[The value of pulsed Doppler echocardiography in noninvasive assessment of pulmonary hypertension in patients with chronic obstructive pulmonary disease].
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Adult↗
Biomedical subjects
M Weissel
Publications and source records attributed to M Weissel.
[Noninvasive assessment of pulmonary hypertension using pulsed Doppler sonography in adult patients with cystic fibrosis].
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Adolescent↗
Fibronectin during thyroid hormone replacement therapy.
Hemostasis may be affected by thyroid function in various ways. We studied plasma concentration of Fibronectin in 13 untreated patients after total thyroidectomy due to thyroid carcinoma. Fibronectin levels were significantly decreased compared to an equal numbered group of healthy volunteers (p 0.0005). The same patients were studied again after an oral thyroid replacement of 200 micrograms L-thyroxine/d over at least six weeks. Fibronectin had increased significantly, compared to untreated patients and controls resp. Furthermore, a significant positive correlation was found between plasma concentrations of Fibronectin and total T4 (r = 0.92; y = 6.617 + 0.52x). In contrast Factor V activity was low in untreated patients but normal during high dose replacement therapy. No correlation was found between Factor V and thyroid hormone concentrations. We discuss the relation between fibronectin plasma levels and thyroid hormones.
Factor V↗
Risk factors for development of amiodarone-induced thyroid dysfunction.
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Amiodarone↗
[Thyrostatic drug therapy of Basedow disease. Combination with thyroid hormones and/or beta blockers].
Basing on the results of the European and Austrian survey on the management of hyperthyroidism due to Graves' disease the theoretical backgrounds of the combination of thyrostatic treatment with thyroid hormones and with beta blocking agents are discussed. A suspected lack of compliance of a hyperthyroid patient is probably the only strong argument for the use of combination therapy with thyroid hormones. Some countries in Europe prefer this way of treatment, whereas other countries decline it. In Austria the opinion of the necessity of thyroid hormones in thyrostatic treatment is also not unanimous, the majority, however, preferring it. In contrast, the supporting use of beta blocking agents especially in highly symptomatic patients stands beyond debate. However, monotherapy with beta blockers for preparation of subtotal thyroidectomy in hyperthyroid patients is generally declined, probably because of the danger of a postoperative thyrotoxic crisis. Most colleagues agree (as well in Europe as in Austria) that the combination of thyrostatic drugs with beta-blockers is the best choice for the preparation of subtotal thyroidectomy, saving time and thereby costs and reducing the danger of a postoperative thyrotoxic crisis.
Adrenergic beta-Antagonists↗
[Value of calcitonin and 6-oxo-prostaglandin Fl alpha in the differentiation of lung cancers].
Plasma calcitonin and 6-oxo-Prostaglandin-F1 alpha (6-oxo-PGF1 alpha), one of the stable metabolite of prostacyclin, were determined in patients with malignant and non-malignant diseases of the lung. 11 out of 14 patients with small cell carcinoma and only 3 out of 17 patients with other histological types of lung cancer had abnormally elevated plasma calcitonin levels. 6-oxo-PGF1 alpha levels were significantly higher in patients with different types of lung cancer, compared to a control group with non-malignant lung disease. Combining the results of calcitonin and 6-oxo-PGF1 alpha measurements led to improved specificity and efficiency for the correct differentiation between small cell and non-small cell carcinoma of the lung; the predictive value for the diagnosis of small cell carcinoma approached 90%.
6-Ketoprostaglandin F1 alpha↗
[Peripheral and right atrial plasma levels of atrial natriuretic peptide and their relation to mean atrial pressure].
Atrial myocytes produce natriuretic and vasodilating peptides. Animal experiments have shown that atrial natriuretic peptide (ANP) is released after stretching the atria and drained via the coronary vein effluent. In this study ANP-plasma levels were measured in 14 patients. Blood samples were simultaneously collected from the right atrial cavum and from an antecubital vein. In the right atrial samples, ANP-plasma concentrations were significantly higher than in samples drawn from a peripheral vein (140.3 +/- 114.8 pg/ml vs 96.9 +/- 69.2 pg/ml; p less than 0.05), but a significant linear correlation was found between both values (r = 0.88; p less than 0.001). In patients with elevated atrial pressures significantly higher ANP-levels could be detected than in patients with normal atrial pressures (204 +/- 115 pg/ml vs 55.3 +/- 18.5 pg/ml; p less than 0.05). Mean right atrial pressure correlated to ANP-levels in right atrial blood (r = 0.79; p less than 0.001) as well as to ANP-levels in peripheral blood (r = 0.68; p less than 0.01). These results indicate that higher ANP plasma levels can be measured in samples drawn from a site close to ANP production. On the other hand, atrial pressure might influence the amount of circulating ANP.
