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Biomedical subjects

F Grunenberger

Publications and source records attributed to F Grunenberger.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Hormonal perturbations in fibromyalgia].

Fibromyalgia is a syndrome characterized by chronic musculoskeletal pain and fatigue without biological detectable disturbances. The mechanisms of this disease are unknown. It has been postulated that it can be the consequence of a chronic stress mediated mainly through the hypothalamo-pituitary-adrenal axis and the sympathetic nervous system. These fields have been extensively studied. Results were scattered and non convincing. A reduction of growth hormone and IGF-1 levels described in a third of patients has led to a double blind random clinical trial with biogenetic growth hormone. Results were equivocal . Other hormonal systems are grossly normals and circadian rhythms are unaltered. Despite some arguments in favour of a CRH neurons hyperactivity, these results are not able to consolide a particular physiopathological mechanism and to argument for a new therapeutic approach. Many of the abnormalities may be the consequence of psychological disturbances.

Adrenocorticotropic Hormone↗
PubMed2000

[Adult celiac disease: importance of delay to diagnosis].

OBJECTIVE: Adult celiac disease is a genetically determined condition resulting from intolerance to gluten. This familial disease is associated with HLA B8 DR3 and is characterized by cytotoxic T-lymphocyte reaction in the digestive wall leading to a maladsorption syndrome. Adult celiac disease would be an expression of a silent disease already present in childhood. PATIENTS AND METHODS: We conducted a retrospective study in 19 patients. Diagnosis was established in a department of internal medicine in adulthood. We analyzed histological findings and the clinical history and course. RESULTS: The age curve at diagnosis peaked at 22 years and 67 years. Female sex predominated. Average delay to diagnosis was 3.1 years. The patients were admitted for reasons other than digestive disorders in 17 out of 19 cases. Careful history taking did however disclose subtle digestive signs. The principal manifestations were hematological disorders such as chronic anemia, abnormal liver function tests, and poor control of associated diseases. Type 1 diabetes mellitus was the main associated disease (4/19). Patients with prolonged nutritional deficiencies experienced serious situations. CONCLUSION: Adult celiac disease is a clinical variant suggesting the presence of other non-digestive disorders. Specific antibodies should be assayed in patients with even minimal signs of deficiency in order to identify associated diseases. The principal cause of mortality is digestive T-cell lymphoma. A gluten-free diet is essential to control the course of this chronic disease.

Adult↗
PubMed2000

Distribution of serum apolipoproteins A-I and B and lipoprotein(a) in European elderly. The SENECA study.

The purpose of this study is to describe sex and geographic differences in apolipoproteins (apo) A-I and B and lipoprotein(a) [Lp(a)] concentrations in elderly Europeans. Subjects were 2164 elderly participants of the SENECA study from different regions of Europe. Sera for apo A-I, apo B, and Lp(a) measurement were available for 1703 individuals. In men, mean values ranged from 1.38 to 1.79 g/l for apo A-I, 1.03-1.36 g/l for apo B, and 0.26-0.67 g/l for Lp(a). In women, mean values ranged from 1.54 to 1.98, 1.20-1.51, and 0.26-0.68 g/l for apo A-I, apo B, and Lp(a), respectively. A comparison of northern (Norway, Denmark, Netherlands), middle (France, Switzerland), and southern (Portugal, Spain, Italy, Greece) communities showed a less atherogenic profile in the south, including lower LDL cholesterol, apo B, TC/HDL cholesterol ratio, and apoB/apo A-I ratio. Men, but not women, also had significantly higher HDL cholesterol and apo A-I concentrations in the South. Paradoxically, Lp(a) concentrations were generally high among all elderly and were significantly higher in the southern communities. These data show that the elderly in Europe are very heterogeneous with respect to plasma lipoproteins, including apo A-I, apo B, and Lp(a).

Aged↗
PubMed2000

[Anemia caused by vitamin B 12 deficiency in subjects aged over 75 years: new hypotheses. A study of 20 cases].

