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Biomedical subjects

P Kopelman

Publications and source records attributed to P Kopelman.

31 records · Page 2Linked to original sources
PubMed1995

A comparison of the effects of human and ovine corticotropin-releasing hormone on the pituitary-adrenal axis.

To compare the clinical efficacy of ovine and human sequence corticotropin-releasing hormone (CRH), we examined the effects of both peptides on ACTH and cortisol secretion in normal human volunteers, obese subjects, and patients with pituitary-dependent (Cushing's disease) and adrenal-dependent Cushing's syndrome. All subjects in each group were studied twice in random order. One hundred micrograms of CRH were administered as an iv bolus through an in-dwelling forearm cannula at 0930 h, and thereafter, blood was drawn every 15 min for 2 h for the measurement of ACTH and cortisol. In the normal subjects, the peak ACTH, peak incremental ACTH, and mean area under the curve after CRH treatment were greater with ovine CRH than human CRH, although there was no difference in the cortisol response, however it was analyzed. There was no difference in the ACTH or cortisol response to the two preparations in the obese subjects, and no significant difference was found, for either cortisol or ACTH, between obese subjects and normal volunteers. With both varieties of CRH, Cushing's disease resulted in greater responses for ACTH and cortisol than those seen in the other 2 groups (P < 0.001 for all comparisons), but there was no difference between the sequences. However, a significant cortisol response, defined as an increase of greater than 4 times the coefficient of variation of the assay (24%), was seen in all 10 Cushing's patients with human CRH, but in only 8 with ovine CRH. In 3 patients with adrenal tumors, serum cortisol did not change after the administration of either preparation, whereas plasma ACTH remained undetectable throughout the study. We suggest that although ovine sequence CRH causes more prolonged and greater ACTH, and possibly cortisol, secretion compared to human CRH, the discriminatory value of the CRH test, in terms of either the diagnosis or differential diagnosis of Cushing's syndrome, is comparable for the two peptide sequences.

Adrenocorticotropic Hormone↗
PubMed1980

Fungal endocarditis after homograft valve replacement: difficulties in diagnosis and treatment.

Fungal endocarditis is an uncommon but important problem after cardiac surgery. Two cases of fungal endocarditis after homograft valve replacement are reported. In both patients prolonged periods of antifungal chemotherapy with apparently satisfactory clinical responses ultimately failed to eradicate the infection. Both patients remain free of infection two years after excision of the infected valves and further chemotherapy. The value of serial estimations of fungal antibody titres in diagnosis and treatment is demonstrated and the necessity for early operation is emphasised.

Adult↗
PubMedDate not supplied

Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance.

BACKGROUND: Sibutramine is a tertiary amine that has been shown to induce dose-dependent weight loss and to enhance the effects of a low-calorie diet for up to a year. We did a randomised, double-blind trial to assess the usefulness of sibutramine in maintaining substantial weight loss over 2 years. METHODS: Eight European centres recruited 605 obese patients (body-mass index 30-45 kg/m2) for a 6-month period of weight loss with sibutramine (10 mg/day) and an individualised 600 kcal/day deficit programme based on measured resting metabolic rates. 467 (77%) patients with more than 5% weight loss were then randomly assigned 10 mg/day sibutramine (n=352) or placebo (n=115) for a further 18 months. Sibutramine was increased up to 20 mg/day if weight regain occurred. The primary outcome measure was the number of patients at year 2 maintaining at least 80% of the weight lost between baseline and month 6. Secondary outcomes included changes in uric acid concentrations and glycaemic and lipid variables. Analysis was by intention to treat. FINDINGS: 148 (42%) individuals in the sibutramine group and 58 (50%) in the placebo group dropped out. Of the 204 sibutramine-treated individuals who completed the trial, 89 (43%) maintained 80% or more of their original weight loss, compared with nine (16%) of the 57 individuals in the placebo group (odds ratio 4.64, p<0.001). Patients had substantial decreases over the first 6 months with respect to triglycerides, VLDL cholesterol, insulin, C peptide, and uric acid; these changes were sustained in the sibutramine group but not the placebo group. HDL cholesterol concentrations rose substantially in the second year: overall increases were 20.7% (sibutramine) and 11.7% (placebo, p<0.001). 20 (3%) patients were withdrawn because of increases in blood pressure; in the sibutramine group, systolic blood pressure rose from baseline to 2 years by 0.1 mm Hg (SD 12.9), diastolic blood pressure by 2.3 mm Hg (9.4), and pulse rate by 4.1 beats/min (11.9). INTERPRETATION: This individualised management programme achieved weight loss in 77% of obese patients and sustained weight loss in most patients continuing therapy for 2 years. Changes in concentrations of HDL cholesterol, VLDL cholesterol, and triglyceride, but not LDL cholesterol, exceed those expected either from weight loss alone or when induced by other selective therapies for low concentrations of HDL cholesterol relating to coronary heart disease.

Adolescent↗
PubMedDate not supplied

Prescribing for obesity. Comment on the Royal College of Physicians' Working Party report on clinical management of overweight and obese patients with particular reference to drugs.

Physicians are reluctant to treat obesity despite the rapid increase in its prevalence in the UK and its associated health problems such as diabetes, coronary heart disease and hypertension. Overweight and obesity are chronic conditions that require long-term treatment. Any therapeutic programme should combine dietary restriction with physical activity and alterations to lifestyle. The use of pharmacological treatment as an adjunct to conventional treatment modalities is justified in certain circumstances. The criteria applied for the prescription of an anti-obesity drug should be comparable to that applied to the treatment of other relapsing disorders. The objective of the Royal College of Physicians' new report, Clinical management of overweight and obese patients with particular reference to the use of drugs, is the provision of such necessary guidance. Based on evidence from clinical trials, the recommendations of the report utilise a 12-week goal (outside a drug trial) of 5% body weight loss from the start of drug treatment. Failure to achieve this goal is an indication for stopping drug therapy. Safety and efficacy demand appropriate use of anti-obesity drugs in a supervised setting with clinicians weighing up likely medical benefit against possible risks.

Anti-Obesity Agents↗