Adolescent↗
Center-specific variations of thyroid hormone serum levels in hemodialysis patients.
Thyroid hormone (free and total thyroxine, total 3,5,3'- and 3,3'5'-triiodothyronine, thyroxine-binding globulin, thyrotropin) serum concentrations were measured in 107 uremic patients of 4 hemodialysis centers, in order to study the prevalence of hypothyroidism in hemodialysis patients. In accordance with the clinical impression there was no laboratory evidence of thyroid dysfunction. In spite of the fact that all patients had the expected low-T3 syndrome, there were highly significant differences between the mean thyroid hormone concentrations of the 4 different centers. The center with the highest thyroid hormone levels (all normal except for borderline low 3,5,3'-triiodothyronine) also had the lowest urea levels, indicating the relatively best metabolic control. One center had significantly lower hormone levels than the other 3 centers (all hormones except free thyroxine were below normal) with urea levels that did not differ significantly from one of these centers. A retrospective analysis of patients and of the techniques of dialysis of 3 centers excluded factors like heparin or the length of time on dialysis to be the reason for the low values of this center. Finally, only the significantly higher proportion of unsuccessfully transplanted patients and some technical differences (lack of water treatment, regenerated cellulose as dialyser membrane, and low magnesium content in the dialysate) unique for this center remained as possible factors that may speculatively explain the observed low thyroid hormone values.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Congenital hypothyroidism in a Turkish family: the role of immunoglobulins blocking the trophic effects of TSH and maternal-foetal relationship.
A Turkish family with frequent intermarriages is described, in which two siblings were born with persistent forms of congenital hypothyroidism, in the elder child concomitant with absent radioactive thyroid imaging. The mother was clinically euthyroid throughout the period of observation, but showed in addition to thyroid microsomal antibodies, high levels of immunoglobulins blocking the trophic action of TSH. These maternal growth blocking antibodies were transiently present in the youngest of the siblings (from birth to 2 months of age). She had a relatively mild form of congenital hypothyroidism (T3: 33 micrograms/100 ml; T4: 3.9 micrograms/100 ml). The older sibling, with proven non-functioning thyroid tissue (negative thyroidscan, T4: 0.4 microgram/100 ml) produced the growth-blocking immunoglobulins herself and may thus represent a juvenile form of thyroid autoimmunity with a very early onset. An aunt and uncle of the children, both hypothyroid since birth, were at the age of 19 and 18 years weakly positive for growth blocking immunoglobulins. This study indicates that familial forms of congenital hypothyroidism are probably complex and may be brought about by maternal to foetal passage of thyroid reactive autoantibodies, but also by the inheritance of a trait for thyroid autoimmunity. In some cases these two mechanisms might act in conjunction.
Adolescent↗
Thyroid hormones and pericardial effusion may influence plasma levels of atrial natriuretic peptide (ANP) in humans.
Fluid and electrolyte homeostasis is impaired in patients suffering from hypothyroidism and myxedema because myxedema induces retention of salt and water. We have measured plasma levels of human atrial natriuretic peptide (hANP) in 8 female patients who had been totally thyroidectomized because of thyroid carcinoma. Estimations of the hormone were done 4 weeks after diagnostic withdrawal (searching for iodine retaining metastases) and after 2 weeks and 4 weeks of reinitiation of thyroid suppressive therapy by L-thyroxine. hANP levels, although within the normal range (10-80 ng/l) throughout the study, were positively linked to the amount of pericardial effusion (determined by echocardiography), which was highest initially and decreased or vanished with duration of L-thyroxine therapy. Additionally, a positive correlation between thyroid hormone levels and hANP was obtained when the counteracting effect of pericardial effusion was allowed for by partial correlation analysis. Our findings might facilitate explanation of mild polyuria in hyperthyroidism and impaired water excretion in hypothyroidism.
Adult↗
[Vasodepressor syncopes in metastasizing laryngeal cancer. Combination therapy using an AV sequential pacemaker and ephedrine].
