Biomedical subjects
Publications and source records attributed to F Hartmann.
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We determined plasma transcortin, total cortisol and free cortisol in mothers, new borns and nonpregnant women. The blood samples were drawn immediately upon delivery. The mothers had significantly higher levels of total cortisol as well as free cortisol and transcortin when compared to non-pregnant women. The new borns had higher levels of total cortisol and free cortisol but unchanged levels of transcortin in comparison to normal subjects. Significant differences were also found with respect to total protein and albumin in all groups.
In 30 resting normal persons, 5 ambulant normal persons and 3 patients with disorders of the pituitary-adrenal-system before and 30 minutes after intravenous injection of 0,25 mg synthetic adrenocorticotrophin (tetracosactid, Synacthen) plasma cortisol and aldosterone levels were evaluated. The evaluation of the corticoids was continued over 240 minutes in intervals of 30 minutes. The basal cortisol and aldosterone levels of the resting normal persons and ambulant persons ordinarily doubled 30 minutes after ACTH application. The plasma cortisol level of a steroid-treated patient with lupus erythematodes disseminatus rose subnormally but his aldosterone level increased normally. 2 patients with untreated hypopituitarism had subnormal plasma cortisol and normal aldosterone responses after ACTH administration. In contrast with patients with primary adrenal insufficiency, whose plasma aldosterone levels fail to rise, patients with secondary adrenal insufficiency had normal corticotrophin-stimulated aldosterone increments. Thus the extended ACTH test can be useful in differential diagnosis of primary and secondary adrenal insufficiency.
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the plasmacortisol-levels of 27 patients suffering from glaucoma were compared with those of 156 healthy persons. There was no difference between the two groups compared. In addition, a diurnal inversion of the plasmacortisol-level in patients suffering from glaucoma as reported in the literature was not found.
The effect of topical use of desoximetasone (Topisolon ointment) and triamcinolone acetonide (Volon A cream) for 3 to 4 days on circadian plasma cortisol levels was studied in 22 hospitalized patients (mean age 61 years) for Topisolon, and in ten patients (mean age 59 years) for Volon A. The differences in cortisol levels (RIA) were examined by the frequency distribution analysis of Daeves and Beckel (1958). The need to analyze the features of the distribution curves was clearly demonstrated in preference to simple averaging statistics which rely upon the arithmetic mean as the main parameter. The results suggest two distinct groups of morning plasma cortisol levels - one at a low level of 5.6 X 1.85 +/- 1 and one at a high level of 15.4 X 1.56 +/- 1 microgram/100 ml. The evening level was uniform 6.5 X 2.13 +/- 1 microgram/100 ml. Topisolon depressed the plasma cortisol levels in all groups. Volon A seemed to reduce only the morning high level group to lower values. In addition, Topisolon altered the proportions of patients with high and low plasma cortisol levels, while Volon A had little effect. The different responses of the plasma cortisol levels may imply different kinetics of cutaneous penetration and cutaneous metabolism of the two synthetic corticosteroids.
Eye drops and ointments containing corticosteroids moderately influence plasma cortisol levels. Subconjunctival or retrobulbar injections of dexamethasone phosphate (4 mg/day) have a pronounced effect on endogenous cortisol synthesis. This effect, however, is reversible. If additional oral corticosteroid medication is given over a prolonged period of time the function of the adrenal glands may be seriously damaged for more than a year.
Plasma cortisol levels in a four-point daily profile were measured by radioimmuno assay before and during treatment with corticoid-containing ointments (triamcinolone acetonide) in 21 patients with psoriasis, who had no endocrine disorders. In the pretreatment phase there were typical circadian fluctuations of the plasma cortisol concentrations. Already after two days of treatment a significant supression of adrenal function could be detected. This dysfunction increased during continuous treatment. In comparison with a fluorimetric method, the radioimmuno assay allowed a better differentiation. This could be due to a lack of specificity and to susceptibility to erroneous measurement of the fluorimetric method. We could also confirm that the distribution of plasma cortisol levels is not a linear but a logarithmic one. Considering the log-normal distribution different mean values and variances are obtained.
Plasma aldosterone levels and the serum electrolytes potassium, sodium and magnesium of 38 patients with healthy adrenals were determined. Under physiological conditions there were no significant correlations between these parameters. In two patients with an aldosterone producing adenoma of the adrenals (syndrome of Conn) we found very low levels of potassium and low levels of magnesium. The levels of sodium lay in the upper normal range. Plasma aldosterone levels are raised strongly. After resection of the tumors the mentioned parameters normalized. In 16 patients with cirrhosis and ascites we generally found values of aldosterone, potassium, sodium and magnesium which lay in the lowest normal range. Under treatment with spironolactone the aldosterone levels raised and reached values which are characteristical of the syndrome of Conn. Potassium raised to the upper normal range, magnesium raised significantly, sodium diminished slightly.
