Search PubMed⌕ Search

Biomedical subjects

J Cassar

Publications and source records attributed to J Cassar.

At least 37 records · Page 2Linked to original sources
PubMed1981

Development of diabetic microangiopathy and diabetic control. A study in non-insulin-dependent diabetics.

The relationship between the development of microangiopathy and the degree of diabetic control was investigated in 61 noninsulin-dependent diabetics after 5-10 years of known duration of diabetes. The degree of diabetic control was assessed by fasting blood glucose (FBG) at the last assessment, haemoglobin A1 (HbA1) and by the mean of all the fasting blood glucose values throughout the follow up (MWFBG). The 29 patients who developed microangiopathy had higher FBG at last assessment (10.1 +/- 0.6 vs 8.2 +/- 0.5 mmol/l, p less than 0.02), HbA1 (13.4 +/- 0.8 vs 11.0 +/- 0.6%, p less than 0.02) and MWFBG (8.0 +/- 0.4 vs 7.5 +/- 0.4 mmol/l, p less than 0.05) than those without microangiopathy. The FBG values at each year of the follow-up were higher in the microangiopathy group. HbA1 determined in 1979 correlated with the mean FBG values of each one of the years 1975-1978 (r = 0.575, r = 0.646, r = 0.657, r = 0.631, p less than 0.001, respectively). These data support the hypothesis that in noninsulin-dependent diabetics the development of microangiopathy is related to the degree of diabetic control.

Blood Glucose↗
PubMed1980

Deoxycorticosterone and aldosterone excretion in Cushing's syndrome.

We have used specific radioimmunoassays to measure urinary free deoxycorticosterone (DOC) and total aldosterone excretion in 15 patients with Cushing's syndrome. Free DOC excretion was increased in 6 of 8 patients with pituitary-dependent adrenal hyperplasia, in 2 of 3 patients with adrenal adenoma, and in all 4 cases with adrenal carcinoma. The most marked increase was noted in the adrenal carcinoma cases. Aldosterone excretion was high, normal, or low in each of the three types of Cushing's syndrome. The free DOC response to metyrapone in Cushing's syndrome due to adrenal adenoma was markedly different from that in patients with adrenal hyperplasia (pituitary-dependent) and may serve as a test to ascertain the etiology of the disorder. Correlations of free DOC and aldosterone excretion with free cortisol excretion, and their responses to the administration of metyrapone and dexamethasone were compatible with ACTH dependency in adrenal hyperplasia, autonomous production of steroids in adrenal adenomas and a chaotic steroidogenesis in adrenal carcinoma.

Adenoma↗
PubMed1979

Treatment of Cushing's disease in juveniles with interstitial pituitary irradiation.

Nine juvenile patients (five boys and four girls aged 10--18 with Cushing's disease were treated with pituitary implantation of 198Au and/or 90Y. No patient had any surgical complication from the procedure. At the latest assessment, 3 months to 17 years after operation, Cushing's disease was in remission in all the patients; the response time following operation was a few days to 3 months. Radiology of the pituitary fossa at time of pituitary implantation was normal in all patients and remains so. The final height in six patients is 149--172 cm (59--67.5 inches) and three patients who continue to grow have increased by 13, 6 and 3 cm since implantation. Only one patient required full pituitary hormone replacement therapy, and he had been previously treated by external irradiation, and one other patient failed to complete puberty. In all the other seven sexual maturation is normal and one has fathered two children. We conclude that pituitary implantation with interstitial irradiation is a satisfactory form of treatment for Cushing's disease in juveniles.

Adolescent↗
PubMed1979

Cushing's syndrome due to adrenocortical carcinoma - a comphrensive clinical and biochemical study of patients treated by surgery and chemotherapy.

Four post-menopausal women had Cushing's syndrome due to adrenal cortical carcinomas. Comprehensive analyses of blood and urinary steroids showed that although the steroid profiles differed between patients, the pattern in each patient remained almost constant as the disease progressed, or remitted due to therapy. Elevations of serum testosterone and oestradiol were commensurate with the extent of virilisation, and the urinary output of aldosterone was associated with the severity of hypertension. A new finding was that all had substantially increased urinary free deoxycorticosterone. Complete surgical removal of the primary tumours was impossible but when most of the tumour tissue was removed, full clinical and biochemical remissions were obtained for a short time in 2 patients. One patient obtained a clinical and biochemical remission from op'DDD. In another patient the drug caused reduction both in blood pressure and in urinary aldosterone excretion, but there were unpleasant side effects. A third patient could not tolerate op'DDD. Metyrapone therapy produced neither clinical nor biochemical improvement in 3 patients. The mean duration of survival was 17 months after the first symptoms and 10 months from the date of operation. Despite advances in drug therapy, adrenal cortical carcinoma remains a lethal disease. Biochemical screening of multiple steroids offers a means of early diagnosis and disease monitoring. Extensive surgical removal of the tumour offers the best chance of a clinical and biochemical remission.

17-Ketosteroids↗
PubMed1978

Diabetic retinopathy and pregnancy.

