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Biomedical subjects

S R Friesen

Publications and source records attributed to S R Friesen.

At least 37 records · Page 2Linked to original sources
PubMed1984

Subtotal parathyroidectomy for secondary hyperparathyroidism.

Controversy exists regarding the relative merits of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation in the treatment of secondary hyperparathyroidism (HPT). Fourteen patients who underwent SPTX for secondary HPT were evaluated to determine the efficacy of this treatment in view of modern dialysis, diet, and drug treatment. Indications for operation included intractable symptoms (two patients), progressive renal osteodystrophy (eight patients), or both (four patients). Duration of renal failure ranged from 3 to 15 years (mean 7.8 years) before SPTX. The operative serum calcium level was normal in 10 patients, elevated in three patients, and low in one patient. Preoperative parathyroid hormone (PTH) levels ranged from 3.9 to 144 ng/ml (average 41 ng/ml) and decreased after operation to an average of 3.6 ng/ml (normal PTH less than 1 ng/ml). There were no deaths or major postoperative complications. Clinical or radiographic improvement occurred in 80% of patients but did not correlate with absolute reductions in PTH levels. Our results reveal that SPTX is a simple and effective treatment in the initial surgical management of uremic, secondary HPT and appears to be comparable to those obtained with more complicated surgical approaches such as total parathyroidectomy and autotransplantation.

Adult↗
PubMed1983

Pancreatic polypeptide update: its roles in detection of the trait for multiple endocrine adenopathy syndrome, type I and pancreatic polypeptide-secreting tumors.

Circulating human pancreatic polypeptide (hPP) concentrations in the plasma of 61 patients were determined by radioimmunoassay and compared with concentrations in normal age-matched subjects to assess the role of plasma hPP in diagnosis and detection of pathologic dysplasias in endocrinopathies. Basal fasting plasma hPP concentrations greater than 3.0 times normal values were found in six of six patients with multiple endocrine adenopathy syndrome, type I (MEA I) who had islet cell tumors that contained hPP and in only three of 15 nonfamilial patients with sporadic islet cell tumors. An exaggerated plasma hPP response to meal stimulation that exceeded greater than 4.5 times the basal value was found in 15 of 18 patients with MEA I, which indicated the presence of endocrine cell hyperplasia as the underlying genetic trait. The abnormal plasma hPP response to meal stimulation correlated most strongly with islet cell hyperplasia in both the genetic and sporadic endocrinopathies and to some extent with antral G cell hyperplasia. In patients with primary hyperparathyroidism, an exaggerated plasma hPP response to meal stimulation is highly indicative of genetic parathyroid hyperplasia in MEA I and not of sporadic parathyroid adenoma. Informed consent was obtained from all patients who were subjects of these investigations.

Adenoma, Islet Cell↗
PubMed1983

Pancreatic polypeptide-secreting islet-cell tumors. A study of three cases.

Three cases of pancreatic islet cell tumors, 1 malignant and 2 benign, producing predominantly pancreatic polypeptide (PP) are described. All 3 patients exhibited elevated plasma PP concentrations, either basal or protein-meal-stimulated, during the period of observation. Immunocytochemical study revealed that while PP cells predominated in the tumor, A, B, and D cells were also present. A comparison of the hormone content of the tumor tissue, adjacent pancreatic tissue, and normal pancreas was made by radioimmunoassay of tissue extracts. The PP content of tumors clearly exceeded that of normal pancreas. The insulin, glucagon, and somatostatin (SRIF) content was more variable, but in one case the glucagon content of the tumor was higher than in normal pancreas, and two of the tumors exhibited an elevated SRIF content. Gel filtration of a tumor extract showed that insulin, glucagon, and PP immunoreactivity was of expected molecular dimensions but immunoreactive SRIF in this extract was composed of two species. The PP in gel fractions reacted equally well with antibody directed toward different parts of the PP molecule.

Adenoma, Islet Cell↗
PubMed1982

Treatment of the Zollinger-Ellison syndrome. A 25 year assessment.

An assessment of treatment methods for the Zollinger-Ellison syndrome over 25 years suggests that the dual surgical approach of excision of resectable tumor and total gastrectomy provides the greatest possibility of attaining tumor and serum gastrin control. Normal serum gastrin levels and reduction of tumor status, not observed with nonoperative management, were attained by surgical treatment, particularly when the tumor (or hyperplasia) was limited to the pancreas, stomach, duodenum and regional lymph nodes. Eleven of 16 such operations resulted in tumor control, and 10 of these patients developed normal serum gastrin concentrations. In elective clinical situations combined medical and surgical therapy is a rational approach allowing confirmation of diagnosis and safe, definitive surgical control of the syndrome before metastases occur.

