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Biomedical subjects

R O Gans

Publications and source records attributed to R O Gans.

At least 91 records · Page 5Linked to original sources
PubMed1993

Clinical features and outcome in patients with glomerulonephritis and antineutrophil cytoplasmic autoantibodies.

We investigated the clinical features and outcome of 60 patients with antineutrophil cytoplasmic autoantibodies with cytoplasmic staining (C-ANCA)- and with (peri)nuclear staining (P-ANCA)-associated glomerulonephritis. Virtually all patients with C-ANCA had antibodies against proteinase 3, which corresponded with a clinical and/or histological diagnosis of Wegener's granulomatosis (WG). P-ANCA were associated with antibodies against myeloperoxidase. Although more often associated with renal-limited disease, a significant number of patients with P-ANCA had also symptoms of organs known to be preferentially affected with WG. The majority of patients presented with rapidly progressive glomerulonephritis which responded favorably to immunosuppressive therapy, albeit at the expense of a considerable number of fatal infections. Furthermore, a more protracted form of glomerulonephritis was recognized. A kidney biopsy scoring system appeared to be of value in predicting which patients would benefit most from treatment. C-ANCA and P-ANCA appear to identify a subset of patients with vasculitis that share common clinical features and a favorable response to immunosuppressive therapy.

Adult↗
PubMed1993

The inflammatory abdominal aortic aneurysm. Prevalence, clinical features and diagnostic evaluation.

Eight patients with an inflammatory abdominal aortic aneurysm are described. They constituted 3.1% of all aortic aneurysms operated in the period 1981-1990. All presented with abdominal complaints and/or backache, and an elevated erythrocyte sedimentation rate (ESR); 3 had significant weight loss. The discovery of the aneurysm was considered a non-related finding except for 2 patients for whom the correct diagnosis was suggested by CT scan. Except for the aortic dilatation, the clinical and histopathological features of the inflammatory aneurysm resembled those of idiopathic retroperitoneal fibrosis with obstruction of the ureters and involvement of the duodenum by extensive perianeurysmal inflammation with infiltrates of mononuclear leukocytes and varying degrees of fibrosis. Although the triad of abdominal complaints and/or backache, an elevated ESR and weight loss has been proposed to suggest the diagnosis, the positive predictive value of these parameters was at best 22%. Additional studies, including CT scan, have to be performed to exclude, among other factors, vasculitis. Treatment should aim at repair of the aneurysm. Resolution of the inflammatory process after operation is frequently observed. Immunosuppressive therapy should only be used with caution, considering the possible increased risk of rupture.

Abdominal Pain↗
PubMed1993

Effect of cilazapril on glucose tolerance and lipid profile in hypertensive patients with non-insulin-dependent diabetes mellitus.

Hypertension frequently complicates diabetes mellitus and is associated with an increased incidence of cardiovascular and microvascular complications. Angiotensin-I converting enzyme (ACE) inhibitors are effective antihypertensive agents and it has been suggested that they may improve glucose tolerance. We performed a double-blind, randomized study comparing treatment for 8 weeks with cilazapril, a new ACE inhibitor, or placebo on metabolic variables in 22 hypertensive non-insulin-dependent diabetes mellitus (NIDDM) patients. At week 8 no significant changes in fasting plasma glucose, fasting plasma insulin, haemoglobin A1 and plasma lipids had occurred. The areas under the glucose [placebo (mean +/- SD): 10.7 +/- 3.27 and 10.6 +/- 2.53; cilazapril: 11.9 +/- 3.23 and 12.1 +/- 2.9 mmol/l per 180 min at 0 and 8 weeks, respectively] and insulin curve [placebo (median and range): 47.4 (31.4-165.1) and 65.3 (16.8-190.8); cilazapril: 51.1 (23.8-132.0) and 57.6 (29.0-150.1) mU/l per 180 min at 0 and 8 weeks, respectively] after a standardized oral liquid test meal were unaltered. A significant decrease in mean arterial blood pressure was observed after cilazapril (122 +/- 8.6 and 106 +/- 8.3 mmHg at 0 and 8 weeks, respectively), in contrast to placebo (122 +/- 6.7 and 120 +/- 6.9 mmHg at 0 and 8 weeks, respectively). In conclusion, cilazapril does not affect metabolic control in hypertensive NIDDM patients, whereas it effectively reduces blood pressure.

Blood Glucose↗
PubMed1992

[Effect of short-term use of omega-3-type polyunsaturated fatty acids in subjects with hypertriglyceridemia].

