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Biomedical subjects

R D Hesch

Publications and source records attributed to R D Hesch.

At least 91 records · Page 5Linked to original sources
PubMed1986

Selective determination of C-terminal (70-84) hPTH: elevated concentrations in cholestatic liver disease.

In order to obtain a better resolution of circulating PTH-fragments, we developed a radioimmunoassay with an antiserum raised against the synthetic 70-84 hPTH molecule in a sheep. [125I](69 Tyr) 70-84 hPTH was used as the radioactive tracer with the antiserum at a final dilution of 1:200 000. Displacement curves showed that only the 70-84 hPTH, (69 Tyr) 70-84 hPTH and 53-84 hPTH fragments were able to compete with the tracer. Synthetic 28-48 hPTH, 44-68 hPTH, (61 Tyr)62-68 hPTH, purified 1-84 hPTH and 53-84 bPTH showed no ability to displace the tracer indicating that the idiotype of the antibody is directed against the 70-84 portion that is usually hidden within the globular structure of the intact molecule. Healthy adults revealed PTH-peptide levels of 153 +/- 86 pg/ml (mean +/- 2 SD); 2 SD range: 67-239 pg/ml. C-terminal PTH-peptide (70-84 hPTH) concentration was normal in patients with primary hyperparathyroidism and chronic renal failure, thus excluding that neither the kidney nor the parathyroid gland is involved in the generation of this C-terminal PTH-peptide sequence. Increased levels of 70-84 hPTH immunoreactivity were found in most individuals with severe cholestatic liver disease. Since the liver appears to be responsible for part of the peripheral PTH metabolism, this assay system might be used as an indicator of altered liver function.

Adult↗
PubMed1986

Thyrotropin--an episodically secreted hormone.

A recently developed highly sensitive immunoradiometric thyrotropin (TSH) assay capable to distinguish between euthyroid and hyperthyroid TSH-levels was used to evaluate the secretion-pattern of TSH in 10 healthy male subjects by taking blood via an indwelling venous catheter at 10 min intervals over 24 h. Visual analysis revealed a pulsatile pattern of hormone release with an average of 10.3 peaks/24 h. Evaluation by computer assisted programs such as the Santen-program (8.9 peaks/24 h, amplitude 0.60 mU TSH/l), the 'Pulsar'-program (6 peaks/24 h, amplitude 0.61 mU TSH/l) or power-spectrum analysis (11.9 peaks/24 h) showed similar results. These data suggest a pulsatile mechanism of TSH secretion similar to other pituitary hormones.

Adult↗
PubMed1986

Renal adenylate cyclase assay for biologically active parathyroid hormone: clinical utility and physiological significance.

The stimulation of cyclic AMP production by human renal cortical membranes in the presence of the GTP analogue 5'-guanylimidodiphosphate and a calcium chelator represents a homologous assay system for the evaluation of biologically active parathyroid hormone (bioPTH) in human serum. Bioactive PTH was raised above normal (normal range: undetectable to 4.6 pmol human PTH(1-34) per 1) in 13/17 (76%) patients with primary hyperparathyroidism, in 5/6 (83%) patients with surgically proven hyperparathyroidism secondary to chronic renal failure, in 4/5 (80%) patients with hyperparathyroidism secondary to hypocalcaemia, in all three patients with pseudohypoparathyroidism, in 5/17 (29%) patients with osteoporosis and in 1/9 (11%) patients with renal stones and/or hypercalciuria. Bioactive PTH correlated positively with immunoreactive PTH (iPTH) measured with a radioimmunoassay predominantly recognizing the middle- and carboxyl-terminal region of the PTH molecule (r = 0.503, P less than 0.001). A positive correlation (r = 0.572, P less than 0.05) was found between values of serum calcium and bioPTH in the group with primary hyperparathyroidism. Immunoreactive PTH did not correlate significantly with calcium in this group. In the other patients except those who had chronic renal failure, a negative correlation between serum calcium and both bioPTH and iPTH was observed (P less than 0.01). When alkaline phosphatase was compared with bioPTH in all patients, the correlation was positive (r = 0.390, P less than 0.01); no significant correlation existed between iPTH and alkaline phosphatase in the patients studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylyl Cyclases↗
PubMed1986

Human atrial natriuretic peptide (ANP) for the treatment of patients with liver cirrhosis and ascites.