Cimetidine↗
PubMed1981

Effective streptozocin therapy for metastatic pancreatic polypeptide apudoma.

An apparently complete remission of metastases in the liver from a resected pure pancreatic polypeptide apudoma occurred following intra-arterial and intravenous administration of streptozocin to a patient in a family with multiple endocrine adenopathy, type 1. Plasma concentrations of human pancreatic polypeptide constitute an excellent marker system for the detection and assessment of tumor status before and after surgical and streptozocin therapy.

Adult↗
PubMed1981

Pseudo-Zollinger-Ellison syndrome: hypergastrinemia, hyperchlorhydria without tumor.

The purpose of the investigation was to detect ulcer patients having nontumorous hypergastrinemic hyperchlorhydria and to diagnostically differentiate this pseudo-Zollinger-Ellison syndrome from neurogenic duodenal ulcer disease and pancreatic gastrinomas. Nine patients having clinical, radiologic and humoral findings simulating the Zollinger-Ellison syndrome or severe duodenal ulcer disease were studied by physiologic provocative testing. The patients, not having pancreaticoduodenal gastrinomas, had an antral mucosal source of their moderate hypergastrinemia even after vagotomy with drainage, which was eliminated in eight patients treated by surgical antrectomy, resulting in normal serum gastrin concentrations. The pseudo-Zollinger-Ellison syndrome is, thus, characterized physiologically by an exaggerated gastrin response to meals, no response to secretin stimulation and pathologically by hyperfunctioning hyperplastic G cells of the antrum. The clinical, physiologic, pathologic and surgical features were integrated for accurate diagnosis and treatment.

Adult↗
PubMed1980

Pancreatic polypeptide cell hyperplasia with and without watery diarrhea syndrome.

Two cases of pancreatic polypeptide cell hyperplasia were obtained by operation. The first case exhibited adenocarcinoma of the stomach with metastases to the neck lymph nodes and pancreatic polypeptide hypersecretion. Pancreatic polypeptide cell hyperplasia was confirmed by the immunoperoxidase method and by the elevated level of pancreatic polypeptide in the pancreatic extracts and in the circulating blood. There was no watery diarrhea syndrome. The second case presented with persistent watery diarrhea of two and one-half year duration, and the resected pancreas contained extremely large atypical islets, exclusively composed of pancreatic polypeptide cells. It is speculated that in some cases pancreatic polypeptide oversecretion may be causative for pseudo-Verner-Morrison syndrome in the absence of ulcer of carcinoma in the upper gastrointestinal tract.

Adenocarcinoma↗
PubMed1980

Pancreatic polypeptide as screening marker for pancreatic polypeptide apudomas in multiple endocrinopathies.

Prospective screening was carried out in 12 members of three families with multiple endocrine adenopathies, type I (MEA,I) and in 14 patients with no multiple endocrine adenopathies with and without other endorcinopathies. Elevated basal and responsive (after a meal) plasma concentrations of a relatively new candidate-hormone, human pancreatic polypeptide (hPP), were associated with pancreatic apudoma tumors in three asymptomatic patients with multiple endocrine adenopathies, type I. Two of these patients had excision of the tumors that resulted in normal plasma hPP concentrations postoperatively. Both tumors contained hPP predominantly by immunocytochemistry; one, a pure pancreatic polypeptide apudoma, was studied extensively demonstrating also by radioimmunoassay a high content of hPP and negligible amounts of insulin, glucagon, somatostatin, vasoactive intestinal polypeptide and gastrin. In this patient plasma concentrations of other polypeptides including insulin, glucagon, somatostatin, vasoactive intestinal polypeptide, gastrin, parathyrin, thyrocalcitonin, prolactin, corticotropin, growth hormone, thyrtropin and amine, serotonin, were within normal limits. The other patient, after excision of an hPP-detected pancreatic mixed hPP-gastrinoma, also became eugastrinemic postoperatively. Normal basal plasma hPP concentrations, but with exaggerated hPP responses to a meal in 11 patients, were associated with various combinations of islet cell hyperplasia, antral G cell hyperplasia with moderate hypergastrinemia and parathyroid hyperplasia. The patients with multiple endocrine adenopathies who have demonstrated this type of increased hPP response to a meal have not been operated on but are at risk for islet hyperplasia. Four of the 12 patients with multiple endocrine adenopathies, type I, with both normal basal and normally responsive hPP concentrations have no evidence as yet of pancreatic involvement.

Adenoma, Islet Cell↗