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Biomedical subjects

A W Reed

Publications and source records attributed to A W Reed.

At least 19 recordsLinked to original sources
PubMed1999

Trichomonas vaginalis as a cause of urethritis in Malawian men.

BACKGROUND AND OBJECTIVES: Trichomonas vaginalis is one of the most common sexually transmitted infections. In Malawi, rates of trichomoniasis in women are high. The prevalence of T. vaginalis infection in men is expected to be high but has not previously been documented. GOALS: We sought to determine the prevalence of trichomoniasis in Malawian men with and without urethritis, to evaluate a polymerase chain reaction detection assay for T. vaginalis in urethral swabs and to examine the effect of T. vaginalis infection on excretion of human immunodeficiency virus (HIV) in semen. STUDY DESIGN: Men presenting at the Sexually Transmitted Diseases (STD) and Dermatology Clinics in Malawi were enrolled in a cross-sectional study. We compared a polymerase chain reaction-based test for T. vaginalis detection with wet-mount microscopy and culture of urethral swabs. HIV serology was determined by enzyme-linked immunosorbent assay (ELISA), and HIV-1 RNA concentrations in semen were measured by quantitative nucleic acid sequence-based analysis. RESULTS: T. vaginalis was detected in 51 of 293 men. The estimated prevalence among symptomatic men was 20.8% and among asymptomatic men, 12.2%. Polymerase chain reaction performed with a sensitivity of 0.82 (95% CI: 0.66-0.92) and specificity of 0.95 (95% CI: 0.91-0.97) compared to wet-mount microscopy and culture. There was no difference in the rate of HIV seropositivity in men with and without T. vaginalis infection. However, in men with symptomatic urethritis, the median HIV RNA concentration in seminal plasma from men with T. vaginalis was significantly higher that in seminal plasma from HIV-positive men without trichomonas.

Animals↗
PubMed1986

Amiodarone inhibits T4 to T3 conversion and alpha-glycerophosphate dehydrogenase and malic enzyme levels in rat liver.

Amiodarone has been found to decrease serum T3 by blocking peripheral T4 5'-deiodinase. This reduction in T3 levels may contribute to the effectiveness of this drug in moderating cardiac arrhythmias. To further characterize the effect of amiodarone on thyroid hormone metabolism and biological action, male Sprague-Dawley rats were thyroidectomized and then fed 500 ug T4 or 50 ug T3 and 500 mg amiodarone/kg of powdered diet for 6 to 8 weeks. Hepatic and cardiac levels of T4, T3, alpha-glycerophosphate dehydrogenase (GPD) and malic enzyme (ME) were used as indicators of thyroid hormone availability and action at the cellular level. Conversion of T4 to T3 was measured in liver homogenates. Serum TSH, T4 and T3 were also measured. Amiodarone reduced hepatic GPD and ME in thyroidectomized rats receiving dietary T4. Liver T4 levels were significantly increased by amiodarone and the T3/T4 ratio was reduced (P less than .05). Amiodarone inhibited hepatic T4 to T3 conversion and decreased serum T3. The decreased T3 action at the cellular level, indicated by the reduction in hepatic GPD and ME, is not due to pharmacologic effects of amiodarone since these enzyme levels were not affected by amiodarone in thyroidectomized rats replaced with T3.

Amiodarone↗
PubMed1985

The image of the hospice chaplain.

In the author's twenty-five years of supervising Clinical Pastoral Education students, a strong emphasis on how to facilitate grief work and how to minister to the dying has been an important element in the students' effective work as parish clergy, institutional chaplains and pastoral counselors. An analysis of more subjective aspects of their CPE experiences indicates that equally important are images that the chaplain represents to the patient, family or staff. Three excerpts from verbatim patient interviews are used to illustrate the place that transferred meanings of the Church, of God, and of the source for dealing with ultimate questions, play in the role of chaplain.

