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Biomedical subjects

A Luger

Publications and source records attributed to A Luger.

At least 91 records · Page 5Linked to original sources

Acute hypothalamic-pituitary-adrenal responses to the stress of treadmill exercise. Physiologic adaptations to physical training.

To study the effects of physical conditioning on the hypothalamic-pituitary-adrenal axis, we examined the plasma ACTH, cortisol, and lactate responses in sedentary subjects, moderately trained runners, and highly trained runners to graded levels of treadmill exercise (50, 70, and 90 percent of maximal oxygen uptake) and to intravenous ovine corticotropin-releasing hormone (1 microgram per kilogram of body weight). Basal evening concentrations of ACTH and cortisol, but not of lactate, were elevated in highly trained runners as compared with sedentary subjects and moderately trained runners. Exercise-stimulated ACTH, cortisol, and lactate responses were similar in all groups and were proportional to the exercise intensity employed. These responses, however, were attenuated in the trained subjects when plotted against applied absolute workload. Only the highly trained group had diminished responses of ACTH and cortisol to ovine corticotropin-releasing hormone, consistent with sustained hypercortisolism. We conclude that physical conditioning is associated with a reduction in pituitary-adrenal activation in response to a given workload. Alterations of the hypothalamic-pituitary-adrenal axis consistent with mild hypercortisolism and similar to findings in depression and anorexia nervosa were found only in highly trained runners. Whether these alterations represent an adaptive change to the daily stress of strenuous exercise or a marker of a specific personality profile in highly trained athletes is unknown.

Adaptation, Physiological↗

[Epidemiology, clinical aspects and therapy of infections with Chlamydia trachomatis serotype D-K].

Chlamydia trachomatis serotype D-K is one of the most important pathogens of communicable diseases. 3 to 5 million new infections are observed annually in the USA. 10% to 30% of young sexually active persons in the age group 15 to 20 years are affected. The organism was isolated from 20% to 30% of patients attending dispensaries for sexually transmitted diseases, 5% to 10% of gynaecological outpatients, 1% to 8% of pregnant women and 0% to 5% of asymptomatic control persons. In men, C. trachomatis was found in 30% to 70% of patients with urethritis (15% to 25% simultaneously with gonorrhoea), in 30% to 60% of persons suffering from nongonoccocal urethritis and in 65% to 70% with postgonoccocal urethritis. 20% of newborns from mothers with positive cultures develop pneumonia and 37% conjunctivitis. Complications such as endometritis, salpingitis, periappendicitis, perihepatitis, ectopic pregnancy, premature birth, proctitis, cystitis, deferenitis, epididymitis, reactive arthritis, morbus Reiter, conjunctivitis, pneumonia (in infants and adults) may cause long lasting disease and may leave behind irreversible sequelae. Treatment with tetracyclines or erythromycin is always effective.

Adult↗

Abnormalities in the hypothalamic-pituitary-adrenocortical axis in patients with chronic renal failure.

The recently described human corticotropin-releasing factor was administered to eight patients with chronic renal failure in order to assess hypothalamic-pituitary-adrenocortical (HPA) function. Acute administration of corticotropin-releasing factor lead to a diminished increase of the basally elevated levels of ACTH and beta-endorphin immunoreactivity in patients on chronic hemodialysis. Basal plasma cortisol concentration was normal in end-stage renal disease; however, considering the corresponding elevated ACTH concentrations, cortisol levels were inadequately low. Thus, the hypothalamus as well as the adrenal gland seems to contribute to the alterations in HPA function observed in patients with chronic renal failure; involvement of the pituitary gland and effects of metabolic alterations cannot be ruled out.

Adrenocorticotropic Hormone↗

Blood-membrane interaction in hemodialysis leads to increased cytokine production.

Recently much interest has been focused on the role of immunoregulatory cytokines such as interleukin 1 (IL 1) and interleukin 2 (IL 2) during the pathogenesis of immunological as well as inflammatory diseases. Therefore peripheral blood mononuclear cells (PBMC) of eight patients undergoing hemodialysis (HD) were tested for IL 1 and IL 2 production. Before starting HD, cytokine production by PBMC in culture was not altered in comparison to normal healthy controls, however, a significant increase of IL 1 and IL 2 production was observed within the first HD hour which lasted throughout the end of HD. Moreover direct effects of cellulose membranes on PBMC cytokine production as well as serum IL 1 levels have been investigated. Serum IL 1 levels were already elevated before onset of HD and increased further during HD. The discrepancy between PBMC IL 1 production and serum IL 1 levels may be due to the diminished excretion in patients with end-stage renal disease. Since addition of dialysis membrane particles enhanced monocytes to produce more IL 1 as well as lymphocytes to release more IL 2, a direct stimulatory membrane effect is postulated. The increased release of immunoregulatory cytokines may account for some of the pathologic findings observed during hemodialysis.

Adult↗

[Clinical value of endotoxin determination in infection. Comparison of the Limulus amebocyte lysate test with detection of bacterial pathogens].

