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Biomedical subjects

P Jaeger

Publications and source records attributed to P Jaeger.

At least 145 records · Page 8Linked to original sources
PubMed1987

[Left ventricular hypertrophy. Advantages and disadvantages].

The increase in left ventricular myocardial mass is a mechanism of adjustment of the ventricular pump to a normal process, such as growth or sports, or a pathological process (mechanical overload or cardiomyopathy). The associated geometrical changes tend to normalize systolic performance and/or strain--one of the main determinants of myocardial metabolic requirements. When left ventricular hypertrophy is inadequate quantitatively, geometrically and functionally, and when contractility and preload reserves are exhausted, the systolic performance of the ventricular pump becomes narrowly dependent upon the increased systolic strain. some types of "pathological" hypertrophy may ultimately result in alteration of myocardial intrinsic properties during contraction, relaxation and/or extension, and this in turn may induce or aggravate ventricular failure. The causes of left ventricular hypertrophy are imperfectly known, the views most commonly held being metabolic imbalance of the myocardium due to increased demands, and reduction of coronary reserve and exchange capacities.

Cardiomegaly↗
PubMed1987

[Usefulness of urinary electrolyte determination].

As a practical contribution to an understanding of the usefulness of measuring some electrolytes in urine, the author first recalls that elements measured in a 24-h urine sample provide nutritional informations, whereas those assayed in fasting morning urine generate data on renal tubular function. To illustrate the first point the author describes assessment of the etiology of hypercalciuria based on a knowledge of concomitant 24-h excretions of sodium, phosphate, urate and creatinine. On the second point, the author suggests dissociating the parameters of which only the urinary concentration is of interest (pH, lysozyme, gamma-glutamyl-transferase) from the parameters of which the excretion--either fractional (Na, K, Cl, P, Mg) or absolute (Ca)--should be calculated. Finally, the reader is reminded how to use the nomogram of Peacock, Robertson and Nordin to evaluate fasting urinary excretion of calcium, and how to use the nomogram of Walton and Bijvoet to estimate the renal threshold phosphate concentration.

Acidosis, Renal Tubular↗
PubMed1987

Paget's disease of bone treated in five days with AHPrBP (APD) per Os.

Amino-hydroxypropylidene bisphosphonic acid (AHPrBP, previously APD) is a potent inhibitor of bone resorption. Since it remains in bone for a long time, and since it was not found to impair bone mineralization, it could be administered at high dose over a short period of time. Therefore, 11 patients with symptomatic Paget's disease received AHPrBP orally at 1200 mg/day over 5 consecutive days. Controls were performed after 1 month in all patients, 6 months in 8 patients, and one year in 4 patients. Clinical improvement and biochemical remission was observed in all patients, except one with severe disease. Side effects were negligible. Disease activity at bone scintigram decreased over 6 months. Plasma alkaline phosphatase activity fell progressively and significantly from 210 +/- 26 U/l (means +/- SEM) to 103 +/- 10 U/l after 6 months (nl less than 120 U/l). Urinary excretion of hydroxyproline decreased immediately and became normal (nl less than 2.3 mumol/lGF) as a mean at day 5 (from 4.6 +/- 0.4 mumol/lGF to 2.1 +/- 0.3 mumol/lGF). Thereafter it remained within the normal range (2.0 +/- 0.2 mumol/l at day 180). Plasma calcium and phosphate concentrations fell transiently between day 4 and 15, whereas plasma PTH levels increased over this period of time. In conclusion, a short course of AHPrBP given per os at high dose induces a rapid decline in activity and remission of moderate Paget's disease, without significant side effects.

Aged↗
PubMed1987

Effectiveness of salmon calcitonin administered as suppositories in tumor-induced hypercalcemia.

