Biomedical subjects

Z Killinger

Publications and source records attributed to Z Killinger.

13 recordsLinked to original sources

PubMed2000

[Early diagnosis of postmenopausal osteoporosis].

Osteoporosis can be diagnosed by history, physical examination, laboratory test and bone mass measurement. A low bone mass is the most important risk factor for osteoporotic fractures. In the assessment of risk is very important the rate of bone loss too. Combining bone density and bone turnover with age and other associated risk factors can improve the assessment of the risk of osteoporosis especially at the postmenopausal women. As in many medical conditions early diagnosis is the key to success in prevention and treatment in osteoporosis.

Aged↗

PubMed2000

Autoimmune thyroiditis with severe hypothyroidism resistant to the treatment with high peroral doses of thyroxine: case report.

Female patient (42 yr) suffered from autoimmune thyroiditis resulting in severe hypothyroidism. She was treated for several years by district physician with the dose of 150 microg L-thyroxine daily. Since the level of TSH was repeatedly very high and no improvement of clinical signs has been observed, she was referred to the Medical Faculty Hospital. Thyroid ultrasound showed remarkable diffuse hypoechogenicity, thyroid scintigraphy showed enlarged thyroid with low 99mTc uptake, TRH test was normal, thin needle biopsy supported autoimmune thyroiditis. X-ray examination showed normal sella turcica and no changes in the pituitary were observed with computer tomography. In spite of increasing the dose of peroral L-thyroxine to 300 microg/d and later to 500 microg/d the clinical status and TSH level did not improve. The patient was originally suspected from malabsorption of thyroxine. However, the test with a large single peroral dose (1000 microg) of L-thyroxine showed a rapid decrease of TSH level (from 126 to 75 mU/l) and increase of total T4 level (from 18 to 64 nmol/l) within 4 hr. Later the patient has been treated with intravenous L-thyroxine (500 microg every 3-4 days for 4 weeks) which resulted in the decrease of TSH level to 10 mU/l and increase of T4 level to 80-100 nmol/l. After that it was concluded that the problem is a poor compliance of the patient who apparently does not actually take the medication, although she always claimed that she is doing so. Referring to some similar cases described in the literature the case was classified as thyroxine pseudomalabsorption. In spite that this problem has been explained to her and her relatives, she refused to take any medication and is consistently neglecting all invitations to further examinations.

Administration, Oral↗

PubMed2000

[Effect of alendronate therapy on bone turnover--results of a multicenter study].

Sodium alendronate is a bisphosphonate of the IInd generation with a strong antiresorptive effect. Its favourable effect on reduction of the incidence of vertebral and non-vertebral fractures was repeatedly confirmed. The objective of the multicentre study was to evaluate the effect of administration of 10 mg of sodium alendronate combined with 1000 mg of elemental calcium administered in the course of three months on the N-terminal telopeptide(NTx) a sensitive marker of bone resorption. The group comprised 275 postmenopausal women with densitometrically confirmed osteoporosis. After three months treatment a 53% decline of NTx values occurred as compared with baseline values. This finding confirms the favourable effect of sodium alendronate on bone remodelling. A decline of the concentration of bone markers is one of the good predictors of the effectiveness of treatment focused on reduction of atraumatic osteoporotic fractures.

Adult↗

PubMed1999

[Bone turnover and bone density in type 1 diabetics in the initial stages of diabetic nephropathy].

OBJECTIVE: To compare the bone turnover and bone mineral density in type 1 diabetic patients with normoalbuminuria and type 1 diabetic patients with diabetic nephropathy with microalbuminuria or mild proteinuria. METHODS: We studied 18 type 1 diabetic patients (Group A) with normoalbuminuria (UAE < 10 micrograms/min) and 8 type 1 diabetic patients (Group B) with UAE 100-1000 micrograms/min and serum creatinine below 150 mumol/l. Markers of bone formation (bone alkaline phosphatase--ALP-B, serum osteocalcin) and bone resorption (serum tartrate-resistant acid phosphatase--ACP-TR, urinary hydroxyproline) were determined. Bone mineral density (BMD) was measured at lumbar spine and right femoral neck. RESULTS: Serum ALP-B was higher in group B [median (95% CI), 518 (405-1070) nkat/l] compared with group A [380 (355-510) nkat/l] (p < 0.05). Urinary hydroxyproline excretion was higher in group B [U-Hxp/U-creat 46.7 (22.9-80) mumol/mmol] compared with group A [18.3 (8.9-22.7) mumol/mmol] (p < 0.001). No difference was found in serum osteocalcin and ACP-TR and in BMD at L2-L4 and femoral neck. CONCLUSIONS: We conclude that bone turnover was increased in type 1 diabetic patients with incipient stage of diabetic nephropathy but there was no difference in BMD as compared with type 1 diabetic patients without nephropathy. This finding might indicate that biochemical markers unlike densitometry reflect initial changes in bone metabolism in preclinical diabetic nephropathy earlier. (Tab. 2, Ref. 17.)

