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Biomedical subjects

E S Lightner

Publications and source records attributed to E S Lightner.

At least 19 recordsLinked to original sources
PubMed2000

Survey of clinical practice: growth hormone use during illness.

Prior to the 1999 National Cooperative Growth Study (NCGS) meeting, a postal card survey was conducted of the NCGS investigators about their current practices regarding continuation of growth hormone (GH) therapy during intercurrent illnesses. The survey results were subsequently compared with responses to the same questions obtained from NCGS investigators who attended lectures at the NCGS meeting describing the physiology and effects of GH in critically ill patients. Comparing results from the two surveys, there were no observed differences in the responses with respect to practices relative to the intercurrent illnesses treated at home. The percentage of NCGS investigators who indicated that they would stop GH treatment during more serious illnesses was greater following attendance at the lectures.

Comorbidity↗
PubMed1993

The adrenal incidentaloma. A pediatric perspective.

In our commentary, we have reviewed the literature on adrenal incidentalomas and specifically have tried to relate it to the pediatric population. The studies of others have shown that adrenal tumors are very common in patients with CAH (homozygote and heterozygote) and that these tumors are very rarely malignant and therefore should not routinely be surgically removed. In fact, we suggest that only under very rare circumstances is surgical removal justified. Perhaps, in the future, biochemical markers will allow us to distinguish between adrenal adenomas and carcinomas. We have tried to give broad guidelines for the care of patients with CAH with adrenal tumors, but these are guidelines only--they are not laws chiseled in stone. Finally, as radiological imaging is done more frequently and becomes even better at finding small adrenal tumors, this general topic will become increasingly relevant. We hope our thoughts will lead to lively discussion and useful studies in this "newly discovered" medical dilemma.

Adolescent↗
PubMed1988

Bromocriptine-unresponsive prolactin macroadenoma in a prepubertal female.

Macroprolactinomas occur rarely in prepubertal children. A prepubertal 11 10/12-year-old female with a macroprolactinoma presented with a diagnosis of anorexia nervosa. Findings included severe headaches, anorexia, weight loss, and growth failure. The initial serum prolactin level was 2,916 ng/ml. This value fell after beginning treatment with bromocriptine, but later rose despite a doubling of the dose. Transsphenoidal surgical resection was performed and postoperative radiation given. The use of bromocriptine, surgical resection, and radiation therapy in the treatment of macroprolactinomas are discussed.

Adenoma↗
PubMed1981

Rapid adrenocortical recovery after short-term glucocorticoid therapy.

The recovery time of adrenocortical function was studied in 13 children receiving intermittent high-dosage glucocorticoid therapy (prednisone, 2 mg/kg/day) for one month out of every four months as treatment for acute leukemia. The data indicate that the adrenal gland's ability to respond to stress recovers rapidly from such treatment. The results of our study clearly show that routine supplementation with glucocorticoid therapy in these patients during periods of clinical stress occurring later than nine days after glucocorticoid therapy is not warranted.

Adolescent↗
PubMed1981

H-Y antigen in XO/X,iso(X) mosaic Turner syndrome.

Androgen excess, found occasionally in gonadal dysgenesis, may be associated with hilus cell hyperplasia within the gonadal streaks. This report describes a phenotypic female with Turner syndrome, clitoromegaly, hilus cell hyperplasia, and a gonadal-to-peripheral venous step-down gradient for testosterone, androstenedione, and estradiol. Cytogenetic analysis of cells from peripheral blood and both streak gonads revealed a mosaic karyotype, 45,X/46,X,iso(X). The isochromosome was a nonfused dicentric type (pter leads to q2105 leads to pter). Despite absence of the Y chromosome, serologic analysis revealed the presence of H-Y antigen, thereby suggesting occult Y chromosomal function in the patient's gonads.

Adolescent↗
PubMed1979

Low-dose intravenous insulin in the treatment of diabetic ketoacidosis.

Continuous slow intravenous infusion of insulin was used in 52 episodes of diabetic ketoacidosis. No complications of therapy, ie, hypoglycemia, induced hypokalemia, insulin resistance, or cerebral edema, were encountered. Potassium phosphate was given to 47 of the 52 patients. Sodium bicarbonate was administered to only one patient. The hyperglycemia frequently resolved more rapidly than the systemic acidosis; this was managed by adding glucose to the intravenous fluids when the blood sugar concentration decreased to approximately 250 mg/dL; insulin infusion, however, was continued until the acidosis was corrected (venous standard bicarbonate greater than 14 mEq/L). We have found this method of treatment to be safe and simple to administer, and we believe it is the preferred treatment of patients with diabetic ketoacidosis.

Adolescent↗
PubMed1977

Intra-amniotic injection of thyroxine (T4Y to a human fetus. Evidence for conversion of T4 to reverse T3.

131I (150 mCi) was inadvertently given to a woman during week 10 to 11 of her gestation. When referred, fetal size was estimated at 31 to 32 weeks' gestation. Because of the potential risk of fetal hypothyroidism, an amniocentesis, with an injection of 500 mug of thyroxine, was performed weekly from week 33 until delivery. T4, T3, thyrodi-stimulating hormone (TSH), and rT3 were measured in amniotic fluid samples obtained at 33, 36, and 37 weeks. Maternal serum T4 was measured on the day of delivery. T4, T3, and TSH concentrations were measured in cord blood and during the neonatal period. The concentration of T4 in amniotic fluid (AF) was within the normal range at 32 weeks (prior to thyroxine); AF T3 and TSH were not detectable. The concentration of AF rT3 at 32 weeks also was normal (160 ng. per deciliter) and increased markedly after beginning intra-amniotic T4 injections; AF T4 increased modestly, but the AF T3 level remained unmeasurable. The concentration of T4 in cord serum obtained within 24 hours of the last amniotic fluid thyroxine injection, was in the hyperthyroid range and the TSH level was low. The cord serum T3 level was at the upper range of normal. The infant's serum T4 and T3 both increased during the first 24 hours. The male infant developed normally and serum T4 and TSH concentrations were normal at 4 months of age. The data indicate: (1) that T4 injected into AF is absorbed by the human fetus, (2) that AF rT3 concentration increases markedly after the AF T4 injection, whereas AF T3 levels do not increase, and (3) that the neonatal TSH surge is not entirely suppressed by hyperthyroid levels of cord serum T4.

Adult↗
PubMed1977

Neonatal hyperthyroidism and heart failure. A differential approach.

Congestive heart failure in neonatal thyrotoxicosis is attributed to sympathetic overstimulation of the myocardium with resulting high-output cardiac failure. An additional case of neonatal thyrotoxicosis with congestive heart failure is discussed; three possible causes (thyrotoxicosis, maternal propranolol therapy, and ventricular septal defect) were present. Along with the usual procedures, the echocardiogram is of value in separating these factors. In addition, we discuss the potential dangers to the newborn of a mother receiving long-term propranolol hydrochloride therapy during pregnancy.

Digitalis Glycosides↗
PubMed1977

Kwashiorkor not associated with poverty.

Four infants are described with kwashiorkor that was unassociated with poverty or infection as predisposing factors of their disease. The condition followed various dietary regimens deficient in protein of five weeks to seven months in duration. Features of this "sugar-bady" form of kwashiorkor included a low level of physician awareness of malnutrition as a diagnostic consideration, growth retardation, edema, muscle wasting, mental changes, and mild lymphocytosis. Initially, recovery was associated with rapid loss of weight and anemia and subsequently with weight gain and return to good health.

Arizona↗