Although calcitonin is a natural, nontoxic, and rapid inhibitor of bone resorption, its use in the treatment of hypercalcemia is limited because of its transient efficacy and the need for repeated parenteral administration. In normal subjects, suppositories of calcitonin have been shown to be biologically active. Peak plasma concentrations of salmon calcitonin after rectal administration in six normal subjects were similar to those measured after parenteral administration. To evaluate the efficacy of calcitonin suppositories in disease states, 10 patients with moderate hypercalcemia due to malignancy were treated with salmon calcitonin, administered as suppositories containing 300 MRC units, three times a day for seven days. The mean plasma calcium level decreased significantly from 2.96 +/- 0.09 mmol/liter to 2.57 +/- 0.09 after one week (p less than 0.005) and rose again after discontinuation of treatment to 2.86 +/- 0.09 mmol/liter one week later. Urinary calcium and hydroxyproline values decreased during treatment and rose after discontinuation of treatment. The plasma calcium level decreased rapidly in six patients, becoming normal in five; three patients showed only a partial response, and one patient had no response at all. No side effects were observed, and clinical improvement was noted in nine of the 10 patients. Little or no response was observed in patients with extremely high urinary calcium or, to a lesser extent, high hydroxyproline excretion. There was a significant negative correlation between the maximal decrease in plasma calcium concentration and initial urinary calcium excretion (r -0.78, p less than 0.01). Thus, salmon calcitonin administered by the rectal route appears to be an easy, safe, and effective treatment of moderate hypercalcemia without apparent side effects.

Administration, Rectal↗
PubMed1987

Parathyroid hormone directly inhibits tubular reabsorption of bicarbonate in normocalcaemic rats with chronic hyperparathyroidism.

The hypothesis that chronic metabolic acidosis encountered in some patients with primary hyperparathyroidism is due to inhibition of proximal HCO3 reabsorption has recently been challenged. Indeed, this action of parathyroid hormone (PTH) has only been observed in acute studies, whereas in animal models of chronic hyperparathyroidism a metabolic alkalosis has been induced, probably owing to the release of alkaline salts from bone tissue, and to the stimulation of tubular acid secretion by hypercalcaemia. Studies were, therefore, performed to determine the effect of PTH on the renal handling of HCO3 in an animal model in which changes in plasma calcium and phosphate, and nephrocalcinosis, all known to affect tubular acidification, did not occur. Thyroparathyroidectomized (TPTX) rats were infused with synthetic bovine hormone fragment bPTH 1-34 via Alzet minipumps at the rate of 0.7 U h-1 to simulate normal endogenous production of PTH (group I) and at the three-fold higher rate of 2.1 U h-1 (group II). In order to prevent changes in serum calcium and phosphate, and nephrocalcinosis, animals of group II were fed a Ca- and P-free diet prior to TPTX (compared with a regular diet for group I) and both groups were treated with dichloromethylene-diphosphonate (Cl2MDP, 10 mg kg-1 day-1) and a Ca-free diet during PTH infusion. During the course of PTH infusion both groups of animals had stable and normal levels of plasma calcium and phosphate.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1987

Improvement of serological diagnosis of neonatal cytomegalovirus infection by simultaneously testing for specific immunoglobulins E and M by antibody-capture enzyme-linked immunosorbent assay.

This study describes the results of testing 92 serum samples, including 10 umbilical cord serum samples, from 38 cytomegalovirus (CMV)-infected neonates for CMV-specific immunoglobulins E (IgE) and M by antibody-capture enzyme-linked immunosorbent assays with enzyme-labeled CMV antigen. All infants excreted CMV in the urine. It was demonstrated that the CMV IgE test was more sensitive than the CMV IgM test in diagnosing CMV infection in neonates by serology. Thus, the sensitivity for the IgE test was 82%, whereas for the IgM test it was only 66%. Furthermore, the CMV-specific IgE response, expressed as absorbance, was higher than the specific IgM response in 91% of the 76 sera which contained antibodies of either one or both immunoglobulin classes. Forty-six control sera, including 18 umbilical cord sera, from 46 neonates from whom CMV was not isolated were also tested. Most sera were negative. Three infants, however, had CMV antibodies of one or both classes, indicating infection. The level of total serum IgE was controlled in 24 of the sera from the CMV-infected neonates, but in none of the cases was the level elevated. No correlation was found between the reactivity of the antibodies in the two immunoglobulin classes and the level of CMV in urine.