Syncope due to hypersensitivity of carotid sinus developed in a patient with laryngeal carcinoma. After implantation of a ventricular demand pacemaker a marked vasodepressor component became evident leading to further episodes of fainting. Only after implantation of an AV-sequential pacemaker and additional oral medication with ephedrine syncopes could be prevented.
Carcinoma, Squamous Cell↗
Changes in biochemical parameters during complete thyroid hormone deficiency of short duration in athyreotic patients.
The effect of withdrawal of suppressive therapy with thyroid hormones (200 micrograms L-thyroxine/day) on serum biochemical profiles and blood cell counts were studied in ten athyreotic thyroid carcinoma patients. After 14 days off therapy, all patients but one were still clinically and biochemically euthyroid. Twenty-eight days without thyroid hormones resulted in severe clinical and biochemical (TT4, TSH) hypothyroidism. At that time, the following parameters changed significantly: CPK activities increased (in five of ten patients above normal) as well as activities of SGOT, SGPT, and LDH (means and s.d.s within the respective normal ranges). Total cholesterol and triglycerides increased within the normal range. There were minimal but significant increases of serum creatinine and of mean corpuscular volume of erythrocytes as well as decreases of serum sodium and calcium. Our study underlines the importance of further investigation if pathologic biochemical or hematologic parameters are obtained in athyreotic patients after 4 wk withdrawal of thyroid hormone therapy.
Adult↗
Surgical treatment of distant metastases in differentiated thyroid cancer: indication and results.
A total of 45 patients have received surgical treatment for distant metastases in 41 follicular and four papillary carcinomas. Fifty-four metastatic lesions were removed. In the majority of cases (n = 25, 46%), surgical intervention was indicated on the basis of oncologic data (reduced administration of radioiodine). Sixteen patients (30%) underwent surgery to relieve pain, and 13 other patients (24%) had surgical treatment of pathologic fracture. At the time of surgery, 29 patients (64%) had only one resectable metastasis, while 16 patients (36%) had further nonresectable metastases (six in the bone, 10 in the bones and lungs). In the course of 53 operations, metastases were resected from bone in 46 cases, from the lungs and greater omentum in two cases, and from the skin, suprarenal gland, pleura, and intra-abdominal lymph node in one case each. A total of 25 metastases (17 bone, eight soft tissue) could be removed by resection. In 16 patients, the resulting bone defect was filled with bone cement after resection of the metastases. Osteosynthesis was necessary in another six cases, while seven required the implantation of an endoprosthesis. Thirty-eight patients died between 1 and 136 months after surgical treatment. Twenty-six (58%) died of their primary disease after an average 49.3 months, seven (15%) died with their carcinomas of other causes after an average of 12 months, and five (11%) died intercurrently after an average of 16 months. Seven patients (15%) are still alive after 12 to 264 months (average, 99.3 months); four of them are without recurrence and three have metastases. Five of these patients exhibit normal activity, while the activity of the other two is limited by the progress of the carcinoma or as a result of surgical treatment. The estimated cumulative survival rate (Kaplan-Meier) was 44.8 +/- 11.2% for 5 years and 32.7 +/- 11.0% for 10 years after removal of a solitary metastasis. Analysis of these patients shows that the surgical removal of resectable metastases can be a valuable complement to nuclear medical therapy. The complicated surgical treatment of metastases is justified by the favorable effect it has on prognosis and on the patient's quality of life.
Adenocarcinoma↗
Atrial natriuretic peptide concentrations in blood from right atrium in patient with severe right heart failure.
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Atrial Natriuretic Factor↗
Effects of variations in thyroid hormone serum concentrations on serum ACE-activity.
Serum angiotensin converting enzyme activities were significantly increased in 26 untreated hyperthyroid patients (20.3 +/- 5.4 U/ml; P less than 0.001) compared with healthy control subjects (13.1 +/- 2.3 U/ml). In 12 patients a significant fall in enzyme activities was observed after treatment compared with pretreatment serum ACE levels (P less than 0.001). Eight patients with hypothyroidism (15.7 +/- 5.1 U/ml) and 11 athyreotic patients, totally thyroidectomized for well-differentiated thyroid cancer, showed no significant differences in serum ACE activities (14.3 +/- 2.2 U/ml) compared with control subjects. After thyroid hormone supplementation a significant increase in serum ACE activity (P less than 0.05) was found in the athyreotic patients. Addition of increasing amounts of L-thyroxine to a serum sample of an athyreotic patient showed no significant effect on ACE activity in vitro. We suggest that the elevated serum ACE activity in hyperthyroidism is not from the thyroid gland, but represents a direct effect of thyroid hormone on ACE synthesis and/or release from endothelial cells.