Adult↗

PubMed1999

Vitamin 1,25-(OH)2 D3 concentrations in patients hospitalized long-term.

Vitamin D deficiency may be one reason for the onset and development of osteoporosis. The aim of the present study was to determine the occurrence rates of hypovitaminosis D in an unselected group of individuals presenting with common medical conditions and hospitalized for long periods. Concentrations of 1,25-(OH)2 D3 were measured in 89 patients (38 males and 51 females). Mean age was 70 years. Thirty-eight patients were tested in the spring and the remaining 51 patients in the autumn. Vitamin D3 levels were significantly reduced in patients tested in the autumn (p < 0.001). The reason for this surprising observation may have been the small number of sunny days and the long hospital stays during the study period, differences in the composition of both groups and the fact that 1,25-(OH)2 D3 reflects the actual vitamin D3 levels rather than those of its reserve in the human body. The results obtained suggesting hypovitaminosis D in an unselected group of elderly patients hospitalized with common diseases, even after the summer season, suggest the need for general supplementation of this vitamin throughout the year, regardless of the risk factors.

Aged↗

PubMed1999

[Vitamin D deficiency in hospitalized patients].

Vitamin D deficiency is one of the important risk factors for the development of osteoporosis and fractures. The high prevalence of hypovitaminosis in elderly people in old age pnesioners homes was proved in several investigations, similarly as the favourable effect of vitamin D (800 IU/day) and calcium supplementation on a decline of fracture risk. Risk factors of hypovitaminosis such as an inadequately varied diet; low exposure to sunlight, chronic liver and kidney disease and treatment affecting the metabolism and clearance of vitamin D are very frequent in elderly patients hospitalized in medical departments. In the submitted trial the authors assessed in a group of 38 patients, mean age 70 years, hospitalized at the medical department at the end of the winter period the vitamin D3 serum level. They found a significant reduction of the concentration of 1.25 hydroxyvitamin D3 (p < 0.01) in the investigated group. The results of the trial, along with data in the literature on the high prevalence of hypovitaminosis D in the European population, indicate the need to introduce this simple cheap and safe therapeutic modality into routine practice.

Aged↗

PubMed1999

[Salmon calcitonin in the treatment of osteoporosis].

Salmon calcitonin is frequently used in the treatment of osteoporosis. Via specific receptors on osteoclasts it reduces bone absorption and has also an osteogenic effect. Treatment with calcitonin leads to an increase in bone density, drop of markers of bone turnover and reduction of risk fractures. In the submitted trial the authors investigated the influence of nasal calcitonin administered in amounts of 100 IU in three-month intervals, on bone density. The group comprised 59 patients, mean age 64 years. The mean period of treatment was 2.5 years. Treatment led to a significant increase of bone density in the region of the lumbar spine and neck of the femur. Treatment was well tolerated and the authors did not record new manifest fractures or side-effects of treatment.

Administration, Intranasal↗

PubMed1998

[Bone changes in gastrointestinal diseases].

BACKGROUND: Gastrointestinal (GIT) diseases are a common cause of metabolic bone changes. The aim of the study was to indicate GIT diseases (lactose intolerance, non-lactose intolerance, Crohn's disease, ulcerative colitis, pancreatic insufficiency, states after gastric resection, chronic diseases of the liver, and coeliac disease) by means of literature data and the authors' own results coinciding with the detected low bone density and thus increased risk of fracture. Bone changes coinciding with GIT diseases are frequent and are commonly asymptomatic for a long period. CONCLUSION: In coincidence with GIT diseases the authors indicate the necessity of being aware of the risk of bone changes development and to investigate them actively. An early diagnosis aids to introduce preventive and therapeutical measures and to halt or at least slow down the origin of bone changes. (Ref. 21.)

Bone Diseases, Metabolic↗

PubMed1997

[Bone changes in ulcerative colitis].