Clergy↗
PubMed1984

Serum angiotensin-converting enzyme in severe nonthyroidal illnesses associated with low serum thyroxine concentration.

We evaluated serum angiotensin-converting enzyme levels as an index of thyroid hormone action in severe systemic illness. Angiotensin-converting enzyme was elevated in hyperthyroid patients (37.3 +/- 3.2 U/mL, p less than 0.01) and depressed in hypothyroid patients (17.9 +/- 1.4 U/mL, p less than 0.05). Compared with normal controls (22.6 +/- 1.6 U/mL), patients in an intensive care unit with free thyroxine index greater than 5.0 had normal angiotensin-converting enzyme levels (19.1 +/- 2.5 U/mL), but patients with a free thyroxine index less than 5.0 had angiotensin-converting enzyme levels significantly lower than the normal and hypothyroid groups (10.7 +/- 1.0 U/mL, p less than 0.05). A group of patients in an intensive care unit with alcoholic liver disease (known to elevate angiotensin-converting enzyme) and a low free thyroxine index had depressed angiotensin-converting enzyme levels (16.9 +/- 1.5 U/mL, p less than 0.01). A strong correlation was seen in the combined groups of all patients studied between levels of angiotensin-converting enzyme and a free thyroxine index (r = 0.70, p less than 0.01) and free T3 index (r = 0.72, p less than 0.01).

Critical Care↗
PubMed1984

A thyrotropin radioimmunoassay kit evaluated vs two reference assays.

We evaluated a double-antibody radioimmunoassay kit for thyrotropin that includes calibrators prepared in a matrix of human serum and involves overnight nonequilibrium. Results were compared with those from two reference assays for thyrotropin. The range of within-assay CVs for the kit for thyrotropin values between 0.9 and 2.4 milli-int. units/L was 2.2 to 5.3%, that for between-assay CVs was 8.3 to 30%. The estimated minimum detectable concentration of thyrotropin was 0.6 milli-int. unit/L. We saw no cross reactivity with human choriogonadotropin by any of 48 sera from pregnant women. The original lot of serum specified as thyrotropin-free contained small but measurable amounts of thyrotropin; a second lot did not. Clinical data generated with the kit and the reference assays correlated well and were consistent with the clinical status of various categories of patients.

Chorionic Gonadotropin↗
PubMed1983

Preferential release of triiodothyronine: an intrathyroidal adaptation to reduced serum thyroxine in aging rats.

In order to identify the changes in thyroid regulation and function that are responsible for the age-related decline in T4 secretion, we measured the secretory response of the rat pituitary and thyroid glands to thyrotropin-releasing hormone (TRH), plasma T1/2 for 125I-rat thyrotropin (TSH), the molecular weight of pituitary TSH, T4 uptake and conversion to T3 by the liver, amount of T4 and T3 in serum and in thyroglobulin, and the thyroid peroxidase concentration. The molecular weight of TSH and the biexponential plasma clearance of TSH were not affected by aging. TSH response to TRH administered intravenously did not differ between old and young rats. T3 response to TRH was greater and T4 response lower in old compared with young rats despite levels of T4 and T3 in thyroglobulin which were not affected by aging. Aging effects on hepatic conversion of T4 to T3 varied between rat strains. T4 uptake by liver in vivo by old rats was the same as that reported for young animals. The data are consistent with a marked decrease in the ratio of T4 to T3 secreted by the aging rat thyroid in both the basal and stimulated state possibly due to increased intrathyroidal conversion of T4 to T3.

Aging↗
PubMed1983

The effects of amiodarone on serum thyroid hormones and hepatic thyroxine 5'-monodeiodination in rats.