To evaluate usefulness of Limulus amoebocyte lysate test and blood culture in the diagnosis of septicemia both tests were performed in 27 intensive care patients. Test results were compared with a clinical sepsis score. Ten (62%) out of 16 patients with clinical diagnosis of septicemia showed a positive endotoxin test and 11 (69%) a positive blood culture. In 14 patients (87%) either endotoxin test or blood culture revealed a positive result. Two out of 11 patients (20%) classified by the sepsis score as non-septic showed positive blood cultures as well as positive endotoxin tests. 4 patients with gram-positive bacteria in the blood cultures showed a positive endotoxin test. Due to lack of sensitivity and specificity the Limulus amoebocyte lysate test is of rather low value in the diagnosis of septicemia. Simultaneous performance of Limulus amoebocyte lysate test and blood culture is able to improve the sensitivity, which then over-rules the one obtained when only blood cultures are performed.

Bacteria↗

Effects of the alpha-glucosidase inhibitor 1 desoxynojirimycin (Bay m 1099) on postprandial blood glucose, serum insulin and C-peptide levels in type II diabetic patients.

Bay m 1099 is a newly developed inhibitor of intestinal alpha-glucosidase. Its ability to lower postprandial plasma glucose, serum insulin and C-peptide levels in Type II diabetics has been investigated. Fifteen obese Type II diabetic patients with inadequate metabolic control during sulphonylurea treatment received a standardized diet and were treated either with Bay m 1099, b.d. (100 mg before breakfast and dinner) or placebo for 3 days, according to a double-blind cross-over design. The postprandial blood glucose level was significantly lower during Bay m 1099 treatment compared to placebo after breakfast and dinner (AUC after breakfast p less than 0.001). The reduced postprandial hyperglycaemia was associated with a decrease in meal stimulated serum insulin and C-peptide levels. Thus, Bay m 1099 may be a useful addition in the treatment of Type II diabetic patients.

1-Deoxynojirimycin↗

Decreased serum interleukin 1 activity and monocyte interleukin 1 production in patients with fatal sepsis.

The role of interleukin 1 (IL 1) in 16 patients with sepsis and 16 normal controls was investigated. Thymocyte costimulation was used to assay in vitro IL 1 levels produced by adherent cells in the peripheral blood, and in vivo IL 1 levels in the serum. Adherent cells (i.e., monocytes) from nonsurviving septic patients produced significantly less IL 1 activity than cells from healthy controls or surviving patients, either spontaneously or by silica stimulation. In contrast, in vitro IL 2 production by T lymphocytes was not altered in septic patients. Serum IL 1 activity was determined using serum fractions from high-pressure liquid chromatographic gel filtration. Suppressor factors in healthy subjects as well as septic patients usually eluted at molecular weights above 50 kilodaltons, while IL 1-like activity was normally present between 35 and 1 kilodaltons. Sera of nonsurviving septic patients contained significantly less IL 1 compared to that of controls or surviving patients. Thus, decreased serum IL 1 levels and diminished monocyte production of IL 1 appear to be negative prognostic indicators, possibly reflecting a breakdown of mononuclear phagocytes.

Adult↗

Effect of cholinergic muscarinic receptor blockade on human growth hormone (GH)-releasing hormone-(1-44)-induced GH secretion in acromegaly and type I diabetes mellitus.

In 10 patients with type I diabetes mellitus, 9 acromegalic patients, and 8 normal subjects, serum GH levels after an iv injection of 1 microgram/kg BW human GH-releasing hormone-(1-44) (GHRH) with and without cholinergic muscarinic receptor blockade (1 mg atropine, im, 15 min before GHRH) were measured. The GH increase after GHRH treatment in type I diabetic patients did not differ significantly from that in normal subjects. Pretreatment with atropine almost completely blocked the GH response to GHRH in patients with type I diabetes and normal subjects, but did not suppress the GH response to GHRH in acromegalic patients. These data indicate that cholinergic muscarinic receptors modulate GH secretion in normal man as well as in patients with type I diabetes mellitus, whereas acromegalic patients have a defect of cholinergic control of GH secretion.

Acromegaly↗

Influence of acute experimental hypercalcemia on peripheral insulin sensitivity in healthy subjects.

Since hypercalcemia is thought to have a modifying effect on glucose metabolism, the possible influence of experimental hypercalcemia on peripheral insulin reaction was investigated in 6 healthy control subjects by the euglycemic clamp technique. Each of these subjects was randomly tested twice, in the normocalcemic as well as in the hypercalcemic state (infusion of calcium gluconate 15 mg/kg body wt. over a period of 180 min). Infusion of calcium gluconate caused a 27% increase in plasma calcium levels, whereas the plasma phosphate levels were not significantly changed during the eucalcemic and hypercalcemic clamp protocol. Steady state plasma insulin levels and plasma glucose levels were nearly identical between the 2 clamp protocols. Exogenous hypercalcemia had no significant influence on peripheral glucose utilization measured by the M-value (M = 4.83 +/- 0.6 mg/kg body wt./min in the eucalcemic state, 4.77 +/- 0.7 mg/kg body wt./min in the hypercalcemic state, n.s.). The present data indicate that at least acute experimental hypercalcemia has no significant influence on peripheral glucose utilization.

