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Biomedical subjects

W J Kalk

Publications and source records attributed to W J Kalk.

At least 73 records · Page 4Linked to original sources
PubMed1981

Serum prolactin after chest wall surgery: elevated levels after mastectomy.

Galactorrhea is a recognized sequel of chest injury, but serum PRL levels in these patients have not been systematically documented. Therefore, we examined the PRL responses over 5 days in patients undergoing either mastectomy (10 patients) or thoracotomy (10) and in seven patients undergoing elective laparotomy (controls). Basal serum PRL levels were normal in every subject. There were no consistent or significant alterations in PRL levels after laparotomy or thoracotomy. After mastectomy, PRL levels rose from a mean preoperative level of 7.1 +/- 1.3 to 16.0 +/- 3.3 ng/ml (P < 0.01) on the first postoperative day. Mean levels continued to rise to 35.6 +/- 6.6 ng/ml (P < 0.005) on day 5; levels were supranormal in eight subjects. Hyperprolactinemia persisted in the four subjects evaluated 4 weeks postoperatively and in one of five patients evaluated at 6 months. In a retrospective study, serum PRL levels were measured months to years after thoracotomy (31 patients) and mastectomy (53 patients) and compared to levels in 41 normal female controls. Mean serum PRL levels were 8.4 +/- 1.3 ng/ml in the control group, 13.1 +/- 0.9 ng/ml in the thoracotomy group (P < 0.005), and 20.6 +/- 3.1 ng/ml in the mastectomy group (P < 0.001). One thoracotomy patient and 18 mastectomy patients (34%) had supranormal PRL levels. It is concluded that mastectomy acutely stimulates PRL secretion in most subjects, and levels may remain elevated for months, perhaps for years, in a proportion of patients. Both the acute and chronic hyperprolactinemic states are probably the result of neurogenic PRL release mediated via the suckling reflex.

Adult↗
PubMed1980

Atypical features of hyperthyroidism in blacks.

Hyperthyroidism is reportedly uncommon in the indigenous populations of Africa. The presenting symptoms volunteered, the symptoms elicited by direct questioning, and the results of physical examination were therefore prospectively compared in 60 Black and 56 White patients with thyrotoxicosis attending a single thyroid clinic. Fewer Blacks than Whites volunteered information about weight loss, while more Blacks complained only of the presence of a goitre. A 'change' diagnosis of hyperthyroidism was made more frequently in Blacks. Symptomatology elicited by direct questioning and findings on physical examination were generally similar in each group, except that Blacks presented more frequently with complicated disease (cardiac failure and overt myopathy) and infiltrative ophthalmopathy. The frequency with which hyperthyroidism presents 'atypically' in Black compared with White patients may reflect educational, socio-economic and Cultural differences in the Black and White populations, and may partly explain the infrequency with which this disease is diagnosed in Blacks.

Adult↗
PubMed1980

Very low doses of radio-iodine for hyperthyroidism. Failure to prevent a high incidence of early hypothyroidism.

One hundred and fifty-one patients with hyperthyroidism were treated with varying doses of radio-iodine (131I), and the results were analysed 1 year later. Of the patients with Graves' disease who received the lowest 131I doses (mean 2,8 mCi) 39% had persistent thyrotoxicosis and 25% were hypothyroid 12 months after therapy. Moderate doses of 131I (mean 5,9 mCi) reduced the rate of persistent disease to 19% and increased the rate of hypothyroidism by only 4% (P less than 0,05). When 131I dosages were calculated according to thyroid weight (microCi/g), patients who received the lowest doses (mean 115 microCi/g) again had significant rates of both persistent hyperthyroidism (38%) and hypothyroidism (24%). These data indicate that very low doses of 131I in the treatment of Graves's disease may result in a high incidence of persistent disease, but do not necessarily result in a very low incidence of early hypothyroidism. Low-dose 131I regimens are unsuitable for treatment of thyrotoxicosis unless very good facilities for patient follow-up are available.

Adult↗
PubMed1980

Computer tomography in basal ganglia calcification.

The computer tomographic findings in basal ganglia calcification are presented. The incidence is much higher than previously recognised in all forms of hypoparathyroidism, on accout of the sensitivity of CT as compared to conventional radiography.

Basal Ganglia Diseases↗
PubMed1980

The pharmacokinetics of methimazole after oral administration of carbimazole and methimazole, in hyperthyroid patients.

