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Biomedical subjects

R Pelkonen

Publications and source records attributed to R Pelkonen.

At least 91 records · Page 5Linked to original sources
PubMed1985

Prolactinoma of the pituitary containing amyloid.

A transsphenoidal operation was performed in a 27 year old man because of a large intrasellar expansion and marked hyperprolactinaemia (33 000 mU/l). The tumour found in the operation bulged into the sphenoidal sinus and was extirpated. On histopathological examination the tumour consisted mainly of congophilic amyloid spherules with intermingled sparse adenoma cells. The adenoma cells were strongly positive for prolactin in immunoperoxidase staining, and in electron microscopy they contained secretory granules. Ultrastructurally the amyloid spherules consisted of masses of concentrical extracellular amyloid filament bundles.

Adenoma↗
PubMed1985

Orbital decompression in endocrine exophthalmos of Graves' disease.

Transantral decompression was performed bilaterally in 27 and unilaterally in 3 patients with endocrine exophthalmos of Graves' disease. In 28 patients there was an immediate reduction of proptosis and in about half of the patients in addition a marked decrease in chemosis and conjunctival injection indicating that these signs were mostly due to orbital vascular congestion. In one patient with exophthalmos of more than 2 years duration and progressive swelling of the eye muscles no response was observed. In another patient decompression did not reduce proptosis which, however, 4 months later responded to retrobulbar irradiation. In one further patient much more marked reduction of proptosis and disappearance of persistent periorbital swellings were obtained after glucocorticoid treatment given half a year after decompression. Postoperatively diplopia occurred in about half of the patients but corrective operations were required only in a quarter of the patients. Transantral decompression is an effective method for rapid treatment of progressive exophthalmos of Graves' disease. In patients with unilateral exophthalmos the asymmetry may be reversed after unilateral operation. The authors use decompression not only in the most severe cases (categories 5 and 6a-c according to the classification of the American Thyroid Association) but also in less severe cases (categories 2b-c and 3b-c) when there is a steady progression as a primary treatment possibly combined with other forms of therapy.

Adult↗
PubMed1985

Comparison of insulin regimens in the therapy of type 1 diabetes.

The major problems with one or two daily subcutaneous injections of fast and intermediate acting insulins are morning hyperglycaemia and nocturnal hypoglycaemia. These problems can be avoided to a great extent by giving a third injection at bedtime. However, the kinetics of plasma free insulin during these insulin regimens is unphysiological and appropriate meal related plasma insulin peaks cannot be achieved. The new intensified methods of insulin delivery, multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) are more physiological. Consequently, a near normal glycaemic control can be achieved with these regimens; more often with CSII than with MDI. The risk of complications of CSII is on the other hand slightly greater. The importance and need of intensified insulin therapy in the treatment of insulin dependent diabetes is not yet fully settled. At the present it is not a primary form of treatment and indicated only if the conservative insulin regimens fail.

Blood Glucose↗
PubMed1984

Roles of chlorpropamide, alcohol and acetaldehyde in determining the chlorpropamide-alcohol flush.

The value and reproducibility of the chlorpropamide-alcohol flush (CPAF) have been questioned, and objective measures of the test are required. Recording of facial skin temperature, measurement of chlorpropamide, ethanol and acetaldehyde concentrations have been proposed for this purpose. The present study was designed to evaluate the relative contributions of these variables in determining CPAF. Twenty-one Type 2 (non-insulin-dependent) diabetic patients (11 CPAF-positive and 10 CPAF-negative according to previous tests with standard amounts of alcohol and chlorpropamide) were investigated in a random fashion with either chlorpropamide or placebo given on three subsequent evenings before a two-step alcohol challenge with increasing body-weight-matched amounts of alcohol. Higher rises in facial skin temperature and heart rate, higher flush-score and higher acetaldehyde levels resulted from chlorpropamide therapy than followed placebo. After smaller alcohol challenges (with chlorpropamide pretreatment) there were positive intercorrelations between flush-score, rise in facial skin temperature, and plasma concentrations of chlorpropamide and blood acetaldehyde. The increased alcohol dose abolished most of these correlations and a minimum temperature rise of 1.8 degrees C appeared in all but two subjects regardless of previous CPAF classification. During the current experimental conditions, the previously-classified CPAF-positive and CPAF-negative patients did not differ with respect to flush-score, rise in skin temperature, heart rate, blood acetaldehyde or ethanol concentrations, whereas they differed with respect to chlorpropamide concentrations. The present results support the view that CPAF is associated with elevated blood acetaldehyde levels due to inhibition of aldehyde dehydrogenase by chlorpropamide.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaldehyde↗
PubMed1984

Remissions in newly diagnosed type 1 (insulin-dependent) diabetes: influence of interferon as an adjunct to insulin therapy.