OBJECTIVE: To study the effect of omega-3 polyunsaturated fatty acid supplementation on lipid profile in hypertriglyceridaemic patients. SETTING: General practice. DESIGN: Prospective, double blind study of 12 weeks' duration. PATIENTS AND METHODS: Eight patients received fish oil (1800 mg C20: 5 omega-3 eicosapentaenoic acid (EPA) and 1200 mg C22:6 omega-3 docosahexaenoic acid (DHA). Nine patients received corn oil (3000 mg C18: 2 omega-6 linoleic acid daily). RESULTS: Lipid profile analysis showed a decrease in triglyceride levels after fish oil supplementation. An unexpected and unexplained finding was the rise in total cholesterol and LDH cholesterol with corn oil supplementation. CONCLUSION: Fish oil causes a decrease in triglyceride levels in hypertriglyceridaemic patients.

Adult↗
PubMed1992

Autoantibodies against constituents of neutrophils in the diagnosis and treatment of (isolated) subglottic stenosis.

Six patients had a subglottic stenosis either as a presenting symptom or as a manifestation of a systemic disease. All patients had in common the presence of circulating autoantibodies against constituents of neutrophils on indirect immunofluorescence. Cytoplasmic and perinuclear staining patterns were recognized. Such autoantibodies have been reported in Wegener's granulomatosis, microscopic polyarteritis, (idiopathic) glomerulonephritis, and Churg-Strauss syndrome. However, only one of the six patients fulfilled the criteria for these conditions. Because a positive test for autoantibodies against constituents of neutrophils is rare in other conditions and because other diseases had been excluded, we suggest that this places subglottic stenosis within the spectrum of necrotizing (granulomatous) vasculitis. The consequences for therapy are discussed.

Adolescent↗
PubMed1992

The occurrence of IgA-nephropathy in patients with diabetes mellitus may not be coincidental: a report of five cases.

We describe five patients with IgA-nephropathy complicating diabetes mellitus. In four cases, diabetic glomerulosclerosis was present at the same time. One patient suffered from dermatitis herpetiformis. The observation of the present five cases together with the notion of an increased prevalence in diabetes mellitus of celiac disease and dermatitis herpetiformis suggests that the occurrence of IgA-nephropathy in diabetic patients is not mere coincidence.

Aged↗
PubMed1992

Acute hyperinsulinemia induces sodium retention and a blood pressure decline in diabetes mellitus.

Hyperinsulinemia supposedly contributes to hypertension in diabetes mellitus. We sought to determine if the renal and cardiovascular effects of insulin are preserved in diabetes despite resistance to its glucose-lowering effect. We studied the effects of two doses of insulin (50 and 500 milliunits/kg.hr-1), using the euglycemic clamp technique, on fractional sodium excretion, blood pressure, and heart rate in two groups of non-insulin-dependent diabetics: eight patients with and eight patients without hypertension. Hypertensive diabetics had higher basal insulin levels than normotensive diabetics (21.8 +/- 2.9 and 14.4 +/- 1.6 milliunits/l, respectively [mean +/- SEM]; p = 0.03). The degree of insulin resistance, but not plasma insulin levels, correlated with the height of mean arterial blood pressure (r = 0.60 and 0.73 at the low and high insulin dose, respectively; p less than 0.05). In contrast, the change in mean arterial blood pressure correlated negatively with the change in endogenous insulin levels during the control experiment (r = -0.41, p less than 0.02). Exogenous insulin induced a similar reduction in fractional sodium excretion in normotensive and hypertensive diabetics (43 +/- 5.9% and 48 +/- 16.4% during the low insulin dose and 57 +/- 9.1% and 62 +/- 12.5% during the high insulin dose, respectively). A decline in blood pressure was noted that correlated with the whole body glucose uptake during the high insulin dose (r = 0.52, p less than 0.05). Since heart rate response and plasma norepinephrine level during the insulin clamp were comparable in both groups, an abnormality of the baroreceptor reflex is suggested. It appears that insulin resistance, but not insulin, is primarily related to hypertension. At the same time, insulin may still exert some effect on blood pressure by way of its renal or vasodilatory, or both, action.

Acute Disease↗
PubMed1991

Bilateral excision of perinephric fat and fascia (Gerota's fasciectomy) in the treatment of intractable chyluria.

