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Biomedical subjects

P Bottermann

Publications and source records attributed to P Bottermann.

At least 19 recordsLinked to original sources
PubMed1991

[Diabetes mellitus and arterial hypertension. In search of the connecting link].

Late diabetic effects are the sequelae of for a long time super elevated blood sugar levels. The diabetic nephropathy is the cause of the secondary arterial hypertension. The investigation seeks for the connections between the diabetes mellitus and the essential, that is primary hypertension. The two diseases frequently appear and clearly increase in the second half of life. Moreover, they are above average frequently associated with each other. Among brothers and sisters of diabetic hypertensives in comparison to normal cohorts clearly increased high blood pressure prevalences were found. The insulin resistance which could be proved in a great number of hypertensive and which has been known since more than two decades might be the connecting link between hypertension and diabetes mellitus. Like the obesity the essential hypertension can be associated with all degrees of an insulin hyposensitiveness. The sodium-retaining effect of the insulin might explain the increased sodium content of the body in hypertensives. The differential diagnostics of the essential hypertension should therefore seek for conditions of an insulin resistance. The type II diabetic lacks a release of bradykinin during muscle work. Thus the glucose uptake into the cell is unfavourable influenced and demands an increased insulin excretion. This genetically (?) fixed defect is found also in essential hypertensives. It could be the connecting link between the two diseases. ACE-inhibitors have via a kininase II inhibition an effect also on the bradykinin decomposition and can favourable influence the glucose uptake into the muscle. An improved insulin effect among the ACE-inhibitors was described. Therefore, they should be preferred in the treatment of hypertensive diabetics.

Diabetes Mellitus, Type 2↗
PubMed1988

Kinetics of biosynthetic human proinsulin in patients with terminal renal insufficiency.

Eight volunteers with terminal renal insufficiency having consented to the investigation, were given an i.v. bolus administration of 40 pmol biosynthetic human proinsulin on their dialysis-free day. Intravenous blood for the determination of blood glucose proinsulin, insulin and C-peptide was collected in short intervals for 6 hours and thereafter in longer intervals for 24 hours. Proinsulin was determined by immunoradiometric assay with monoclonal antibodies. The proinsulin kinetics were compared with the kinetics of normal volunteers. The behaviour of proinsulin concentration-time is best described with a 3-compartment model. The dominant biological half-life in terminal renal insufficiency was 6.8 hours which signifies a 4.4-fold increase of the normal half-life. The distribution volumes (V1) in the central compartment do not differ in the two groups, whereas the distribution volume after complete distribution (Vss) is significantly increased in renal insufficiency. The total metabolic clearance in renal insufficiency namely 0.63 ml/kg/min is 2.6 times lower compared to normal subjects with 1.67 ml/kg/min. The extra-renal clearance is 39% of the total metabolic clearance rate, whereas the renal clearance comprises 61%. Peripheral conversion from proinsulin to insulin and C-peptide does not occur in terminal renal insufficiency. The basal endogenous proinsulin secretion rate in renal insufficiency does not differ from that of normal volunteers. The following conclusions can be drawn: 1) Hyperinsulinism observed in renal insufficiency can be explained by circulating proinsulin. 2) In the potential therapeutic use of biosynthetic human proinsulin in diabetics with renal insufficiency dosis adjustment according to the remaining renal function would probably be required.

Adult↗
PubMed1988

Action profile of biosynthetic human proinsulin trials with the BIOSTATOR in metabolically normal subjects.

Studies to examine the pharmacokinetics and pharmacodynamic properties of biosynthetic human proinsulin were conducted with the aid of the "glucose-controlled insulin infusion system BIOSTATOR". Seven metabolically normal healthy volunteers were given subcutaneous injections of 0.1 mg human proinsulin per kg body weight, and the subsequent behaviour of the serum proinsulin concentration was monitored over a period of 21 hours. The drop in the blood-sugar levels was counteracted by corresponding infusions of glucose by the BIOSTATOR via a special clamp technique. The intensity and frequency of the glucose infusions given by the BIOSTATOR equipment enable us to draw conclusions regarding the hypoglycaemic efficacy of human proinsulin. Two to three hours after the subcutaneous injection, the serum proinsulin concentration had reached its plateau-like maximum value. After approximately 5 hours it had dropped to 2/3 of the maximum, and after another 3 to 4 hours it had fallen further to 1/3 of the maximum. It returned virtually to its initial value after a total of 14 to 16 hours. The dextrose infusion rate calculated by the BIOSTATOR reflects these changes in the form of an "action profile". Proinsulin has a mean transit time (MTT) of 322 minutes. This is longer than the MTT of normal insulin (188 minutes) but markedly shorter than that of NPH insulin (625 minutes). If the hypoglycaemic effects of insulin and human proinsulin are compared on the basis of the areas under their respective action profile curves, the hypoglycaemic effect of 1 mg human proinsulin corresponds to 5.2 IU insulin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Clinical investigations into the modification of the effect of endogenous and exogenous insulin by human proinsulin in type II and type I diabetics.