PURPOSE: New hypotheses have recently been developed on vitamin B12 deficiency and the frequently observed occurrence in the elderly subject of food cobalamin malabsorption, i.e., the non-dissociation of B12 and its carrier protein (ND B12), and the possibility of rectifying this imbalance by oral crystalline B12 supplementation. The aim of this study was therefore to confirm these hypotheses in a series of patients aged over 75 years with anemia due to B12 deficiency. METHODS: A retrospective study was carried out over a 5-year period on patients aged over 75 years presenting with megaloblastic anemia (hemoglobin [Hb] < 12 g/dL) and vitamin B12/cobalamin deficiency (B12 < 160 pg/mL). RESULTS: Twenty cases were analyzed. The average age of the patient population was 82.5 +/- 6 years, and the F/M sex ratio was 1:2. Mean Hb levels were 7.9 +/- 2.4 g/dL, mean serum B12 levels were 83 +/- 24 pg/mL, and mean homocysteinemic levels were 35 +/- 27 mumol/L. The diagnosis was as follows: food cobalamin malabsorption/ND B12 (n = 10), Biermer's disease/pernicious anemia (n = 5), malabsorption due to pancreatic insufficiency (n = 1), and low dietary B12 levels (n = 1). Disorders associated with ND B12 were: atrophic gastritis and Helicobacter pylori infection (n = 6), antacid or biguanide intake (n = 3), alcohol abuse (n = 2), or idiopathic syndrome (n = 2). In the patients who were followed up (n = 10), i.m. (n = 5) or oral (n = 5) administration of crystalline B12 resulted in the correction of hematological abnormalities. CONCLUSION: In the elderly subject, food cobalamin/ND B12 malabsorption appears to be the main cause of B12 deficiency, and is frequently associated with atrophic gastritis. In these cases, administration of oral crystalline B12 may be an efficient means of treating this disorder.

Aged↗
PubMed2000

[Hypothalamo-pituitary-adrenocortical function during and after steroid therapy: recent data and critical review].

Prolonged corticosteroid treatment is considered to be the main cause of adrenal insufficiency (AI). AI is due to adrenal atrophy caused by the inhibition of ACTH secretion. Risk factors for AI after corticosteroid treatment remain unknown. Various functional tests, particularly the "standard" Synacthene 250 microg, demonstrate frequent abnormal responses in these patients. However, these abnormalities are not predictive of the risk of AI in particular in case of stress. More recent tests (CRH, "low dose" Synacthene) need to be further evaluated in this situation. Several recent studies in animals and in humans have demonstrated that the need for glucocorticoid coverage during a surgical stress has been greatly overestimated and that maintenance of the usual daily dose seems to be sufficient and safe in most patients with minor surgical stress. Revision of guidelines for more important surgical stress or for other medical conditions in patient treated with glucocorticoids is necessary.

Adrenal Cortex Hormones↗
PubMed1999

Hepatic and pulmonary metastases from a meningeal hemangiopericytoma and severe hypoglycemia due to abnormal secretion of insulin-like growth factor: a case report.

A 42-year-old woman was hospitalized for severe hypoglycemic coma. She had a voluminous hepatic metastasis and multiple small lung metastases from a meningeal hemangiopericytoma initially operated on 11 years earlier. High blood levels of an abnormal form of insulin-like growth factor type 2 (IGF II) associated with low blood levels of insulin, growth hormone, IGF I, and IGF BP3 were observed. After surgical resection of the liver and pulmonary metastases, serum glucose levels and hormonal abnormalities returned to normal.

Adult↗
PubMed1999

Predominant Staphylococcus aureus isolated from antibiotic-associated diarrhea is clinically relevant and produces enterotoxin A and the bicomponent toxin LukE-lukD.

Staphylococcus aureus was isolated as the predominant or only isolate from cultures of stools of 60 patients over 2 years in a university hospital, leading to the collection of 114 isolates. Diarrhea was observed in 90% of the patients. Ninety-eight percent of the patients had received antibiotics in the month before the diarrhea. Ninety-two percent of the S. aureus isolates were methicillin resistant. S. aureus was encountered with antibiotic-associated diarrhea among 47 quite elderly patients affected or not affected by a gastrointestinal disease. Among the antimicrobial treatments, cessation of the previous therapy when possible or rapid application of oral vancomycin therapy was the most appropriate. Analysis of total DNA by pulsed-field gel electrophoresis revealed 27 different SmaI pulsotypes distributed in 15 clusters. The pulsotypes never differed for related isolates from a single patient, even if they originated from patients with bacteremia. S. aureus was not isolated as the predominant isolate in cultures of stools of 57 patients who received an antimicrobial treatment for more than 5 days without diarrhea. Occurence of production of both enterotoxin A and the bicomponent leucotoxin LukE-LukD by the S. aureus isolates was significantly different from that by random isolates. The results strongly suggest that when predominant in stool samples, S. aureus should be considered a possible etiologic agent for some cases of antibiotic-associated diarrhea.

