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J Jervell

Publications and source records attributed to J Jervell.

At least 37 records · Page 2Linked to original sources
PubMed1995

Future perspectives of lay organizations.

The article describes the contributions of lay organizations in the field of diabetes. Attention is paid to the often-used terminology like laymen, patients and chronic disease. Further, the major contribution of lay organizations is stressed--their unique knowledge advocacy group for social rights, improvement, and partnership, also concerning the relationship with professionals. Financial restraints for the organization of people with chronic diseases are presented. Conclusions are drawn on the future role of lay organizations.

Diabetes Mellitus↗
PubMed1995

Sandostatin LAR in acromegalic patients: a dose-range study.

Sandostatin LAR is a sustained release formulation of octreotide that has been developed by microencapsulating the drug with biodegradable poly(lactide-glycolide)-glucose. We have investigated the efficacy and tolerability of Sandostatin LAR given as a single dose im to patients with active acromegaly who showed good GH suppression during a 2- to 4-week pretreatment period with octreotide given sc. Two double blind studies were performed. Initially, 14 patients were randomized and observed over 42 days after a single im injection of 3, 6, 9, or 12 mg Sandostatin LAR. In the second study, 15 patients were randomized and observed over 60 days after a single im injection of either 20 or 30 mg Sandostatin LAR. Assessments of 12-h GH and octreotide profiles and adverse events were made on day -14 (during treatment with Sandostatin, sc); day 0 (off treatment after wash-out period); days 1, 7, 14, 21, 28, 35, and 42; and, for study 2, also on days 49 and 60 after the im injection. Only injections of 20 or 30 mg were followed by a suppression of basal GH and insulin-like growth factor I to levels comparable to those seen during sc treatment. The suppression of mean GH to less than 5 micrograms/L lasted for 4 weeks in the group receiving 20 mg and for at least 6 weeks in those given 30 mg Sandostatin LAR. The pharmacokinetic profile fitted a biphasic drug release model previously described for peptides in similar drug delivery systems. Serum concentrations correlated with the im administered dose. Suppression of GH and insulin-like growth factor I was achieved at serum octreotide concentrations exceeding approximately 600 ng/L. Tolerability was good. Sandostatin LAR holds promise as a valuable drug for the treatment of acromegaly. The results of ongoing long term studies will provide further necessary knowledge of the drug.

Acromegaly↗
PubMed1994

A comparison of octreotide, bromocriptine, or a combination of both drugs in acromegaly.

We investigated the pharmacokinetics of bromocriptine and octreotide, both individually and in combination, in 12 patients with active acromegaly. The pharmacodynamics of the drugs were assessed by 12-h profiles of GH secretion and insulin-like growth factor-I (IGF-I) measurements. During the 42-day study period, bromocriptine was administered for 28 days (from day 8; 5 mg, orally, twice daily) and octreotide (200 micrograms, sc, twice daily) from days 15-42. IGF-I levels, 12-h GH, and plasma bromocriptine and octreotide profiles were obtained on days 0, 14, 28, and 42. During bromocriptine treatment, both the area under the GH day curves (AUC) and mean IGF-I decreased to 64% (95% confidence limits, 43-72% and 48-82%, respectively) of initial values. During octreotide treatment, the respective values were 23% (18-30%) and 32% (21-36%), which were greater decreases than those during bromocriptine treatment [36% (95% confidence limits, 32-54%) for AUC for GH and 50% (95% confidence limits, 34-58%) for IGF-I]. With combined treatment, the AUC for GH was reduced to 16% (12-21%) and that of IGF-I to 25% (16-27%) of initial values. This combination was more effective than bromocriptine [25% (95% confidence limits, 22-37%) for AUC for GH and 39% (95% confidence limits, 25-43%) for IGF-I] and octreotide alone [78% (95% confidence limits, 53-89%) for AUC for GH and 78% (95% confidence limits, 57-98%) for IGF-I]. The pharmacokinetic parameters of octreotide were unchanged by the coadministration of bromocriptine. The bioavailability of bromocriptine increased by approximately 40% when bromocriptine was administered together with octreotide compared with administration alone (P < 0.01). Bromocriptine disposition parameters were unaltered. In conclusion, treatment of acromegalics with a combination of octreotide and bromocriptine increases the bioavailability of bromocriptine and reduces both GH and IGF-I levels more effectively than treatment with either drug alone. This presents the possibility of less frequent drug administrations, lower doses of octreotide, and, consequently, lower treatment costs.

Acromegaly↗
PubMed1993

[Acute endocrinology].