The acute effects of human atrial natriuretic peptide (ANP) were investigated in 10 patients with liver cirrhosis and ascites. In all patients, diuresis and natriuresis were stimulated with a wide individual variation (50 to 500%) in response to a bolus injection of 30 micrograms ANP. No side effects of treatment were observed. Continuous infusion of ANP (300 micrograms/10 h/d) in a patient with liver cirrhosis and ascites, resistant to conservative forms of diuretic therapy, resulted in an initial increase of diuresis and natriuresis which subsequently returned to pretreatment levels. After initiation of pulsatile nocturnal treatment (5 pulses of 30 micrograms ANP every 3 h), diuresis increased, leading to a persistent normalization of sodium and chloride excretion. The patient lost 8 kg of weight during 16 days of treatment. Out of 3 additional patients on the same therapeutic regime, only one experienced a weight loss of 5 kg due to increased natriuresis and chloruresis. The remaining 2 patients did not respond during 5 resp. 7 days of therapy.

Adult↗
PubMed1986

[Evaluation of risk factors in various forms of inner ear hearing loss].

As in cardio-vascular diseases certain risk factors are held responsible for the genesis of inner ear affections. We thoroughly examined 205 patients, suffering from various kinds of internal ear disorders. Examinations included audiometric tests, medical, neurological and ophthalomological consultations and laboratory findings. Evaluation showed a significant increase of certain risk factors in our patients compared to the normal population. 50.2% of our patients were overweight, 29.3% had a high blood cholesterol, 28.8% had anaemia, and 22.4% had hypertension. These lesions of the auditory system thus share the same risk factors as the coronary and cerebral circulations. In the second stage of the study we looked for correlations between individual parameters and certain variations of inner ear disturbances, eg. sudden hearing loss, progressive or non-progressive hearing loss, low or high frequency disorders. It was not possible to distinguish between the forms of inner ear disease mentioned on the basis of the prevalence of certain risk factors.

Arteriosclerosis↗
PubMed1985

[Hyperprolactinemia and prolactinomas. Results of surgical and drug therapy].

185 patients with hyperprolactinaemia and prolactinoma were evaluated in a retrospective investigation. 128 patients were treated surgically whereby the prolactin serum level in 47% of the macroprolactinoma and 60% of the microprolactinoma patients was normalised (prolactin less than 25 ng/ml, no radiological evidence of tumor). Of those patients in whom the operation was less successful, a normal prolactin level could be achieved in 77% by additional therapy with dopamine agonists. Of 57 patients handled exclusively with drugs, the prolactin level was normalised by dopamine agonists in 78%. A small number of patients from both groups did not show a satisfactory fall in the prolactin level despite the use of markedly higher doses of dopamine agonists. During dopamine agonist therapy progressive tumor enlargement was detected radiologically in a previously operated patient.

Adolescent↗
PubMed1985

[Operative indications and surgical procedure in iodine-induced hyperthyroidism].

Clinical course, indications for surgical treatment, and results of treatment in 8 female patients with iodine induced thyrotoxicosis (IIT) are reported. The diagnosis of IIT could be established in all patients by a) clinical hyperthyroidism, b) increased T3 and T4 serum concentrations, and c) previous iodine contamination. Sources of iodine were radiographic contrast agents for urography (n = 4), oral cholecystography (n = 3), intravenous cholangiography (n = 1), phlebography (n = 1), and cranial computer tomography (n = 1). The onset of hyperthyroidism occurred 1-8 weeks after iodine exposure. Indications for surgical treatment of IIT were: 1. autonomous nodular goiter (n = 6), and 2. iodine exacerbation of preexisting thyrotoxicosis in patients with Graves' disease (n = 2). Corresponding to the different pathogenesis of autonomous and immunogenetic goiter the following surgical treatment is recommended: Enucleation of solitary autonomous adenomas or unilateral lobectomy in case of large adenomas, subtotal bilateral lobectomy in toxic multinodular goiter or, preferentially, unilateral lobectomy combined with subtotal resection of the contralateral thyroid lobe; "Near-total" thyroidectomy in Graves' immunopathy.

Adult↗
PubMed1985

[Thoughts on long-term estrogen substitution--should gynecologists change their mind?].

Public opinion and a large proportion of physicians believe that very often women must necessarily experience a restricted quality of life as a result of menopause, postmenopause and the senium, and that even a possible early death from the sequels of osteoporosis is quite natural and hence inevitable. However, the present state of the art rules out such fatalism, since it has been established beyond doubt that early initiation of oestrogen and progestagen substitution after the menopause is of high prophylactic value both from the viewpoint of social medicine and also in each individual case. Calculations of cost and effect in elderly women have shown that treatment results in reduced morbidity and mortality caused by carcinoma of the breast and of the endometrium, and also by cardiovascular disease, quite apart from an enhanced quality of life. Hence, all women who would like to receive such prophylactic treatment--in particular, also risk patients likely to suffer from osteoporosis-should definitely not be deprived of regular long-term administration of oestrogen that should continue until old age. The only basic condition is the sequential administration of oestrogen and progestagen at low dosage levels.

