[Medical education].
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Biomedical subjects
Publications and source records attributed to F Hartmann.
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In a 50-year-old woman, working as a dental assistant for more than ten years, chronic mercury poisoning developed insidiously, apparently from careless handling of mercury-amalgam. The main signs consisted of mental and neurological changes such as erethism, tremor and mercurial psellism. Peripheral arterial circulatory disorders occurred in the course of the disease, as well as abdominal colic and a polyneuropathy, which provided the first clues to panarteritis nodosa subsequently confirmed histologically.
The present paper describes the plasma cortisol concentrations on four daily measurements in normal subjects assayed with the fluorescence method after de Moor and with a radioimmuno assay. A comparison of these two methods shows that the determinations of plasma cortisol with the fluorescence method always yielded higher values. Both methods are sensitive enough to detect the circadian rhythm of cortisol secretion. For the purpose of routine diagnostics it is sufficient to measure the maximal and minimal concentrations of plasma cortisol in blood samples taken at 8 a.m. and 8 p.m., respectively. The plasma cortisol measurements should only be attempted after allowing a few days of adaption to the hospital situation. Table 2 shows that the normal plasma cortisol levels are represented only by log-normal distributed values. These concentrations are lower than the linear distributed levels reported so far.
Plasma cortisole concentration was measured in 44 patients with chronic dermatitis before, during, and after occlusive treatment with corticosteroid-containing ointment (triamcinolone-acetonide). In all patients plasma cortisole concentration decreased (p less than 0.001) and the day-night-rhythm disappeared. Five patients in whom less than 20% of the body-surface was treated, showed the same but less significant changes in the plasma cortisole concentration. In some patients the plasma coritsole concentrations increased three days after therapy, and their day-night-rhythm returned. This "systemic effect" of topical treatment with triamcinolone-acetonide is not the reason for the therpeutic efficacy, but rather the local concentration of steroids in the skin.
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We have reported of a case of generalised sarcoidosis with primary hyperparathyroidism. A pathogenetic relation between sarcoidosis associated with hypercalcemia and the development of parathyroid adenoma will be discussed and a causal connection will be proposed. According to our hypothesis every primary hyperparathyroidism could have developed from regulatory hyperfunction. This is illustrated by sarcoidosis with hypercalcemia and hypercalcuria. In this case a disturbance in vitamin D dependent calcium metabolism induces hyperplasia of the parathyroid which later leads to the development of a parathyroid adenoma. In addition a review of literature describing similar cases is given.
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