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Biomedical subjects

E G Lufkin

Publications and source records attributed to E G Lufkin.

At least 19 recordsLinked to original sources
PubMed1992

Treatment of postmenopausal osteoporosis with transdermal estrogen.

OBJECTIVE: To evaluate the tolerance and effectiveness of transdermal estrogen for women with established postmenopausal osteoporosis and vertebral fractures. DESIGN: Double-blind, randomized, placebo-controlled clinical trial lasting 1 year. SETTING: Referral-based outpatient clinic. PATIENTS: Seventy-five postmenopausal women, 47 to 75 years of age, with one or more vertebral fractures due to osteoporosis. INTERVENTIONS: Thirty-nine women received dermal patches delivering 0.1 mg of 17 beta-estradiol for days 1 to 21 and oral medroxyprogesterone acetate for days 11 to 21 of a 28-day cycle. Another 39 women received placebo. MEASUREMENTS: Bone turnover assessed by biochemical markers and iliac bone histomorphometry; bone loss assessed by serial measurement of bone density; and vertebral fracture rate. RESULTS: Compared with the placebo group, the median annual percentage change in bone mineral density in the estrogen group reflected increased or steady-state bone mineral density at the lumbar spine (5.3 compared with 0.2; P = 0.007), femoral trochanter (7.6 compared with 2.1; P = 0.03), and midradius (1.0 compared with -2.6, P less than 0.001) but showed no significant difference at the femoral neck (2.6 compared with 1.4; P = 0.17). Estrogen treatment uniformly decreased bone turnover as assessed by several methods including serum osteocalcin concentration (median change, -0.35 compared with 0.02 nmol/L; P less than 0.001). Histomorphometric evaluation of iliac biopsy samples confirmed the effect of estrogen on bone formation rate per bone volume (median change, -12.9 compared with -6.2% per year; P = 0.004). Also, 8 new fractures occurred in 7 women in the estrogen group, whereas 20 occurred in 12 women in the placebo group, yielding a lower vertebral fracture rate in the estrogen group (relative risk, 0.39; 95% CI, 0.16 to 0.95). CONCLUSIONS: Transdermal estradiol treatment is effective in postmenopausal women with established osteoporosis.

Administration, Cutaneous↗
PubMed1991

The black bag.

Explore the source record for details and available documents.

House Calls↗
PubMed1989

Estrogen replacement therapy for the prevention of osteoporosis.

Estrogen replacement therapy is the most effective single means of preventing and treating osteoporosis. The most common objection by patients, the resumption of menses if the uterus is present, may be eliminated by providing estrogen and progestin continuously. An additional concern, endometrial carcinoma, appears to be largely alleviated by coadministration of progestin. Evidence indicates that concomitant progestin administration actually reduces the incidence of endometrial carcinoma to less than that in untreated women. An incidental but potentially more important benefit is protection against coronary artery disease. Optimal management includes initiation of estrogen therapy shortly after menopause, long-term continuation and calcium supplementation.

Bone and Bones↗
PubMed1988

Estrogen replacement therapy: current recommendations.

Estrogen replacement therapy is effective for the prevention and treatment of postmenopausal osteoporosis and should be offered to all women at high risk for osteoporosis. Such therapy is particularly beneficial for prevention of spinal compression fractures; in addition, it alleviates menopausal symptoms (hot flushes, genitourinary symptoms, and changes in mood). In each patient, these benefits must be weighted against the potential risks of endometrial hyperplasia and carcinoma, breast tenderness, hypertension, vascular headaches, and the inconvenience of menstrual bleeding if the uterus is intact. The risk of endometrial cancer associated with estrogen replacement therapy can be considerably reduced by the addition of a progestin, and other side effects can be diminished or eliminated by use of the new transdermal estrogen preparations. Thus, estrogen replacement therapy should be considered in all women who have experienced natural or surgically induced menopause, and it is advisable in women who have osteoporosis or an increased risk for this disorder and no contra-indications to its use. Estrogen replacement therapy should be instituted as soon after menopause as possible and seems to be well tolerated until at least 75 years of age.

Aged↗
PubMed1987

Influence of phlebotomy treatment on abnormal hypothalamic-pituitary function in genetic hemochromatosis.

