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Biomedical subjects

J Wortsman

Publications and source records attributed to J Wortsman.

At least 145 records · Page 8Linked to original sources
PubMed1981

The QT interval in clinical hypercalcemia.

Corrected QT intervals were determined in 13 patients with severe, chronic hypercalcemia. The QoTc interval was short in only 2 of 14 instances; QATC in 5 of 15 instances, and QETC in 5 of 16 instances. The correlations between serum calcium and the QTC measurement were not significant when evaluating either linear or curvilinear (quadratic) relationships. Small and inconsistent changes were found when comparing the QT intervals before the development of the hypercalcemic episode, during hypercalcemia, or after successful treatment. We conclude that shortening of the QT interval is an unreliable index of clinical (chronic) hypercalcemia.

Electrocardiography↗
PubMed1981

Evidence for the hypothalamic origin of the polycystic ovary syndrome.

The effect of suppression of gonadotropin secretion was evaluated in 21 patients with the polycystic ovary syndrome. Medroxyprogesterone acetate (MPA) was administered intramuscularly in a dose of 400 mg every 15 days for 9 months. A significant decrease in luteinizing hormone (LH) and testosterone levels (70 and 40%, respectively) was apparent after 3 months. At the end of the treatment period, the ovaries had become impalpable and hirsutism was markedly improved in 13 of 19 women. Side effects of treatment included local pain, vaginal spotting, galactorrhea, and hyperprolactinemia. Discontinuation of therapy was followed by a rapid return of follicle-stimulating hormone levels to baseline values, whereas LH and testosterone levels recovered only partially after more than 1 year. The improvement of hirsutism and ovarian shrinkage persisted for up to 2 years, and endometrial biopsy uniformly showed a pseudodecidual reaction in the stroma. After 1 year, prolactin levels declined to 52% of the baseline value and galactorrhea disappeared. The suppression of all the peripheral abnormalities of the reproductive system in polycystic ovary syndrome with MPA treatment suggests a primary hypothalamic disorder as the cause for the syndrome.

Female↗
PubMed1981

Preradial myxedema in thyroid disease.

Patients with Graves' disease were noted to have thickening of the skin on the extensor surfaces of their forearms. Skin biopsy specimens were obtained from nine consecutive patients with Graves' disease treated with sodium iodide I 131, from three patients with other thyroid disorders, and from one patient with acromegaly. Skin specimens from one patient with scleredema and one patient with scleromyxedema were used as controls for the histologic stains. Hematoxylin-eosin-stained sections of forearm skin from eight of nine patients with Graves' disease showed prominent round-cell (probably lymphocytic) infiltration around dermal capillaries and distortion of collagen fibers. In five of the patients with Graves' disease, staining with Mowry's colloidal iron disclosed dense deposits of mucin in the papillary dermis, with a distribution similar to that reported for pretibial myxedema. Mucopolysaccharide deposition in the skin on the extensor surface of the forearms may be the clinical counterpart of pretibial myxedema.

Acromegaly↗
PubMed1981

A rapid method for the determination of ultrafilterable calcium in serum.

Alterations of calcium homeostasis may be expressed as hypercalcemia, hypocalcemia, and normocalcemia with abnormal distribution of serum calcium fractions. The accurate diagnosis of disorders of calcium homeostasis requires the direct determination of free (ionized) serum calcium. The major problem in the direct measurement of ionized calcium with a calcium-sensitive electrode is the dependence on an anaerobic environment. We evaluated the determination of ultrafilterable calcium in serum as an index of free calcium unbound concentration. Ultrafilterable calcium measured in normal subjects by membrane binding analysis was (mean +/- S.E.M.) 4.8 +/ 0.14 mg/dl. The intra-assay coefficient of variation was 2.9% for ultrafilterable calcium and 3.0% for the calculated fraction bound to proteins. Storage at 0 degrees C had minimal effects: the interassay coefficient of variation was 5.1% for ultrafilterable calcium and 8.5% for the protein-bound fraction. The same determinations in a serum pool standard showed an interassay coefficient of variation of 4.8% and 4.2%, respectively. Freezing and thawing for up to three times did not affect ultrafilterable calcium concentration. In 56 subjects who were normocalcemic, hypercalcemic, or hypocalcemic, simultaneous determination of ionized calcium (by a calcium electrode) and ultrafilterable calcium showed a correlation coefficient of 0.91 (p less than 0.001). These results show that membrane-binding analysis by ultrafiltration is a valid method, suitable for the routine determination of unbound (free) calcium in normal subjects and in patients with disorders with calcium homeostasis.

Calcium↗
PubMed1980

Palpebral redundancy from hypothyroidism.

A patient is described with disabling palpebral edema. Primary hypothyroidism had been previously diagnosed and treated. Testing of thyroid function revealed persistence of the hypothyroidism. Treatment with L-thyroxine produced normalization of the biochemical parameters and resolution of palpebral edema. The search for hypothyrodism in patients with palpebral redundancy is emphasized.

Edema↗
PubMed1980

Biological activity of protein-bound calcium in serum.