Adult↗

[Venereology 1985].

A new generation of sexually transmissible diseases affects the individual by severe long lasting complications and requires public health measures. The danger for the fetus and the newborn of perinatal transmission, the risk for pregnant women of complications before, at, and after birth, as well as the evidence of connections between venereal infections and the development of cancer demand close cooperation of physicians of different branches and reorientation regarding the training of students and physicians.

Acquired Immunodeficiency Syndrome↗

[Intrapulmonary percussion. A new method of respiratory therapy].

Intrapulmonary percussion with a high-frequency jet system is a new method in the treatment of respiratory impairment. It imitates the conventional percussion massage of the thorax by introducing high-frequency gas oscillations (300 impulses per minute) into the tracheobronchial system. In 14 patients with abnormal alveolo-arterial oxygen differences due to bronchial mucostasis ventilation was satisfactorily improved by its application.

Humans↗

Severe hyperprolactinaemia is associated with decreased insulin binding in vitro and insulin resistance in vivo.

We studied insulin receptor binding and carbohydrate metabolism in 10 patients with severe hyperprolactinaemia and compared the findings with those obtained in 20 healthy control subjects. Insulin binding to monocytes and erythrocytes was significantly decreased in the patients with an excess of prolactin. Scatchard analysis of binding data indicated that a decrease in the number of receptors rather than in receptor affinity seems to be the prevailing cause of lowered binding in hyperprolactinaemic patients. Furthermore, patients with severe hyperprolactinaemia demonstrated significantly elevated blood glucose levels following oral or intravenous glucose load despite having significantly increased insulin levels after glucose administration. The infusion of insulin induced a delayed hypoglycaemic effect and a decreased inhibition of endogenous insulin secretion, as indicated by the suppression of C-peptide in the hyperprolactinaemic patients. The present data indicate that severe hyperprolactinaemia is associated with an insulin-resistant state, which seems to be caused, at least in part, by a down-regulation of insulin receptors.

Adult↗

Glucose metabolism and insulin sensitivity in patients on chronic hemodialysis.

In order to evaluate the potential role of parathyroid hormone on glucose metabolism in patients on chronic hemodialysis hyperglycemic clamp studies were performed in 7 parathyroidectomized and 11 nonparathyroidectomized patients on chronic hemodialysis and in healthy controls. There were no significant differences in the peripheral glucose uptake of the 3 groups. The beta cell response to hyperglycemia during the early phase as well as during the steady state was almost identical in controls and in nonparathyroidectomized uremics, whereas in the parathyroidectomized group a markedly enhanced insulin secretion was found. Calculated tissue sensitivity to insulin therefore was equal in controls and in nonparathyroidectomized uremics, whereas patients after parathyroidectomy had peripheral insulin resistance. Our results demonstrate that patients on chronic hemodialysis apparently have normal peripheral glucose uptake. The subgroup of patients who have undergone parathyroidectomy, however, show an enhanced insulin response to hyperglycemia suggesting peripheral insulin resistance. We conclude that longstanding and severe secondary hyperparathyroidism--the usual cause for parathyroidectomy in these patients--results in irreversible insulin resistance with a compensatory increase of insulin secretion.

Adult↗

Nutrition in renal transplantation.

This study was conducted to determine whether a high-nitrogen, low-carbohydrate diet in the immediate post-operative renal transplant period could result in a positive nitrogen balance and fewer cushingoid side effects. Twelve consecutive nondiabetic renal transplant recipients were randomly assigned to the isocaloric control or experimental diet group. The six patients ingesting the experimental diet achieved positive nitrogen balance whereas five of the six patients on the control diet had a negative nitrogen balance. The nitrogen balance varied directly and proportionately with the protein intake. Potassium balance mirrored the nitrogen balance data. Cushingoid side effects did not develop in any of the six experimental diet patients whereas four of the six control diet patients had evidence of severe cushingoid appearance and two had moderate cushingoid appearance (P = .01). Based upon the findings of this study, we suggest that the renal transplant recipient's diet could be altered to provide more protein and less carbohydrate to improve nitrogen balance and prevent cushingoid features. It is possible that a high-protein, low-carbohydrate diet may be used by additional patients taking steroids for other disease states to prevent cushingoid side effects and improve nitrogen balance.

Adult↗

[Leg ulcers in congenital dyserythropoietic anemia].

We report on an 18-year-old male patient suffering from leg ulcers due to congenital dyserythropoetic anemia and thrombocytosis. Based on this case, we discuss the importance of hematologic disorders for the development of leg ulcers as well as the pathogenetic mechanisms involved.

Adolescent↗

[Hyperkeratosis lenticularis perstans (Flegel's disease)].

Hyperkeratosis lenticularis perstans (Flegel's disease) is a rare form of dermatosis, which can only be diagnosed microscopically. A typical case is reported; histological differential diagnosis and treatment with systemic retinoids are discussed.

Aged↗