To test the hypothesis that deficiencies in hypothalamic-pituitary function in genetic hemochromatosis result from cellular injury by iron deposits, we conducted provocative tests in 11 men with genetic hemochromatosis before and after iron depletion by serial phlebotomy and in 10 control subjects. We gave combination intravenous injections of insulin (0.15 U/kg), luteinizing hormone releasing hormone (LHRH, 100 micrograms), and thyrotropin releasing hormone (400 micrograms) and then measured plasma glucose, growth hormone, corticosteroids, follicle-stimulating hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone at 30-minute intervals for 90 minutes. Phlebotomy caused a substantial decrease in median values for serum ferritin, deferoxamine-chelatable iron, and hepatic iron concentration. Before phlebotomy, stimulation by hypoglycemia and thyrotropin releasing hormone caused significantly less secretion of growth hormone (P = 0.004) and prolactin (P = 0.03) in patients than in control subjects. No significant improvement was noted, however, in growth hormone or prolactin secretion after phlebotomy. Of the 11 patients, 7 had secondary hypogonadism, and phlebotomy did not improve the serum testosterone, follicle-stimulating hormone, luteinizing hormone, or responses to LHRH in any case. Chlorpromazine injections failed to elevate serum prolactin in all patients, and administration of levodopa caused a partial reduction in serum prolactin; thus, the hypothalamus may be an important locus of endocrine malfunction in these patients. We conclude that abnormal hypothalamic-pituitary function in genetic hemochromatosis is not substantially improved by iron-depletion therapy.

Adult↗
PubMed1986

Outpatient percutaneous biopsy of the iliac crest: methods, morbidity, and patient acceptance.

Bone histology and histomorphometry have become important in the diagnosis and management of metabolic bone disease, but the invasive nature of the biopsy procedure has limited its use. We describe an outpatient technique for obtaining one or more transiliac bone biopsy specimens. Thirty-eight women with osteoporosis, each of whom had sustained one or more spinal compression fractures, underwent two separate bone biopsies during which two 7.5-mm transiliac cores of bone were removed. No morbidity (such as infection or hemorrhage) was encountered. Subjective responses to the level of pain were surveyed by questionnaire. At the time of biopsy, 46% of the study subjects experienced no or only mild discomfort, and 24% judged their pain to be severe. At 16 hours after biopsy, 64% had no or mild pain and 8% experienced severe pain. At 7 days after biopsy, 79% experienced no or mild pain but 9% judged their pain to be severe. In four patients, temporary ambulatory disability occurred but resolved spontaneously in 7 to 10 days. We conclude that the described outpatient bone biopsy procedure is safe, efficient, and generally acceptable to patients.

Aged↗
PubMed1985

Serum angiotensin-converting enzyme activity. Its use in the evaluation and management of hypercalcemia associated with sarcoidosis.

Serum angiotensin-converting enzyme (SACE) was measured in 14 patients (eight women and six men) with sarcoidosis and hypercalcemia. Thirteen patients were treated with prednisone, and 12 achieved normal or nearly normal serum calcium values. Two patients had coexistent hyperparathyroidism. Seven of eight patients with serial SACE measurements exhibited parallel falls in SACE and serum calcium levels. Eleven patients were successfully treated with alternate-day prednisone regimens. The data suggest that serial SACE measurements are useful in the evaluation and management of sarcoidosis with hypercalcemia. In patients with sarcoidosis, the reduction of SACE levels during glucocorticoid treatment may be due to a suppression of granuloma formation. Concomitant falls in serum calcium level suggest an important role of the granuloma or its cellular precursors in vitamin D metabolism.

Adult↗
PubMed1979

Increased von Willebrand factor in diabetes mellitus.

Abnormal platelet function may play a role in the genesis of vascular complications in diabetes mellitus. We measured plasma levels of ristocetin-Willebrand factor and factor VIII antigen in 75 subjects and also measured aggregation-enhancing factor in subsets. We found increased levels of ristocetin-Willebrand factor in all groups of diabetics studied, even in mild diabetics free of vascular disease. Factor VIII antigen was increased only in diabetics with vascular disease. We could not find an aggregation-enhancing factor in any group.

Adult↗
PubMed1977

Abnormal sella turcica. A tumor board review of the clinical significance.

