Effect of human growth hormone on muscle function in post-polio syndrome.
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Female↗
Biomedical subjects
K L Gupta
Publications and source records attributed to K L Gupta.
Neoplasm of the thyroid gland.
Although the prevalence of thyroid nodule is approximately 1% to 5% in the general adult population, 6% to 10% of older persons may have solitary nodules. Between 2% and 10% of thyroid nodules are noted to be carcinomatous. Approximately 1200 persons die of thyroid carcinoma each year in the United States alone; the incidence is much higher in women than in men. With early diagnosis and treatment, patients with thyroid cancers are living longer than ever before. In terminally ill older patients with nonresectable tumors and distant metastasis, all attention must be given to adequate pain control and maintenance of quality of life.
Adult↗
Endocrine causes of bone disease.
Hyperthyroidism, glucocorticoid excess, hyperparathyroidism, hypogonadism, and acromegaly decrease bone mineral density and aggravate the osteoporotic tendencies of elderly individuals. After effective treatment of endocrinopathy, the bone attempts to return to the normal mineral density. In most circumstances, however, this attempt is incomplete. Early diagnosis and treatment of these endocrine problems in older patients helps to maintain their skeletal integrity and prevent osteoporotic fractures.
Adrenal Gland Diseases↗
Correlation of transcranial Doppler ultrasonography with MRI and MRA in the evaluation of sickle cell disease patients with prior stroke.
We prospectively evaluated a group of patients with sickle cell disease and a clinical history of prior stroke, comparing transcranial Doppler sonography (TCD) to both magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to determine its efficacy for the detection of flow abnormalities associated with prior cerebral infarction. Using MRI as the standard examination, there was 94% sensitivity and 30% specificity, and using MRA as the standard examination, there was 91% sensitivity and 22% specificity. We concur with other reports that the transcranial Doppler examination is a highly sensitive study. In our group of sickle cell disease patients with prior stroke, TCD reliably detected flow abnormalities that correlated to areas of prior cerebral infarction.
Adolescent↗
Human growth hormone effect on serum IGF-I and muscle function in poliomyelitis survivors.
Previous work showed low insulin-like growth factor I (IGF-I) in polio survivors compared with age-matched controls and it was hypothesized that the low IGF-I was caused by the lack of growth hormone (GH) secretion. The present study asked: Is the nocturnal release of GH subnormal in polio survivors? Can the low IGF-I level be raised to the range of healthy young men (240 to 460 ng/mL) by human growth hormone (hGH) treatment? If so, what dose of hGH is required? Does the hormone treatment affect muscle function? Eleven polio survivors with evidence of postpoliomyelitis syndrome, aged 50 to 65 years, and low IGF-I levels (average IGF-I value of 170 ng/mL) were studied. The serum level of GH was measured in the first 4 hours of sleep. The serum IGF-I level was determined before and during hGH treatment at 0.0075, 0.015 or 0.03 mg/kg of ideal body weight (IBW), three times a week for successive periods of 1 month. Before and after hGH treatment, strength was determined in knee extensor and flexor muscles and the elbow flexor and elbow extensor muscles. Nocturnal GH was low in the polio survivors compared with healthy young men. Serum IGF-I was raised into the target range by either 0.0075 or 0.015 mg hGH/kg three times a week. After 3 months of hGH treatment, no consistent changes in muscle strength were observed in the study group.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
De novo diabetic glomerulosclerosis in a renal allograft recipient.
Posttransplant diabetes mellitus is a well-recognized complication of renal transplantation. Although such patients are at risk for the development of de novo diabetic glomerulosclerosis with increasing graft survival, this has rarely been reported. We describe a patient with posttransplant diabetes mellitus who developed end-stage renal failure due to diabetic glomerulosclerosis 12 years after renal transplantation.
Diabetic Nephropathies↗
Spectrum of dermatological lesions in renal allograft recipients in a tropical environment.
A total of 157 renal allograft recipients were followed for over 1-23 months for the development of dermatological lesions. The non-infective lesions related to immunosuppressive drugs included cushingoid features in 133 (84.7%), xerosis in 120 (76.4%), striae in 69 (43.9%), hypertrichosis in 65 (21.6%), facial erythema in 42 (26.7%) and friable skin in 34 (21.4%) patients. Of the infective lesions, cutaneous mycoses were the most frequent (82.6%) and included tinea corporis and cruris in 82 (52.2%), tinea versicolor in 21 (13.3%), candidiasis in 7 (4%), onychomycosis in 4 (2%) and cryptococcosis in 2 (1.2%) patients. Viral infections included those due to herpes zoster in 17 (10.8%), herpes simplex in 5 (3.1%) and viral warts in 13 (8.2%) patients. Cutaneous malignancy was seen in 1 patient only.
