Search PubMed⌕ Search

Biomedical subjects

W Winkelmann

Publications and source records attributed to W Winkelmann.

At least 181 records · Page 10Linked to original sources
PubMed1984

Adrenocortical suppression by a single induction dose of etomidate.

In a prospective controlled trial we studied the effect of a single induction dose of etomidate or thiopentone on the adrenocortical function in 29 patients undergoing elective surgery. During anesthesia and in the recovery period serum cortisol rose significantly in the thiopentone group only. In contrast, after induction with etomidate serum cortisol decreased and remained below the starting values throughout the study period (5 h). The differences between the two groups were significant at 120, 150, 180, 210, and 240 min after induction (p less than 0.05). Moreover, plasma ACTH increased significantly more after etomidate than after thiopentone (p less than 0.02) indicating relative unresponsiveness of the adrenal cortex to stimulation by endogenous ACTH. We conclude that a single i.v. bolus of etomidate (0.26 mg/kg) leads to significant adrenal insufficiency in patients without preexisting endocrine abnormalities.

Adolescent↗
PubMed1984

Adrenocorticotropin, calcitonin, and antidiuretic hormone as tumor markers in patients with bronchogenic carcinoma of various histological types.

We measured basal and dexamethasone-suppressed plasma ACTH in 246 patients with bronchogenic carcinoma (105 with small-cell carcinoma); in 138 of these patients (67 with small-cell carcinoma) basal and pentagastrin-stimulated serum calcitonin was also determined. In addition, in a subgroup of 120 patients (58 with small-cell carcinoma) plasma ADH with reference to plasma osmolality was also assayed. Non-suppressible plasma ACTH was found in 45% of patients with small-cell carcinoma but only in isolated cases of large-cell carcinoma, adenocarcinoma, and squamous-cell carcinoma. Serum calcitonin was increased in 28% of patients with small-cell carcinoma but only in few patients with other tumor types. Stimulation of calcitonin by pentagastrin was ineffective. Plasma ADH was inappropriately high in 47% of patients with small-cell carcinoma. Strikingly high also was the incidence of increased ADH concentrations in patients with large-cell (40%), adenocarcinoma (46%), and squamous-cell carcinoma (29%). By measuring plasma ACTH after dexamethasone suppression and ADH with reference to osmolality, the sensitivity of these tumor markers in detecting pathological hormone secretion is markedly increased. In small-cell carcinoma the simultaneous measurement of ACTH, ADH, and calcitonin gives a high yield of positive results (74%), indicating that this set of tumor markers is a promising aid in diagnosis and therapy control.

Adenocarcinoma↗
PubMed1984

The narrowing of the bony pelvic cavity (birth canal) by the different osteotomies of the pelvis.

We measured on pelvic models as well as on female cadaver specimens the narrowing of the bony pelvic cavity after the osteotomies according to Chiari, Salter, Sutherland, Steel, Carlioz and Tönnis. In our own patients the parameters were taken by X-ray and CT examinations as far as possible. The osteotomies according to Chiari, Salter and Sutherland lead to a more or less narrowing of the intertuber-ischial diameter of the pelvic outlet, in addition the Chiari osteotomy leads to a narrowing of the transverse diameter of the pelvic brim. The triple osteotomies according to Steel, Carlioz and Tönnis lead to a narrowing of the middle part of the bony pelvic cavity. It is necessary to inform patients who are operated after the end of growth that a future pregnancy may have to be terminated by a caesarean section.

Adolescent↗
PubMed1983

Effect of meclastine, a selective H1 receptor antagonist, upon ACTH release.

To elucidate further the role of histamine in the control of ACTH secretion we investigated the effect of the selective H1 receptor antagonist meclastine on the ACTH response to insulin hypoglycaemia and to metyrapone-induced hypocortisolaemia in normal subjects. Intravenous meclastine (4.8 mg/90 min) significantly inhibited the hypoglycaemia-induced ACTH and cortisol increase whereas serum GH and PRL concentrations were unaffected. Orally administered meclastine (3 X 2 mg) also reduced the ACTH feedback response to cortisol deficiency in a modified metyrapone test, compared to a placebo. Our findings support the concept of an excitatory influence of histamine upon ACTH secretion via H1 receptors, possibly by stimulation of CRF release.

Adolescent↗
PubMed1982

Effects of a met-enkephalin analog on adrenocorticotropin (ACTH), growth hormone, and prolactin in patients with ACTH hypersecretion.