We studied the effect of interferon as an adjunct to conventional insulin therapy on the early course of Type 1 diabetes in 43 newly diagnosed patients. Compared with conventional therapy, interferon administration slightly delayed the improvement of glucose homeostasis and the rise of high density lipoprotein cholesterol, while C-peptide secretion was unaffected. Independent of the type of therapy, 18 patients (42%) entered partial remission. The remission began 2.0 +/- 0.6 months (mean +/- SEM) from the start of therapy and lasted for 4.1 +/- 1.1 months. Seven patients (16%) were still in remission 1 year after diagnosis. The patients who entered remission had higher initial C-peptide secretion, lower glycosylated haemoglobin levels and better initial control than patients without remission. Thus, interferon provided no benefits as an adjunct to conventional insulin therapy in unselected patients with newly diagnosed Type 1 diabetes. An important factor for the development of remission was the presence of C-peptide secretion at the time of diagnosis.

Adolescent↗
PubMed1984

Development of Cushing's disease in a patient with anorexia nervosa.

A young woman developed clinical features of anorexia nervosa with a maximal loss of ideal body weight of 54 per cent at the age of 16 yr. A partial recovery from the anorectic symptoms was encountered six years later. At the age of 27 yr pituitary Cushing's disease was diagnosed and corticotroph cell pituitary adenoma subsequently removed by transsphenoidal surgery. Within two years after the operation the clinical and biochemical signs of hypercortisolism had disappeared but some of the anorectic features reappeared. Without neglecting the likelihood of a simple coincidence, the possibility of a common pathogenetic mechanism for anorexia nervosa and Cushing's disease, either affecting the function of the hypothalamic serotonergic pathways or concentration of glucocorticoid receptors, is discussed.

Adenoma↗
PubMed1984

Long-term results of adrenal surgery in patients with Cushing's syndrome due to adrenocortical adenoma.

Fourteen of 16 patients with Cushing's syndrome due to adrenal adenoma who had undergone adrenal surgery in the period 1967-1981 participated in a follow-up study 1 to 15 (mean 4.5) years after the operation. There were 14 unilateral and two bilateral adenomas. Two patients have died: one from postoperative complications, the other by suicide 10 years after surgery. None of the patients relapsed and none showed clinical features of Cushing's syndrome. However, five patients remained obese and four hypertensive. Furthermore, in the female patients the bone mineral density was lower than in age-matched controls. The function of the pituitary-adrenal axis recovered slowly. Postoperative replacement therapy was withdrawn 3 to 28 (mean 11.8) months after surgery in all but one patient. The function of the remaining adrenal gland was completely normal in 10 patients. In two patients the plasma cortisol response to ACTH-stimulation was still blunted and associated with elevated plasma ACTH-levels. The plasma ACTH-level was low in the only patient having persistent hypocortisolism. In conclusion, the results show that most patients with Cushing's syndrome due to adrenal adenoma recover fully after surgery. In some patients, however, the suppressed pituitary and/or adrenal fail to resume normal function.

Adenoma↗
PubMed1984

Sex hormones in amenorrheic women with alcoholic liver disease.

Urinary excretion of estrogens and plasma concentrations of estrone, estradiol, LH, FSH, PRL, progesterone, testosterone, and sex hormone binding globulin were measured in nine chronic alcoholic women with cirrhosis or alcoholic fatty liver. They were aged 24-40 yr and all had secondary amenorrhea which had lasted for at least 3 months. The response of pituitary gonadotropin secretion to administration of LHRH and estradiol benzoate and of PRL secretion to TRH were also investigated. Urinary excretion of estrogens in the alcoholic women with liver disease was similar to that in normal postmenopausal women and less than half that in normal women of the same age in the midfollicular phase of the menstrual cycle. Plasma estradiol levels in the alcoholic women were lower than in the menstruating women but higher than in the postmenopausal women, whereas their plasma estrone levels were higher than in the menstruating women. Plasma concentrations of progesterone and testosterone in the alcoholic women did not differ from those in the postmenopausal women but were lower than in the menstruating women. In spite of the relative estrogen deficiency plasma LH and FSH levels were not elevated in the alcoholic women. The responses of LH and FSH to LHRH were similar in the patients and in the menstruating women. Intramuscular administration of estradiol benzoate did not increase plasma LH and FSH concentrations in the alcoholic women. Hyperprolactinemia was not found and there were no differences in the PRL responses to TRH between the patients and the control groups. In conclusion, disturbed regulation of gonadotropin secretion is an important factor in the genesis of estrogen deficiency and amenorrhea in alcoholic women with liver disease, although ovarian function may also be directly impaired.