Adolescent↗
Postheparin lipolytic activity in acute and chronic renal failure.
Lipid profile and postheparin lipolytic activity (PHLA) were investigated in 21 patients with acute renal failure (ARF), 24 with chronic renal failure (CRF), and 23 healthy volunteers. Plasma triglycerides were significantly elevated in ARF (155.19 +/- 72.39 mg/dL) as well as CRF (166.79 +/- 72.36 mg/dL), as compared to controls (89.91 +/- 23.41 mg/dL, p < .001). PHLA was determined at 5, 10, 30, and 60 min after intravenous heparin (100 U/kg) and was observed to be reduced in ARF (7.82 +/- 1.41 mumol FFA/mL/h) as well as CRF (8.44 +/- 1.68 mumol FFA/mL/h) at 10 min, as compared to the values in the control subjects (12.03 +/- 2.43 mumol FFA/mL/h, p < .01). No correlation was found between PHLA and plasma triglycerides in ARF or CRF. In 15 patients in each group, PHLA subfractions, hepatic triglyceride lipase (HTGL), and lipoprotein lipase (LPL) were determined at similar time intervals after heparin. Both fractions were found to be reduced significantly (p < .01) in ARF as well as in CRF versus controls. These findings indicate that the lipid alterations in acute and chronic renal failure share common features including hypertriglyceridemia and reduced PHLA and its subfractions HTGL and LPL.
Acute Kidney Injury↗
Wolfram (DIDMOAD) syndrome with diabetic retinopathy.
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Adolescent↗
Esophageal candidiasis after renal transplantation: comparative study in patients on different immunosuppressive protocols.
OBJECTIVES: The incidence of esophageal candidiasis (EC) in renal allograft recipients has not been well documented. The present study was done to determine the incidence of EC in renal allograft recipients receiving different forms of immunosuppressive therapy and to identify patients at a high risk of developing Candida esophagitis. METHODS: We conducted a retrospective study of 265 live related renal allograft recipients and compared three groups: patients given azathioprine and prednisolone (group I), those given cyclosporine, azathioprine, and prednisolone (group II), and those given cyclosporine and prednisolone (group III). EC was diagnosed by esophagogastroduodenoscopy. RESULTS: The overall incidence of EC was 10.5%. Group II patients had a significantly higher incidence (28.6%) than those in group I (10.4%) and group III (3.8%). EC was noted earlier in patients in groups II and III, who were on higher doses of steroids than group I patients. Dysphagia (57.1%) was the most common presenting symptom of EC, but 21.4% of patients were asymptomatic. Oral thrush was present in 42.9%. The entire esophageal mucosa was affected in six (46.1%) patients in group II and one (20%) in group III. No correlation was found between fungal serology or daily dose of steroids and extent of esophageal involvement. Treatment included nystatin in seven, nystatin and ketoconazole in 10, ketoconazole alone in eight, amphotericin B in one, and ketoconazole and amphotericin B in two episodes. Treatment failure occurred in seven (25%). Three patients died of disseminated candidiasis. Serology and biopsy were poor predictors of dissemination. CONCLUSIONS: In this retrospective study of renal allograft recipients, patients on triple drug immunosuppression, diabetics, and those with myelosuppression had an increased risk of developing EC. This high incidence calls for prophylactic use of antifungal agents in selected renal transplant recipients.
Adult↗
Renal mucormycosis: computerized tomographic findings and their diagnostic significance.
Isolated renal involvement by mucormycosis has been reported rarely in immunocompromised individuals. We describe four patients with mucormycosis confined to the kidneys, three of whom did not exhibit any predisposing factors. Only one patient had acute viral hepatitis with fulminant hepatic failure as the preceding disease. Two patients presented with oliguric renal failure of undetermined etiology and investigations revealed bilateral extensive involvement of the kidneys. Computerized tomography showed diffuse enlargement of the kidneys and multiple low-density areas. Treatment included systemic amphotericin B therapy in all four patients and nephrectomy in three patients. Two patients recovered completely. Our experience emphasizes the need for a high index of suspicion and recognition of computed tomographic scan appearances for making a prompt diagnosis. Early surgical intervention and systemic antifungal therapy are necessary for survival in this life-threatening condition.