Aged↗
PubMed1985

Immunoreactive parathyroid hormone is present in subretinal fluids of the human eye.

(44-68) human Parathyroid hormone (hPTH) was studied in subretinal fluids (SRF) of 20 human eyes with rhegmatogenous retinal detachments. A (44-68) hPTH carboxyl mid-regional radioimmunoassay was used. Depending on the extent and the duration of the retinal detachments, (44-68) hPTH ranged between normal serum levels (ca. 100-300 pg/ml) up to excessive amounts of 4000 pg/ml with longstanding disease and proliferative vitreoretinopathy. Aqueous humors (AH) of one patient with bilateral iridocyclitis and complicated cataract ranged at 90-132 pg/ml (44-68) hPTH, whereas a control population undergoing surgery for senile cataracts had no detectable (44-68) hPTH in AH. The AH of one diseased eye of heterochromia complicata Fuchs showed excessive amounts of more than 4000 pg/ml (44-68) hPTH.

Adult↗
PubMed1985

[Methods and clinical evaluation of a new enzyme immunologic method for determination of thyroxin binding globulin (TBG) and T4/TBG quotient: a multicenter study].

A heterogeneous enzyme immunoassay for the determination of thyroxine binding globulin (TBG) was developed and assessed in clinical trials in 12 laboratories. The assay is based on the competition principle and employs plastic tubes coated with goat anti-TBG. CV's between 1.4-8.9% for intra-assay precision and 2.9-8.6% for inter-assay precision were found over the concentration range of 4-40 mg/l TBG. In comparative studies using highly purified TBG as standard, values with Enzymun-Test TBG were found to be on average 30% lower than those obtained by various TBG-RIAs. A broad-base study, to determine reference values, was carried out on a group of control persons 18 to 50 years old without previous history of thyroid disease. This study revealed a median of 14.33 mg/l TBG, with 95% of all values between 9.6 and 18.5 mg/l TBG. The median in women of 14.5 mg/l TBG was significantly higher than in men (13.4 mg/l TBG). TBG values in hyperthyroid patients were within the reference range while those in hypothyroid individuals were elevated. Highly elevated TBG values were seen in women receiving oestrogen (median: 22.2 mg/l TBG) and in pregnant women (median: 28.5 mg/l TBG). The T4/TBG ratios made it possible to distinguish between euthyroid, hyperthyroid and hypothyroic subjects (median: 4.9, 11.3 and 1.0, respectively). These ratios were significantly lower in pregnant women (median: 3.1) than in the control persons.

Anticoagulants↗
PubMed1984

[Diagnostic procedure in suspected functional disorders of the thyroid gland].

In an attempt to derive diagnostic concepts for thyroid diseases we present pathophysiological models for the prevalent thyroid disorders. 'Euthyroid goiter' is a disease mainly caused by iodine deficiency but an additional immunopathogenesis was recently proposed. The 'immunthyropathy' is the thyroid disease with orbitopathy and other extraglandular immunological manifestations. A complete model of the immunological phenomena which begin with a tolerance defect is given, and both the T-cell, and B-cell-mediated pathways are detailed. The complex interaction of immunoglobulins at the thyroid-stimulating hormone receptor and their dependency on human leukocyte antigen loci are presented. The peripheral metabolism depends ultimately upon a prevalence of thyroid gland stimulation (thyrotoxicosis) or glandular destruction (hypothyroidism) and this is true for overt thyroid disease under antithyroid drug therapy or any other therapy. Euthyroidism during 'immunethyropathy' is presented as an equilibrium between thyroid stimulation and destruction. This concept allows an exact description of the thyroid disease and the resulting clinical situation provided that established laboratory tests are used as suggested by the model. 'Disseminated thyroid autonomy and autononous thyroid adenoma' develops during goitrous thyroid disease as a consequence of uncoupling of thyroid cellular growth stimulation, iodine utilization, and thyroid hormone synthesis. The polyclonal origin seems more frequent than monoclonal foci. The size of autononous tissue and individual iodine supply determines the endocrine function in this disease. The TRH test monitors with great sensitivity subtle increases in T4 or T3 production and indicates critical clinical situations earlier than the scintiscan.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