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Biomedical subjects

U Bürgi

Publications and source records attributed to U Bürgi.

At least 19 recordsLinked to original sources
PubMed1992

Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a cause of elbow pain? A controlled study.

Elbow pain is a common complaint and elbow hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the relationship between spinal and extraspinal hyperostotic features and the clinical relevance of elbow hyperostosis we have performed the first controlled, double-blinded study of 85 hospitalized probands, 33 with and 52 without thoracospinal hyperostosis on lateral chest X-ray. Elbow and shoulder hyperostosis were graded on bilateral standard radiographs. Elbow pain was assessed by an interviewer using a standardized questionnaire and extraskeletal causes of elbow pain were recorded. The prevalence of elbow hyperostosis was increased in cases with thoracospinal hyperostosis compared to controls (82% versus 58%, chi 2 = 5.32, P less than 0.025, n = 85, olds ratio (OR) 3.30 (95% CI 1.16-9.35)). Similarly, the prevalence of elbow hyperostosis was increased in cases with shoulder hyperostosis compared to controls (83% versus 60%, chi 2 = 4.51, P less than 0.05, n = 84, OR = 3.20 (95% CI 1.06-9.66)), emphasizing the multifocal nature of hyperostotic features. Elbow pain was only slightly more prevalent in cases with elbow hyperostosis compared to controls (21% versus 13%, chi 2 = 0.75, NS, OR = 1.84 (95% CI 0.46-7.44)). We conclude that elbow hyperostosis is a radiological finding of doubtful clinical relevance.

Aged↗
PubMed1992

The prevalence of palpable finger joint nodules in diffuse idiopathic skeletal hyperostosis (DISH). A controlled study.

The presence of clinically palpable finger joint nodules (Heberden's and Bouchard's nodes) was documented in 123 consecutive cases with diffuse idiopathic skeletal hyperostosis (DISH) of the thoracic spine and 191 matched DISH negative controls. The prevalence of palpable finger joint nodules was almost twice as frequent in cases with spinal DISH compared to controls (46% versus 31%, chi 2 = 7.67, P less than 0.01; multivariate adjusted odds ratio OR = 1.84; 95% CI: 1.14-2.98). This increase was most marked at the proximal interphalangeal joint, in males and in patients up to the age of 65 years. In addition and independent of other variables such as hyperostotic features, age and sex, the prevalence of palpable finger joint nodules was about twice as high in probands with a history of physically heavy work compared to those without (43% versus 26%, chi = 9.18, P less than 0.005; multivariate adjusted odds ratio OR = 2.10; 95% CI: 1.26-3.52). From these results we conclude that DISH should be considered as an independent risk factor in the development of finger joint nodules.

Aged↗
PubMed1992

[Hypophyseal dysfunction and tumors].

Some pituitary hormones secrete hormones while others do not. Nonsecreting tumors can interfere with normal pituitary hormone secretion and produce tumor symptoms and signs like headaches and visual field defects. The most frequent hormone-secreting tumors are prolactinomas. Growth hormone or ACTH or gonadotropin or gonadotropin-alpha and beta chain-producing tumors are less frequent, TSH producing tumors are extremely rare. The most important elements of the diagnostic work-up are clinical signs and symptoms, assessment of pituitary function (measurement of TSH, free T4, LH, FSH, oestradiol/free testosteron, growth hormone, IGF-1, prolactin, ACTH, Cortisol, serum and urine osmolality), CT and/or MRI and, in patients with large tumors, a visual field exam. The treatment of choice of pituitary tumors is often surgery. Alternative therapies are radiation treatment (in nonoperable patients or when hormone levels are persistently elevated after pituitary surgery) and drug treatment (dopamine agonists in hyperprolactinemia, somatostatin analogues in acromegaly). Pituitary hormone deficiencies are treated depending on the specific deficiency with thyroxine, cortisone, oestrogen/gestagen/testosterone gonadotropines or ADH analogues.

Adenoma↗
PubMed1991

[Severe endocrine ophthalmopathy. A review with case reports].

The autoimmune pathogenesis of endocrine ophthalmopathy (EO) is only partly elucidated. About 40% of all patients with Graves' disease have clinically overt ophthalmopathy. 5% of all Graves' disease patients develop severe EO, independently of the treatment modality for thyrotoxicosis (radioiodine, surgery, antithyroid drugs) and require multidisciplinary treatment. In cases where glucocorticoid treatment is unsuccessful, orbital decompression, as described by Walsh and Ogura, should be considered.

