calculations on the basis of the current costs for treatment of the acute diseased and for nursing of incapacitated patients reveal that routine screening of all in- and out-patients of the Viennese municipal hospitals is completely justified from the medical and the economic point of view and should, therefore, be reinforced.
Austria↗