The investigation on hand leads to the conclusion that HPRO can additively increase the blood glucose lowering effect of endogenous and exogenously administered insulin. Etiologically the prolonged retention time of HPRO in the circulation - compared to HI - must be primarily discussed. In the further course the question arises to what extent traditional retard insulins would have to be replaced or supplemented by HPRO.

Aged↗
PubMed1988

Pharmacokinetics of biosynthetic human proinsulin following intravenous and subcutaneous administration in metabolically healthy volunteers.

40 pmol of biosynthetic human proinsulin was administered to 8 healthy volunteers by intravenous and by subcutaneous route. Following proinsulin administration, venous blood was collected in regular intervals within which proinsulin was determined by a specific radioimmunometric assay with monoclonal antibodies. The proinsulin concentration was determined simultaneously with the insulin and C-peptide radioimmunoassay. Through this investigation the following kinetic parameters were found: The kinetics of the biosynthetic human proinsulin can be best described by the 3-compartment model. The dominant biological half-life was 92 minutes. In intravenous proinsulin administration a proinsulin mean transit time of 80 minutes was found, whereas in subcutaneous administration a proinsulin retention time of 225 minutes was measured. The mean resorption velocity of the subcutaneously applied proinsulin amounted to 145 minutes. Two lag times for subcutaneous resorption can be described, a short one with 9.4 minutes and a long one with 65 minutes. The initial distribution volume for proinsulin was 3.8 l, whereas the distribution volume after complete distribution was 9.3 l. The mean total metabolic clearance was determined with 120 ml/min. Since no difference for the proinsulin concentration was found using the 3 different determination methods a peripheral proinsulin conversion to insulin and C-peptide is not likely. The basal endogenous secretion rate for proinsulin is 68.7 pmol per hour.

Adult↗
PubMed1986

The dexamethasone suppression test in depressive and schizophrenic patients under controlled treatment conditions.

Endogenous depressive and schizophrenic patients demonstrated the same frequency of pathological DST results after admission. After 3 weeks of psychopharmacological treatment the percentage of abnormal DST results was significantly reduced in both groups, although the treatment conditions were different. A correlation between the DST non-suppression and intensity of depression was observed only in the depressive group, not in the schizophrenic group. Normalization of DST results in depressive patients was mostly associated with an improvement of depressive scores. Other course patterns of DST results did not seem to be combined with psychopathological changes. From this data it has to be concluded that DST non-suppression is in some part related to depressive symptoms, but is not characteristic or specific for endogenous depression or for depressivity.

Adult↗
PubMed1986

[New observations in a case of Cronkhite-Canada syndrome].

We report about a 76 years old patient with Cronkhite-Canada syndrome. The diagnosis has been found with the following clinical symptoms: diarrhea, anorexia, alopecia, and onychotrophia. Laboratory values: severe hypoproteinemia (total serum protein 4.3 g/dl, albumin 2.4 g/dl); endoscopical and radiological findings: a generalized polyposis which involved the whole intestine except the oesophagus. As far as we saw in our literature-overview of 55 patients with Cronkhite-Canada syndrome, this patient had for the first time a carcinoma of the urinary bladder and a Bricker operation 17 years before the onset of his disease. Further we remarked a lack in the resorption of the enterally administered thyroidal hormones. The progress was fatal despite a parenteral hyperalimentation and a treatment with antibiotics and glucocorticoids.

Aged↗
PubMed1979

[Intravenous and oral TRH-stimulation test: comparison of the value of both tests concerning diagnosis and therapy of thyroid diseases (author's transl)].

