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Biomedical subjects

L Verschoor

Publications and source records attributed to L Verschoor.

At least 37 records · Page 2Linked to original sources

A comparison of the effects of two somatostatin analogues in a patient with an external pancreatic fistula.

In a 30-year-old man, a total external pancreatic fistula developed after enucleation of an insulinoma of the head of the gland. The output of the fistula was reduced to some extent by total parenteral nutrition. Much greater reductions of volume were noted during short-term administration of two somatostatin preparations, SMS 201-995 and Somatofalk, for 1 week consecutively. Although the former showed several advantages over the latter drug, such as absence of an escape phenomenon and of a rebound effect, neither drug caused a closure of the fistula. Spontaneous closure of the fistula occurred after 3 1/2 months.

Adult↗

On the use of a new somatostatin analogue in the treatment of hypoglycaemia in patients with insulinoma.

A novel potent analogue of somatostatin, the octapepide SMS 201-995 was tested as a therapeutic manoeuvre to prevent hypoglycaemia in patients with insulinoma. We investigated the acute effects of a single 50 micrograms dose of the analogue administered s.c. in three patients, comparing the results in two of them with those obtained after administration of saline (control) and native somatostatin. In addition two patients were treated for up to 5 d with two or three daily s.c. injections (daily dose of analogue ranging from 100 to 300 micrograms). In two of the three patients SMS 201-995 suppressed circulating insulin levels by more than 50% and increased plasma glucose to hyperglycaemic levels for 6-8 h after a single injection. No undesirable effects of the administration of the analogue were observed. As opposed to insulin suppression obtained with native somatostatin, no rebound increase in insulin levels was observed after administration of the analogue. We conclude that SMS 201-995 prevented hypoglycaemia in two out of three patients with insulinoma. The advantage of s.c. administration, the long duration of action and the absence of a rebound phenomenon give this analogue a place in the pre-operative management of patients with insulinoma.

Adenoma, Islet Cell↗

A comparison among the growth hormone-lowering effects in acromegaly of the somatostatin analog SMS 201-995, bromocriptine, and the combination of both drugs.

The acute GH inhibitory effects of 50 micrograms SMS 201-995, a somatostatin analog, and 2.5 mg bromocriptine were compared in 17 acromegalic patients. SMS 201-995 suppressed plasma GH levels after 2-6 h to 5 micrograms/liter or less in 10 of these 17 patients, while bromocriptine did the same in only 5 of them. There was much variation in the responsiveness to both drugs in these patients, but the GH-lowering effect of 50 micrograms SMS 201-995 was significantly greater than that of 2.5 mg bromocriptine. SMS 201-995 and bromocriptine together significantly suppressed plasma GH levels in 2 of 3 acromegalic patients who were insensitive to both compounds when tested separately. We conclude that most acromegalic patients respond better to SMS 201-995, while a few patients are more sensitive to the GH-lowering effect of bromocriptine. In addition, the combination of SMS 201-995 and bromocriptine can be of value in a few acromegalic patients who do not respond to either drug alone.

Acromegaly↗

Long-term treatment of acromegaly with the somatostatin analogue SMS 201-995.

We treated four patients with acromegaly for 8 to 24 weeks with SMS 201-995, the long-acting somatostatin analogue, in dosages of 100 to 300 micrograms a day given subcutaneously. A rapid amelioration of the clinical signs and symptoms and near normalization of laboratory test results occurred in all patients. Mean plasma growth hormone concentrations (+/- S.E.M.), as measured over 24 hours, fell from an initial value of 57 +/- 18 micrograms per liter to 7.5 +/- 2 micrograms per liter at the end of the investigational period. Likewise, levels of plasma somatomedin-C, which were originally elevated in all patients, dropped to the normal or nearly normal range. The suppression of insulin secretion and the resulting hyperglycemia that were observed at the beginning of treatment became less marked as therapy progressed. There was evidence of slight tumor shrinkage in three of the subjects. No side effects were recorded throughout the treatment period. These preliminary results suggest that SMS 201-995 represents an additional option for the management of acromegaly, especially in patients who do not benefit sufficiently from surgery or radiotherapy and do not respond well to treatment with dopaminergic drugs.

Acromegaly↗

Glucose and fructose feeding lead to alterations in structure and function of very low density lipoproteins.

Young male rats were fed regular lab chow, or a diet containing 66% of total calories as either glucose or fructose. Both experimental diets led to hypertriglyceridemia, with fasting TG concentrations after one week of 195 +/- 20 and 296 +/- 44 mg/dl for rats fed glucose and fructose, respectively, compared to 94 +/- 10 mg/dl in the control rats. Moderate changes in VLDL composition were observed with both test diets, characterized by slight increases in TG: protein ratio, and increased total cholesterol and phospholipid content. In addition, VLDL isolated from rats fed high carbohydrate diets were increased in size, with a mean VLDL particle diameter of 666 A and 720 A in glucose-fed and fructose-fed rats, as compared to 536 A in control rats. The changes in lipid composition and size of VLDL particles isolated from glucose and fructose-fed donor rats were associated with an increase in their rate of removal from the circulation following their injection into normal recipient rats (half-life time 2.4 +/- 0.2 and 3.2 +/- 0.3 min respectively) as compared to VLDL-TG derived from chow fed donors (4.1 +/- 0.2 min). These data indicate that diets high in either glucose or fructose can lead to both structural and functional changes in VLDL, and provide additional evidence that the ability of fructose to induce profound hypertriglyceridemia is not secondary to a defect in VLDL-TG catabolism.