The effect of D-Ala2, MePhe4, Met-(0)enkephalinol (Sandoz FK 33-824; 0.5 mg, im) on pituitary hormone secretion was studied in 11 patients with Addison's disease and 11 patients with ACTH-dependent Cushing's disease. In patients with Addison's disease, a pronounced fall of plasma ACTH levels was observed (P less than 0.005). The ACTH response to FK 33--824 was partially reversed by naloxone (4 mg, iv). In patients with Cushing's disease, no unequivocal decrease in either ACTH or cortisol was seen. Moreover, FK 33--824 failed to influence the vasopressin-induced ACTH increase in 5 patients with Cushing's disease. In patients with cortisol deficiency due to either Addison's disease or bilateral adrenalectomy for Cushing's disease, FK 33--824 led to increases in PRL and GH similar to those described in normal subjects. However, in the presence of longstanding hypercortisolism, the PRL increase was significantly diminished, and the GH response to FK 33--824 was completely abolished. Our results suggest that in Addison's disease ACTH release is influenced by inhibitory opiate receptors. In patients with Cushing's disease, ACTH secretion is insensitive to FK 33-284, presumably because of an autonomous pituitary adenoma or hypothalamic derangement. The impairment of the PRL and GH responses to FK 33--824 in Cushing's syndrome seems to reflect a direct action of the elevated cortisol level, for it is not seen after bilateral adrenalectomy.

Addison Disease↗
PubMed1981

[Surgical Treatment of Ewing's sarcoma (author's transl)].

Radical tumor surgery for Ewing's sarcoma implies the complete removal of the tumor bearing bone. Ablative surgery can be considered in some cases e.g. distal lower extremity tumors in growing children. Resection often leads to poor functional results when the whole tumor bearing bone is removed. The poor function can be improved with the use of custom made endoprosthesis. The resection of the tumor bulk with postsurgical radiation might be an alternative approach with optimal function and minimal risk for the patient. The importance of biopsy technique is stressed to avoid confusion in the diagnosis and difficulties for definite surgical control.

Amputation, Surgical↗
PubMed1981

Effect of meclastine, an H1-antihistamine, on plasma ACTH in adrenal insufficiency.

In order to evaluate the possible role of endogenous histamine in ACTH secretion we investigated the effect of the H1 antagonist meclastine on plasma ACTH in patients with ACTH hypersecretion. Seven patients with primary adrenal insufficiency (group 1) and 5 patients with ACTH dependent Cushing's syndrome (group 2) were given an iv infusion of meclastine (4.8 mg/90 min). In patients of group 2 plasma ACTH was unaffected by meclastine infusion. However, in patients of group 1 with intact steroid feedback meclastine was followed by a significant drop in plasma ACTH as compared with ACTH levels after saline infusion (46.0 +/- 4.6% vs 85.0 +/- 7.0%, P less than 0.01). These results suggest that histamine is involved in the control of ACTH secretion, possibly by stimulation of CRF release.

Addison Disease↗
PubMed1981

[Prolactin producing adenomas of the pituitary gland with primary localization in the sinus sphenoidalis (author's transl)].

The radio-immuno-assay of the pituitary hormone prolactin represents the basis for a functional differentiation of the so-called chromophobic adenomas. Two thirds of these tumors produce this hormone. For a long period of growth these adenomas are localized in the middle of the sella turcica. Their first direction of growth is towards the sinus sphenoidalis. At the ENT-clinic of the Cologne University two prolactin producing adenomas have been detected as the cause of suspected changes of the sinus sphenoidalis. The need for an endocrinological diagnosis in cases of unknown processes of the sinus sphenoidalis, the indication for surgery, and the medicamental treatment of these tumors with 2-Br-alpha-Ergocriptine (Parlodel) is discussed.

Adenoma, Chromophobe↗
PubMed1980

[Alcohol-induced Cushing's syndrome: case report (author's transl)].

Reversible Cushing's syndrome with typical physical appearance and increased basal plasma-cortisol level developed in a 48-year-old man with essential arterial hypertension, as a result of chronic alcohol abuse and could not be supressed by prolonged dexamethason inhibition. Alcohol abstinence within a few weeks produced remission with normal adrenocortical function and regulation without any other therapeutic measures. Renewed alcohol consumption quickly brought about again the alcohol-induced Cushing's syndrome. An abnormality of central regulation with inadequate ACTH secretion was the cause of the hypercortisolism. Previously reported cases of alcohol-induced Cushing's syndrome are not uniform: in some the diagnosis is in doubt.

Adrenocorticotropic Hormone↗
PubMed1980

Increased activity of the Na-K-ATPase in red cell-ghosts of patients with Cushing's syndrome: possible significance for the pathogenesis of glucocorticoid-induced hypertension.

The Na-K-ATPase activity of erythrocyte ghosts was increased in 6 patients with Cushing's syndrome compared with 28 control subjects (0.986 +/- 0.291 versus 0.259 +/- 0.1 microM Pi . h-1 . mg-1, p less than 0.001). Ouabain insensitive Mg-ATPase activity was similar in both groups. These data support the concept of an activation of the Na-pump in patients with glucocorticoid excess.

Adult↗
PubMed1980

The prophylactic use of antibiotics in alloarthroplasty of the hip joint for coxarthrosis.

In alloarthroplasty of the hip joint due to coxarthrosis a randomized prospective controlled study was performed to test the efficiency of prophylactic antibiotics in reducing the postoperative infection rate. The minimum follow-up time was 730 days. There were three infections (two superficial and one deep) in the group who received antibiotics (105 patients), 10 infections (two superficial and eight deep) in the control group (89 patients). The overall rates of infections and also the rate of the deep wound infections were significantly lower in patients who received prophylactic antibiotics.

Anti-Bacterial Agents↗