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Biomedical subjects

D Barzilai

Publications and source records attributed to D Barzilai.

At least 73 records · Page 4Linked to original sources
PubMed1980

Bromocriptine for an acromegalic patient. Improvement in cardiac function and carpal tunnel syndrome.

A 64-year-old woman with active acromegaly of 33 years' duration, severe carpal tunnel syndrome, and subclinical heart disease was treated with bromocriptine mesylate. Within eight months of therapy, basal growth hormone (GH) levels decreased from 90.0 to 7.0 ng/mL, and hand volume was reduced from 375 to 295 mL. Concomitantly, echocardiographic studies showed normal left ventricular size and function. Electromyographic studies demonstrated normal function in both median nerves. Bromocriptine may correct cardiac dysfunction and carpal tunnel syndrome in acromegaly either by reduction of GH oversecretion or by a direct effect of bromocriptine on dopamine receptors in the heart and peripheral nerve endings.

Acromegaly↗
PubMed1980

Bromocriptine-induced pregnancy in an acromegalic patient.

A 30-year-old acromegalic woman with amenorrhea and elevated growth hormone and prolactin levels was treated with bromocriptine. Growth hormone levels remained elevated, while prolactin levels decreased to normal. Forty days after initiating treatment the patient menstruated and conceived shortly afterward. The uneventful pregnancy terminated in delivery of a normal baby, who has been developing normally since. No changes in the size of the sella turcica or the visual field were noted during pregnancy and up to one year after delivery. Resumption of ovulatory menses is possible when treating acromegalic women with bromocriptine. Hyperprolactinemia rather than elevated growth hormone levels or reduced gonadotropins reserve is probably the cause for amenorrhea in some of the acromegalic patients.

Acromegaly↗
PubMed1980

Cholestatic jaundice caused by cloxacillin: macrophage inhibition factor test in preventing rechallenge with hepatotoxic drugs.

Severe intrahepatic cholestasis occurred in a patient after taking nitrofurantoin, ampicillin, and cloxacillin. As only nitrofurantoin was known to cause cholestasis she was given cloxacillin again two years later. The cholestasis reappeared at once. A macrophage inhibition factor test confirmed that cloxacillin was the offending drug. Cloxacillin should be added to the growing list of drugs causing cholestasis. Inadvertent rechallenge with hepatototoxic drugs might be prevented by routine use of the macrophage inhibition factor test.

Aged↗
PubMed1980

Subacute bacterial endocarditis.

Two patients in whom various immunological phenomena obscured and delayed the diagnosis of subacute bacterial endocarditis (SBE) are described. Immunological abnormalities usually correlate well with the chronicity and severity of the disease, as is demonstrated here. The mechanisms underlying the various immunological phenomena are discussed. The importance of alertness to the possibility of SBE in cases of disease manifesting itself as an immunological disorder, thus achieving early diagnosis and early antimicrobial treatment, is stressed.

Adult↗
PubMed1980

Diminished prolactin reserve in acromegaly.

Prolactin (PRL) secretion has been evaluated in twenty acromegalic patients. All had intact LH, FSH, and cortisol levels and normal thyroid function. Five patients had persistent hyperprolactinemia. The remainder had decreased basal PRL levels with impaired PRL responses to TRH and the dopaminergic antagonist metoclopramide (MET). Despite adequate hypoglycemia and an intact cortisol response, there was no PRL rise following insulin hypoglycemia. The imparied PRL response to TRH was evident in treated and untreated patients and was independent of GH levels. Basal hyperprolactinemia may be related to PRL secretion by the tumor cells or interference with the transport of PIF by the tumor. The decreased PRL reserve noted in the majority of the patients may be related to a decrease in lactotrope cell mass or, alternatively, to enhanced dopaminergic activity.

Acromegaly↗
PubMed1980

Cutaneous pigmentation: a probable sign of spontaneous bacterial peritonitis.

A cirrhotic patient with ascites was apparently well managed with diuretics and salt and water restriction for 9 months. A spontaneous bacterial peritonitis (SBP) developed and the patient finally died following septic shock. There were enough findings indicating that SBP in this case had been existing silently for some time. During this period the only apparent manifestation of this complication was a cutaneous pigmentation on the abdomen. It is suggested that pigmentation may be incuded among other presentations of this frequently silent process.

Aged↗
PubMed1980

Hypoxemia and pulmonary function in acromegaly.

Pulmonary function was assessed in 11 patients with acromegaly, 8 of whom were previously treated by external pituitary irradiation. None of the patients had any overt respiratory ailment. Ventilatory function tests were normal in all patients and all had normal total lung capacity ranging from 75 to 123% (mean, 98.18 +/- 4.69%). Eight of ten patients (80%) had hypoxemia with a partial pressure of oxygen in arterial blood ranging between 58 and 90 mmHg (mean, 76.0 +/- 4.2). Calculated alveolar-arterial differences for oxygen ranged between 5.25 and 46.0 (mean, 26.0 +/- 4.7). In 4 of 5 patients in whom lung perfusion scans were performed, perfusion defects were found. There was a significant correlations (p < 0.05) between the presence of hypoxemia and the known duration of acromegaly, but not with the present growth hormone levels or previous therapy. The results indicate that pneumomegaly is not common in acromegaly. However, most patients have some degree of hypoxemia present usually as subclinical disease and it is probably due to a ventilation-perfusion derangement, which is probably a direct effect of the prolonged oversecretion of growth hormone.

Acromegaly↗
PubMed1980

Complete remission of Cushing's disease by total bilateral adrenalectomy and adrenal autotransplantation.

