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Biomedical subjects

D Zimmerman

Publications and source records attributed to D Zimmerman.

At least 109 records · Page 6Linked to original sources
PubMed1986

Endocrine disorders of the pancreas and adrenal cortex in pediatric patients.

Hyperinsulinemia, a common cause of persistent hypoglycemia in infants and children, can result in permanent damage to the central nervous system. Thus, early diagnosis and treatment are important. The typical clinical manifestation of hyperinsulinemic hypoglycemia is symptomatic hypoglycemia that responds poorly to medical therapy. Affected infants may have tremors, jitteriness, apnea, cyanosis, or seizures. If initial medical therapy (frequent feedings, large amounts of intravenously administered glucose, diazoxide, and glucocorticoids) fails to stabilize plasma glucose levels, subtotal pancreatectomy is indicated. This surgical intervention does not completely correct the hypoglycemia in all patients, but it effectively reduces the severity of the condition. Surgical treatment of pediatric patients with Cushing's syndrome or aldosteronoma has also been effective. In our experience, survival of patients with adrenocortical adenomas has been 100%, whereas only five of nine children with adrenocortical carcinomas survived, and four of the five were younger than 10 years of age.

Adrenal Cortex Neoplasms↗
PubMed1985

Hashimoto thyroiditis associated with thyroid cancer in adolescent patients.

Three girls had Hashimoto thyroiditis and thyroid cancer. Cervical exploration revealed a follicular carcinoma in one, an oxyphilic cell carcinoma in another, and a papillary carcinoma in the third. These cases add clinical and pathologic data to the previously debated concept that Hashimoto thyroiditis coexists with thyroid carcinoma.

Adenocarcinoma↗
PubMed1985

Pediatric endocrine surgery.

The pediatric surgeon is in a unique position to understand endocrine surgery and, therefore, is expected to develop considerable expertise in this area. In recent years numerous advances and changes have occurred in pediatric endocrine surgery that have led to greater understanding of the disease processes and syndromes and the development of new diagnostic techniques and surgical approaches.

Adolescent↗
PubMed1984

Changes in specific B cells and the dissemination of the primed state in vivo following antigenic stimulation by different mucosal routes.

Immunologic dogma holds that the adaptive and long-term potential of the antibody response is fashioned by antigen-dependent, selective clonal proliferation of specific B cells and the retention of some which may undergo a second round of antigen-stimulated clonal expansion with antibody production. Apparently, the short-term, immediate consequences of an antibody response depend on the mix of isotypes displayed in vivo upon exposure to antigen. This latter seems to be clearly regulated by T cells, but it is also likely that the isotype potential of a B cell population and its future possible display of isotypes is linked to the initial, antigen-dependent proliferative phase in the development of an antibody response. In vitro analysis at limiting dilutions of specific B cells primed in vivo has led to the operational definition of IgA-committed cells. These B cells increase in frequency following chronic or acute antigenic stimulation of gut mucosa and have the potential to proliferate again in the presence of antigen and TH(Ag) cells to produce exclusively IgA. A general relationship exists between mucosal or parenteral priming of B cells and their potentials to express IgA and/or IgE--both isotypes appear to be likely products of secondary B cells and frequently both can be expressed by the same clone activated by a second-round of T-dependent antigenic stimulation. Cross priming--exposure of GALT or BALT leading to secondary B cells in the opposite mucosal lymphoid tissue--suggests an inherent antagonism between development of allergic (IgE) and putative allergy blocking (IgA) potentials.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Pheochromocytoma in the pediatric age group: current status.

Pheochromocytoma is an unusual tumor in the pediatric age group. Several aspects serve to differentiate children with pheochromocytoma from their adult counterparts. Children have fewer malignant tumors, more extraadrenal tumors, and greater bilaterality and multiplicity of tumor. Similarly, they have an increased incidence of multiple endocrine neoplasia (MEN) and familial disease. The records of 16 children (age 17 years and younger) with pheochromocytoma were evaluated. One newborn died at 36 hours of age, and a 3-year-old died four days after exploratory laparotomy. Of the 14 survivors (with an average follow-up of 8 years), three had manifestations of multiple endocrine neoplasia type 2 and two had familial pheochromocytoma only. One patient had malignant paragangliomas. Three patients had bilateral tumors; one of these had MEN. Four patients underwent operation before the use of alpha- and beta-adrenergic blockade was routine at our institution. An additional patient received blockade in preparation for the removal of the pheochromocytoma but was not prepared for preoperative angiography. Hypertensive complications were encountered in four of these five children; in one, this complication was fatal. There were no intraoperative complications in the 12 patients who had received appropriate blocking agents. Eleven of the 14 survivors are currently normotensive without the need for antihypertensive medication. Two patients have medically controlled hypertension, and one continues to have severe hypertension. An overview of this series underscores the characteristic features of pheochromocytoma in the pediatric age group. Angiography has been replaced by high-resolution computed tomography for localization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Analysability in relation to early psychopathology.

