Failure to respond to dexamethasone with fatal consequences, after initial response to multidrug treatment in a case of amiodarone-associated thyrotoxicosis.
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Amiodarone↗
Biomedical subjects
J Unger
Publications and source records attributed to J Unger.
[The eye and acromegaly: apropos of a case of ptosis].
A 60-year-old woman presents with bilateral ptosis and tearing, predominant on the right and existing since many years. Upper tarsus is much enlarged on the right; lacrymal glands are palpable under the upper lid and seem enlarged as well. CT scan and RMN confirms the hypertrophy of subcutaneous lid tissues, lacrymal glands and ocular muscles. The patient is aware of a progressive change in her physical aspect since years. Medical work-up diagnoses major acromegaly. Discussion about the consequences of acromegaly upon the ocular adnexa.
Acromegaly↗
Thyroid consequences of Chernobyl accident in the countries of the European Community.
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Absorption↗
Characteristics and prognosis of extradural hematomas in children.
This is a report on 31 children with operated extradural hematoma. The aim of the study was to elucidate the characteristics of extradural hematoma in childhood and the different clinical pattern and outcome compared to adults. For that reason the charts of the patients seen at the Department of Surgery of the Children's University Hospital Zurich between 1972 and 1990 have been revised. Follow-up criteria were recorded according to the Glasgow Outcome Scale. Most hematomas have been provoked by minor injuries and almost all children presented with at least one typical clinical sign. Associated intracranial injuries have been found in four patients, while two were polytraumatised. 30 of the 31 patients survived. One patient died of malignant brain edema. The mean range of follow-up was seven years. 28 patients had a "good recovery", "moderate disability" and "severe disability" was found in a patient one each. Our results demonstrate that the long-term outcome in children with extradural hematoma is far better than in adults regarding survival as well as quality of life. The causes may be minor traumas with fewer associated lesions and presentation with typical clinical findings and therefore early diagnosis and treatment.
Adolescent↗
Effects of amiodarone on serum T3 and T4 concentrations in hyperthyroid patients treated with propylthiouracil.
Amiodarone (Cordarone) has been proven to be useful in the management of atrial fibrillation. However, because of a large iodine content, this drug is not used in this complication of thyrotoxicosis. We previously have observed a greater fall in serum T3 and T4 concentrations in hyperthyroid patients treated with amiodarone and methimazole than with methimazole alone. In the present study, we determined whether the addition of amiodarone to propylthiouracil (PTU) could improve the levels of circulating thyroid hormones in hyperthyroid patients, and we assessed the release of iodide from amiodarone by measuring the 24 h urinary iodine excretion. Twelve hyperthyroid patients were treated either with PTU, 600 mg daily for 10 days (group PTU), or with amiodarone (A), 1200 mg daily for 3 days in addition to PTU (group A-PTU). Basal serum T4, T3, and rT3 concentrations (mean +/- SEM) were respectively 206 +/- 13 nmol/L, 5.13 +/- 0.8 nmol/L, and 81 +/- 7 ng/dL for group PTU and 238 +/- 39 nmol/L, 4.73 +/- 1.06 nmol/L, and 84 +/- 12 ng/dL for group A-PTU (NS). In group A-PTU, plasma amiodarone peaked on day 3 (mean +/- SEM: 0.48 +/- 0.11 mg/L), and urinary iodine reached 5.27 +/- 1.28 mg/day on day 5. The fall in serum T3 and the increase in serum rT3 concentrations were significantly greater in group A-PTU than in group PTU (ANOVA, p less than 0.05). In group A-PTU, the minimal serum T3 concentration was observed on day 5 of treatment (28 +/- 6% of the pretreatment values).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The effect of amiodarone on the control of hyperthyroidism by propylthiouracil.
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Amiodarone↗
Treatment of supraventricular tachyarrhythmias associated with hyperthyroidism by radioiodine, amiodarone and propylthiouracil.
Beta-blockers and calcium antagonists have been advocated for thyrotoxicosis induced tachyarrhythmias. Amiodarone is generally considered as contraindicated because of its high iodine content. Since amiodarone combined with propylthiouracil induced a greater fall in serum thyroid hormone concentrations than propylthiouracil alone, we treated 2 hyperthyroid patients with supraventricular arrhythmias by radioiodine (day 0) followed after 24 h by amiodarone and propylthiouracil. Serum T3 was normalized on day 2 (patient 1) and 3 (patient 2). Effective t1/2 of intrathyroidal 131I were 6.6 and 4.3 days (versus 5.9 days for 131I given alone). In patient 1, atrial fibrillation, reverted to sinus rhythm after verapamil and digoxin, and did not recur. In patient 2, conversion of atrial fibrillation to sinus rhythm occurred on day 11; from day 0 to day 11, ventricular rate decreased and was significantly correlated to T3 (r = 0.82; p < 0.05). In conclusion, amiodarone may be beneficial in thyrotoxicosis associated tachyarrhythmias, given with propylthiouracil 24 h after radioiodine, it did not decrease thyroid irradiation and rapidly decreased serum T3.