Antibodies, Viral↗
PubMed1987

Animal model of primary hyperparathyroidism.

An experimental model of hyperparathyroidism was developed in the rat to simulate primary hyperparathyroidism in humans. In this model thyroparathyroidectomized (TPTX) or parathyroidectomized (PTX) animals were infused for 6 days with an amount of bovine synthetic parathyroid hormone (PTH)-(1-34) fragment to restore plasma calcium levels to normal (0.7 U X h-1) or with PTH at twofold (1.4 U X h-1) or threefold (2.1 U X h-1) this basal level. Animals infused with 2.1 U X h-1 of bovine PTH-(1-34) exhibited hypercalcemia, hypophosphatemia, a reduction in theoretical renal threshold for phosphate and an increase in 1,25-dihydroxyvitamin D plasma levels that were approximately threefold the control value. In addition, these animals demonstrated nephrocalcinosis and changes of bone histology that were typical of the findings in patients with primary hyperparathyroidism. In contrast, in animals infused at 1.4 U X h-1, plasma calcium, phosphate, and theoretical renal threshold for phosphate remained within normal limits, but plasma 1,25-dihydroxyvitamin D was increased above control, suggesting that increased activity of 1 alpha-hydroxylase may be the most sensitive index of increased PTH levels. This animal model permits sustained elevation of PTH plasma levels at basal or pathologically elevated levels and should provide an effective means by which to evaluate the consequences of chronic hyperparathyroidism on epithelial function, bone, and other organ systems.

Acid-Base Equilibrium↗
PubMed1987

Dietary factors and medullary sponge kidneys as causes of the so-called idiopathic renal leak of calcium.

Out of 89 stone formers with idiopathic hypercalciuria, 51 remained hypercalciuric on a low calcium diet over 5 days: a renal leak of calcium could thus have been suspected in them. Dietary factors such as high sodium or high animal protein intake, and metabolic factors such as obesity with or without hyperinsulinemia, which all might account for the hypercalciuria of these patients, have been evaluated. This evaluation revealed conditions known to be associated with hypercalciuria in 37 of these 51 patients: 15 had hypercalciuria related to a high sodium intake, 7 had severe hyperuricosuria (greater than 1 g/24 h) reflecting a high animal protein intake, 20 were obese (greater than 120% of ideal weight) with (7 cases) or without (13 cases) concomitant high fasting plasma level of insulin (greater than 18 microU/ml). A careful retrospective analysis of the intravenous pyelograms disclosed medullary sponge kidneys in 8 cases which had remained undiagnosed so far. One of them was studied histologically. Only 14 out of 51 patients had an otherwise unexplained hypercalciuria on a low calcium diet. It is concluded that dietary causes appear to play a key role in 'idiopathic' hypercalciuria, that the incidence of a primary renal leak of calcium among idiopathic stone formers is much smaller than initially thought, and that this condition can hide unrecognized medullary sponge kidneys.

Calcium↗
PubMed1987

Renal bicarbonate reabsorption in the rat. II. Distal tubule load dependence and effect of hypokalemia.

We studied two groups of rats acutely loaded with bicarbonate, control rats on a standard diet and rats kept on a K-free diet for 3 wk. Compared with controls, K-depleted rats had reduced fractional excretion of bicarbonate despite their elevated filtered bicarbonate load. Distal bicarbonate reabsorption increased in K-depleted rats. In the presence of almost identical early distal bicarbonate loads (481 +/- 40 pmol/min in controls and 444 +/- 50 pmol/min in K depletion), distal bicarbonate reabsorption was significantly enhanced in K depletion (247 +/- 17 pmol/min) as compared with controls (179 +/- 18 pmol/min). These values are significantly different from each other, and both are severalfold higher than bicarbonate reabsorption in nonloaded conditions. In conclusion, distal bicarbonate reabsorption is load dependent, and distal bicarbonate reabsorption is stimulated in K depletion.