Amiodarone (2-n-butyl-3,4'-diethylaminoethoxy-3', 5'-diiodobenzoyl-benzofurane) is an antiarrhythmic drug which increases serum T4 and rT3 levels in patients and lowers serum T3 levels. To investigate its effects on T4 metabolism and its cardiac action, we fed amiodarone to male Fisher rats at doses of 5, 15, and 45 mg/kg BW X day; controls received potassium iodide for 4-7 weeks, and another group received sodium ipodate. At 4 weeks, amiodarone caused a dose-dependent increase in the serum T4 concentration and a slight reduction of serum TSH without a change in the serum T3 concentration. These changes were not present at 7 weeks. Sodium ipodate raised serum T4 concentrations at both times. Rats treated with T4 (150 micrograms/kg BW X day) to suppress thyroidal secretion of hormone and with amiodarone (15 mg/kg) had marked reduction of serum T3 concentrations compared with controls receiving T4 without amiodarone. Liver homogenates from rats treated with amiodarone showed marked reduction on T4 5'-monodeiodinase activity in a dose-related manner. Amiodarone added to liver homogenates in vitro at concentrations of 0.001-1 mM did not inhibit T3 production from T4, whereas ipodate added in vitro (0.01-1 mM) did inhibit T3 production. Rats treated with amiodarone showed a lowering of the resting heart rate and a reduction of the increment in heart rate after iv isoproterenol administration. The cardiac Ca++ myosin ATPase activity was reduced in rats receiving amiodarone (45 mg/kg) compared with that in controls. The data indicate that rats treated with amiodarone have reduced peripheral conversion of T4 to T3 owing to impaired hepatic T4 5'-monodeiodinase activity. In addition, these rats have slowing of heart rate and reduction of cardiac Ca++ myosin ATPase activity. These findings are consistent with the hypothesis that amiodarone blocks some effects of thyroid hormone on the heart, but additional studies are needed to test this hypothesis.

Amiodarone↗
PubMed1983

Endemic goiter in Vietnam.

Endemic goiter involves about 15% of the population of Vietnam. To define the role of various factors which contribute to endemic goiter in Vietnam, we surveyed 935 people in Vancon, a lowland commune with goiter appearing only in the past decade, and 619 people in Dich Giao, a highland commune with endemic goiter treated erratically with iodized salt. In Dich Giao, cassava, a goitrogenic food, constitutes half of the dietary caloric intake. The prevalence of goiter was 45% in Vancon and 28% in Dich Giao. Laboratory studies were carried out in a subgroup of 63 subjects in Vancon, 52 subjects in Dich Giao, and a control group of 46 women in Hanoi. The mean serum TSH levels were 1.4 +/- 0.1 (+/- SE) microU/ml in Hanoi, 3.6 +/- 0.5 microU/ml in Vancon (P less than 0.001), and 2.4 +/- 0.2 microU/ml in Dich Giao (P less than 0.05). The mean serum T4 concentrations were similar in the three groups, but the mean free T4 concentration was low in Vancon. Serum T3 levels and the T3 to T4 ratios were significantly elevated in the goitrous regions. The mean serum thyroglobulin (Tg) concentrations were 27 +/- 3 ng/ml in Hanoi, 101 +/- 20 ng/ml in Vancon (P less than 0.01), and 44 +/- 5 ng/ml in Dich Giao (P less than 0.01). The 4-h thyroid uptake was higher in Vancon than in Hanoi. The urinary iodine concentration was low in both goitrous regions, and urinary thiocyanate was increased in Dich Giao, reflecting the ingestion of cassava. For all regions combined, there was a direct correlation between serum TSH and T3 and between serum TSH and Tg. In Vancon, where iodine deficiency was more severe, there was an inverse correlation between thyroid uptake and the urinary iodine concentration; thyroid uptake correlated directly with serum T3, the T3 to T4 ratio, and serum Tg. In Dich Giao, there was no correlation between urinary thiocyanate and thyroid uptake or urinary iodine levels. The data show that low iodine intake is a major factor in the causation of goiter in Vancon, where iodine deficiency had not been suspected. The ingestion of cassava in Dich Giao did not cause a major change in thyroid hormone economy even though iodine intake was marginally low; the data suggest that the goitrogenic effect of cassava is easily overcome by supplementary iodine, even when it is ingested irregularly.