Adult↗
Distribution of neuropeptide Y in the prosencephalon of man and cotton-head tamarin (Saguinus oedipus): colocalization with somatostatin in neurons of striatum and amygdala.
The presence, chromatographic properties and localization of neuropeptide Y was demonstrated in postmortem human brain areas of neurologically and neuropsychiatrically normative controls using immunocytochemistry and high performance liquid chromatography combined with radioimmunoassay. NPY-immunoreactivity was found in many regions of the prosencephalon. Numerous perikarya and fibers were present in the neocortex, basal ganglia and limbic-hypothalamic areas. A moderate number of neurons and fibers was observed in the basal forebrain, including the septal complex. A comparative immunohistochemical investigation in perfusion-fixed brains of the old-world ape Saguinus oedipus revealed an almost identical distribution of NPY-immunoreactivity with only minor differences. Colocalization experiments on 1-2 microns thin consecutive paraffin sections revealed a large number of NPY neurons throughout the human neostriatum and amygdaloid complex that were also positive for somatostatin. Our findings indicate that detection of neuropeptides in fresh or fixed post-mortem human tissue by different immunochemical methods may actually reflect the in vivo conditions. In addition, the wide distribution of NPY throughout the human brain and its colocalization with other neurotransmitters suggests a physiological role as neuroactive substance, i.e. neuromodulator in the primate central nervous system.
Amygdala↗
Peptidergic innervation within the prostate gland and seminal vesicle.
An immunohistochemical study in which antisera against several neuropeptides were used demonstrated the presence of neuropeptide Y(NPY) and vasoactive intestinal polypeptide (VIP) immunoreactivity in nerve fibers in the human prostate gland and seminal vesicle, whereas no immunostaining for substance P and calcitonin gene-related peptide was observed. The peptidergic innervation was found to be generally moderate to low. NPY- and VIP-immunoreactive fibers were localized in the subepithelial connective tissue as well as the smooth muscle layers in both organs, although the peptidergic fiber networks were more prominent in the seminal vesicle. Most NPY-immunoreactive fibers were observed in the musculature of the seminal vesicle. In addition, NPY- and VIP-immunoreactive fibers were demonstrated in the walls of blood vessels. The results of our study suggest that the innervation of the prostate gland and seminal vesicle by various neuroactive peptides may be involved in the autonomic regulation of these organs in adult man, as well as sympathetic and parasympathetic nerve fibers.
Adult↗
Amiodarone-induced thyrotoxicosis suggestive of thyroid damage.
Amiodarone-induced thyrotoxicosis (AIT) is generally believed to result from increased hormonal synthesis related to the iodine overload. Thyroid damage has recently been incriminated as a pathophysiological mechanism. We report 3 cases of AIT associated with clinical and/or biochemical features consistent with thyroid damage. This hypothesis was supported by a painful thyroid (case 1), transient high serum Tg (case 2), a transient (case 2) or persistent (case 3) hypothyroid phase and an undetectable technetium thyroid uptake during the hypothyroid period (case 3). These clinical observations support the previous histological data indicating that thyroid follicular disruption might contribute to the pathogenesis of AIT.
Adult↗
Calcitonin gene-related peptide and somatostatin immunoreactivities in the rat lumbar spinal cord: sexually dimorphic aspects.
The immunohistochemical distribution of calcitonin gene-related peptide and somatostatin in rat lumbar spinal laminae VII-X was investigated using the peroxidase-antiperoxidase technique. Within L1,2 laminae VII and X, calcitonin gene-related peptide and somatostatin fibers demarcate the location of preganglionic sympathetic neurons in a similar fashion in either sex but somatostatin is distributed in a sexually dimorphic manner in the lumbosacral (L5-S2) spinal cord with the male rat containing more somatostatin fibers and neurons than females. Within the ventral horn (lamina IX), calcitonin gene-related peptide has a sexually dimorphic distribution. Calcitonin gene-related peptide varicose fibers are found within the sexually dimorphic male cremaster nucleus but are virtually absent in the female cremaster nucleus. Calcitonin gene-related peptide varicose fibers are nearly absent in the remainder of the male and female lamina IX: this area includes the other two known sexually dimorphic spinal motonuclei: the dorsomedial and dorsolateral nuclei. Virtually all motoneurons in the lumbosacral spinal cord which are not sexually dimorphic contain calcitonin gene-related peptide. However, calcitonin gene-related peptide containing motoneurons have a heterogeneous distribution within sexually dimorphic nuclei. Calcitonin gene-related peptide containing motoneurons within the male and female cremaster nucleus are extremely rare. Some motoneurons within the male and female dorsomedial and dorsolateral nuclei contain calcitonin gene-related peptide with the female dorsomedial and dorsolateral nuclei containing a greater percentage of calcitonin gene-related peptide-containing motoneurons (c. 50%) than males (c. 20%). Somatostatin fibers are preferentially located in sexually dimorphic nuclei of either sex and are distributed in a sexually dimorphic manner within these nuclei with males containing a greater amount of somatostatin fibers than females. The amount of somatostatin immunoreactivity is most dense in the medial aspect of the dorsolateral nucleus, dense in the dorsomedial nucleus, moderate in the cremaster nucleus, and sparse in the lateral portion of the dorsolateral nucleus. In addition, a small column of motoneurons, between the dorsomedial and dorsolateral nuclei at the L5 level, is outlined by somatostatin fibers in females but is absent in males. Somatostatin containing motoneurons were not observed within the lumbar sexually dimorphic nuclei of either sex.