A case is described of a 59-year-old black man with massive chyluria, probably due to previous infection with Wuchereria bancrofti. Notably, no edema was present despite a urinary protein loss of 40 gm. per day resulting in a serum albumin level of 13 gm./l. Conservative treatment after lymphography, including prolonged bedrest and a medium chain triglyceride diet, was unsuccessful. Bilateral excision of the perinephric fascia and fat (Gerota's fasciectomy) in 2 separate operative sessions finally resulted in complete resolution of the chyluria.

Adipose Tissue↗
PubMed1991

Renal and cardiovascular effects of exogenous insulin in healthy volunteers.

1. Renal and cardiovascular effects of three dosages of insulin [50 (Ins I), 300 (Ins II) and 500 (Ins III) m-units h-1 kg-1] were investigated in healthy males by using a euglycaemic clamp technique. On separate days, control experiments were carried out to correct for any circadian variation in the variables studied. 2. All three insulin dosages resulted in a marked decline in fractional sodium excretion (actual experiments: basal, 0.95 +/- 0.15%, Ins I, 0.79 +/- 0.10%, Ins II, 0.80 +/- 0.12%, Ins III, 0.84 +/- 0.08%; control experiments: basal, 0.96 +/- 0.10%, Ins I, 1.20 +/- 0.12%, Ins II, 1.53 +/- 0.15%, Ins III, 1.43 +/- 0.10%; means +/- SEM, P less than 0.005, analysis of variance). With the highest insulin dosage, the reduction in fractional sodium excretion tended to be less striking. This coincided with a rise in heart rate, pulse pressure and pulse rate-systolic blood pressure product (double product). Although blood pressure itself did not change, systolic blood pressure also tended to increase (actual experiments: basal, 133 +/- 5 mmHg, Ins I, 132 +/- 5 mmHg, Ins II, 139 +/- 5 mmHg, Ins III, 143 +/- 4 mmHg; control experiments: basal, 128 +/- 3 mmHg, Ins I, 129 +/- 3 mmHg, Ins II, 130 +/- 3 mmHg, Ins III, 133 +/- 3 mmHg; means +/- SEM, P = 0.09, analysis of variance). There was a positive correlation between the change in fractional sodium excretion and the change in systolic blood pressure over control values (r = 0.696, P less than 0.028).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

The effect of angiotensin-I converting enzyme inhibition on insulin action in healthy volunteers.

Acute hyperinsulinaemia, achieving insulin levels within the physiological range, induces sodium retention. At the same time an activation of the renin-angiotensin system occurs, with a rise in plasma renin activity (PRA) and angiotensin-II level but no change in plasma aldosterone. After administration of higher, pharmacological doses of insulin an increase in systolic blood pressure and heart rate can also be observed, while further increases in PRA and angiotensin-II are noted. To determine whether angiotensin-II is involved in observed insulin actions, we studied the renal and cardiovascular effects of three dosages of insulin (50 (Ins I), 300 (Ins II) and 500 (Ins III) mU kg-1 h-1) in healthy subjects after one week of treatment with the angiotensin-I converting enzyme inhibitor enalapril (10 mg twice a day), using the euglycaemic clamp technique. Control data were obtained from two previously conducted experiments in the same subjects, one with infusion of insulin and one with the insulin solvent only. The effect of insulin on fractional sodium excretion, blood pressure and heart rate was unaffected by enalapril, which precludes any involvement of the renin-angiotensin system with regard to these aspects of insulin action. Insulin sensitivity increased significantly during treatment with enalapril (with enalapril: Ins I: 11.3 +/- 3.0, Ins II: 20.0 +/- 3.4 and Ins III: 20.6 +/- 3.9 mg kg-1 min-1 glucose (mean +/- SD); without enalapril: Ins I: 8.7 +/- 2.3, Ins II: 13.7 +/- 3.0 and Ins III: 15.5 +/- 3.1 mg kg-1 min-1 glucose; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Catecholamines and blood glucose control in type 1 diabetes.

To evaluate the influence of blood glucose control on serum catecholamine levels (which reflect both plasma and platelet levels), six healthy non-diabetic subjects, seven well-controlled Type 1 diabetic patients, and six poorly controlled Type 1 diabetic patients were studied before (baseline) and after standardized exercise. A significant correlation was found between serum noradrenaline and HbA1 at baseline (r = 0.53, p less than 0.025) and after exercise (r = 0.71, p less than 0.001). Similar results were found for serum adrenaline (r = 0.68, p less than 0.005 and r = 0.61, p less than 0.005, respectively) and consequently total serum catecholamine content (r = 0.65, p less than 0.005 and r = 0.75, p less than 0.001, respectively). However, no relationship was found between serum catecholamine levels and actual blood glucose levels, age, body mass index or insulin dose. A moderate correlation was found between systolic blood pressure and serum levels of noradrenaline and total catecholamines after exercise (r = 0.48 and r = 0.48, both p less than 0.025).