The author presents a practical guide for diagnosis and management of some common emergencies. The most common are hypoglycaemia in persons with diabetes, diabetic ketoacidosis and non-ketotic hyperosmolar diabetic coma. Acute adrenocortical failure is also quite common. These three conditions can be presented in persons with diagnosed disease. Therefore prevention should be possible with proper education. In rare cases the emergency situation is the presenting symptom. Thyreotoxic crisis, myxoedema coma and hypercalcemic crisis are less common. A high level of suspicion is important for early diagnosis and successful treatment of these conditions.

Acute Disease↗
PubMed1993

[Nutrition on the world map. The UN International Conference on Nutrition].

The first International Conference on Nutrition ever organized by the United Nations took place in Rome in December 1992. The conference was attended by representatives of 159 countries and of various non-governmental organizations and the food industry. Preparations for the conference included preparation of a number of background documents, including an analysis of the nutritional situation in the different countries (country papers), twelve in-depth studies, eight theme papers and an assessment of the global nutrition situation. This article describes the process leading up to the conference, some of the problems and conflicts that appeared, controversial issues that were discussed and the final outcome of the conference (The world declaration and Plan of action for nutrition). The countries that participated in the conference pledged to make every effort to eliminate, before the end on this decade, famine and famine-related deaths, starvation and nutritional deficiencies related to natural and man-made disasters, and deficiencies of iodine and vitamin A.

Global Health↗
PubMed1993

[Endocrine disorders in adolescents and young adults].

Evaluation of 158 patients younger than 25 years-of-age who had been hospitalized in a specialized adult endocrine department during an 11 year-period, brought to light specific endocrine problems connected both to pediatrics and internal medicine. There is need for close collaboration between pediatricians, as experts on disturbances in growth and pubertal development, and internists, with experience of diagnosing rare endocrinological disorders. Such collaboration might also improve the follow-up of young patients into adulthood.

Adolescent↗
PubMed1993

Long-term treatment of macroprolactinomas with CV 205-502.

The long-term efficacy and tolerability of CV 205-502, a non-ergot dopamine agonist with D-2 receptor affinity, were studied for up to 36 months in 16 patients with macroprolactinomas. Prolactin values were reduced in all cases, becoming either normalized or suppressed in 12. The pituitary tumor size was reduced in the 13 patients with an obvious tumor and visual function normalized in all six patients with initial defects. Concomitantly we observed improvement in gonadal function, galactorrhea, headache, libido and general well-being. Adverse reactions were experienced by 15 patients during dosage increment and caused one patient to discontinue the medication. Seven patients had persistent adverse effects which prohibited a dosage increase of CV 205-502, sufficient to normalize PRL levels in three. Two patients experienced serious adverse events, causing the discontinuation of treatment in one case. In eight patients treatment with CV 205-502 and bromocriptine could be compared. Three patients responded better to CV 205-502 than to bromocriptine treatment. Only one patient preferred bromocriptine to CV 205-502 for long-term treatment. We conclude that CV 205-502 is an effective and in most cases well-tolerated treatment for patients with macroprolactinomas. CV 205-502 is preferable to bromocriptine as an initial treatment and should also be tried in patients where treatment with bromocriptine has failed.

Adult↗
PubMed1992

Persistence of hyperinsulinemia in polycystic ovary syndrome after ovarian suppression by gonadotropin-releasing hormone agonist.

To investigate the effect of long-term androgen suppression on insulin sensitivity, obese and non-obese women with the polycystic ovary syndrome and obese and non-obese ovulatory women were given an oral glucose tolerance test before and after treatment with a gonadotropin-releasing hormone agonist. The women with polycystic ovary syndrome showed higher basal luteinizing hormone and androgen levels than the ovulatory women. All women with the polycystic ovary syndrome responded non-diabetically to the glucose tolerance test. However, compared with controls, the obese women with the polycystic ovary syndrome showed a hyperinsulinemic response to the glucose tolerance test, indicating insulin resistance. During the 3-h glucose tolerance test there was no concomitant change in androgen levels in the hyperinsulinemic women with the polycystic ovary syndrome. The insulin response to an oral glucose tolerance test remained unchanged in all women, although a hypogonadotropic hypogonadal state was maintained for several weeks. This study therefore suggests that endogenous androgens do not play a role in sustaining insulin resistance in women with the polycystic ovary syndrome.

Adult↗
PubMed1991

[Insulin consumption in Norway 1975-89. How much did the change to insulin 100 cost?].