1 Methimazole plasma concentrations were measured in two groups of hyperthyroid subjects after the oral administration of either carbimazole or methimazole. 2 With the HPLC method it was also possible to measure the concentration of a methimazole metabolite, 3-methyl-2-thiohydantoin in one patient. 3 Large interindividual differences were observed, especially within the carbimazole group. 4 Incomplete absorption of carbimazole could explain particular high apparent volumes of distribution and apparent clearances.

Administration, Oral↗
PubMed1980

Basal ganglia calcification in postoperative hypoparathyroidism.

The presence of bilateral basal ganglia calcification was sought in nine patients with post-operative and two patients with primary hypoparathyroidism, using computerized axial tomography (CAT) and plain skull radiographs. Calcification was detected with CAT in seven patients; five with post-operative and both with primary hypoparathyroidism, but in only one was it demonstrable on plain X-ray films. The presence of calcification appeared to be related to the duration of the disease and possibly the degree of control of serum calcium. Six of the seven patients with cerebral calcification also had cataracts. The incidence of basal ganglia calcification in hypoparathyroidism is probably much greater than previously recognized, especially in post-operative hypoparathyroidism.

Adult↗
PubMed1980

Gastric acid secretion and serum gastrin levels in patients with chronic renal failure on regular hemodialysis.

Previous studies of gastric secretory function and serum gastrin levels in patients with chronic renal failure (CRF) have yielded conflicting results. In a study of 30 patients on regular hemodialysis, serum gastrin levels were higher than normal (p less than 0.05), and the gastric secretory response to pentagastrin was normal for the group as a whole. There were, however, 8 patients who were hypochlorhydric (4 achlorhydric) and 7 who were hyperchlorhydric. The patients with gastric hyposecretion were older, predominantly male and this group was associated with the highest gastrin levels as well as the highest incidence of gastrointestinal hemorrhage. Chronic gastritis is thus more common in CRF than generally believed and may be responsible for much of the morbidity from gastrointestinal complications during hemodialysis.

Adolescent↗
PubMed1980

Pituitary and thyroid function before and after portacaval anastomosis in patients with normal livers.

Basal plasma thyroid hormone, testosterone and cortisol levels, TSH and PRL responses to TRH, and LH and FSH responses to LRH were assessed in six young subjects with normal liver function and anatomy before and after portacaval anastomosis. All tests were normal and unchanged by the operations. It is concluded that in patients with normal liver function, portal systemic shunting does not produce alterations in the pituitary-gonadal and pituitary-thyroid axes. The abnormalities of these endocrine functions in patients with cirrhosis are probably related to the severity of hepatocellular dysfunction rather than to the effects of portal systemic shunting.

Adolescent↗
PubMed1979

Comparison of 99mTc and 131I scans in thyroid function studies.

Thyroid function was studied in 170 patients, using technetium-99m (99Tc) and oral radio-iodine (131I); 110 patients had normal thyroid function, and 60 had hyperthyroidism. The 20-minute 99mTc uptake gave an accurate assessment of thyroid function in 95% of patients, and the 24-hour 131I uptake was accurate in 92%. One hundred 99mTc and 131I scintiscans were compared by 3 observers. Scans obtained with each isotope were of comparable quality, and in only 1 patient were both scans of poor quality. 99mTc is as good as 131I for assessing thyroid function and morphology, but has several advantages over 131I.

Evaluation Studies as Topic↗
PubMed1979

Insulin secretion and pancreatic exocrine function in patients with chronic pancreatitis.

The relationship between insulin responses to oral glucose and pancreatic exocrine function were examined in 15 patients with chronic pancreatitis. Good correlations were found between the insulin responses and exocrine pancreatic function measured as the concentrations of pancreatic enzymes in duodenal juice after intravenous cholecystokinin-pancreazymin (CCK-PZ). There appears to be a roughly parallel loss of endocrine and exocrine function in the course of chronic pancreatitis.

Administration, Oral↗
PubMed1978

Post-thyroidectomy thyrotoxicosis.

94 patients with postoperative recurrent hyperthyroidism were evaluated for duration of remission, goitre size, and response to radio-iodine (131I). 6 patients required 131I therapy within twelve months of operation--5 had large remnants because of inadequate surgery. 57% of patients relapsed within 5 years, but 16% relapsed after 20 years and 8% after more than 30 years. Estimated goitre weights ranged from 4 g to 65 g, and goitre size was unrelated to the duration of remission. All patients were treated with 131I. 23% of the patients became hypothyroid in the first postoperative year and 10% in the second year. The results indicate that postoperative thyrotoxicosis can recur decades after operation. Operation seems to sensitise the thyroid to the early effects of radiation by 131I.

Adult↗