Biomedical subjects
Publications and source records attributed to F H Tyler.
A patient presenting with tetany was found to have thoracic outlet obstruction. This was treated by transaxillary first rib resection, and good relief of the carpal spasm was obtained. The mechanism whereby neurovascular compression may produce tetany is discussed.
In a six-year survey of 5,179 school children in Arizona, Utah, and Nevada 62 cases of chronic lymphocytic thyroiditis were identified giving a prevalence of 1.2%. Thyroids were enlarged in 85%, firm in 60%, and had an irregular or lobulated surface in 75%. Antibodies to thyroglobulin were demonstrable in the serum at some time during the course of the disease in 76% by the tanned red blood cell technique and in 93% by radioimmunoassay. Serum TSH concentrations were elevated in seven of 15 subjects. Many of the cases were early or mild thyroiditis and, in most instances, subjects were asymptomatic and considered clinically euthyroid. Two subjects were hypothyroid, and two appeared clinically hyperthyroid. Spontaneous resolution of thyroiditis occurred in 15 of 32 individuals who received no treatment. Resolution occurred in 14 of 30 children treated with thyroid hormone supplement. The results suggest that lymphocytic thyroiditis in children may be present without symptoms and in many is a self-limiting disorder from which complete recovery occurs spontaneously.
To assess the effects of metyrapone and reduced metyrapone on 11 beta-hydroxylase inhibition, the plasma levels of cortisol, 11-deoxycortisol, and the inhibitors were measured by radioimmunoassays in 34 normal subjects 8 h after they received a single oral dose of metyrapone at midnight. The ratio of 11-deoxycortisol to cortisol, as an index of 11 beta-hydroxylase inhibition, was compared to plasma levels of metyrapone and reduced metyrapone. One subject received an infusion of metyrapone ditartrate in order to study the sequential conversion of metyrapone to reduced metyrapone. A new radioimmunoassay was developed for measurement of plasma concentrations of metyrapone and reduced metyrapone. Following intravenous administration of metyrapone, it is rapidly converted to an active metabolite, reduced metyrapone. At 8 h after a dose was given, the average reduced metyrapone level was 1.5 times higher than the average metyrapone level. Following oral administration of the drug, we found a high correlation when plasma levels of metyrapone were compared to reduced metyrapone and when the ratio of 11-deoxycortisol to cortisol was related to metyrapone or to total metyrapone levels. In conclusion, the conversion of metyrapone to reduced metyrapone is such that by 8 hours after a single oral dose, more than one-half of the inhibitory effect on 11 beta-hydroxylase appears to be produced by reduced metyrapone. The inhibitory action of metyrapone and reduced metyrapone on the enzyme system is reflected by their concentration in plasma.
To determine the kinetics of metabolism and interconversion of prednisolone and prednisone, the plasma levels of these synthetic glucocorticoids were measured by new radioimmunoassays (RIA) after intravenous (iv) or oral administration to normal humans. Following the iv injection of prednisolone phosphate in 8 normal subjects, the mean half-time of prednisolone was 240+/-20 min (mean+/-SE) and the metabolic clearance rate was 82+/-7.2 1/24 h/m2. Of 10 mg of prednisone given orally to 5 normal subjects, 69+/-5% was absorbed and converted to peripheral plasma prednisolone within 8 h. The data indicate that prednisone is extensively metabolized to prednisolone before it clears the splanchnic circulation and the formation prednisone by oxidation of the 11-hydorxyl group of prednisolone appears to occur mainly in peripheral tissues.
In this study, we evaluated the responses of the pituitary-adrenal axis to the suppressive action of dexamethasone by relating plasma dexamethasone (Dex) and cortisol (F) levels in normal subjects and patients with Cushing's syndrome. Various doses of Dex were ingested at midnight as a single dose or at 6-hour intervals for 2 days beginning at 8 A.M. A nomogram was prepared by plotting the 8 A.M. plasma F concentration as a function of the plasma Dex value. Two patients with Cushing's syndrome had normal responses to Dex suppression as assessed by conventional tests. With the nomogram, we found that all patients with Cushing's syndrome, including these two, exhibited abnormally high plasma F values at some time during our evaluation. A decreased metabolic clearance rate of Dex appears to explain why one showed normal suppression. Another patient with bilateral adrenal hyperplasia showed sequentially over 13 months abnormal, normal, and abnormal suppression, which could not be attributed to an abnormality of Dex metabolism. We conclude that relating plasma Dex and F provides the investigator with a reliable index for evaluating resistance of the pituitary-adrenal axis to the suppressive effect of Dex.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.