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Biomedical subjects

H Kehlet

Publications and source records attributed to H Kehlet.

At least 361 records · Page 20Linked to original sources
PubMed1981

Decreased insulin removal contributes to hyperinsulinemia in obesity.

Peripheral plasma insulin and C-peptide concentrations during oral glucose tolerance tests were measured in 7 severely obese and 12 normal weight nondiabetic subjects. The insulin and C-peptide levels as well as incremental areas under the plasma curves were 2--5 times higher in the obese subjects (P less than 0.05). The C-peptide to insulin molar ratios as well as the relation between incremental areas under the plasma curves of the two peptides were used as relative measures of the hepatic insulin extraction. They were both reduced in the obese subjects, which suggests that decreased insulin removal may contribute to the hyperinsulinemia of obesity. Sixty minutes after the oral glucose load, all of the obese patients had higher peripheral venous insulin concentrations compared with those found in normal subjects with similar C-peptide levels. This suggests that the reduced insulin extraction is not entirely explained by increased beta-cell secretory activity, but is also a specific consequence of obesity.

Blood Glucose↗
PubMed1981

Adrenocortical function compared with computed tomography of the adrenals in small cell carcinoma of the lung.

Autopsy in patients with pulmonary small cell carcinoma frequently reveals metastases to the adrenal glands. In order to test the hypothesis that CT scanning might demonstrate such metastases at the time of clinical diagnosis of the pulmonary disease, the results of adrenal CT in 15 patients were correlated to adrenocortical function tests. No statistically significant relationship was found. It is concluded that no reliable non-invasive method exists to diagnose adrenal metastases in patients with pulmonary small cell carcinoma.

Adrenal Cortex↗
PubMed1980

Prevention of postoperative lymphopenia and granulocytosis by epidural analgesia.

Blood leucocyte-counts, cortisol, and glucose were measured in twelve healthy premenopausal women undergoing elective abdominal hysterectomy during either general anaesthesia (six women) or epidural analgesia (T4 to S5) (six women). Surgery during general anaesthesia caused significant lymphopenia 6 and 9 h after skin incision and significantly increased granulocyte-counts 6, 9, and 24 h after skin incision. Epidural analgesia prevented lymphopenia and reduced granulocytosis to about 40% of that seen in the group receiving general anaesthesia. The normal increase in plasma glucose and cortisol during and after surgery was abolished by epidural analgesia. These results indicate that neurogenic stimuli from the surgical area, probably through their influence on adrenal hormones (cortisol and adrenaline), are the main mediators of postoperative lymphopenia and are partly responsible for postoperative granulocytosis. Inhibition of the endocrine-metabolic response to surgery may prevent postoperative immunodepression.

Adult↗
PubMed1980

30 Min ACTH stimulation test as predictor of hypothalamic-pituitary-adrenocortical function. Comparison with metyrapone test.

In 32 subjects the hypothalamic-pituitary-adrenocortical (HPA) response to metyrapone was found to correlate significantly with the adrenocortical response to exogenous ACTH. This report provides additional evidence suggesting that a 30 min exogenous ACTH stimulation test accurately predicts the integrated responsiveness of the HPA system to various stimuli.

Adolescent↗
PubMed1980

Effect of epidural analgesia on glucose tolerance during surgery.

Intravenous glucose tolerance tests were performed on 12 surgical patients the day before surgery and during surgery. Six patients were anesthetized with enflurane and six were operated on during an epidural lumbar blockade (Th8-S5). In the general anaesthesia group the plasma glucose concentration was significantly higher after the intraoperative glucose load than after the preoperative load. The pre- and intraoperative glucose tolerance tests were identical in the epidural group. Pre- and intraoperative glucose disappearance rates and plasma insulin responses were similar in the two groups, indicating that the observed differences in plasma glucose were caused by differences in hepatic glucose release, rather than differences in peripheral glucose utilization.

Aged↗
PubMed1980

Impaired conversion of prednisone to prednisolone in patients with liver cirrhosis.