Sixty of 146 patients with intracranial neoplasms or arterial aneurysms had roentgenographic abnormalities of the sella turcica. These abnormalities were most commonly due to chromophobe adenoma, craniopharygioma, and acromegaly, but ten of them were caused by lesions arising distant to the sella. There were also three cases of empty sella syndrome. Headache, visual disturbance, and sexual dysfunction were the most frequent presenting complaints, with visual field abnormality being most common. Pituitary dysfunction was manifested most frequently by alterations in growth hormone level and gonadotrophin secretion and less frequently by hypothyroidism and adrenocortical insufficiency. When the abnormal sella was associated with evidence of symptomatic intracranial disease, endocrine dysfunction, or visual field compromise as evidence of an anatomically aggressive intracranial neoplasm, specialized neuroroentgenographic localizing procedures were usually positive, and treatment for most of the causative lesions was highly effective.

Acromegaly↗
PubMed1977

Acute cerebral dysfunction in diabetic ketoacidosis: survivial followed by panhypopituitarism.

We report a unique case of a 15-yr-old diabetic patient who survived ketoacidosis complicated by acute severe encephalopathy, hypopituitarism, and optic atropy. We reviewed our 25-yr experience with fatal diabetic ketoacidosis; three additional cases resembled the "cerebral edema" syndrome. We observed that (1) cerebral edema is not often documented in this syndrome, (2) the cause of the acute neuronal disturbance in these patients may be hypoxic, with cerebral edema a secondary development, and (3) development of encephalopathy was probably unrelated to overvigorour correction of acidosis and hyperglycemia in our cases.

Acute Disease↗
PubMed1976

Acute effects of oral and intravenous ethanol on rat hepatic enzyme activities.

1. Oral administration of ethanol (3 ml) of 95% in 12 ml total volume over a two day period) significantly decrease plasma glucose and insulin levels and the activities of two key gluconeogenic enzymes, pyruvate carboxylase (pyruvate: CO2 ligase (ADP), EC 6.4.1.1) and fructose diphosphatase, (D-Fru-1,6-P2 1-phosphohydrolase, EC 3.1.3.11), and one glycolytic enzyme, fructose-1,6-P2 aldolase (Fru-1,6-P2 D-glyceraldehyde-3-P lyase, EC 4.1.2.13). In each instance, the administration of 2400 mug daily of oral folate in conjuction with the ethanol prevented these alterations in carbohydrate metabolism. 2. Intravenous injection of ethanol produced a rapid decrease (within 10--15 min) in the activities of hepatic phosphofructokinase, (ATP:D-fructose-6-phosphate 6-phosphotransferase, EC 2.7.1.11), pyruvate kinase, (ATP:pyruvate phosphotransferase, EC 2.7.1.40), fructose diphosphatase and fructose-1,6-P2 aldolase. 3. Intravenous ethanol significantly increased hepatic cyclic AMP concentration approximately 60% within 10 min, while oral ethanol did not alter hepatic cyclic AMP concentrations. 4. These data confirm the known antagonism ethanol and folate and suggest that oral folate might offer a protective effect against hypoglycemia in rats receiving ethanol.

Administration, Oral↗
PubMed1976

Improvement in jejunal enzyme adaptation in obese adult-onset diabetic patients following a 30-day fast.

The adaptive responses of gastrointestinal enzymes, glucose tolerance, and plasma insulin to diet, folic acid, and insulin of five obese adult-onset diabetic patients were studied before and after a 30-day fast. Their data were compared to the adaptive responses of gastrointestinal enzymes to diet, folic acid, and insulin of 15 normal male volunteer subjects, ages 18 to 24. Each group during each testing period received a carbohydrate diet (50% calories as carbohydrate consisting of 1/2 glucose and 1/2 fructose) and a noncarbohydrate diet (70% of calories as corn oil and 30% as sodium caseinate) each without and with folic acid (5 mg three times per day). The effect of insulin was studied only on the carbohydrate diet plus folic acid. Our data demonstrate that obese adult-onset diabetic patients have an impaired adaptive response of jejunal carbohydrate-metabolizing enzyme activities (hexokinase, pyruvate kinase, fructose-1-6-diphosphate aldolase, fructosediphosphatase) to dietary carbohydrate, oral folic acid, and insulin when compared to normal subjects and nondiabetic obese patients. Following a 30-day fast, the obese diabetic patients showed an improvement in glucose tolerance, hyperinsulinemia, and the adaptive response of the jejunal carbohydrate-metabolizing enzyme activities to dietary carbohydrate, folic acid, and insulin. The greatest improvement in the adaptive response of the jejunal enzyme activities occurred on the carbohydrate diet.

Adaptation, Physiological↗