The consumption of the various types of insulin in the period 1975-89 has been examined. Norway changed from insulin U-40 to insulin U-100 on 1 April 1987. This led to a marked increase in sales of insulin. Sales from the Norwegian Medicinal Depot (the national drug wholesale monopoly) in 1989 were 23% higher than average sales for the three years preceding the change (1984-86). This increase represents a retail value of NOK 59 million. The main reason for the increase is probably a disproportionate relationship between the amount of insulin in each vial (10 ml) and the recommended deadline for using the rest of the insulin in the vial after the first withdrawal. This has most likely led to an extensive discarding of vials containing surplus insulin. Vials with a smaller volume (5 ml) and/or re-assessment of the recommended lifespan of an opened vial might decrease the amount of insulin discarded as waste.

Costs and Cost Analysis↗
PubMed1991

Long-term metabolic control in recipients of combined pancreas and kidney transplants.

Metabolic glucose control was followed in 36 patients at 12-month intervals for up to 5 years after a successful combined kidney and segmental duct-occluded pancreas transplantation. All recipients had normal blood glucose levels at each examination. HbA1 values, intravenous glucose tolerance test, C-peptide levels and C-peptide responses to glucagon stimulation were also, on average, within the normal range. Several individual patients had, however, abnormal values for these parameters. At most 46% had abnormal values for HbA1 and intravenous glucose tolerance test, up to 13% showed low C-peptide values and up to 46% of the stimulated C-peptide responses were inadequate at the different intervals. These parameters did not deteriorate with time. This was true both for the whole group of patients as well as for the 6 patients with a 5-year observation time evaluated separately. Despite these abnormalities in glucose metabolism, all patients remained normoglycaemic without need for exogenous insulin up to 5 years after transplantation. The long-term ability of duct-occluded segmental pancreatic grafts to preserve euglycaemia therefore seems to remain intact at least for 5 years.

Adult↗
PubMed1991

Contrasting effects of lisinopril and nifedipine on albuminuria and tubular transport functions in insulin dependent diabetics with nephropathy.

An open, randomized, cross-over study was undertaken to assess the effects of lisinopril and nifedipine on albumin excretion, renal haemodynamics and segmental tubular reabsorption in overt diabetic nephropathy. The study consisted of a 4-week run-in period, a 3-week active treatment period, a 4-week wash-out period and a second 3-week active treatment period. Twelve patients with type 1 diabetes with albuminuria, mild to moderate hypertension and a serum creatinine level of less than 200 mumol l-1 were included. Lisinopril reduced albumin excretion from 1343 +/- 337 micrograms min-1 to 879 +/- 299 micrograms min-1 (P less than 0.01), whereas nifedipine was without effect, 1436 +/- 336 micrograms min-1 vs. 1319 +/- 342 micrograms min-1. Glomerular filtration rate (GFR) was unchanged by either drug. Both drugs increased effective renal plasma flow (ERPF) by about 20%. No differences between the drugs were observed with regard to their effect on renal haemodynamic parameters. By contrast, nifedipine exerted an inhibitory effect on several proximal tubular transport markers, whereas lisinopril was without effect. The different actions on tubular transport mechanisms exerted by lisinopril and nifedipine may contribute to the observed effect on albumin excretion.

Adult↗
PubMed1991

Long-term results of treatment of Cushing's disease by adrenalectomy.

Patients treated by adrenalectomy for suspected Cushing's syndrome were reviewed for the incidence to early and late complications, side effects, survival, and quality of life. Of a total of 141 patients, 109 had Cushing's disease, and were treated with subtotal (n = 15) or total (n = 94) adrenalectomy. All hospital charts were reviewed, and surviving patients were asked to fill in a questionnaire. Ten patients died in hospital. Morbidity was 13% (n = 18). Five patients required reoperation because of recurrent adrenal hyperplasia after subtotal adrenalectomy (n = 3) or incomplete adrenalectomy (n = 2). All patients received conventional corticosteroid supplementation. Ten patients developed Nelson's syndrome 3-20 years after adrenalectomy. Of the 109 patients with Cushing's disease 80 were alive 1-34 years after operation. Only four late deaths were related to Cushing's disease: 3 postoperative deaths followed reoperation and 1 was the result of an Addisonian crisis. About two thirds of the patients interviewed had satisfactory quality of life and were able to work. Total bilateral adrenalectomy has a five to seven fold higher perioperative mortality than transphenoidal operations. The prognosis of patients who survive the early postoperative period, however, is comparable to that of the general population.

Adolescent↗