Adolescent↗
PubMed1982

Pharmacokinetic significance of serum reverse T3 levels during amiodarone treatment: a potential method for monitoring chronic drug therapy.

We studied the antiarrhythmic effects of amiodarone, 600-1400 mg/day, in 18 patients with refractory arrhythmias, and related to drug efficacy and side effects to serum levels of T4, reverse T3 (rT3) and the QTc interval. In the 11 patients with ventricular arrhythmias, premature complexes were reduced by 90-98%, and complex ectopy and runs of ventricular tachycardia were abolished; in the seven patients with paroxysmal atrial flutter, there were no recurrences on stable drug therapy. The QTc lengthened by 11.6% (p less than 0.01), T4 increased by 31.6-63.3% (p less than 0.001) and rT3 increased by 82.9-176.8% (p less than 0.001) as a function of dose and duration of amiodarone therapy. A close correlation was found between rT3 (normal up to 50 ng/dl) and drug efficacy and some of the drug side effects; arrhythmia suppression occurred at levels of 55-100 ng/dl, and some of the known side effects at levels of 100-110 ng/dl. When amiodarone was stopped in nine patients, the changes in QTc, T4 and rT3 regressed toward normal and arrhythmia recurred in eight 2-20 weeks (mean 7.4 weeks) and when rT3 levels fell below 55 ng/dl; arrhythmia resuppression was achieved 3-28 days (mean 11 days) after resumption of amiodarone therapy. The indirect therapeutic half-life of amiodarone in seven patients, computed from the semilogarithmic plots of plasma rT3 after cessation of amiodarone therapy, ranged from 25 to 55 days (mean 35 days). The data suggest that rT3 levels may be useful in monitoring the efficacy and certain side effects of amiodarone.

Adult↗
PubMed1982

A comparison of methods for assessing thyroid function in nonthyroidal illness.

We studied various tests of thyroid function in sick patients with nonthyroidal illness (NTI) in order to determine the utility of each test for differentiating these patience from a group with hypothyroidism. We evaluated each test in 22 healthy volunteers who served as controls, 20 patients with hypothyroidism, 14 patients admitted to medical intensive care unit whose serum T4 was less than 5 micrograms/dl, 13 patients with chronic liver disease, 32 patients on chronic hemodialysis for renal failure, 13 ambulatory oncology patients receiving chemotherapy, 16 pregnant women, 7 women on estrogens, and 20 hyperthyroid patients. On all samples, we measured serum T4, the free T4 index by several methods, free T4 by equilibrium dialysis, free T4 calculated from thyronine-binding globulin (TBG) RIA, free T4 by three commercial kits (Gammacoat, Immophase, and Liquisol), T3, rT3, and TSH (by 3 different RIAs). Although all of the methods used for measuring free T4 (including free T4 index, free T4 by dialysis, free T4 assessed by TBG, and free T4 assessed by the 3 commercial kits) were excellent for the diagnosis of hypothyroidism, hyperthyroidism, and euthyroidism in the presence of high TBG, none of these methods showed that free T4 was consistently normal in patients with NTI; with each method, a number of NTI patients had subnormal values. In the NTI groups, free T4 measured by dialysis and the free T4 index generally correlated significantly with the commercial free T4 methods. Serum rT3 was elevated or normal in NTI patients and low in hypothyroid subjects. Serum TSH provided the most reliable differentiation between patients with primary hypothyroidism and those with NTI and low serum T4 levels.

Alpha-Globulins↗
PubMed1981

Treatment of hyperthyroidism with sodium ipodate (oragrafin) in addition to propylthiouracil and propranolol.