Adult↗
[Diastolic compression of the right atrium and right ventricle as an echocardiographic sign of pericardial tamponade. Case report].
A 33 years old female patient requiring regular hemodialysis for chronic renal failure exhibited a severe hypotensive episode. 2-dimensional echocardiography enabled rapid recognition of the underlying cause. 2-dimensional echocardiography revealed a large pericardial effusion and from the apical window a marked diastolic compression of the right atrium and the right ventricle was noted. These findings have been previously described to be specific for cardiac tamponade. After removal of 400 ml of fluid by pericardiocentesis the clinical symptoms rapidly improved and in the 2-dimensional echocardiography diastolic compression of the right sided heart chambers was not longer evident, although a substantial amount of pericardial fluid was still present. This case report underlines the clinical usefulness of 2-dimensional echocardiography for the diagnosis of cardiac tamponade.
Adult↗
Decreased insulin receptor binding in hyperthyroidism.
The binding of 125I-insulin to insulin receptors on circulating mononuclear leukocytes was studied in ten patients with hyperthyroidism and 20 euthyroid normal volunteers. The hyperthyroid patients demonstrated significantly elevated glucose levels following an oral glucose load, despite normal insulin secretion. The infusion of insulin resulted in a delayed hypoglycaemic effect in the hyperthyroid patients; however, the inhibition of the endogenous insulin secretion as indicated by suppression of C-peptide levels was not different from euthyroid control subjects. Insulin binding to monocytes was significantly decreased in the hyperthyroid patients. Scatchard analysis of binding data indicates that a decrease of receptor number rather than receptor affinity seems to be the cause of the lowered insulin binding in hyperthyroid patients with diffuse toxic goitre. The findings of decreased insulin receptor number, mild degree of glucose intolerance despite normal insulin secretion and the delayed hypoglycaemic effect following insulin infusion suggest that peripheral insulin resistance could be involved in the highly complex pathophysiology of glucose intolerance in hyperthyroidism.
Adult↗
[Antiarrhythmic effect and side effects of amiodarone].
UNLABELLED: Amiodarone (AM) is one of the most potent antiarrhythmic drugs, the value of which is limited by reversible and irreversible side-effects (SE). 59 patients, 50 male, 9 female (age 33 to 81 years) entered the study with ventricular tachycardia (VT, 68%), WPW-tachycardia (12%), non-sustained VT (12%) or untreatable paroxysmal atrial fibrillation or supraventricular tachycardia (8%). Prior to AM the patients had received 1 to 8 different antiarrhythmic drugs (m 3.5) and maximal 9 different combinations of antiarrhythmics. The drug regimen started with a loading dose of 1200 mg/d for 1 to 2 weeks and was continued with a maintenance dose of 200 to 600 mg/d. The patients were followed up 1 to 41 months (m 14 m). The drug effect was evaluated using clinical criteria (recurrence of arrhythmias, death), computer-assisted analysis of several 24 hr long-term ECGs and programmed electrophysiological stimulation. Three- to six-monthly the patients were seen in our outpatient department for check up and blood-sample analysis (liver, thyroid gland etc.). Also in the majority of the patients frequent ophthalmological and dermatological investigations, as well as lung functions tests were carried out. RESULTS: under AM therapy the initial arrhythmias were no longer detectable in 41% of the patients. In 37% a significant amelioration of the formerly life-threatening arrhythmias was found. 7 patients (12%), predominantly with reduced left ventricular function, died during follow up. No pulmonary, hepatotoxic or neurological SE were found. All patients developed reversible AM keratopathy. In 27% ETR and T4 were elevated, but only one patient developed hyperthyroidism with an increase in TT3. Another patient showed signs of hypothyroidism with an elevated TSH prior to TRH stimulation. Increased phototoxicity was found in 31%, whereas in two patients typical AM hyperpigmentation occurred, especially on the face. In conclusion, AM is a highly effective antiarrhythmic agent, despite a negatively selected collective, but it should only be used in patients with refractory arrhythmia in view of the SE.
Adult↗