Combined Modality Therapy↗
PubMed1991

[Endocrine and other medical causes of abnormal fatigability].

Many endocrine diseases can cause fatigue. Tiredness is a frequent symptom of primary and secondary hypothyroidism, hyperthyroidism, excessive glucocorticoid or mineralocorticoid production, primary and secondary adrenal insufficiency, primary and secondary hypogonadism and hyperprolactinemia in the male, acromegaly, diabetes mellitus and diabetes insipidus. A great number of medical diseases other than those mentioned in the articles on cardiological and pneumological fatigue can also cause abnormal tiredness (infectious diseases, hematological, renal, hepatic, gastrointestinal and rheumatological disturbances, vasculitis and malignant tumors). The pathogenesis of tiredness caused by endocrine or medical illnesses, i.e. how the sensation of fatigue is produced, is not clear. The fatigue of the various endocrine or other medical diseases is not disease-specific, i.e. its characteristics do not differentiate it from the fatigue of other illnesses.

Adrenal Gland Diseases↗
PubMed1990

[Late-onset diabetes 1989].

Type II diabetes is a frequent disease among older people (approximately 7% of 60-year-olds in the US). Genetic factors play a more important role in the etiology of type II than of type I diabetes. The metabolic derangements of type II diabetes are due to the combination of a diminished effect of insulin (insulin resistance due to a decreased number of insulin receptors and a postreceptor defect the nature of which is not clear) and a disturbance of insulin secretion. Type II diabetes is associated with a more than doubling of the age-specific mortality, mainly due to diabetic macroangiopathy (myocardial infarctions, cerebrovascular insults). Diet remains the basis of treatment for type II diabetes. The composition of the diet, however, has been altered in that the proportion of carbohydrates has been increased, the proportion of fat decreased and the fibre content increased. If necessary, oral antidiabetics or insulin are added to the dietary treatment. Measurement of C-peptide may help to decide when insulin therapy is required. Measuring HbA1c permits assessment of the mean blood sugar value of the last 1 1/2-2 months. The greatest progress recently made in the treatment of the chronic complications of type II diabetes has been in the field of diabetic retinopathy (photocoagulation for retinopathy lesions, vitrectomy).

Aged↗
PubMed1990

Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder: a cause of shoulder pain?

Shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the clinical relevance of shoulder hyperostosis we performed a controlled, blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest X-rays. The study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs, assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain. The prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls (chi 2 = 5.90, P less than 0.025, n = 99). Shoulder hyperostosis, irrespective of thoracospinal hyperostosis, predisposed to shoulder pain (40% versus 18%, chi 2 = 4.06, P less than 0.05, n = 74). Shoulder hyperostosis in combination with thoracospinal hyperostosis (shoulder DISH) predisposed to shoulder pain to an even greater extent (46% versus 12%, chi 2 = 6.64, P less than 0.01, n = 47). We conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance.

Arthrography↗
PubMed1990

T3 plus high doses of beta-blockers: effects on energy intake, body composition, bat and heart in rats.

The effects of a combined treatment with supraphysiological doses of the thyroid hormone T3 (15 micrograms/kg BW/day, s.c.) and high doses of a predominant beta 1-blocker (atenolol, 12.5 and 25 mg/kg BW, 3X/day, s.c.) or a non-specific beta-blocker (propranolol, 5 mg/kg BW s.c. and 33 mg/kg BW p.o., each 3X/day) on energy intake, body composition and the heart were studied in overfed rats with an increased body fat content. The goal of the study was to investigate whether the above treatment constitutes a therapy for obesity in that T3 causes weight and fat loss and the beta-blockers prevent the unwanted T3-effects on the heart (tachycardia and increased heart weight). T3 did not increase energy intake above the level seen in overfed animals. It caused loss of body weight due to loss of fat but not protein, an increase in interscapular brown adipose tissue (IBAT) weight and fat, tachycardia and an increase in heart weight. Atenolol and propranolol blocked T3-induced tachycardia. With the exception of the highest propranolol dose which abolished the T3-induced increase in IBAT fat content, the beta-blockers did not modify the other T3 effects. Thus, in spite of the weight and fat loss and the lack of significant protein loss and tachycardia observed under T3/high dose beta-blockers treatment, the T3-induced increase in heart weight makes this treatment unsuitable as a therapy for obesity.