Adolescent↗
PubMed1998

Relapse of Graves' disease after subacute thyroiditis.

We report the case of a 46-year-old man whose Graves' disease relapsed 5 years after its first appearance. At the time of relapse thyrotropin (TSH) receptor antibodies were very high, as was radioactive uptake in the left lobe of the thyroid. After thyroidectomy, histological analysis of the specimen showed evidence of treated Graves' disease, and there were signs of subacute thyroiditis in the right lobe. The clinical and immunologic characteristics of this observation are discussed as well as the hypothesis explaining the succession of an inflammatory and autoimmune thyroid disease.

Autoantibodies↗
PubMed1997

[Treatment of malignant adrenal cortex carcinoma].

UNCOMMON MALIGNANCY: Adrenocortical carcinoma is a very rare malignancy with poor prognosis. Median survival ranges from 12 to 25 months. Most clinicians recommend aggressive surgical management of either local or recurrent and metastatic disease. ANTICORTISOL AGENTS: Mitotane, the most tested agent against inoperable and metastatic adrenocortical carcinoma, procures overall response rates of 20 to 25%, but recent data do not support its use in the adjuvant setting. CHEMOTHERAPY: The efficacy of cytotoxic chemotherapy is low but new agents or associations (with platinum salts), new concepts (dose-intensification, MDR (the chemoresistance gene) reversing agents) may be useful and five some hope in this difficult disease. RADIOTHERAPY: The role of radiation therapy must be developed.

Adrenal Cortex Neoplasms↗
PubMed1997

[Iodine and thyroid function].

Iodine is a raw material for the thyroid production of hormone which is on the major external control of TSH. The thyroid adaptation to iodine deficiency consists in an increasing iodine concentration from the circulation, an enhancing iodination of the tyrosyl residues in thyroglobulin, a decreasing iodine storage associated to a better recycling of non hormonal iodine and thyroid hyperplasia to provide more synthetic possibilities. Genetic variation and environmental factors explain the wide variation of individuals response to iodine deficiency resulting in a high prevalence of goiter, a mild TSH level increase or overt hypothyroidism. At long term iodine deficiency may have severe pathological consequences and induce neuropsychological deficits in school-children. A policy of iodine supplementation mainly by iodized salt must be undertaken in many areas in the world. Effects of an iodine excess on thyroid function are variable depending upon the underlying thyroid disorder and ambient iodine intake. The most subjects remain euthyroid by mechanisms of autoregulation based on an inhibition of thyroid hormone synthesis and a decrease in the thyroid iodide trap. Euthyroid individuals from high iodine intake areas or those with a history of lymphocytic thyroiditis, treated Graves' disease or subtotal thyroidectomy develop hypothyroidism. On the other hand iodine induced hyperthyroidism is more common in areas of iodine deficiency and in older patients with nodular goiter.

Humans↗
PubMed1996

[Fatal hemorrhagic necrosis of pituitary macro-adenoma after a stimulation test].

Pituitary stimulation tests are widely used to explore hypophyseal adenomas. There are few disadvantages, although a few cases of pituitary necrosis have been published. We report a new case with a dramatic outcome. A 30-year-old man with clinical signs of acromegalia and major visual disorders was found to have a voluminous macro-adenoma of the pituitary gland. Thirty minutes after beginning the stimulation test, the patient complained of major headache and experienced persistant vomiting for several hours. Brain magnetic resonance imaging the next day did not reveal evidence of pituitary necrosis. Sudden onset coma occurred one hour later. The CT scan demonstrated hemorrhagic necrosis of the adenoma. The patient died despite emergency surgery. Due to the risk of hemorrhagic necrosis of a pituitary adenoma, baseline assays may be sufficient for diagnosis in patients with clinical signs highly suggestive of pituitary oversecretion, especially when a voluminous tumor is involved. Rigorous clinical surveillance is required after stimulation tests.