One of the complications of ulcerative colitis with frequent relapses is mineral deficiency (potassium, calcium, magnesium and phosphorus). The objective of the present work is to examine the bone density and laboratory parameters of bone metabolism in 25 patients with a medium severe and severe form of ulcerative colitis. In patients with ulcerative colitis a significantly reduced bone density was found in the era of neck of the femur (p < 0.05), a a non-significantly reduction of the bone density in the era of the lumbar vertebrae and an elevated level of osteocalcin (p < 0.05). These findings indicate a higher prevalence of bone changes in patients with ulcerative colitis. Early detection of bone changes makes adequate prevention and treatment of bone complications possible.

Adult↗

PubMed1995

[Safety of hormone replacement therapy in menopause and its favorable effect on the lipid spectrum].

The authors pay attention to changes of the serum lipid spectrum and blood sugar level during hormonal substitution treatment of menopausal women. The observation pertains to 70 women (mean age 50 years, 36 women after hysterectomy, mean duration of the menopause 4.5-5.0 years). The lipid spectrum and blood sugar level were assessed by enzyme methods from venous blood collected in the morning on fasting before administration of treatment (a combination of oestrogen and gestagen), on average after 8 months on these drugs. With regard to total cholesterol and HDL-cholesterol before treatment the women were, consistent with recommendations of the European Society for Atherosclerosis divided into four groups: hypercholesterolaemic group (5.2-7.8 mmol/l) 47 women; hypercholesterolaemic group with a reduced HDL-cholesterol (less than 1.1 mmol/l) 5 women; a very high cholesterol group (more than 7.8 mmol/l) one woman only; and women with a normal lipid profile (total cholesterol less than 5.2 mmol/l), 17 women. The authors recorded in the whole group a significant drop of total cholesterol (-0.30 mmol/l), VLDL-cholesterol (-0.08 mmol/l) and triacylglycerols (-0.27 mmol/l) and a significant rise of HDL-cholesterol (+0.13 mmol/l). The blood sugar level did not change. There was an insignificant drop of LDL-cholesterol. Hepatic serum enzymes did not change during this treatment. The most marked changes (a drop of LDL-cholesterol by 0.49 mmol/l and rise of HDL-cholesterol by 0.29 mmol/l) were recorded in the group with the highest risk, i.e. group 2. The total drop of triacylglycerols was striking. The body weight and dietary habits did not change during the mentioned 8-month period. The authors consider hormonal replacement therapy indicated. They emphasize its favourable effect on the lipid spectrum of women which is one of the mechanisms of cardiovascular oestrogen protection.

Adult↗

PubMed1994

[Congenital atransferrinemia].

Congenital atransferrinemia was first diagnosed at the age of 11 months in a now 27-year-old woman. Until she was aged 14 years treatment with human transferrin was irregular and, as it turned out, inadequate. But since then she has regularly received human transferrin (1 g monthly) and deferoxamine (500 mg twice weekly). Despite this she developed haemosiderosis affecting heart, liver, hypophysis, thyroid and the locomotor apparatus. This case report demonstrates the need of early diagnosis and treatment of congenital atransferrinemia to prevent the mentioned complications.

Adult↗

PubMed1993

[Hypereosinophilia syndrome].

The authors of the submitted paper describe the diagnosis, course and treatment of hypereosinophilic syndrome in a 36-year-old female patient with marked affection of the right ventricle: endomyocardial fibrosis with parietal thrombi obliterating the cavity of the right ventricle. The clinical picture was dominated by rapid progression of severe cardiac decompensation with a fatal outcome.

Adult↗

PubMed1993

[Time delay in acute myocardial infarct].

The authors present their experience concerning the time-delay in 357 patients with acute myocardial infarction admitted to the coronary unit over the years 1988-1991. This time indicator was evaluated by using two approaches, i.e. the global time-delay (the time between the onset of the patient's complaints and his/her admission to the coronary unit) and patient's time-delay (the time between the onset of the patient's complaints and his/her decision to notify the health care service). Arbitrary criteria were set up: 10 hours for the former and 5 hours for the latter parameter. The established criteria were met by 40% of the patients. Only 24% of the patients presented at the coronary unit within 6 hours, and these could receive thrombolytic treatment. The decision time (patient's time-delay) amounted that the education level of our population has to be enhanced so as to increase the number of patients with acute myocardial infarction presenting at the coronary unit at an early stage. (Tab. 1, Ref. 9.)

Coronary Care Units↗