Adolescent↗
Alcoholism in the elderly. Uncovering a hidden problem.
Currently, about 12% of people in the United States are elderly, and this age-group is one of the most rapidly expanding segments of the population. The incidence of alcoholism in older persons is increasing, and diagnosis can be difficult. Because of age-related physiologic changes, the effects of alcohol are more pronounced in older persons. Furthermore, alcoholism may mimic the effects of aging and many conditions prevalent in this age-group. A high index of suspicion, together with thorough history taking and recognition of the clinical features of alcoholism in the elderly, can aid early detection and appropriate management.
Age Factors↗
Hereditary nephritis (Alport's syndrome)--clinical profile and inheritance in 28 kindreds.
Sixty-three patients, (52 males and 11 females) from 28 kindreds of hereditary nephritis (Alport's syndrome) were identified over a 14-year period from 1977 to 1991. Group I included 51 patients with (a) positive family history of haematuria with or without chronic renal failure, (b) characteristic GBM changes on electron-microscopy, (c) characteristic ocular signs, and (d) high-frequency sensorineural deafness. Group II included 12 patients with a negative family history. All of them had evidence of renal disease with characteristic ocular signs and deafness and four had characteristic GBM changes on electron-microscopy. The main clinical features were haematuria in 96.8%, deafness in 82.5%, and diminished visual acuity in 66.7% of affected subjects. Hypertension was present in 71.4% patients. Pure tone audiometry revealed high-frequency sensorineural deafness in 96.8%. Ocular examination showed bilateral anterior lenticonus in 37.8%, retinal flecks in 22.2%, cataract in 20%, and keratoconus in 6.7% patients. Proteinuria (> 2.0 g/24 h) was detected in 31.8%. Sixteen (57.1%) of the 28 index patients (all males) were diagnosed for the first time when they presented with end-stage renal disease. Serum creatinine in the overall group ranged from 0.9 to 18.7 mg/dl(7.81 +/- 5.37 mg/dl). Adequate renal tissue was obtained by biopsy in 14 patients. Light-microscopy revealed focal segmental glomerulosclerosis in five, mesangial proliferation in four, chronic interstitial nephritis in three, and mesangiocapillary and crescentic glomerulonephritis in one each. Electron-microscopy showed characteristic changes in the GBM in seven specimens.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Comparing the teaching of physical diagnosis in a primary care setting and a hospital setting.
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Clinical Competence↗
Two-month headache in a nine-year-old boy.
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Brain↗
Corticotropin-dependent Cushing's syndrome in a patient with chronic renal failure--a rare association.
Corticotropin-dependent Cushing's syndrome was detected in a 32-year-old male suffering from membranous nephropathy and chronic renal failure. Cortisol dynamics revealed high basal cortisol, loss of circadian rhythm, and nonsuppressibility with low-dose dexamethasone. However, the latter was suppressible with high-dose dexamethasone. Treatment with ketoconazole led to a remarkable response both clinically and biochemically. The occurrence of Cushing's syndrome in a patient with chronic renal failure is extremely rare and poses significant diagnostic and therapeutic problems.
Adrenocorticotropic Hormone↗
Invasive pulmonary aspergillosis and nocardiosis in an immunocompromised host.
A case of invasive pulmonary aspergillosis and nocardiosis following high dose prolonged steroid therapy given for suspected rapidly progressive glomerulonephritis is reported. A favourable response was achieved with a combination of amphotericin B and cotrimoxazole. A high index of suspicion and aggressive investigations are necessary for confirmation of diagnosis and early institution of appropriate therapy.
Amphotericin B↗
The effect of aspirin, paracetamol and analgin on pharmacokinetics of chloroquine.
The effect of Aspirin, paracetamol and analgin on the kinetic profile of a single oral dose of chloroquine was studied in 8 healthy subjects. Aspirin did not alter the kinetic parameters of chloroquine whereas paracetamol and analgin significantly enhanced the Cmax and AUC0-alpha of chloroquine (P < 0.01, < 0.05 respectively).
Acetaminophen↗