Analysability is a highly important subject, both in the treatment of patients and in selecting candidates for analytical training. The assessment of analysability can be studied from two complementary points of view: the dynamic (with the data obtained in the preliminary interviews) and the genetic (with data obtained from early childhood by means of psychoanalytical treatment). The purpose of this study will be to contribute to the study of analysability from the genetic point of view. When one goes deeper into the analysis of a patient there may be doubts as to the limits and possibilities of his analysability. The same occurs with regard to the assessment of the amount of psychic changes made by the patient. The study of analysability related to early psychopathology can help us clear up such problems. Summaries of two psychoanalytical treatments with commentaries are presented: one with understandable limitations in analysis and the other which will be difficult to analyse. In the final considerations, based on the aforementioned clinical examples and on many others, experiences of reasonable initial psychic development are mentioned, and early psychopathological experiences--traumas, deprivations, bad relationships with important objects--which determine analysability or its limitations, obstacles or even impossibility.

Adult↗
PubMed1981

Endorphins, ventilatory control and sudden infant death syndrome--a review and synthesis.

Evidence is reviewed which supports the hypothesis that sudden infant death syndrome and "near-miss" sudden infant death syndrome may be caused by overactivity of the endogenous opioid system (endorphins). The characteristic features of sudden infant death syndrome are listed, and then by reviewing effects that have been observed with (or which would be expected to result from) overactivity of the endogenous opioid system, it is shown that all of the characteristic features of sudden infant death syndrome may be opioid mediated effects. The hypothesis proposes that the endogenous opioid system is tonically overactive for weeks or months prior to death from SIDS causing the ventilatory abnormalities and subtle CNS dysfunction such as behavioral indifference, thermal instability and decreased responsiveness to pinprick which have been noted in these infants. Most significantly, excess CNS endorphin activity explains the quiet asphyxial death during sleep. Research strategies for proving the hypothesis are briefly discussed.

Endorphins↗
PubMed1981

Effect of casein and starch infusion in the large intestine on nitrogen metabolism of growing swine.

Eight crossbred female pigs (40 kg) with cannulae placed in the terminal ileum were used to evaluate the effect of infusions of casein starch and casein plus starch on organic matter fermentation and microbial protein synthesis in the large intestine, and their effect on urinary urea and orotic acid excretion, and on nitrogen (N) retention. Infused casein and starch were both totally digested. Nitrogen retention was increased (P greater than 0.05) when casein was infused. Starch infusion resulted in an increase (P greater than 0.05) in fecal N in the form of total protein (amino acids). The high correlation (P greater than 0.01) between fecal total protein and RNA indicates that the increase in fecal N resulted from an increase in microbial protein synthesis. About 5.2 g of bacterial protein was synthesized per 100 g of cornstarch fermented in the large intestine. Casein infusion increase (P greater than 0.05) total urinary N. Differences between treatments for urinary N were entirely because of changes in urinary urea. Urinary ammonia and unaccounted N were not affected by treatments. Urinary orotic acid was a good indicator of the urea cycle activity because of its hig correlation (P greater than 0.0) with urinary urea. Plasma urea N concentration was increased (P greater than 0.05) only when casein plus starch was infused.

Animals↗
PubMed1981

Histamine and human parathyroid adenoma: effect on adenosine 3',5'-monophosphate accumulation in vitro.

We studied in vitro the presence of histamine and the effect of histamine and its antagonists on cAMP accumulation in parathyroid tissue (parathyroid adenoma or hyperplasia) from patients with primary hyperparathyroidism. Parathyroid adenomatous tissue contained 11.2 +/- 2.9 ng histamine/g wet weight (approximately 2 X 10(-5) M), as determined by a specific radioenzyme assay. Histamine caused a prominent increase in cAMP accumulation in parathyroid tissue slices in a dose-dependent manner, with half-maximal stimulation being achieved at 5 X 10(-6) M and maximal stimulation occurring at 10(-4) M histamine. The histamine H2 receptor antagonists, cimetidine and metiamide, caused profound inhibition of histamine-stimulated cAMP accumulation in the parathyroid tissue. Pyrilamine, an H1 antagonist, also inhibited histamine-stimulated cAMP accumulation. Isoproterenol, a beta-adrenergic agonist, elicited marked elevation of cAMP, and its stimulatory effect was blocked by propranolol, but the effects of histamine on cAMP levels in parathyroid tissue were not blocked by propranolol. Histamine significantly stimulated (an increase of 50%) the release of immunoreactive parathyroid hormone. The present observations demonstrate that parathyroid adenomatous tissue has a relatively high content of histamine, and the release of immunoreactive parathyroid hormone from this tissue. The effects of antagonists suggest that histamine stimulates cAMP accumulation in the parathyroid adenomatous tissue by an action on both H2 and H1 histamine receptors.

Adenoma↗
PubMed1980

Venous thrombosis and splenic rupture in paroxysmal nocturnal hemoglobinuria.

A patient with an 11 year history of paroxysmal nocturnal hemoglobinuria presented with severe abdominal pain. On admission, the hematocrit value was 30 per cent and unchanged from repeated measurements during the previous three years. Abdominal angiography identified extensive thromboses of the splenic and portal venous systems. After initial improvement on heparin therapy, the patient experienced additional abdominal crises. A ruptured and multifragmented spleen was removed at the time of exploratory laparotomy. Postoperatively, after a several days' interval of improvement, the patient experienced additional thrombotic episodes of the abdomen, upper extremities and cerebral cortex. The latter was associated with disabling nerve paralysis. With continuous intravenous heparin plus steroid therapy, the patient's condition improved progressively. Despite the numerous thrombotic episodes during the prolonged hospital course, no hemolytic episodes were observed. This is the first report of documented splenic rupture in a patient with paroxysmal nocturnal hemoglobinuria.

Adult↗