Ten patients with hyperthyroidism due to Graves' disease were treated with sodium ipodate (1 g daily) in addition to propranolol (P) plus propylthiouracil (PTU; 100 mg every 8 h) and were compared with a control group of 8 patients treated with P and PTU. Patients on P and PTU had a mean (+/- SEM) basal free T3 index of 387 +/- 59 (normal, 70--160) compared with that of 409 +/- 47 (P greater than 0.05) in the sodium ipodate group. The respective basal free T4 index values (normal, 4.5-10.9) were 21.3 +/- 2.8 for the controls and 25.9 +/- 2.8 for the ipodate group (P greater than 0.5), and the basal rT3 values were 192 +/- 49 and 210 +/- 41 (normal, 16--50 ng/dl; P greater than 0.05). The average percent changes in each thyroid index and rT3 were calculated. The first 3 days on P and PTU served as the basal period for the control group, and comparisons were made to the following 9 days. The ipodate group received P and PTU for 2.7 +/- 3.0 days, and comparisons were made with the interval on ipodate, P, and PTU (mean, 9.1 +/- 0.9 days). For the free T3 index, the control group showed a mean decrement of 20.5 +/- 4.4% compared with 50.2 +/- 3.1% for the ipodate group (P less than 0.001). The respective free T4 index decrements were 14.5 +/- 4.4% and 18.5 +/- 2.7% (P greater than 0.05). The respective changes in rT3 were -13.4 +/- 7.6% and +140 +/- 26.9% (P less than 0.001). In patients with hyperthyroidism, short term daily therapy with sodium ipodate plus P and PTU produces a greater reduction of free T3 index values than that caused by P and PTU alone.

Female↗
PubMed1981

Hyperthyroxinemia with bradycardia and normal thyrotropin secretion after chronic amiodarone administration.

Pituitary-thyroid function was tested in 15 euthyroid patients before, during, and after long term oral treatment with amiodarone (2-n-butyl-3,4'-diethylaminoethoxy-3',5'-diiodobenzoylbenzofurane; 600-1200 mg daily), an iodine-containing potent antiarrhythmic drug. The drug caused increases in serum total T4, free T4, and rT3, with a concomitant decrease in T3. Baseline serum TSH was significantly higher after 1 week of drug treatment and returned to normal levels after 12 weeks of treatment. All patients receiving amiodarone had a slowing of their heart rate (P less than 0.01), and heart rate gradually increased 6 weeks after drug withdrawal, concurrent with the slow fall in T4 and rT3 levels. Amiodarone did not cross-react in the iodothyronine RIAs. The results suggest that amiodarone inhibits the peripheral conversion of T4 to T3 and may block the metabolic action of thyroid hormone in man.

Aged↗
PubMed1979

Pituitary and peripheral resistance to thyroid hormone.

A 32-year-old Caucasian male, clinically euthyroid, with paranoid schizophrenia and granulocytopenia, had elevated total and free serum T4 and T3; serum TSH was normal (2.7 +/- 0.7 micronU/ml). There was no goitre present, no evidence of Graves' disease, and no evidence of pituitary tumour. He had a normal response to methyl-TRH, with a TSH increment of 14.6 micronU/ml, T3 increment of 212 ng/dl, and T4 increment of 4.7 microgram/dl; baseline value and decreased the TSH increment in response to methyl-TRH. T3 therapy (100 microgram/day) decreased the thyroidal radioactive iodine uptake to less than half the baseline prolactin was normal with a normal response to methyl-TRH to 4.1 micronU/ml. Iodine therapy caused an increase in his baseline TSH with an increase in the TSH response to TSH. The metabolic clearance rates (MCR) and production rates (PR) of T3 and T4 were increased. Baseline serum levels of glycoprotein hormone alpha-subunit were normal and showed a slight increase in response to methyl-TRH, similar to normal subjects. This patient has evidence of partial pituitary and peripheral resistance to thyroid hormone; his only evidence for hyperthyroidism is the elevated MCR and PR of T3 and T4.