Fourteen patients with liver cirrhosis received oral prednisone or prednisolone (0.3 mg per kg) randomised on two consecutive days. Serum prednisone and prednisolone were measured over the following four hours. Mean serum prednisolone concentration after oral prednisone decreased with impaired liver function estimated by galactose elimination capacity (r = 0.64, P less than 0.03). Mean serum prednisolone concentration after oral prednisone in the seven patients with severely impaired liver function was only 53% (P less than 0.05) of that observed in the seven patients with slightly impaired liver function. Conversely, mean serum prednisone concentration after oral prednisone in the patients with severely impaired liver function was 74% higher (P = 0.05) than in patients with slightly impaired liver function. Mean serum prednisolone after oral prednisolone was independent of liver function. As only prednisolone exerts glucocorticoid activity, our results indicate that prednisolone should be preferred to prednisone in the treatment of patients with impaired liver function.

Administration, Oral↗
PubMed1980

Effect of ketone body infusion on plasma catecholamine and substrate concentrations during acute hypoglycemia in man.

Experimental studies have shown that ketone body infusion inhibits the catecholamine response to hypoglycemia. We have studied six men during insulin-induced hypoglycemia who were concomitantly infused with saline or 3-hydroxybutyrate at dose rates of 4 and 13 mg/kg.min. The mean blood concentrations of 3-hydroxybutyrate increased to about 0.45 and 3 mmol/liter, respectively. The results show that the glucose response to insulin; hypoglycemic symptoms; and the adrenaline, noradrenaline, and cortisol responses to hypoglycemia were not influenced by ketone infusion at any dose rate.

3-Hydroxybutyric Acid↗
PubMed1980

Urinary excretion of cortisol in acromegaly.

Free urinary cortisol excretion was measured in 19 patients with acromegaly and 19 matched controls with other pituitary disorders who were comparable with regard to age, sex, and adrenocortical response to ACTH. Excretion of cortisol was significantly higher (P less than 0.01) in the acromegalics (mean, 161 micrograms/24 h or 444 nmol/24 h) compared to the controls (mean, 82 micrograms/24 h or 226 nmol/24 h) normal subjects (mean, 85 micrograms/24 h or 235 nmol/24 h). Seven of the acromegalics had excretion of urinary cortisol exceeding the upper normal limit. The most probable cause is an increased glomerular filtration of cortisol.

Acromegaly↗
PubMed1980

Prolactin, LH, FSH, GH and cortisol response to surgery and the effect of epidural analgesia.

The prolactin, LH, FSH, growth hormone and cortisol responses to surgical stress were studied in female patients receiving halothane (general) anaesthesia or epidural analgesia. Plasma cortisol, prolactin, and growth hormone concentrations increased during surgery, and post-operatively in patients operated under general anaesthesia, but not in patients operated during epidural analgesia. Gonadotrophin concentrations were unchanged in the general anaesthesia group until 9 h after stimulation when levels decreased slightly. In contrast plasma gonadotrophin levels decreased immediately after the administration of epidural analgesia and during the following 9 h. It is concluded that neurogenic blockade inhibits the anterior pituitary response to surgical stress.

Adult↗
PubMed1980

Release mechanisms of postoperative changes in various acute phase proteins and immunoglobulins.

Postoperative changes in various acute phase proteins (transferrin, albumin, prealbumin, orosomucoid, haptoglobin, IgA, IgG, and IgM), plasma glucose, and cortisol were studied in twelve otherwise healthy premenopausal women undergoing elective hysterectomy during either general anaesthesia or epidural analgesia (T4-S5). The results showed a 10-20% decrease of all proteins during the first postoperative day (p less than 0.05), followed by a gradual, significant increase of orosomucoid to 80% and of haptoglobin to 140% above preoperative levels on day seven after surgery in both groups. The other proteins remained significantly decreased during the second postoperative day, but returned to preoperative levels by day seven after surgery in both groups. Epidural analgesia blocked the normal postoperative increase in plasma glucose and cortisol. Plasma levels of transferrin, albumin, prealbumin, IgA, IgG, and IgM were significantly lower during the first postoperative day in the epidural group. It is concluded that postoperative changes in acute phase proteins are mediated by factors other than neurogenic stimuli and adrenal hormones.