A 15-yr-old girl was diagnosed as suffering from Cushing's disease. She was treated by bilateral adrenalectomy and autotransplantation of one third of each adrenal to the corresponding thigh. The adrenal that was embedded in the right satorius muscle started functioning after about 1 yr, as proven by significant differences in cortisol levels in both femoral veins (82.5 and 17.5 micrograms/100 ml). 19-[131I]Cholesterol scanning showed adrenal tissue in the right thigh, while no adrenal remnant was demonstrated. Eleven years after surgery, the patient is symptom free and does not require replacement therapy. We find that adrenal autotransplantation, which is a simple and nonrisky procedure, should be considered whenever bilateral adrenalectomy is chosen as a treatment for Cushing's disease.

17-Ketosteroids↗
PubMed1980

Monoarthritis with heterophil-negative infectious mononucleosis. Case of an older patient.

A patient aged 57 years with infectious mononucleosis and monoarthritis of the knee joint is described. To our knowledge, this association in elderly patients has not been reported heretofore, nor has the pathogenesis of arthritis in infectious mononucleosis been established. Because of the clinical picture and the synovial fluid findings, we suggest that the main mechanism of this arthritis is viral replication in the synovia.

Antibodies, Viral↗
PubMed1980

Improved single-dose metyrapone test.

One dose of metyrapone (1.5 g) administered at 6 AM, with subsequent measurement of plasma ACTH, 11-deoxycortisol, or 17-hydroxycorticosteroids (17-OHCS) (cortisol + 11-deoxycortisol) at noon and 2 PM allowed an accurate assessment of the pituitary-adrenal reserve. Eighteen subjects with a normal pituitary-adrenal reserve were studied before and after the administration of this single metyrapone dose. By noon, plasma ACTH rose from a premedication value of 39 +/- 22 (SD) to 193 +/- 104 pg/ml and 11-deoxycortisol, from 0.0 +/- 0.3 (SD) to 9.0 +/- 2.7 microgram/dl. By 2 PM, plasma 17-OHCS had increased from a premedication value of 5.0 +/- 1.5 (SD) to 16.0 +/- 1.8 microgram/dl. The differences between pre- and postmedication values were statistically significant for all indices measured (P less than 0.001). No overlap was found between values before and after metyrapone. This protocol eliminates the need for metyrapone administration every 4 h over a 24-h period. It offers the advantage of low dose and low toxicity. The integrity of the pituitary-adrenal axis can be demonstrated by measuring either plasma ACTH and 11-deoxycortisol or even 17-OHCS 6 to 8 h after the administration of this single metyrapone dose.

17-Hydroxycorticosteroids↗
PubMed1980

Placental concentrations of progesterone, estradiol-17 beta, and cyclic AMP at delivery.

In contrast to most mammals, human parturition is not preceded by a rise in the estradiol : progesterone ratio in peripheral plasma. Thus tissue concentrations of progesterone, estradiol-17 beta, and cyclic adenosine monophosphate (AMP) were measured in placentas obtained after spontaneous vaginal delivery (SVD, N = 11), after oxytocin-induced labor (OXIL, N = 5), and at elective cesarean section (ECS, N = 8). Both progesterone and estradiol were higher in placentas obtained from SVD compared with those from ECS (progesterone: 2.95 +/- 0.26 versus 1.96 +/- 0.29 ng/mg tissue, P < .025; estradiol: 33.6 +/- 5.2 versus 26.4 +/- 3.8 pg/mg). Placentas from OXIL had intermediate progesterone (2.50 +/- 0.47 ng/mg) but the highest estradiol concentration (41.4 +/- 3.2 pg/mg). Cyclic AMP was 29.8 +/- 1.5, 39.6 +/- 8.0, and 35.9 +/- 3.9 pmoles/100 mg tissue in SVD, OXIL, and ECS placentas, respectively. Thus no rise in the placental estradiol : progesterone ratio was found in association with spontaneous labor.

Cesarean Section↗
PubMed1980

The heart in acromegaly: correlation of echocardiographic and clinical findings.

Echocardiography was performed in 14 patients with acromegaly in order to characterize cardiac involvement in this disease. The left ventricle was enlarged or hypertrophic in 10 patients (71%): the fraction of myocardial shortening, an index of left ventricular contractility, was normal in all but one; and 10 patients had a reduced mitral EF slope, suggesting that their left ventricular compliance was reduced. Cardiac disease was not suspected clinically as most patients had normal clinical, ECG and X-ray examinations of the heart. Left ventricular hypertrophy occurred in the absence of hypertension, diabetes or evidence of coronary artery disease. There was a positive correlation between left ventricular wall thickness and duration of acromegaly but not between the former and growth hormone levels after fasting, suggesting that ther must be prolonged hypersecretion of growth hormone, and not simply high levels, before cardiac hypertrophy develops.

Acromegaly↗
PubMed1980

Improved glucose tolerance and insulin response in obese and diabetic patients on a fiber-enriched diet.

Twenty-two subjects, six of them obese, five latent diabetics, six overt diabetics, and five control subjects, were given a daily dietary supplement of 16 g guar gum and 10 g pectin for three successive days. Postprandial blood glucose and insulin responses to an initial standard meal and to a fiber-enriched meal given 72 h later were compared. A significant decrease of blood glucose levels was found in all subjects, with maximal response in the obese group. We conclude that supplementing the diet with certain fibers can be regarded as an important therapeutic measure in the treatment of diabetic and obese patients.

Adolescent↗