We have previously reported the existence of a subfraction of serum calcium that is tightly bound to normal human serum proteins. This tightly bound calcium fraction (TBC) is thought to be a calcium-albumin-fatty acid complex (ACP) because similar complexes can be prepared by the sequential addition of albumin to calcium in the presence of palmitic acid. These studies deal primarily with TBC from rat serum and the uptake of calcium by bone cells in palmitate-treated serum. It is reported that TBC does not exchange with ionized calcium and that calcium binds strongly to albumin in the presence of palmitate. The uptake of calcium in palmitate-treated serum is three times greater than the uptake of calcium in control serum in both in vitro and in vivo systems. These findings demonstrate that 1) a tightly bound albumin-calcium fraction is present in both human and rat sera; 2) calcium in TBC may be complexed to albumin via fatty acids; 3) TBC does not participate in the maintenance of the level of ionized calcium in serum and 4) circulating TBC or ACP complexes may be taken up by living cells.

Animals↗
PubMed1980

Generation of urinary calcium in advanced renal failure.

The use of radioactive calcium kinetics as an index of the deposition of calcium in renal tissue was evaluated. Following the intravenous administration of 47Ca, the activity of calcium in the urine was significantly lower (p less than 0.01) than serum activity in uremic but not in control subjects. It is suggested that the cause for the abnormal calcium kinetics in advanced renal failure is the increased calcium content in the renal tissue.

Calcium↗
PubMed1980

Galactorrhea and hyperprolactinemia during treatment of polycystic ovary syndrome.

The serum concentration of prolactin and the presence of galactorrhea were evaluated systematically in a prospective study of the effect of medroxyprogesterone acetate (MPA) in polycystic ovary syndrome (PCO). In 21 patients, the diagnosis of PCO was made by laparoscopy. Three women presented with galactorrhea and increased prolactin levels, 2 had galactorrhea with normal prolactin levels, and 3 had an isolated elevation in the serum concentration of prolactin. Treatment with MPA induced galactorrhea in 10 additional patients. Elevated levels of prolactin were detected in 18 of the patients during treatment. There was no correlation between the score for galactorrhea and the level of prolactin. Tomograms of the sella turcica were abnormal in 3 of 8 patients with hyperprolactinemia. The authors conclude that galactorrhea and/or hyperprolactinemia are important side effects of MPA in patients with PCO.

Adolescent↗
PubMed1979

Cyproheptadine in the management of the galactorrhea-amenorrhea syndrome.

We evaluated long-term treatment with the antiserotonergic agent cyproheptadine in the management of the galactorrhea-amenorrhea syndrome. Fifteen women with a mean initial serum prolactin of 37 +/- 7 ng/mL received 16 to 24 mg of cyproheptadine daily; they had a significant decrease in prolactin concentration at 8 and at 16 weeks (P less than 0.01). Gonadotropin responses were variable, but no significant changes were recorded during treatment. Ten of the 15 women had menstrual bleeding while receiving cyproheptadine, seven had decreased galactorrhea, and two had cessation of galactorrhea. The side effects of treatment were transient drowsiness and weight gain. We conclude that long-term treatment of the galactorrhea-amenorrhea syndrome with cyproheptadine is effective in lowering serum prolactin in patients with mildly elevated or normal levels. Its effect on fertility remains to be ascertained.

Adult↗
PubMed1979

Clinical resistance to vasopressin. Detection of antibody by hemagglutination.

We describe a patient with hypothalamic diabetes insipidus who after 20 years became refractory to the effect of commercial vasopressin injection. Vasopressin antibodies were measured using a sensitive hemagglutination technique. Resistance was associated with a high titer of antibodies that disappeared once vasopressin therapy was withdrawn and the diabetes insipidus was controlled with chlorpropamide. Antibodies were also measured in four additional patients with diabetes insipidus while they were or were not receiving vasopressin. A patient who had received the drug for only two years already had a substantial titer of antibodies to vasopressin, but in this case the response to the hormone was not impaired.

Adolescent↗
PubMed1979

Sex steroid levels during treatment of endometriosis.

Ovarian endocrine function in endometriosis was studied in 19 women before, during, and after treatment with danazol. Striking abnormalities were seen during treatment. Serum estradiol (E2) and testosterone (T) levels increased markedly, while follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were unaffected. Direct interference of danazol in the assays for E2 and T was excluded by in vitro experiments. The most likely explanation for the isolated alterations in peripheral hormone levels is that danazol affects the carrier proteins in the circulation. However, other explanations are also possible and cannot be excluded at this stage.

Danazol↗
PubMed1979

Isolated high serum triiodothyronine levels. Clinical relevance after sodium iodide I 131 therapy.

Ten of 25 thyrotoxic patients treated with sodium iodine I 131 had thyroid function test results that indicated a high triiodothyronine (T3) level, with normal thyroxine (T4) and thyroid-stimulating hormone (TSH) levels, within 15 months of treatment. This pattern was usually transitional and lasted a variable time, eventually leading to euthyroidism, hyperthyroidism, or hypothyroidism. It is concluded that an isolated elevation of T3 levels after radioactive iodine therapy can be associated with any clinical pattern of thyroid function and has no clear prognostic value. No specific treatment is needed for this abnormality.

Adult↗