Animals↗
[Amiodarone and thyroid: the Janus effect].
Iodide released from Amiodarone during a chronic treatment is 100 x higher than food iodide intake. Thyroid adaptation allows normal function but over-adaptation leads to hypothyroidism and hypo-adaptation to thyrotoxicosis. Thyrotoxicosis may also result from follicular disruption. Amiodarone inhibits 5' deiodinase type I and II and hence increases serum T4 and (transiently) TSH and decreases serum T3 concentrations. Perchlorate and corticoids may be useful in the treatment of thyrotoxicosis.
Adaptation, Physiological↗
[Rhabdomyolysis following insulin therapy in hyperosmolar syndrome].
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Female↗
Novel poly-substituted aryl acridinium esters and their use in immunoassay.
A new series of stable acridinium ester conjugates have been developed for use as non-isotopic labels in immunoassay. They have proved to be a flexible alternative to radioimmunoassay. We present data showing the successful development of immunoassays in sandwich, competitive and receptor formats. In addition, hydrophilic acridinium ester analogues have been synthesized, encapsulated in liposomes, and utilized as labels in immunoassay. The potential of this technology is discussed.
Acridines↗
Future applications of Magic Lite technology.
The features that Magic Lite products offer as an immunoassay delivery system are discussed. The use of paramagnetic particles and acridinium ester labels confers advantages of speed, sensitivity, and stability. The technology has been used to measure analytes of widely varying molecular weights and serum concentrations, indicating its potential to detect the full range of clinically relevant analytes. Initial development efforts have indicated that the advantages of the system can be effectively exploited in an automated instrument.
Autoanalysis↗
Demonstration of atrial natriuretic peptide/cardiodilatin (ANP/CDD)-immunoreactivity in the salt gland of the Pekin duck.
A novel peptide hormone, atrial natriuretic factor/cardiodilatin (ANP/CDD), was recently isolated and characterized from mammalian heart. Its presence has been demonstrated in several organs that contribute to water and sodium homeostasis, such as salivary glands. This study demonstrates the presence of ANP/CDD immunoreactivity in the salt gland of Pekin ducks by high performance liquid chromatography, radioimmunoassay and immunocytochemistry, using a specific antibody against atriopeptide I. A small number of distinct, ovoid or cuboid shaped ANP/CDD-immunoreactive cells were localized in the connective tissue surrounding and separating the central secretory tubules, whereas no immunostaining was observed in the peripheral tubules. Salt glands of ducks that were adapted to salt water revealed a significant hypertrophy of their secretory lobules. However, no differences were found between the number or localization of immunoreactive cells in the salt gland of salt water-acclimatized ducks and nonstimulated glands of ducks that were housed with ad libitum access to fresh water. Our results indicate that ANP/CDD may play a role in the regulation of sodium secretion in the salt gland of aquatic birds.
Animals↗
Distribution of insulin receptor-like immunoreactivity in the rat forebrain.
Previous studies have suggested that insulin may play a role in the hormonal regulation of neurotransmitter metabolisms within the central nervous system. In order to provide additional information to support this hypothesis, we examined the distribution of insulin receptors within the forebrain of adult male rats. Insulin receptors were localized by immunocytochemistry, using an antibody directed against the carboxy-terminus of the beta-subunit of the insulin receptor. The antibody specificity was tested by immunoprecipitation of brain insulin receptors with antiserum and the purity of the receptor-antibody preparation was determined using hormone binding-assays with radiolabeled insulin and insulin-like growth factor-l. Insulin receptor-like immunoreactivity was found in a widespread, but selective, distribution on neurons throughout the rat forebrain. Double-labeling with glial fibrillary acidic protein did not demonstrate any detectable insulin receptor-like immunoreactivity on glial cells. Areas with the highest density of insulin receptor-like immunoreactivity were found in the olfactory bulbs, hypothalamus and median eminence, medial habenula, subthalamic nucleus, subfornical organ, CA 1/2 pyramidal cell layer of the hippocampus and piriform cortex. Double-staining of hypothalamic sections with somatostatin and vasopressin antisera revealed insulin receptor-like immunoreactivity on a subpopulation of somatostatin neurons in the periventricular region and on vasopressin neurons in the supraoptic nucleus. A moderately dense insulin receptor-like immunoreactivity was observed in layers II-IV of cerebral cortex, medial amygdala, reticular thalamic nucleus, zona incerta, and preoptic and septal regions, whereas a low density of insulin receptor-like immunoreactive neurons was found in basolateral amygdala and most thalamic regions. The basal ganglia and most parts of the thalamus were almost devoid of insulin receptor-like immunoreactivity. Our findings provide morphological support for a direct action of insulin on selected regions of the rat forebrain and suggest that the insulin receptor may modulate synaptic transmission or the release of neurotransmitters and peptide hormones in the CNS.
Animals↗