Adult↗
PubMed1979

Comparison of thyroid stimulators and thyroid hormone concentrations in the sera of pregnant women.

To clarify the role of various thyroid stimulators in normal human pregnancy, we measured serum TSH, chorionic TSH (hCT), hCG, bioassayable thyroid-stimulating activity, T4, T3, T3 uptake, free T4 and free T3 indexes, free T4, and free T3 by dialysis in 339 serum samples from pregnant women at various intervals of pregnancy and in 40 normal female controls. Serum T4 and T3 and free T4 and free T3 indexes were significantly elevated throughout pregnancy in comparison with controls. Free T4 concentration was elevated after 10 weeks of pregnancy and free T3 concentration was elevated at 13--20 weeks. Bioassayable thyroid-stimulating activity was elevated from 9--16 weeks when serum hCG concentrations were highest. Serum TSH levels were significantly lower at 9--12 weeks compared with the rest of pregnancy. hCT was detected in only 35% of sera tested; the mean detectable value was 0.60 +/- 0.04 (SE) microU/ml; only 15% of the detectable values exceeded 1 microU/ml. The level of hCG correlated with bioassayable thyroid-stimulating activity (P less than 0.01). The data indicate that hCT is not a significant thyroid stimulator. We propose that hCG, as a weak thyroid stimulator, causes a modest rise in free thyroid hormone levels early in pregnancy which in turn causes a modest reduction in pituitary TSH secretion.

Biological Assay↗
PubMed1978

Thyroid function in patients undergoing maintenance hemodialysis: unexplained low serum thyroxine concentration.

Thyroid function was studied in 55 patients undergoing maintenance hemodialysis who were all judged to be clinically euthyroid. The dialysis patients, in comparison to normal control subjects, had significantly lower mean values for serum T4 (4.0 +/- 1.4 [SD] microgram/dl versus 7.9 +/- 1.5 microgram/dl, p less than 0.001), T3 (118 +/- 31 ng/dl versus 147 +/- 28 ng/dl, p less than 0.001), free T4 measured by equilibrium dialysis (1.22 +/- 0.38 ng/dl versus 2.15 +/- 0.67 ng/dl, p less than 0.001), free T3, free T4 index, and free T3 index. Serum TBG, measured by radioimmunoassay, was similar to that of the controls and serum TSH, 2.2 +/- 1.3 micromicron/ml, was also similar to that of control values, 2.0 +/- 1.1 micromicron/ml. The serum PBI did not change during the dialysis procedure, but serum inorganic iodine fell slightly from 2.1 +/- 1.1 microgram/dl before dialysis to 1.2 +/- 0.6 microgram/dl after dialysis (p less than 0.05). The marked reduction in serum total T4 and free T4 concentrations and the moderate reduction in serum total T3 and free T3 levels in apparently euthyroid patients undergoing hemodialysis has not been explained. The normal serum TSH levels in the face of these low concentrations of thyroid hormone suggests an abnormality in the control of TSH secretion in these patients.

Adult↗
PubMed1976

Dose-response of prolactin and thyrotropin to N3im-methyl-thyrotropin releasing hormone in euthyroid men.

The synthetic N3im-methyl analogue of thyrotropin releasing hormone (methyl-TRH) was administered intravenously to 15 euthyroid men, ages 36-62, in graded doses from 6.25 mug to 500 mug in order to establish the range of response of prolactin (PRL), TSH, T3 and T4 to various doses of methyl-TRH. There was a dose-related rise in serum TSH, PRL, T3, and T4 which gave a nearly linear relationship when the integrated area of response was used as an index of response to the various doses of methyl-TRH. All 15 men had a clear elevation in TSH, PRL, T3 and T4 following the lowest dose of methyl-TRH TESTED (6.25 mug). There was considerable variability in the response to methyl-TRH among the individuals. One hundred mug of methyl-TRH gave a maximum TSH response; a 25 mug dose elicited a maximum PRL response.

Adult↗