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Biomedical subjects

G Kahaly

Publications and source records attributed to G Kahaly.

At least 73 records · Page 4Linked to original sources
PubMed1991

Graves ophthalmopathy: role of MR imaging in radiation therapy.

Twenty-three patients with Graves ophthalmopathy who underwent radiation therapy were monitored by means of magnetic resonance (MR) imaging. T2 relaxation times of extraocular muscles and orbital fat, areas of extraocular muscles, and degree of exophthalmos were measured by means of MR imaging at the beginning, at the end, and 3 months after completion of radiation therapy. As a result, patients with primarily elevated T2 times of extraocular muscles showed a better therapy response regarding muscle thickening than patients with primarily normal T2 times. Elevated T2 times, which probably represent acute inflammatory changes, were markedly decreased at the end of therapy. Therefore, quantitative MR imaging favors the choice of anti-inflammatory therapy regimens in patients with elevated T2 times of extraocular muscles. However, the clinical response (activity scores) to the low-dose treatment protocol that was used did not correlate well with primarily elevated T2 times. Furthermore, T2 times increased again after cessation of therapy. Whether a higher radiation dose or a different fractionation scheme leads to better results must be clarified by means of further study.

Adult↗
PubMed1990

Long-term observation of endocrine ophthalmopathy and retrospective appraisal of therapeutic measures.

The course of endocrine ophthalmopathy was investigated on the basis of clinical and biochemical parameters and in relation to different therapeutic strategies. A retrospective appraisal was made of 297 patients (44 +/- 14 yr, 249 women) with inclusion of anamnestic and clinical data as well as the results of computer tomography. At the beginning of therapy, 253 patients were hyperthyroid, 36 were euthyroid and eight were hypothyroid. The HLA typing carried out in 89 patients showed the phenotypes B8 and DR3 in 32% and 42% of the cases, respectively. Raised microsomal antibodies were present in 56% of the patients and there were raised thyroglobulin antibodies in 19%. Sixty-three % of the patients received immunosuppressants in the course of therapy: glucocorticoids in all cases, nonsteroid immunosuppressants in 15%. Eight % of the patients were irradiated retrobulbarly. The inflammatory parameters could be favorably affected, whereas eye muscle involvement and bulbar protrusion proved to be more resistant to therapy. In patients with combined immunosuppressant therapy or steroids + retrobulbar radiation, there were unequivocal successes with regard to the proptosis, vision and intraocular pressure. None of the strategies applied constitutes an optimal treatment with regard to the long-term course. Following therapy, there is an improvement of endocrine ophthalmopathy, but not complete healing.

Adolescent↗
PubMed1990

Urinary glycosaminoglycans in Graves' ophthalmopathy.

An increased accumulation of glycosaminoglycans (GAG) in retrobulbar tissues has been reported in patients with thyroid eye disease. We examined the quantitative urinary GAG excretion in 101 patients with Graves' ophthalmopathy of different classes, 36 patients with Graves' hyperthyroidism without ophthalmopathy, 14 patients with toxic nodular goitre and 103 control subjects. Glycosaminoglycans were isolated from 24-h urine collections by precipitation with cetylpyridinium chloride and ethanol followed by photometrical quantification of hexuronic acids after reaction with carbazole. In comparison with the control group (15.8, 10.4, 21.6 mg/24 h; median, 25th, 75th percentile) a significant (P less than 0.005) elevation of urinary GAG excretion was found in patients with ophthalmopathy (19.2, 12.2, 28.7 mg/24 h), whereas patients with Graves' hyperthyroidism and no ophthalmopathy (16.2, 11.9, 21.7 mg/24 h) and patients with toxic nodular goitre (15.8, 11.5, 21.2 mg/24 h) exhibited no markedly increased values. Especially, patients with active, untreated ophthalmopathy showed on average a twofold increase (36.7, 28.1, 48.4 mg/24 h) in urinary GAG excretion. In contrast, high values were not found in patients with inactive ophthalmopathy and elevated values decreased under treatment, which correlated with clinical findings. Further, relapses were also accompanied by high GAG excretion. Thus, using a simple laboratory method, quantitative determination of urinary GAG excretion appears to present an effective parameter for the activity of Graves' ophthalmopathy.

Adolescent↗
PubMed1990

Ciamexone in endocrine orbitopathy. A randomized double-blind, placebo-controlled study.