Animals↗

Why does experimental insulin deficiency lead to a decrease in removal of very low density-triglyceride from plasma?

We have previously suggested that mechanisms other than reduced lipoprotein lipase (LPL) activity might contribute to the defect in plasma removal of very low density lipoprotein (VLDL)-triglyceride (TG) observed in insulin-deficient rats. To further evaluate this phenomenon, removal rates of TG in nonfractionated plasma, as well as in isolated lipoprotein fractions obtained from insulin-deficient and control rats, were compared in a new, sensitive in vivo bioassay system (estradiol-treated male rats with a consistently low endogenous VLDL-TG pool). Removal of TG in nonfractionated plasma from insulin-deficient rats was slower than that of control rats: 3.0 +/- 0.3 vs 1.6 +/- 0.2 min (P less than 0.001). No difference was found in removal rate of isolated VLDL-TG (2.5 +/- 0.3 vs 2.6 +/- 0.4 min), or in removal rates of TG carried in other lipoprotein fractions. We next determined the effect of injection into normal rats of aliquots of dialyzed lipoprotein-free (D greater than 1.215) plasma from insulin-deficient and control rats on the removal rate of normal VLDL-TG, and found that lipoprotein-free plasma from insulin-deficient rats significantly (P less than 0.01) prolonged removal of normal VLDL-TG (4.3 +/- 0.4 to 6.8 +/- 0.7 min). This same fraction did not interfere with the in vitro hydrolysis of normal VLDL-TG by post-heparin LPL. Thus, a factor in the D greater than 1.215 plasma fraction of insulin-deficient rats is present which interferes with the rate of removal of TG from plasma, unrelated to inhibition of LPL activity.

Animals↗

Elimination of high affinity heparin fractions and their anticoagulant and lipase activity.

High and low affinity heparin (HA and LA heparin) were prepared from commercial heparin by affinity chromatography to insolubilized antithrombin III. HA heparin was radiolabeled with 35S and subdivided by gel chromatography into high molecular weight (HMW, average 17,000-26,000 daltons), intermediate molecular weight (MMW, average 12,000-13,000 daltons), low molecular weight (LMW, average 5,000-7,000 daltons), and very low molecular weight (VLMW, average 4,600 daltons) fractions. The kinetics of lipolytic and anticoagulant activity and protein-bound radioactivity were studied after intravenous injection of these fractions. LA heparin failed to induce anticoagulant activity but released the hepatic triglyceride lipase (H-TGL) and lipoprotein lipase (LPL) activities normally. VLMW and LMW heparin failed to release both lipolytic enzymes and did not induce anticoagulant activity measurable by the activated partial thromboplastin time (APTT). A powerful anticoagulant effect was found in the anti-Xa assay, which disappeared according to a continuously concave curve in semilogarithmic plots, with elimination rates similar to those of the protein-bound radiolabel. The other heparin preparations induced all activities measured. Heparin anticoagulant activity estimated by the two assays disappeared following a convex curve, preceded by a rapid initial elimination phase in semilogarithmic plots. The disappearance rates of plasma protein-bound heparin radioactivity and heparin anticoagulant activity estimated by factor Xa inactivation were similar. Peak values of the two lipolytic activities were attained rapidly. H- TGL activity, as well as LPL activity, disappeared following convex curves in semilogarithmic plots, with elimination rates similar to those of plasma protein-bound heparin radioactivity. On the basis of these kinetics, we suggest that, after intravenous administration of heparin, the two lipolytic enzymes present in plasma are complexed with heparin, analogous to the heparin-antithrombin III complex. Finally, the kinetic data indicate that elimination of these activities is determined by the heparin part of the complexes, probably by removal of free heparin.

Adult↗

Different causes for hypertriglyceridemia in male and female patients with chronic renal failure?

The changes in plasma postheparin lipolytic activities that occur in patients with chronic renal insufficiency were found to be sex dependent. Male patients showed decreased hepatic lipase activity, while female patients exhibited decreased lipoprotein lipase activity. These findings offer 1) an explanation for the hitherto confusing data on postheparin lipolytic activities in chronic renal failure reported in the literature, and 2) a further argument for a role of hepatic lipase activity in the regulation of the breakdown of plasma triglycerides.

Female↗

Role of exogenous cholesterol in regulation of adrenal steroidogenesis in the rat.