Diabetic retinopathy was found to be present in 12 out of a group of 67 diabetic patients supervised by us during 92 pregnancies, and 3 further pregnant diabetics were referred to us because of retinopathy. The mean duration of diabetes was 13 years (range 3--25 years). Nine patients had minimal retinopathy, 2 had background retinopathy, and the remaining 4 proliferative retinopathy. The cases with minimal retinopathy showed no progression during pregnancy. In 1 patient with background retinopathy there was deterioration. Of the 4 patients with proliferative retinopathy 1 showed regression during the pregnancy, 2 showed advance and were treated with photocoagulation (these 2 patients now have normal vision), while the patient with extensive retinitis proliferans, with retinal detachment in both eyes and previous photocoagulation remained unchanged. The prognosis during pregnancy for patients with diabetic retinopathy is reasonable and has been improved by the advent of photocoagulation.

Adolescent↗
PubMed1978

Simplified management of pregnancy complicated by diabetes.

Simple methods for the management of pregnancy complicated by diabetes are described. Emphasis was placed on keeping patients out of hospital, good control of diabetes and vaginal delivery at 38 weeks: using these methods, there were nine perinatal deaths in a consecutive series of 101 pregnancies complicated by diabetes. Four of the perinatal deaths were due to the respiratory distress syndrome. The patients whose diabetes was diagnosed during pregnancy had significantly heavier babies (18 pregnancies, mean birth weight 3337 g) than the established diabetics (83 pregnancies, mean weight 3011 g) despite significantly lower fasting blood glucose levels in the former and similar mean gestational ages at delivery. Mean fasting blood glucose levels for the whole series during the first, second and third trimesters were 9.0, 6.7 and 5.6 mmol/l respectively. The mean duration of antenatal stay in hospital for complications related to diabetes was 29 days. Diabetic retinopathy did not seem to be adversely affected by pregnancy.

Birth Weight↗
PubMed1978

Rapid enlargement of carniopharyngioma in pregnancy.

A patient is described in whom rapid enlargement of a craniopharyngioma during pregnancy caused visual disturbance. The tumour was removed at 29 weeks gestation and the patient went on to have a spontaneous labour and vaginal delivery at term.

Adult↗
PubMed1977

Bromocriptine treatment of acromegaly.

Bromocriptine at a dose of 7.5-30 mg/day was given to 12 acromegalics for 6 mo. Mean serum growth hormone (GH) levels during a glucose tolerance test (GTT) were significantly lowered by the drug. In four patients the serum GH response during a GTT was suppressed to normal (i.e. less than or equal to 5 mlU/liter). If bromocriptine had not brought the serum GH response to a GTT to normal at a dose of 20 mg/day, this effect was not achieved by raising the dose to 30 mg/day. Bromocriptine was effective for the duration of treatment. On discontinuing therapy there was an increase in serum GH levels. No obvious clinical changes in the acromegalic features were noted. One patient with impaired glucose tolerance and one with established diabetes had normal glucose tolerance while on bromocriptine and another two patients with impaired glucose tolerance showed no obvious changes while on the drug. Side effects were minor. X-rays of the pituitary fossa before starting and at the end of treatment showed no significant change. We conclude that although bromocriptine is the most promising form of medical treatment for acromegaly to date, it is fully effective only in a minority of patients.

Acromegaly↗
PubMed1976

Treatment of Nelson's syndrome by pituitary implantation of yttrium-90 or gold-198.

Eight patients with Nelson's syndrome were treated with a pituitary implant of yttrium-90 or gold-198 four to 16 years after adrenal surgery. All had considerable pigmentation. One already had cranial nerve abnormalities and visual field defects and had had both a craniotomy and deep x-ray treatment. Radiographs showed that the pituitary fossa was abnormal in seven patients. A biopsy performed in six cases showed mucoid (or basophil) adenoma in all. In the four specimens examined ACTH was identified by electron microscopy or immunofluorescence, or both. Patients were followed up after pituitary implantation for three months to 12 years. All showed decreased pigmentation, and six became normal. Four patients regained normal ACTH levels and the other two studied had decreased levels. In no case did new cranial nerve disease or further sellar expansion develop since operation, and two patients showed remodelling of the sella. Complications were temporary leakage of cerebrospinal fluid and diabetes insipidus in one patient and gonadotrophin deficiency in another.

Adenoma↗
PubMed1976

Effects of methyldopa on prolactin and growth hormone.

The effects of administration of methyldopa on serum prolactin and growth hormone (GH) concentrations in hypertensive patients were studied. Single doses of methyldopa (750 or 1000 mg) significantly increased serum prolactin levels, peak concentrations occurring four to six hours after drug administrations. Long-term methyldopa treatment was associated with threefold to fourfold increases in basal prolactin levels compared with those in normal subjects. In patients treated with methyldopa for two to three weeks the GH response to insulin hypoglycaemia was significantly greater than in normal subjects and untreated hypertensive patients. In contrast, patients treated for prolonged periods (mean 13-4 months) had a GH reponse indistinguishable from normal.

Adult↗
PubMed1975

Possible parathyroid origin of gastrin in a patient with multiple endocrine adenopathy type I.

After removal of two large pancreactic insulinomas, although the presenting spontaneous hypoglycaemia was eliminated, severe and persisting haematemesis and melaena supervened with a rise in serum gastrin. The patient had multiple endocrine adenopathy (pituitary, parathyroids and islet cells), but no evidence of a pancreatic gastrin-producing tumour. After emergency gastric operation for the bleeding, the serum gastrin remained high until the hypercalcaemia and hyperparathyroidism had been corrected by subtotal parathyroidectomy. Immunofluorescence studies showed gastrin in the parathyroid tissue.

Adenoma, Islet Cell↗