Adenoma↗
PubMed1996

[Thyroid function and dysfunction in the elderly].

The consequences of aging function are appreciated in various ways. In fact most of the thyroid hormone abnormalities described in the elderly are secondary to associated disease or treatments. Health and nutritional status seem to be more determinant than age. However, there is an increased prevalence of dysthyroidism in the elderly. Symptoms may be misleading and induce severe general repercussions. Mild or occult forms of dysthyroidism characterized by abnormal TSH levels with normal free thyroid hormone levels are not uncommon. Their clinical significance and their prognosis without treatment are still unresolved. The frequency of dystrhyroidism during old age and the possibility of a specific treatment may be in favour of a screening by a systematic TSH determination in elderly patients.

Aged↗
PubMed1996

Longitudinal changes in serum lipids of elderly Europeans. SENECA Investigators.

OBJECTIVE: To describe the serum total cholesterol, lipoprotein cholesterol and triglyceride concentrations in elderly people from the SENECA follow-up study and report on longitudinal changes in these lipid concentrations over a four-year follow-up period. DESIGN: Longitudinal study including baseline measurements taken in 1988/1989 which were repeated in 1993. SUBJECTS: In 1993 lipid concentrations were assayed in blood serum collected from 1181 elderly men and women, born from 1913 to 1918 and living in twelve small towns in ten European countries and one town in the USA. 1062 of these subjects had also participated in the baseline study. RESULTS: Mean concentrations ranged from 4.91 to 6.72 mmol/l for total cholesterol, 1.15 to 1.64 mmol/l for HDL cholesterol, 3.04 to 4.47 mmol/l for LDL cholesterol and 1.03 to 1.79 mmol/l for triglycerides. Thirty-two per cent of European men and 18% of women had plasma total cholesterol concentrations below 5.16 mmol/l; 32% of men and 56% of women had HDL cholesterol concentrations exceeding 1.42 mmol/l. Total- and HDL-cholesterol concentrations, and the HDL:total cholesterol ratio were higher in women than in men. Despite large variations between towns no clear north-south gradient was observed. Yet, lowest values for LDL cholesterol tended to be located in the south, while the highest values for LDL cholesterol showed up in the north. Comparisons between the 1989 and 1993 surveys revealed a significant decrease in total cholesterol and an increase in the HDL:total cholesterol ratio without significant variation in HDL cholesterol or triglyceride concentrations. CONCLUSION: Though serum lipid concentrations varied widely across Europe, a marked decline in total cholesterol values along with an increase in the HDL:total cholesterol ratio occurred across the SENECA towns.

Aged↗
PubMed1996

Longitudinal changes in the intake of energy and macronutrients of elderly Europeans. SENECA Investigators.

OBJECTIVE: To assess longitudinal changes in intakes of energy and macronutrients in elderly Europeans. DESIGN: Longitudinal study including a dietary assessment in 1988/1989, which was repeated in 1993. SETTING: Serial data were collected in nine European towns: Belgium: Hamme (H/B); Denmark: Roskilde (R/DK); France: Haguenau (H/F) and Romans (R/F); Italy: Padua (P/I); the Netherlands: Culemborg (C/NL); Portugal: Vila Franca de Xira (V/P); Spain: Betanzos (B/E) and Switzerland: Yverdon (Y/CH). In other centres dietary intake data were collected in 1993 only: Portugal: Coimbra (C/P); Poland: Marki (M/PL); Northern Ireland: Ballymoney-Limavady-Portstewart (BLP/NI/UK) and United States: Mansfield (Connecticut) (M/CT/USA). SUBJECTS AND METHODS: Using standardized methodologies, data were collected from a random stratified sample of elderly men and women born between 1913 and 1918. In 1993 dietary intake data were collected from 1125 subjects by a modified validated dietary history method. RESULTS: Over the 4-year study period, a decline in mean energy intake of one MJ or less per day was observed in most towns, which was significant (P < 0.01) in only four of the towns. The within- and between-centre variation of change was large. Overall, a slight decline was reported for all macronutrients and with the exception of protein, large within and between centre variations were observed in both men and women. CONCLUSION: Intake of energy and macronutrients was found to decline with age. This may be of special concern for small eaters.

Aged↗