Rat steroidogenic tissues take up cholesterol, and it has been suggested that this process plays a regulatory role in steroid hormone synthesis. To provide evidence for this hypothesis, we carried out studies in lipoprotein-deficient rats. Lipoprotein deficiency, achieved by treating male rats with pharmacological amounts of estradiol, led to profound lowering of plasma cholesterol (8 +/- 2 versus 54 +/- 4 mg/dl) and adrenal cholesteryl ester content (113 +/- 57 versus 747 +/- 108 micrograms/organ). Basal serum corticosterone levels were decreased by 50%, and the response to adrenocorticotropic hormone (ACTH) was totally abolished. Injection of high density lipoprotein (HDL) to estradiol-treated animals restored the response of corticosterone to ACTH. Comparable in vitro studies with adrenal cell suspensions obtained from lipoprotein-deficient rats confirmed the in vivo data. Measurement of [14C]acetate incorporation and uptake of both HDL- and low density lipoprotein (LDL)-cholesterol in these adrenal cells showed a progressive increase with the duration of estradiol treatment, and neither of these two phenomena was altered by ACTH. These results provide in vitro and in vivo evidence for the hypothesis that normal adrenal steroidogenesis depends upon cholesterol delivery from plasma. Furthermore, under the conditions studied, ACTH does not stimulate adrenal de novo cholesterol biosynthesis nor the uptake of either HDL- or LDL-cholesterol.

Acetates↗

Massive ovarian oedema. Case report.

A case is described of massive ovarian oedema with secondary amenorrhoea and evidence of masculinization in a young girl. Pre-operative testosterone levels in peripheral plasma were markedly raised, but returned to normal immediately following wedge resection of both ovaries. Microscopic examination revealed lutein cells in the right ovary which were predominantly located within and around atretric follicles and Stein-Leventhal-like features in the left ovary. Irregular ovulatory cycles started four weeks after surgery.

Adolescent↗

Triglyceride turnover in severe chronic non-nephrotic renal failure.

In 12 patients with chronic non-nephrotic renal failure (creatinine clearance 3.5-11 ml/min) and 8 control subjects, plasma triglyceride turnover was studied. The patients showed significantly increased fasting triglyceride concentrations and absolute plasma triglyceride turnover rates, while the fractional turnover rate was significantly decreased. The finding of an elevated triglyceride turnover rate with a near normal fractional removal rate in the patients with the highest creatinine clearance suggests the involvement of an increased triglyceride synthesis rate in these patients. However, most patients showed an impaired removal mechanism as the major cause of the hypertriglyceridemia.

Adult↗

Cryoprecipitated plasma perfusion preservation and cold storage preservation of duct-ligated pancreatic allografts.

It has been shown previously that, at least in dogs, a vascularized pancreatic allograft with ligation of the pancreatic duct can maintain normal beta-cell function for at least 5 years. In this study common organ preservation techniques, as used in human cadaveric kidney transplantation, were applied to canine pancreatic allografts to determine the influence of 24-hour preservation on beta-cell function, graft survival and histological appearances. Three groups of dogs were compared: group A consisted of 9 dogs with fresh grafts; group B consisted of 5 dogs who received grafts preserved for 24 hours by pulsatile hypothermic cryoprecipitated plasma perfusion; and group C was composed of 5 animals who received grafts that had been flushed with Collins' solution followed by hypothermic storage for 24 hours. It appeared that both preservation methods were equally effective and that preservation did not alter either the graft's function or its histological appearance. No significant differences after transplantation were observed in the endocrine function tests of the three groups when compared with the preoperative values; neither was there a significant difference in the mean graft survival time between the groups.

Animals↗

Endocrine function of the canine pancreas. The effect of duct ligation and transplantation of the total duct ligated pancreas.

Pancreas transplantation was studied in the dog using a total duct ligated pancreas as allograft. In a group of 10 mongrel dogs the effects of long-term (6-36 months) total duct ligation on the endocrine pancreas function were studied by means of repeated intravenous glucose tolerance tests (iv-GTT). One year after total duct ligation the mean glucose assimilation coefficient (k-value) was 75%, the median insulin peak value (IPV) 63% and "total" insulin secretion in the first thirty minutes (TIS) 58% of the pre-operative values. These levels were maintained up to three years after duct ligation. The total duct ligated pancreas was then used as an allograft in 28 beagles in order to study the influence of DL-A (dog leucocyte-antigens) matching on the survival time of the graft. DL-A identity compared to one or two haplotype difference gave a fourfold increase in median survival time from 9 to 40 days. In a second group of 14 beagles with one haplotype difference the effect of immunosuppressive therapy was studied. The methods used (antilymphocyte serum and a combination of prednisone and azathioprine) increased the median survival time to the level seen in DL-A identity. In conclusion the total duct ligated pancreas can be used as an insulin secreting allograft, providing rejection can be suppressed adequately.

Animals↗