15 euthyroid patients, 15 patients with a so-called non toxic goiter, 7 patients with hypothyroidism and 14 patients with hyperthyroidism (Grave's disease and autonomous adenoma) were submitted to intravenous (200 micrograms) and oral (40 mg) TRH-stimulation tests. After the oral application of TRH the patients with a normal thyroid function and the patients with a goiter showed an increase of the concentration of TSH which was about 1 1/2 fold higher than after the intravenous application of TRH. The patients who suffered from hypothyroidism showed a different reaction after intravenous and oral application of TRH. The patients with a hyperthyroidism had neither after the intravenous nor after the oral application of TRH an increase of the peripheral concentration of TSH. Therefore both intravenous and oral TRH-stimulation tests seem to be apt in the same way for the diagnosis of thyroid diseases and for the control of the therapy when thyroid hormones are applied.

Administration, Oral↗
PubMed1978

[Concentration of C-peptide and insulin in serum of patients with acute virus hepatitis (author's transl)].

Intravenous glucose tolerance tests were performed in 10 patients with acute virus hepatitis. The assimilation coefficient of glucose and the level of insulin and C-peptide in serum were determined before and in the course of the glucose tolerance tests. In comparison to healthy normal weight persons C-peptide concentration in patients with acute hepatitis increased twice as high whereas the pattern of insulin secretion did not differ significantly. The higher levels of C-peptide indicate an increase of the beta-cell secretion in acute hepatitis. One could suppose an increased hepatic destruction of insulin in acute hepatitis, because there is no significant difference among the insulin levels. More likely, there is a reactive increase of secretion of the beta-cell due to a reduction of insulin sensitivity and this is indicated much better by C-peptide- than insulin levels because of the longer half live of the the C-peptide molecule.

Acute Disease↗
PubMed1978

[Radioimmuno-assay of TSH before and after TRH in 350 patients with previous resection of euthyroid goiter (author's transl)].

Radioimmuno-Assay (RIA) of Thyroid-Stimulating-Hormone (TSH) was performed before and after i.v.-injection of Thyrotropin-Releasing-Hormone (TRH) in 350 patients subsequent to previous resection of euthyroid goiter to find out the optimal treatment schedule for preventing recurrent goiter. In patients without recurrent goiter the dosis of thyroid hormone was considered to be sufficient, if the difference in TSH-levels before and after TRH (delta-TSH) was equivalent to or less than 10 microunits/ml. In patients with recurrent goiter the optimal suppressive dosis of thyroid hormone was accepted for a delta-TSH less than or equal to 2,5 microunits/ml. 126 out of 135 patients, who were set on an immediate and continuous postoperative treatment were free of goiter, 58 presented a delta-TSH less than or equal to 10 microunits/ml (average interval of treatment = 2,5 years), 68 patients had elevated delta-TSH (average interval of treatment 2,1 years) as a sign of insufficient treatment. In 9 patients recurrent goiter was detected in spite of "adequate" treatment. 41 out of 57 patients, set on delayed and partly continuous, partly discontinuous treatment had recurrent goiter (in average after 10 years). delta-TSH was not indicative. 158 patients without any treatment had borderline or slightly increased delta-TSH (in average after 10 years). 122 of these 158 patients had recurrent goiter, 36 were free of goiter. The results favor the necessity of treatment with thyroid hormones starting immediately after operation and with continuous treatment. The combined use of TSH-RIA and TRH-test reliably informs about the individual thyroid hormone dosis necessary for prevention or treatment of recurrent goiters.

Goiter↗
PubMed1978

[Effects of the beta-adrenergic blocking agent propranolol on the carbohydrate- and lipometabolism (author's transl)].

Intravenous glucose tolerance tests were performed in 17 patients suffering from hyperthyreosis before and after a week of treatment with propranolol. The blood taken until the 125. minute after the glucose load was used for the determination of serum glucose, the free fatty acids (FFA), the free glycerol and the radioimmunologically measurable insulin (IRI). The following results were received: After the treatment with propranolol the glucose tolerance decreased significantly. The insulin secretion was diminished showing a significant difference for the fifth minute after glucose injection. The concentration of the FFA remained unchanged. The levels of the free glycerol were significantly lower after the propranolol treatment than before. Though an inhibition of lipolysis was possible by the propranolol treatment the glucose tolerance did not improve due to the inhibition of insulin secretion under propranolol. Beta-adrenergic blocking agents do not lead to an essential change in the carbohydrate- and lipometobolism. Therefore, their use in hyperthyroidism is mainly justified because of the cardial symptomatology.

Carbohydrate Metabolism↗