Adipose Tissue↗
PubMed1989

Diffuse idiopathic skeletal hyperostosis (DISH) of the spine: a cause of back pain? A controlled study.

This is the first controlled study of the frequency of back pain in a European caucasian population with diffuse idiopathic skeletal hyperostosis (DISH). Elderly patients admitted to hospital for reasons other than back pain were assessed for the presence of spinal DISH using the routine lateral chest radiograph films. A total of 106 probands (82 males, 24 females) with a mean age of 70 years fulfilled the criteria for DISH as defined previously. One hundred and seventy-eight patients (117 males, 61 females) not meeting these criteria were used as controls. The prevalence of back pain was assessed by a blinded interviewer using a structured questionnaire. Our primary hypothesis was that spinal DISH positive probands had not had back pain more often than controls. This controlled study showed no statistically significant difference in pain frequency between spinal DISH positive probands and controls at any spinal level. We conclude that back pain does not occur more often in radiographically defined DISH positive probands than in controls. The radiological finding of spinal DISH, as far as it does not lead to stenosis of the spinal canal or dysphagia, thus seems to be a finding without clinical relevance.

Aged↗
PubMed1989

Food intake, body and heart composition, and heart rate in T3 plus atenolol-treated rats.

Thyroid hormones and beta-blockers both affect energy balance and the heart. The interaction of 3,5,3'-triiodothyronine (T3) and the beta-blocker atenolol on some cardiac and energy balance parameters was therefore investigated. Stock-fed male Wistar rats (approximately 400 g) received 5 micrograms (expt 1) or 1.5 micrograms (expt 2) T3.100 g body wt-1.day-1 for 3 wk, with or without atenolol. In expt 3, rats were overfed with a "cafeteria" diet before and during the experiment and otherwise treated as in experiment 2. Compared with stock-fed (expt 1 and 2) or overfed (expt 3) controls, T3 caused an increase in food intake in experiments 1 and 2 but not in experiment 3. There was a large loss of body fat in all experiments, disproportionately greater than the body weight loss. Protein loss was significant only in experiment 1 and negligible in cafeteria rats. Heart rate and weight were increased, although heart composition remained unchanged. Atenolol, in a dose that abolished T3-induced tachycardia, did not modify any of the other T3 effects investigated, including the hypertrophy of the heart. These results indicate that T3-induced tachycardia can be abolished by concomitant treatment with a beta-blocker without altering parameters connected with energy balance, whereas protein loss caused by T3 can be attenuated by lowering the dose of T3 used and can be further blunted by dietary manipulation (cafeteria overfeeding).

Animals↗
PubMed1989

[Normal and pathologic endocrinology of the adrenal glands].

The adrenal glands produce glucocorticoids (approximately 25 mg cortisol/day), mineralocorticoids (approximately 100 micrograms aldosterone/day) and androgens (e.g. dehydroepiandrosterone = DHEA approximately 10 mg/day) in their cortex and catecholamines in their medulla. Excessive cortisol production leads to Cushing's syndrome. In approximately 2/3 of the cases this is due to ACTH oversecretion most often from a pituitary adenoma and can be cured by removal of this adenoma. Cushing's syndrome caused by an adrenal adenoma, carcinoma or bilateral nodular adrenal hyperplasia is treated by adrenal surgery. Nelson's syndrome consists of hyperpigmentation of the skin and an often aggressively growing pituitary adenoma which secretes excessive amounts of ACTH. Treatment is surgical. Conn's syndrome (primary hyperaldosteronism) is due to aldosterone hypersecretion most often from an adrenal adenoma (therapy: unilateral adrenalectomy), more seldom from bilaterally hyperplastic adrenals (therapy: spironolactone). Excessive adrenal androgen secretion is found in the adrenogenital syndrome in which defective cortisol biosynthesis leads to ACTH oversecretion and ACTH-stimulated overproduction of cortisol precursors, some of which are androgens. Treatment consists of glucocorticoids which suppress the ACTH oversecretion. Pheochromocytomas produce excessive amounts of catecholamines and cause hypertension which can be persistent as well as episodic. Therapy consists of adrenalectomy. Malignant tumors of the adrenals have a poor prognosis. Incidentally found adrenal masses ("incidentalomas") are observed at regular intervals if they are small and should be surgically removed if they have a tendency to grow or are large (greater than or equal to 5 cm phi).