Adult↗
PubMed1984

Human and porcine insulins are equally effective in the regulation of glucose kinetics of diabetic patients during exercise.

The rate of hepatic glucose production (Ra) and peripheral utilization (Rd) was determined in 8 insulin-dependent diabetic subjects in basal state and during 40 min cycle ergometric exercise. The patients were treated with continuous sc infusion of either semisynthetic human or porcine (Actrapid) insulin. Basal rate of glucose production was comparable during human (2.29 +/- 0.19 mg/kg/min) and porcine (2.18 +/- 0.12 mg/kg/min) insulin therapy. In response to exercise, Ra rose 30 to 40% (P less than 0.05), to 2.85 +/- 0.35 vs 3.18 +/- 0.42 mg/kg/min, similarly during both studies. The peak rise in Rd (to 3.20 +/- 0.32 during human vs 3.78 +/- 0.44 mg/kg/min during porcine insulin) was comparable in both groups and not significantly different from the rise in Ra. Consequently, blood glucose levels remained unchanged. During the exercise tests, the metabolic conditions were stable and comparable in both studies, as indicated by similar levels of blood glucose, plasma free insulin HbA1, serum lipids and insulin binding to erythrocytes. In conclusion, semisynthetic human insulin is equally effective as porcine insulin in regulating glucose kinetics in the basal state and during exercise.

Adult↗
PubMed1984

Factors predicting remission in type I diabetes.

The remission period often following the clinical onset of insulin-dependent (type I) diabetes, is characterized by residual B cell function, reduced insulin requirements, and good metabolic control. Known factors predicting remission include high age at onset, male sex, mild initial metabolic derangement and absence of frank ketoacidosis. It has been possible to increase the frequency of remissions by strict initial control of diabetes with intensive insulin therapy and by immunological manipulation with corticosteroids, cyclosporin A or plasmapheresis. Patients who have experienced a remission show higher plasma C-peptide levels even after the remission period, but there is no conclusive evidence so far about any beneficial effect of therapeutic intervention on residual B cell function beyond the remission period.

Blood Glucose↗
PubMed1984

Hormonal changes in noncirrhotic male alcoholics during ethanol withdrawal.

Serum concentrations of iodothyronines, cortisol, prolactin, testosterone and the respective tropic hormones were measured in 32 noncirrhotic male alcoholics, aged 28-51 years, at the end of a long drinking period and subsequently during ethanol withdrawal over 1-2 weeks. Seven men had testicular atrophy. On admission one patient had high values for serum thyroxine (T4) and free thyroxine index (FT4I). A blunted response of serum thyrotropin (TSH) to thyrotropin-releasing hormone (TRH) was found in 9 men. Apart from a blunted TSH-response in one man the abnormalities disappeared during the first week of alcohol abstinence. Simultaneously the mean levels of serum T4, FT4I, triiodothyronine, free triiodothyronine index and reverse triiodothyronine were reduced by 12, 14, 5, 8 and 21%, respectively, and the mean of the maximum TSH-response to TRH was increased by 55%. At the time of stopping drinking two men had high morning values and six an abnormal diurnal rhythm of serum cortisol. High serum ACTH-levels associated with normal serum cortisol concentrations were found in 12 men. During the first week of alcohol abstinence the mean morning values for serum cortisol and ACTH were reduced by 18 and 42%, respectively. The serum ACTH-levels remained high in 6 men but the abnormalities in cortisol secretion disappeared. On admission four men had low serum concentrations of testosterone which were normalized during ethanol withdrawal over one week. At the same time the mean level of serum testosterone was increased by 19%. Mild hyperprolactinaemia found in 7 patients on admission disappeared in 4 men during the first week of ethanol withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Long-term outcome after jejunoileal bypass for morbid obesity.

Long-term results after jejunoileal bypass operation for morbid obesity in 47 patients are presented. Two patients died postoperatively and a reanastomosis was made in three. Forty-one patients were re-examined on average 4.7 years after operation. Mean weight loss was 43 kg or 31 per cent of original weight. Increased stool frequency and abdominal discomfort were common postoperative symptoms. Abnormalities in serum electrolytes, serum vitamin levels and in liver function were relatively uncommon and in none serious. The net effect of the operation on joint and back symptoms was positive. In most patients the quality of life was clearly improved and all except two were satisfied with the results. Our experience suggests that jejunoileal bypass is still an alternative in the treatment of morbid obesity.

Adolescent↗