The influence of ciamexone on the activity and course of endocrine orbitopathy was investigated. Fifty-one patients with active orbitopathy classes II-VI were allocated randomly to two groups: over a period of six months, 26 patients received 300 mg/day ciamexone and 25 patients received placebo tablets. In both groups, prednisolone was administered in addition in the first four weeks. Ophthalmological investigations and clinical tests as well as orbit sonography were carried out before as well as one, three and six months after the beginning of therapy. Before and after treatment, computer tomography of the orbit was performed. Symptoms and signs did not show any significant improvement one and six months after therapy. No differences between the two therapy groups were observed. Detailed examination did not reveal any preferential action of the product on individual parameters. Sonography and computer tomography showed no significant alterations of the thickness of the oculomotor muscles. Thus administration of 300 mg ciamexone once a day as compared with placebo did not show any effect on the course and activity of endocrine orbitopathy.

Adjuvants, Immunologic↗
PubMed1990

[Effect of hyperlipidemia and hypothyroidism on auditory evoked brain stem responses].

Temporary changes in audiometry have been reported in hypercholesterolaemia and in hypo- and hyperthyroidism. The purpose of the present prospective and controlled study was to record changes in conduction time of auditory brain-stem response (ABR) in patients with hyperlipidaemia and hypothyroidism before and after therapy over a period of 6 months. The acoustic evoked brain-stem response Jewett waves I-V were delayed in patients with hypercholesterolaemia, hypertrigliceridaemia and hypothyroidism in comparison with an age-matched control group. The changes in pure-tone threshold and brain-stem responses correlated with the degree of hyperlipidaemia or hypothyroidism. After treatment the brain-stem responses of hypothyroid patients tended to return to normal, and in a few cases normal pure-tone thresholds were achieved. Of the patients with hypercholesterolaemia and hypertrigliceridaemia, 28% had improvements in pure-tone thresholds, whereas no significant changes were found in the ABR following therapy.

Auditory Threshold↗
PubMed1989

[Petit mal status in hyperthyroidism].

A 68-year-old woman who, for the first time, had a generalized tonic-clonic seizure and persisting confusional state was found to have nodular enlargement of the thyroid and a tachycardic arrhythmia. Electroencephalography (EEG) demonstrated a continuous irregular polyspike wave pattern. Total T4 concentration was elevated to 23 micrograms/dl. Consecutive Administration of 250 mg phenytoin, 4 mg clonazepam and 7.5 mg midazolam changed neither the clinical nor the EEG findings. But after general intensive care measures and high-dose thyrostatic treatment (40 mg thiamazole intravenously every four hours) the clinical and neurological status became normal. Serial EEGs over the subsequent weeks and months showed gradual disappearance of the abnormal changes with increasingly prolonged periods of normal activity.

Aged↗
PubMed1989

Cardiac arrhythmias and heart rate in hyperthyroidism.

The arrhythmia profile and heart rate (HR) were analyzed by 24-hour Holter monitoring in 37 hyperthyroid patients before (triiodothyronine [T3] hormone level = 331 +/- 108 ng/dl), during (T3 level = 202 +/- 98 ng/dl) and after an antihyperthyroid therapy of 8 to 89 weeks' duration (T3 level = 149 +/- 41 ng/dl). The data were compared with those of 50 control subjects free from cardiac disease. Only 12 hyperthyroid patients (32%) had complex ventricular arrhythmias (Lown grade 3 or 4) as compared with 6 normal subjects (12%, p greater than 0.05). Three patients (8%) had repetitive ventricular arrhythmias (Lown grade 4A/B) as compared with 4 normal subjects (8%, p greater than 0.05). Supraventricular premature complexes occurred more often in hyperthyroid patients than in normal subjects before and after therapy (p less than 0.001). The prevalence of supraventricular tachycardia decreased from 8 patients to 1 during therapy (p less than 0.002). The HR decreased from 95 +/- 13 to 79 +/- 9 beats/min after therapy, but was still increased as compared with the normal subjects (72 +/- 8 beats/min, p less than 0.001). A day/night difference in HR greater than 10% was found in 32 patients (86%) and was more pronounced than in the normal group (p less than 0.001). Compared with the normal HR profile, the HR curve of hyperthyroid patients was shifted to a higher level (about 20 beats/min). Serum T3 level correlated best with HR at night in hyperthyroid patients (r = 0.74, p less than 0.001). Thus, hyperthyroid patients show frequent supraventricular arrhythmias that might be reversible during therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1989

[Long-term study of endocrine ophthalmopathy and retrospective assessment of therapeutic measures].