Adult↗
PubMed1979

Effect of epidural analgesia on metabolic profiles during and after surgery.

Blood concentrations of glucose, lactate, alanine, free fatty acids, glycerol and 3-hydroxybutyrate were measured during 24 h in 12 females undergoing elective hysterectomy under either general anaesthesia or epidural analgesia extending from T4 to S5. The results showed that the peroperative and immediate postoperative metabolic profiles in the group receiving general anaesthesia reflected substrate mobilization (increased glucose, lactate, 3-hydroxybutyrate), and that epidural analgesia blocked these changes, probably mediated through an inhibited adrenaline response to surgery. Peroperative values of free fatty acids and glycerol were significantly lowered by epidural analgesia, indicating inhibition of lipolysis. Alanine decreased similarly in both groups. In the later postoperative period metabolic profiles were similar in two groups, indicating that the influence of fasting may override the effect of the relatively minor trauma.

Adult↗
PubMed1979

Influence of age on the endocrine-metabolic response to surgery.

The pathogenesis of the increased operative risk in elderly patients is unknown. From a theoretical point of view, a change in endocrine-metabolic response might be involved. In the present study, a battery of hormonal and metabolic variables were measured in eight young and eight elderly healthy males undergoing elective inguinal hernial repair under general anesthesia. Blood was drawn before induction of anesthesia, at skin incision, and one, two, and six hours after skin incision. The findings were: 1) Plasma cortisol increase was significantly higher in elderly than in young controls. 2) Plasma renin level was lower in old age, but renin-aldosterone and electrolyte response patterns were alike in the two groups. 3) Thyroid parameters, in terms of serum T4, serum T3, serum rT3, and T3-resin uptake, responded normally to surgery and showed no age-related differences. 4) The hyperglycemic response was not significantly influenced by age indicating unchanged glycoregulatory mechanisms also verified by determinations of plasma catecholamines, cAMP, and insulin. 5) Blood lymphocyte count was constantly lower in elderly than in young and decreased with time, but the age-related difference was not significant. 6) Blood polymorphonuclear leukocytes showed an increase of the same magnitude in both age groups, although at a significantly slower rate in the elderly. It is concluded that age affects some aspects of the initial endocrine-metabolic response to surgery.

Adult↗
PubMed1979

Pancreatic beta cell secretion during oral and intravenous glucose administration.

The contribution of decreased hepatic insulin extraction to the relative hyperinsulinemia after oral glucose load as compared to intravenous glucose load was studied in 6 normal weight male volunteers by means of an analysis of the relationship between peripheral venous concentrations of insulin and C-peptide following similar glycemic stimuli after oral and intravenous glucose administration. The incremental areas under the insulin and C-peptide curves were higher during oral as compared to intravenous glucose administration, 436 (251--762) per cent and 267 (124-378) per cent respectively (mean and range). The ratio between corresponding incremental areas of insulin and C-peptide were 53 (17--103 per cent higher during oral glucose load. These findings suggest that the augmented peripheral insulin levels after oral glucose administration are caused by a combination of increased beta cell secretion and decreased hepatic insulin extraction.

Adult↗
PubMed1979

Thyrotropin, free and total triiodothyronine, and thyroxine in serum during surgery.

Changes in free and total thyroxine (T4), triiodothyronine (T3) and thyroid stimulating hormone (TSH) in serum were measured before, during, and for nine days after uncomplicated abdominal surgery in eight patients. The results showed a pronounced fall in total as well as in free T3 levels, amounting to 50% in both variables on the first postoperative day, and returning towards preoperative levels on the seventh and ninth day. Apart from an increase during surgery, free T4 levels were constant in the whole period despite a slight postoperative decrease in total T4. The TSH level fell about 80% within the first 24 postoperative h, but returned to the preoperative level thereafter. These results suggest a suppression of both T3 and TSH production during the pre- and early postoperative period.

Female↗