Hyperglycemic hyperosmolar syndrome (HHS) during pregnancy.
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Adult↗
Biomedical subjects
H A Lippes
Publications and source records attributed to H A Lippes.
Total thyroidectomy for Graves' disease.
BACKGROUND: Therapeutic options for treatment of hyperthyroidism caused by Graves' disease remain controversial. There are three main options: thiourea drugs, radioactive iodine ablation, and thyroidectomy. Each treatment has significant advantages and potential problems. METHODS: The present study is a retrospective analysis of our experience with total thyroidectomy in Graves' disease. Sixty-two patients underwent this procedure in 11 years' time and were followed for a minimum of 2 years after surgery. All had measurement of total thyroxine, T3 uptake, and radioactive iodine (RAI) uptake and scanning. Sixty-three percent of all patients had some element of hyperthyroid eye signs. All patients were rendered euthyroid with pharmacologic therapy prior to surgery. Postoperatively, the patients were evaluated for improvement in eye signs, incidence of recurrent laryngeal nerve injury, and hypoparathyroidism. RESULTS: None of the patients in this study have developed recurrent hyperthyroidism. All patients are maintained on levothyroxine. None of our patients incurred bilateral vocal cord paralysis. One patient (1.6%) demonstrated an immobile vocal cord more than 1 year following surgery. Ten patients (16%) demonstrated impaired mobility of one vocal cord in the immediate postoperative period. Nine of these patients recovered full vocal cord mobility within 6 months after surgery. Only one patient (1.6%) still required calcium and vitamin D therapy 1 year following surgery. However, in the immediate postoperative period, 23 patients (37%) required supplemental calcium and vitamin D. In 12 patients, calcium and vitamin D was discontinued within 1 month. In an additional 6 patients, calcium and vitamin D were discontinued within 4 months; 3 patients, within 6 months; and 1 patient, within 12 months after surgery. Incidental papillary carcinoma was found in 3 patients (5%). CONCLUSIONS: Total thyroidectomy for Graves' disease is an effective and safe therapy. When performed by an experienced head and neck surgeon, it carries a low morbidity rate. It should be presented to patients as a therapeutic option within the context of a comprehensive discussion of the risks and benefits of radioactive iodine, pharmacologic therapy, and surgery.
Adolescent↗
Histiocytosis X and pregnancy.
BACKGROUND: Histiocytosis X, a clinically heterogeneous infiltrating disorder, is rarely associated with pregnancy. Diabetes insipidus is a common manifestation of histiocytosis X. CASE: A 27-year-old pregnant woman was diagnosed with histiocytosis X by biopsy. At 31 weeks' gestation, she developed diabetes insipidus and required treatment with intranasal 8-D-arginine vasopressin. A hypothalamic mass was noted on magnetic resonance imaging. She delivered a 363-g male at term by cesarean. Two months postpartum, after a motor vehicle accident, she developed a T6 sensory and motor deficit. An intramedullary spinal cord mass was diagnosed and surgically removed. She was treated postoperatively with radiation therapy to the spine and hypothalamus. Despite systemic chemotherapy, the disease progressed, and the patient died 18 months after delivery. CONCLUSION: Pregnancy in patients suffering from histiocytosis X is rare. When pregnancy and histiocytosis X do coincide, diabetes insipidus may appear or worsen. Treatment with intranasal 8-D-arginine vasopressin does not pose risks for the fetus or for premature labor.
Accidents, Traffic↗
Phosphorylation of the human erythrocyte glucose transporter by protein kinase C: localization of the site of in vivo and in vitro phosphorylation.
1. The human erythrocyte glucose transporter was phosphorylated in vitro by protein kinase C. 2. Tryptic cleavage of phosphorylated native transporter produced two major unphosphorylated membrane-embedded fragments weighing 23 and 19 kDa and released numerous water-soluble peptides. 3. Ion-exchange FPLC of the soluble tryptic peptides resolved the mixture into two phosphopeptide peaks. 4. Tryptic digestion of glucose transporter that was phosphorylated in vivo in response to phorbol esters produced soluble phosphopeptides that eluted at identical salt concentrations. 5. Proteolytic digestion and peptide mapping of the transporter revealed that the site(s) of phosphorylation lie within the large cytoplasmic domain that bisects the molecule.