The follow-up of Graves' ophthalmopathy was analysed regarding to clinical and chemical data on the one hand and to dependence on different therapeutic alternatives on the other. 297 patients (44 +/- 14 years, 249 female, 48 men) were observed with inclusion of data from the history and clinical data as well (computer tomography and orbital sonography). At the onset of therapy 253 patients were hyperthyroid, 36 euthyroid and eight showed hypothyroidism. The staging was: I 13, II 54, III 113, IV 95, V five, VI eight patients. The HLA-typing in 89 patients showed the following results: B8 in 32%, DR3 in 42%, B8 as well as DR3 in 24% of the patients. In about 50% of the cases there were raised microsomal and in about 18% there were raised thyroglobuline antibodies. 63% of the patients received immunosuppressive medication: corticosteroids in 100% (more than one time in 43%), cyclosporine A in 11%, ciamexone in 10%, other non-steroid immunosuppressants in 5% of the cases. The retrobulbar irradiation was performed in 9%, and total thyroidectomy in 7%. During therapy the inflammatory process was clearly ameliorated, however exophthalmos and diplopia were more resistant to treatment. In the group of patients with combined cyclosporine and prednisone therapy and in the group of patients with total thyroidectomy and partly retrobulbar radiotherapy, significant differences were observed regarding to visual acuity and Hertel values. None of the therapies applied constitutes an optimal treatment with the regard to the long-term course. Under therapy an improvement can be reached, but no complete healing.

Adolescent↗
PubMed1989

[Thyroxine vs iodine and thyroxine. Comparison of the TSH suppression test].

In a crossover study 20 subjects (12 with non-toxic goiter) were given 150 micrograms levo-thyroxine (LT4) or a combination of 100 micrograms LT4 and 100 micrograms iodide daily for 8 weeks. Group I took 150 micrograms LT4 and group II the combination. After 4 weeks the two groups switched medications. A clinical examination, an intravenous TRH test and thyroid sonography were performed before the start of the study and 4 and 8 weeks thereafter. 150 micrograms LT4 daily resulted in significantly higher TSH suppression than the combination. A decrease in thyroid volume from 45 ml (mean range 24-85) to 26 ml (17-70 ml) was registered after as little as 4 weeks' therapy in 12 of 20 subjects with goiter.

Adult↗
PubMed1989

Ciclosporin and thyroid-stimulating immunoglobulins in endocrine orbitopathy.

The study investigated whether ciclosporin (C) affected the thyroid-stimulating immunoglobulins (TSI) in serum of patients with endocrine orbitopathy (EO). The effect of C was compared with that of prednisone (P). Fifteen patients with EO classes III-V received C (n = 7) or P (n = 8). In addition to the immunosuppressants, five patients with Graves' disease in each group received methimazole (MMI). The stimulation of the cAMP levels in the medium of thyrocyte cultures was determined as a parameter of TSI. The TSI levels were markedly lowered in both groups during and after therapy. C group: before therapy 6.2 pmol/ml +/- 1.63 (100%, mean +/- SEM), during treatment 4.6 pmol/ml +/- 2.28 (74%), after treatment 4.1 pmol/ml +/- 1.33 (66%). P group: before treatment 9.1 pmol/ml +/- 3.42 (100%), during treatment 5.9 pmol/ml +/- 2.90 (65%), after treatment 3.7 pmol/ml +/- 1.20 (41%). There is neither a significant difference between the two groups nor between the patients who received the combined therapy (MMI + immunosuppressants) or only received immunosuppressants (P more than 0.05). The mean cAMP value of the healthy reference group (n = 19) is 0.4 pmol/ml +/- 0.03. There is a significant difference between this value and the cAMP values of the patients both before and after therapy (P less than 0.01). Thus, both C and P markedly lower the TSI titers of patients with EO.

Adult↗
PubMed1989

Eye muscle antibodies in endocrine exophthalmos. Clinical and serological observations.

Serum samples were obtained from 65 patients with endocrine exophthalmos class I-V. In 33/65 patients who were treated either with prednisone or with ciclosporin, blood was sampled before, during and after therapy. Antibodies against eye muscle were determined during the course of immunosuppressive therapy in order to have an objective parameter of the therapeutic effect. To ascertain the specificity of the reaction both eye and abdominal muscles were used as antigens in an ELISA system. Both IgG and IgM antibodies were detected. In 45/65 patients (71%) eye muscle antibodies were positive before starting therapy. Antibodies were mostly detected in patients with active disease. Patients with exophthalmos of recent onset always had IgM antibodies whereas patients with chronic exophthalmos were mostly IgG positive. Patients with relapse showed mostly IgG but also IgG and IgM positivity in 2 cases. In 58% of cases only IgG antibodies were found whereas in 34% both IgG and IgM were detected and in 8% only IgM antibodies. There was no association between antibodies directed against eye muscle and thyroid microsomal and thyroglobulin antibodies or with the state of thyroid function. Furthermore there was no correlation between exophthalmos classes and eye muscle antibody binding activity. The antibody level declined during therapy with prednisone or with ciclosporin but rose again 8-12 weeks after stopping the drug in patients with progressive disease.

