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Biomedical subjects

D Longson

Publications and source records attributed to D Longson.

16 recordsLinked to original sources
PubMed1988

Long-term treatment of Nelson's syndrome with sodium valproate.

Eleven patients with Nelson's syndrome were given sodium valproate (Epilim, Sanofi). Plasma ACTH and cortisol levels were measured under carefully controlled conditions which were designed to eliminate spontaneous fluctuations in ACTH. At 6 weeks all 11 patients were reassessed while taking sodium valproate 600 mg/day; there was then a small but significant (P less than 0.05) reduction in plasma ACTH concentration. Six patients continued to take sodium valproate, and were reassessed at 1 year when five were taking 1200 mg/day and one patient was taking 600 mg/day. At 1 year for these six patients there had been an increase in mean plasma ACTH which was then not significantly different from basal values. The five patients who discontinued sodium valproate were also reassessed at 1 year, when there were no significant differences compared to basal or 6-week values. During therapy with sodium valproate, there were no significant changes in the half-life of plasma cortisol, plasma sodium and potassium concentrations, or serum liver enzymes. Weight gain on sodium valproate was the main reason for patients asking to discontinue therapy. Sodium valproate is not an effective long-term therapy for reducing plasma ACTH for patients with Nelson's syndrome.

Adolescent↗
PubMed1984

A large outbreak of keratoconjunctivitis due to adenovirus type 8.

A large nosocomial outbreak of keratoconjunctivitis due to adenovirus type 8 is described. Two hundred cases were identified, 123 by isolation of the virus and 77 by detecting HI antibodies in convalescent sera. Infection usually presented as a severe keratoconjunctivitis, and 107 (54%) of infected patients developed sub-epithelial corneal opacities. The majority (66%) of infections were acquired at the accident and emergency department attached to a large urban eye hospital when patients attended for other reasons; trauma to the eye, especially corneal foreign bodies, was the most frequent cause for the initial attendance. Transmission of virus within the family occurred in 13% of cases, but there was little spread outside family or hospital environments. The outbreak lasted from May to September, 1982, but it was not confirmed by isolation of the virus until the end of June when control measures were instituted. Delay in applying control measures was probably the major factor accounting for this large, prolonged outbreak of epidemic keratoconjunctivitis.

Adenoviridae Infections↗
PubMed1983

Single daily dose short term carbimazole therapy for hyperthyroid Graves' disease.

Twenty-one patients with hyperthyroid Graves' disease were treated with carbimazole 30 mg daily, given as a single dose. Propranolol was also given for the first 3 weeks. All became clinically euthyroid with normal serum thyroxine (T4) levels, usually within 1-3 months. Patients with large goitres and raised serum alkaline phosphatase concentrations took longer to respond. In 19 patients a positive thyroid stimulating hormone (TSH) response to intravenous thyrotrophin releasing hormone (TRH) developed. Carbimazole was stopped soon after (median time of treatment 18 weeks, range 9-41 weeks) and 18 patients have been followed. Seven of these (39%) have remained in remission from hyperthyroidism for more than one year (median 77 weeks). Carbimazole 30 mg once daily is a convenient and effective treatment for hyperthyroid Graves' disease. Many patients will achieve prolonged remissions if treatment is stopped when serum T3 and T4 levels are in the low-normal range, usually 2-4 months after clinical euthyroidism has been reached.

Adult↗
PubMed1983

An evaluation of plasma exchange for Graves' ophthalmopathy.

Eighteen patients with ocular manifestations of Graves' disease were treated by plasma exchange. Detailed clinical, ophthalmological and orthoptic assessments were made including computerized axial tomography and A + B scan ultrasound of the orbits. Seventeen different ocular parameters were separately rated for each patient. The changes recorded were small, statistically insignificant, and no patient was cured of ocular disease. There were no significant correlations between the ocular changes recorded and age, sex, duration of ophthalmic symptoms, the presence of thyroid antibodies, the number of exchanges, or the concurrent administration of azathioprine.

Adult↗
PubMed1983

Cushing's disease treated by total adrenalectomy: long-term observations of 43 patients.

Forty-three patients were treated by total adrenalectomy for pituitary-dependent Cushing's disease. The median period of observation was 10 years (range one to 20 years). Thirty-eight patients (88 per cent) had rapid and lasting remissions. Of the 38 in remission, 21 became pigmented but without pituitary enlargement, 11 became pigmented with evidence of further pituitary expansion (Nelson's syndrome) and six neither became pigmented nor showed pituitary expansion. Pituitary expansion was associated with high plasma ACTH values, and treatment of pituitary tumours by surgery or radiotherapy gave poor results. However, when compared with alternative methods of treatment, total adrenalectomy for Cushing's disease is still satisfactory for many patients, despite advances in pituitary surgery, and has advantages over 'medical adrenalectomy' with drugs.

17-Ketosteroids↗
PubMed1978

Cushing's syndrome, nodular adrenal hyperplasia and virilizing carcinoma.

A 48-year-old hypertensive diabetic woman rapidly became virilized. Urine 17-oxo-and oxogenic steroids and plasma testosterone, androstenedione, DHEA, DHEA-sulphate and androstenediol were greatly elevated. Plasma cortisol was constantly high and was not suppressed by dexamethasone. Circulating immunoreactive ACTH was consistently detectable at 18-24 ng/l. A 450 g carcinoma arising from a nodular hyperplastic right adrenal gland was resected. Production by the tumour of 17a-hydroxypregnenolone, 17a-hydroxyprogesterone and five C-19 steroids, but very little prenenolone, progesterone or cortisol, was shown by blood sampling, tumour culture and dramatic falls after operation. The plasma cortisol fell to half, with no diurnal variation, consistent with persistent Cushing's syndrome, and the plasma ACTH rose to 55 ng/l. She died 3 months later from a myocardial infarction. Autopsy revealed a pituitary basophil adenoma at a site where radiologically there had been an indentation in the fossa floor for at least 7 years. The left adrenal gland showed nodular hyperplasia. Therefore we conclude that mild pituitary-dependent Cushing's syndrome may have been present for many years before development of a virilizing carcinoma. This case demonstrates that adrenal carcinoma in man can sometimes develop as a consequence of nodular adrenal hyperplasia which may in turn be due to long-standing trophic hyper-stimulation.

Adenocarcinoma↗
PubMed1975

Anabolic steroids in athelics: crossover double-blind trial on weightlifters.

Thirteen experienced male weightlifters taking high-protein diets and regular exercise took part in a double-blind crossover trial of methandienone 10 or 25 mg/day to seeif the drug improved athletic performance. Their improvemments were significantly greater on methandienone than on placebo; their body weights rose (though this seemed to be associated with water retention); and systolic blood pressure rose significantly. Methandienone caused many side effects, and three men had to withdraw because of them. All side effects disappeared after the drug was stopped. Anabolic steroids are effective only when given combination with exercise and high-protein diet. We deprecate their use in athletics but can suggest no way of stopping it.

Acne Vulgaris↗
PubMed1972

Androgen therapy.

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Anabolic Agents↗