Chromatography, High Pressure Liquid↗
Corticotroph cell pituitary adenoma within an ovarian teratoma. A new cause of Cushing's syndrome.
A 24-year-old woman with severe Cushing's syndrome was found to have corticotroph cell pituitary adenoma arising within a benign cystic ovarian teratoma. The patient manifested sustained hypercortisolemia and lack of suppression of either adrenocorticotropin (ACTH) or cortisol production. There was no evidence of a pituitary mass or secretion of other hormones. After careful clinical evaluation, no other tumor masses were found. Resection of the ovarian tumor led to normalization of ACTH and cortisol levels. Densely granulated corticotroph tumor cells with prominent Type I microfilaments and intracytoplasmic ACTH immunoreactivity characterized the neoplasm as a pituitary corticotroph cell adenoma. This is, to our knowledge, the first case reported of a functioning pituitary adenoma arising within a benign cystic teratoma.
ACTH Syndrome, Ectopic↗
Peroxide formation and glucose oxidation in calf thyroid slices: regulation by protein kinase-C and cytosolic free calcium.
We have determined the effects of tetradecanoyl phorbol acetate (TPA) and of the calcium ionophore A23187 on two thyroid responses to TSH previously reported to be cAMP-independent. We observed that TPA and A23187, at doses of 1.0 microM, stimulated both hydrogen peroxide generation and glucose oxidation in calf thyroid slices. A subthreshold dose of A23187 (0.1 microM) added to a submaximal dose of TPA (0.5 microM) acted synergistically, stimulating H2O2 production to the same degree as a maximally effective dose of TSH (50 mU/ml). Forskolin (25 microM), a direct stimulator of adenylate cyclase, actually inhibited both glucose oxidation and hydrogen peroxide generation. Lithium chloride (25 mM) had no effect on either response, either in the basal state or with TSH stimulation. The calcium channel antagonist verapamil (50 microM) decreased the basal activity of glucose oxidation and peroxide generation but did not substantially inhibit the effect of TSH on H2O2 generation under the conditions studied. These data support the concept that TSH induces changes in the thyroid phosphatidylinositol metabolism which activates protein kinase-C (c-kinase) and raises cytosolic free calcium. These events appear to act in concert to mediate certain metabolic responses in differentiated thyroid tissue.
Adenylyl Cyclases↗
Some effects of flavonoids on lymphocyte proliferative responses.
A number of representative flavonoids reversibly inhibit human lymphocyte proliferative responses in a concentration-dependent manner. The flavonoids quercetin and tangeretin are most effective when added during the early phase of exposure of lymphocytes to the mitogenic stimuli but become progressively less effective when added after increasing lengths of time following stimulation, suggesting an early flavonoid-sensitive step(s) in cell activation. In the proliferative response to phytomitogens, they do not act by inhibiting the early increase in calcium influx. They do not augment cellular cyclic-AMP concentration in basal or phytomitogen-stimulated lymphocytes nor reduce its increment in the presence of inhibitors of phosphodiesterase. At concentrations inhibitory to the proliferative response, quercetin (but not tangeretin) inhibits the calcium-activated, phospholipid-dependent protein kinase (C kinase). Certain flavonoids powerfully inhibit the uptake of thymidine into phytomitogen-stimulated lymphocytes but do not directly affect incorporation of already transported thymidine into newly synthesized DNA.
Calcium↗
The effects of flavonoids on human lymphocyte proliferative responses.
Flavonoids reversibly inhibit lymphocyte proliferative responses to phytomitogens, soluble antigens and phorbol esters by blocking an early event or events that follow stimulation. Quercetin and tangeretin inhibit thymidine transport in stimulated lymphocytes. These flavonoids reversibly inhibit antigen processing by monocytes and inhibit the expression of class II histocompatibility (DR) antigens in PBM cells.
Antigen-Presenting Cells↗
Role of carbohydrate in human chorionic gonadotropin. Effect of periodate oxidation and reduction on its in vitro and in vivo biological properties.
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Amino Acids↗