Adolescent↗
PubMed1988

Immunosuppressant therapy of thyroid eye disease.

Thyroid eye disease is attributed to an autoimmune process where both cellular and humoral immunity play a role. In this report, after a short introduction dealing with immunopathogenesis of the disease, immunosuppressant therapy is discussed. Treatment with glucocorticoids (as the standard substance), nonsteroid immunosuppressants (azathioprine, cyclophosphamide, lately cyclosporin) and with the immunomodulatory substance ciamexone is reviewed. Retroorbital irradiation as a "local" immunosuppressive method and plasmapheresis are also discussed. While systemic glucocorticoids and to a lesser extent orbital radiotherapy are routinely administered for severe Graves' ophthalmopathy, nonsteroid immunosuppressants and plasmapheresis are not yet part of the established treatment of thyroid eye disease. Their use should currently remain confined to controlled studies.

Graves Disease↗
PubMed1988

[Arrhythmia profile and heart rate in hyperthyroidism].

Arrhythmia profiles and heart rates, obtained by 24-hour ECG monitoring, were analysed in 48 patients with hyperthyroidism before (T3 level: 331 +/- 108 ng/100 ml, heart rate: 95 +/- 13/min), during (T3 level: 202 +/- 98 ng/100 ml, heart rate: 85 +/- 11/min) and after (T3 level: 149 +/- 41 ng/100 ml, heart rate: 79 +/- 9/min) antithyroid treatment. 50 persons in whom organic heart disease has been excluded by invasive and noninvasive tests served as controls. Only 6% of patients had repetitive ventricular arrhythmias (Lown group IV) before treatment (controls: 4%; P greater than 0.05). Supraventricular extrasystoles were common both before and after treatment (P less than 0.001), especially in elderly patients. The number of patients with supraventricular tachycardias decreased in the course of treatment from eleven to two. There was a clear correlation between the T3 level and nocturnal heart rate (r = 0.74; P less than 0.001). A day-night difference in heart rate (a ratio of greater than or equal to 1.10) was present in 43 patients and higher than in the controls (P less than 0.001). Thus with respect to ventricular arrhythmias hyperthyroid patients had a normal profile, but a marked tendency towards supraventricular arrhythmias which was partly age-related. Antithyroid treatment affected only the incidence of supraventricular tachycardias, while day-night differences in heart rate remained unchanged.

Adult↗
PubMed1988

Exophthalmos and basilar impression. A contribution to differential diagnosis of endocrine orbitopathy.

We report on a male patient with exophthalmos of unclear etiology, basilar impression, syringohydromyelia and type II Arnold-Chiari malformation. Two diseases involving the orbital region were to be considered in differential diagnostic terms: endocrine orbitopathy and osseous orbit dysplasia. The typical physical appearance associated with basilar impression as well as suppurative keratitis in Lagophthalmos was striking. Tetraspasticity with pareses, bulbar symptoms, proximally pronounced muscular atrophy as well as a left hemihypesthesia was shown neurologically. Although the orbit CT was normal, sonography revealed thickened ocular muscles. There was euthyroidism in diffuse goiter with negative thyroid autoantibody findings. Because of lack of definitive detection of muscular swelling, tumor, or vascular anomaly in the various images, orbital dysplasia in the context of a malformation syndrome affecting several organs is suggested as the cause of the exophthalmos.

Arnold-Chiari Malformation↗
PubMed1988

Multiple peptide hormone producing adenocarcinoma of lung with neurotensin and CRF-like immunoreactivity.

A pulmonary cancer of a 43 year-old-man was classified according to WHO-criteria as a poorly differentiated adenocarcinoma because of demonstration of mucinous substances in tumor cells and in rarely occurring acinar lumina. Immunohistochemical reactivity for several peptide hormones was detected in the predominant solid parts of the carcinoma. In many tumor cells an immunoreactivity to neurotensin, bombesin and - according to the elevated serum levels - to ACTH, CRF and calcitonin was found. Therefore the present lung cancer must be defined as a combined carcinoma composed of mucous producing and endocrine cell types. Because peptide hormone production is not restricted to the classical "neuro"-endocrine lung tumors, the histogenesis of this heterogeneous lung cancer is discussed.

Adenocarcinoma↗