Adult↗
PubMed1991

Renal function and renal function reserve in insulin-dependent diabetic patients during (near) normoglycaemia.

Twenty-three normoalbuminuric (N) and 7 microalbuminuric (M) insulin-dependent diabetes mellitus (IDDM) patients were studied under (near) normoglycaemic conditions. They were reasonably well controlled during the period preceding the renal function test (HbA1: N = 7.6 +/- 1.3%, N = 8.0 +/- 2.2%; normal less than 6.0%). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured using the clearances of 125I-thalamate and 131I-hippuran, respectively. The renal reserve filtration capacity (RRFC) was tested by using a combination of a liquid mixed meal and an amino acid infusion. Blood glucose levels were kept as constant as possible throughout the testing procedure, both under baseline (BL) conditions and after stimulation (S). Under such (near) normoglycaemic conditions, no BL GFR values exceeding 150 ml/min/1.73 m2 could be established. Furthermore, a RRFC could be established in all patients. Both groups showed a comparatively larger increase in GFR (N 13.0 +/- 3.8%, M 10.8 +/- 3.6%) than in ERPF (N 4.8 +/- 7.0%, M 2.2 +/- 5.8%; % delta GFR vs. % delta ERPF p less than 0.01), resulting in a higher filtration fraction (FF) during stimulation (N: BL FF 0.25 +/- 0.03 vs. S FF 0.27 +/- 0.03, p less than 0.01; M: BL FF 0.25 +/- 0.01 vs. S FF 0.27 +/- 0.01, p less than 0.05). This suggests afferent vasodilation during stimulation in these (near) normoglycaemic, reasonably well-controlled IDDM patients, a situation comparable to that in non-diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Exogenous insulin augments in healthy volunteers the cardiovascular reactivity to noradrenaline but not to angiotensin II.

Hyperinsulinemia has been implicated in the pathogenesis of the blood pressure elevation in patients with noninsulin-dependent diabetes mellitus, obesity, but also essential hypertension. In these conditions an increased cardiovascular reactivity to noradrenaline (NA) and angiotensin II (AII) can be observed. Using the euglycemic clamp technique, we determined the cardiovascular reactivity to graded infusions of NA and AII in nine healthy males before (Bas), and 1 and 6 h after infusion of insulin (50 mU/kg per h) was started. On separate days control experiments were carried out to control for any circadian variation. Insulin led to a decrease of the amount of circulating NA necessary to increase the diastolic blood pressure (DBP) 20 mmHg (actual experiment [mean +/- SEM]: Bas, 23.1 +/- 5.0; 1 h, 14.8 +/- 3.0; and 6 h, 12.3 +/- 3.1; and control experiment: Bas, 20.7 +/- 5.0; 1 h, 18.6 +/- 3.5; and 6 h, 17.3 +/- 3.3 nmol/liter; Bas vs. 1 and 6 h: P less than 0.05). Although the amount of NA infused to raise DBP 20 mmHg showed a similar decline after 1 h of insulin infusion, no such change from baseline could be observed at 6 h. This appeared to be due to an increase in NA clearance with more prolonged insulin infusion. Insulin exerted no effect on the amount of AII infused to increase DBP 20 mmHg (actual experiment: Bas, 27.6 +/- 6.4; 1 h, 28.8 +/- 10.0; and 6 h, 21.2 +/- 5.3; and control experiment: Bas, 33.6 +/- 5.7; 1 h, 34.2 +/- 6.1; and 6 h, 23.4 +/- 4.7 ng/kg/min; NS). We did observe a circadian variation in AII reactivity. Whether the increase in cardiovascular responsiveness to NA after administration of insulin contributes to the elevation in blood pressure frequently observed in patients with insulin resistance remains to be proven.

Adult↗
PubMed1991

Endocrine organ failure due to systemic AA-amyloidosis.

We describe a patient with panhypopituitarism and adrenal insufficiency associated with systemic AA-amyloidosis caused by tuberculosis. This case demonstrates the ongoing process of amyloidosis, despite a presumed cure for the tuberculosis more than 30 years previously. Difficulties in recognizing clinical symptoms and interpreting laboratory data in a patient on regular haemodialysis are discussed.

Adrenal Insufficiency↗