Adrenal Cortex Function Tests↗
PubMed1988

[Switzerland changes from U-40 to U-100 insulin].

At present over 95% of the insulin used in Switzerland is sold in a concentration of 40 units per ml (U-40 insulin). Only recently a small but increasing amount of more concentrated insulin has been introduced through the use of "pen" injectors which are all designed for U-100 (= 100 units per ml) insulin. Experience in other countries has shown that when different insulin concentrations are available on the market the risk of dosage errors with potentially severe consequences is high. The Swiss Diabetes Association has therefore taken the initiative in standardizing the concentrations available in Switzerland. A change from U-40 and U-100 to exclusively U-100 insulin is planned for the period from October 1988 to March 1989. A survey among 82 Swiss doctors and 243 IDDM patients has shown that about 60% of doctors and patients are in favour of the change while the remaining 40% are either neutral or opposed to it. Advantages, disadvantages and logistic problems of the change to exclusive use of U-100 insulin, and the possibility of pharmacological differences between insulins of different concentrations, are discussed. It is stressed that the change to U-100 must be medically supervised in every patient. An intensive information campaign providing detailed advice for patients, doctors and pharmacists is essential for the prevention of accidents.

Diabetes Mellitus, Type 1↗
PubMed1988

Can serum thyroglobulin predict the effect of thyroid hormone therapy on goitre growth?

Serum thyroglobulin and goitre size were followed in 22 patients with simple goitre or single thyroid nodules during 9 months of thyroxine therapy, to see whether alterations in serum thyroglobulin correlated with changes in goitre size. In the case of such a correlation serum thyroglobulin could be used to predict which goitres respond to thyroxine therapy and which require surgery. Pretreatment serum thyroglobulin was elevated in 11 patients. It normalized in one of 7 patients whose goitre did not shrink and in none of the 4 patients whose goitre shrank during thyroxine treatment. Thus no simple correlation exists between alterations in serum thyroglobulin and goitre size during short-term thyroxine therapy. Since other studies suggest that increased serum thyroglobulin indicates ongoing goitre growth, thyroxine treatment might have been unsuccessful in all patients with persistently elevated serum thyroglobulin with a longer follow-up. The presence of predominantly thyroxine responsive tissue together with some autonomously growing, thyroglobulin-releasing areas in the same goitre could explain the failure of serum thyroglobulin to normalize in patients whose goitre shrank during therapy. The study shows that after eradication of iodine deficiency, thyroxine treatment is rarely successful in the Swiss goitre population and that surgical treatment is usually required.

Adult↗
PubMed1987

Irreversible inactivation of lactoperoxidase in the course of iodide oxidation.

In the course of lactoperoxidase-catalysed I- oxidation, which is a model for the initial step of thyroid hormone biosynthesis, irreversible enzyme inactivation can occur if free molecular iodine (I2) or other oxidized iodine species accumulate. Evidence is presented that the breakdown of the catalytic activity is the result of the iodination of the peroxidase-apoprotein. This kind of enzyme inactivation, which can be prevented by iodine acceptors' such as thyroglobulin or high concentrations of I-, may well play a role in the regulation of the synthesis of thyroid hormones in vivo.

Iodides↗
PubMed1987

A disproportionate accumulation of fibrous tissue is not a causal factor in human goitre growth.

Histological preparations from human nodular goitres reveal the presence of variable and sometimes considerable amounts of acellular material separating the individual follicles. Part of this interstitial tissue consists histologically of fibrous strands. However, quantitative data on the fibrous tissue content of goitres are scarce. In the present study the proportion of fibrous tissue in normal human thyroids and human goitres was determined biochemically by measuring their content of collagen, the predominant component of fibrous tissue. Total collagen content increased in parallel to thyroid weight. The relative collagen content, however, decreased slightly but significantly with increasing thyroid weight. The collagen/DNA ratio (= fibrous tissue/cell number ratio) was not higher in goitres than in normal human thyroids. These results indicate that in goitre growth, there is no disproportionate accumulation of fibrous tissue accompanying the multiplication of thyroid follicular cells. They are in line with the earlier findings that despite histological heterogeneity, the main component of nodular goitres is newly generated follicles.

Age Factors↗