In 17 patients with retrospectively healthy adrenals we performed a LHRH-test, a TRF-test and an ACTH-test in the short modification. Additionally we determined plasma aldosterone and renine levels. Concerning the LHRH-tests and the TRF-tests we did not find any differences on the aldosterone values. Concerning the ACTH-tests in the short modification we found an increase of the aldosterone values which resembled that of the cortisol levels (increase of cortisol 104.7%, increase of aldosterone 93.3%). The renin values remained unchanged. Therefore the plasma aldosterone levels are modified in accordance with the cortisol levels by hypophysial influences.
We determined plasma aldosterone levels of patients with healthy adrenals after rest (n = 80) and exercise (n = 30) using a radioimmune assay with highly specific antibodies. The obtained normal values had a log-normal distribution. The normal values did not show any differences regarding sex and age. At rest they ranged between 50 pg/ml and 190 pg/ml, after exercise between 110 pg/ml and 310 pg/ml.
Amphiphilic drugs like chlorphentermine induce a generalized lipid storage disease upon chronic application. The adrenal cortex is among the organs most heavily affected. We therefore determined the urinary corticosterone excretion during the treatment of rats with chlorphentermine and the corticosterone content of the adrenals and its blood level at the end of the treatment period. In addition, the responsiveness of adrenal cortex was tested by application of ACTH. During treatment, the corticosterone excretion declined considerably. Both the corticosterone content of the adrenals and the plasma level were found depressed at the end of a treatment period of 8 weeks. The ACTH evoked response was also diminished. The results indicate that the chlorphentermine-induced lipidosis is associated with a reduced corticosterone production of the adrenal cortex of rats. At present it cannot be decided whether the cortical insufficiency is causally related to lipidotic alterations of the cortical cells, or whether it is caused or additionally influenced by alteration at a higher level, e.g. hypothalamic centers or anterior pituitary.
Monooxygenase enzymes are involved in the biotransformation of drugs and of environmental carcinogens. The activity of 7-ethoxycoumarin 0-deethylase and associated NADPH-cytochrome c reductase was determined in 9000 g supernatant from bioptically obtained liver specimens from patients with various liver diseases in order to study in vitro drug metabolising capacity. Monooxygenase and reductase activity was significantly higher in the livers of 21 patients with alcoholic liver disease (fatty liver, alcoholic hepatitis, cirrhosis of the liver) than in 22 normal controls or in six patients with chronic active hepatitis. The raised activity of drug-metabolising enzymes obtained from alcoholics with liver damage differs from normal values found in five alcoholics without liver disease. Both groups were comparable in respect to the amount of alcohol consumed and duration of abuse. A strikingly low monooxygenase activity was observed in eight patients with cirrhosis of the liver and ascites, with, however, no apparent effect on reductase activity. The results show that alcoholic liver disease is associated with enhanced monooxygenase and reductase activity, but alcoholism, per se, is not. This rise of drug-metabolising enzyme activity could lead to selectively increased rates of biotransformation in patients with alcoholic liver damage.
Drug-metabolizing enzymes, especially monooxygenases, play a major role in biotransformation and detoxification of many foreign compounds including environmental carcinogens. Although largely localized in the liver they are also found in the small intestine, which is the portal of entry of dietary toxins. Therefore cytochrome P-450 content as well as monooxygenase (7-ethoxycoumarin O-deethylase) and NADPH-cytochrome c reductase activities were determined in surgical specimens of the human small intestine and in jejunal biopsy material obtained from patients by use of a hydraulic biopsy instrument. Microsomes were prepared from surgical material; these ranged in P-450 content from 30 to 120 pmole/mg protein and in monooxygenase activity from 60 to 110 pmole/min-mg protein. In the 20,000g supernatant of the homogenized biopsy material, monooxygenase activity was undetectable in patients who had total villous atrophy, and low enzyme rates were found when the mucosa showed a partial villous atrophy. The mucosal monooxygenase activity of patients with normal jejunal histology and steatorrhea was significantly higher than in mucosa with villous atrophy but was only half of that observed in normal controls. These eight control patients had normal histology and no malassimilation. Our results suggest that monooxygenase activity in the human small intestine is dependent on the morphological integrity of the mucosa and that in normal mucosa the enzyme rates are reduced when malassimilation is present.
No clinical symptoms are usually produced by dental procedures utilizing endodontic medicines with corticoid additives. Root fillin pastes with corticoid are particularly deserving of attention. Whether the effect of such root filling pastes is limited to the apical tissue or whether endocrine reactions are also evoked was studied in animal experiments. The possibility of endocrine reactions cannot be definitely excluded. Given the possibility of such counter effects and their sequelae, the discussion of the indications and/or the counterindications for the use of root filling paste with corticoid additives for permanent treatment of root canals should in no way be considered concluded.
The major part of chronic skin ulcers resulting from a trauma show no tela peculiarities during the whole of their development apart from the formation of chronic granulation tissue. In a few cases there is a malign degeneration, which is often detected too late. Based on the experience of two cases, the necessity of exercising a precise control of their development is pointed out. This can be achieved by taking biopsies and by histological treatment.
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