Animals↗
PubMed1987

[Supra-symphyseal ultrasound study as a simple method for determining the size of prostatic adenoma. Results in over 100 open prostatectomies].

In more than 100 patients with benign prostatic hypertrophy a preoperative ultrasound evaluation was performed by transabdominal longitudinal and transverse scan. The result was compared to the weight of the enucleated adenoma. Dependent on measuring errors, the best prognostic value was the largest diameter of the prostate: less than 4 cm means less than 40 g in all cases; 5 cm corresponds to 50 g and 6 cm to about 70 g. This is of great help when deciding between transurethral resection or open prostatectomy from these data.

Aged↗
PubMed1987

[Reduction of auricular fibrillation and tachycardia using intravenous flecainide].

Fifty-one consecutive patients with atrial tachycardia [atrial fibrillation (FA) 37, atrial flutter (Fl) 10, tachycardia (TSA) 4] received a single 2 mg/kg dose of flecainide injected intravenously over 5 to 10 minutes. Patients over 75 years of age or presenting with heart failure or disorders of conduction were excluded from the study. Sinus rhythm was restored during the injection or within the following 5 minutes in 15 patients (FA 12, Fl 1, TSA 2). The most frequent side-effects were visual disorders (5 cases) and moderate prolongation of QRS (all cases). Five patients had more pronounced disorders of conduction, but none developed heart failure. Reduction was obtained in 12 of the 18 patients whose arrhythmia had lasted for less than 8 days, against only 3 of the patients whose arrhythmia was more than 8 days old. Drug-induced reduction always failed in patients with left atrial dilatation (greater than 45 mm at echocardiography). An increase in the ventricular rate of unreduced flutter was observed in only one patient. Plasma flecainide levels were high (1.5 and 5.5 mg/l) at the end of the injection, but they fell to the therapeutic range within less than 10 minutes. Flecainide therefore appears to be effective in reducing recent atrial fibrillation on a non-dilated atrium. In cases with disorders of conduction, altered ventricular function or flutter, the therapeutic risk is such that another method of conversion should be used.

Adult↗
PubMed1987

[Drug treatment of left ventricular insufficiency. Current aspects].

The medical treatment of left ventricular failure classically relies upon the use of diuretics with or without digitalis. The recent arrival of vasodilators allows for both an improvement in the quality of life as well as a prolongation of survival for people in heart failure. The "new" positive inotropic agents which can be used orally in the longterm have not yet given the results which were anticipated. The prognosis of left ventricular failure remains poor, underlining the importance of preventive treatment and in the last resort the possibility of cardiac transplantation.

Cardiotonic Agents↗
PubMed1986

[Hypocalcemia and myelofibrosis: an unrecognized association].

Observation of a case of myelofibrosis with myeloid metaplasia of liver and spleen associated with hypocalcemia led us to investigate whether this association was fortuitous. We retrospectively analyzed the data of 30 patients with myelofibrosis and identified 9 patients with hypocalcemia out of 22 in whom the plasma calcium level corrected for serum protein could be obtained, i.e. a prevalence of hypocalcemia of 41%. The spleen was significantly larger in the patients with hypocalcemia than in those with normal plasma calcium level, suggesting that hypocalcemia was related to the duration of the disease. In 5 patients with hypocalcemia, biological and/or morphological evidence of osteomalacia was found. It is concluded that an association exists between myelofibrosis and hypocalcemia, possibly as a consequence of a disturbed vitamin D metabolism.

Aged↗