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Biomedical subjects

H Stracke

Publications and source records attributed to H Stracke.

At least 19 recordsLinked to original sources
PubMed1992

Disappearance of a pituitary tumor after 15 months of treatment with CV 205-502, a new dopamine agonist.

We report the case of a 27-year-old woman with a prolactin-secreting macroadenoma of the pituitary gland who was under treatment with a new dopamine agonist, Sandoz CV 205-502. Immediately after diagnosis of a 12 x 10 mm intrasellar prolactinoma, treatment with CV 205-502 was begun at a daily dose of 0.075 mg. Under this low dose, prolactin in the serum normalized after 4 weeks, the initial hormone value being 189.9 ng/ml. After 6 months of therapy there was still a 6 x 6 mm tumor, and after 15 months of treatment the pathological process could no longer be observed with magnetic resonance imaging. In the 20th month of therapy the patient became pregnant. An ovulatory menstrual cycle had been present for a few months.

Adult↗
PubMed1992

Results of continuous long-term intravenous application of octreotide via an implantable pump system in acromegaly resistant to operative and X-ray therapy.

Long term results after surgery for growth hormone (GH)-secreting adenomas indicate only a limited cure rate, particularly in patients with tumours invading the dural boundaries of the sella with suprasellar extension. Since octreotide had become a treatment option, it was used i.v. via an implantable pump system in five patients (age range 24-46 yr) showing symptoms of uncontrolled acromegaly, in spite of previous surgery and X-ray therapy. The octreotide doses used permanently for a cumulative treatment period of 8.8 yr ranged between 300 and 1000 micrograms/24 h. Serial evaluations of clinical findings, 24-h GH and insulin profiles, insulin growth factor-1 (IGF-1), oral glucose tolerance test and pituitary function revealed sustained GH suppression, without interim escape, below 2 ng/ml in two and below 5 ng/ml in three patients, IGF-1 decrease in all with normalization in two patients and no clinically relevant disturbances of carbohydrate tolerance or thyroid-stimulating hormone secretion. In one case of previous unresponsiveness to dopamine agonists i.v. octreotide application for 29 months facilitated later disease control by bromocriptine only. In two patients octreotide was terminated after 15 and 30 months of i.v. administration, respectively, because the effects of irradiation had occurred. For a subgroup of patients with resistant acromegaly continuous i.v. octreotide can be considered as a safe and effective alternative, which increases patients' independency from the inconvenience of daily repeated s.c. injections.

Acromegaly↗
PubMed1992

Mexiletine in the treatment of diabetic neuropathy.

OBJECTIVE: To prove the efficacy of mexiletine in painful diabetic neuropathy. RESEARCH DESIGN AND METHODS: Treatment was provided in three dosages. For pain measurements, a VAS and McGill's verbal rating scale were chosen. Ninety-five patients were included in the study. RESULTS: A global assessment of the VAS among patients showed no differences between mexiletine treatment and placebo. The total evaluation (PRIT) of the McGill scale fell just below the level of significance. More specific exploratory evaluations of subclasses of the McGill scale, representing different degrees of pain, gave remarkable differences between mexiletine and placebo in sensory and miscellaneous items. In special subgroups, which were formed according to types and courses of complaints compiled at the beginning of this evaluation, the substantial advantages of the mexiletine treatment were shown with both the VAS and the McGill scale. CONCLUSIONS: Evidence strongly indicates that, in particular, those patients with stabbing or burning pain, heat sensations, or formication will benefit most by mexiletine therapy. Concerning the dosage, a medium regimen of 450 mg/day seems to be appropriate. With an increase in the antiarryhthmic dosage level, the efficacy does not rise proportionally. Mexiletine proved to be a safe therapy with negligible side effects at the medium dose range, even less than placebo; and remarkably, no cardiovascular side effects were noted. Further studies should avoid global assessments and pay more attention to the variety of complaints and quality of life.

Adult↗
PubMed1992

Surgery, dopamine agonist therapy of combined treatment--results in prolactinoma patients after a 12 month follow-up.

In a non-randomized retrospective study n = 36 prolactinoma patients (n = 7 micro- and n = 29 macroadenomas) were evaluated before (E0), 4 (E1) and 52 weeks (E2) after applying 3 different treatment modalities: A dopamine agonist (DA) therapy (n = 14), B surgery as initial procedure (n = 12) and oral DA therapy, C DA preinjection, subsequent surgery (n = 10) and oral DA medication. T0 outline the effect of the 3 regimens upon serum prolactin (PRL) and tumour size reduction, clinical signs and symptoms, anterior/posterior pituitary lobe function and MRI/CT findings were evaluated in each patient at E0, E1 and E2. In group A, PRL normalization was achieved in n = 10 patients (71%), although the frequency of an empty sella was only one out of 12 macroprolactinoma patients (less than 10%). Patients of group C showed the lowest PRLE2 levels (32 +/- 11 ng/ml, normalization rate 60%), although not statistically significant when compared with the other groups (A: 41 +/- 28 ng/ml, B: 114 +/- 33 ng/ml, normalization rate 31%). According to MRI studies in groups B and C total removal was achieved in 33% and 50% of macroprolactinomas, respectively. The most favourable ratio of the leading pre/posttreatment signs and symptoms was observed in patients of group C. It was concluded that no superiority of either treatment regimen exists for prolactinoma patients. Each mode of therapy has its own benefits which may be applied to the different biological behaviour of a prolactinoma in the respective patient.

Adolescent↗
PubMed1991

Diabetes mellitus-associated decrease in nerve growth factor levels is reversed by allogeneic pancreatic islet transplantation.

After an untreated 5-month duration of streptozotocin (STZ)-induced diabetes mellitus (DM), nerve growth factor (NGF) levels in BDE rats were decreased to 45-65% of control in the sympathetically innervated target organs iris and submandibular gland, in the superior cervical ganglion (containing NGF-dependent sympathetic perikarya projecting to the cranial targets), and in the NGF-transporting sciatic nerve. Successful allogeneic pancreatic islet transplantation (providing a physiological glucose homeostasis without immunosuppression) after 3-4 weeks of DM reversed the DM-related decrease in NGF levels 4 months after transplantation as compared with untreated diabetic rats. By contrast, NGF levels in the treated vas deferens (innervated by short postganglionic sympathetic neurons) remained increased as in the untreated diabetic rats (175% of control). Thus, DM-associated changes in endogenous NGF levels seem to be reversible by institution of metabolic control, at least at an early stage of DM when NGF-responsive neurons have not been deprived of NGF for a long time.

Animals↗
PubMed1991

Serum osteocalcin levels in rheumatoid arthritis: a marker for accelerated bone turnover in late onset rheumatoid arthritis.

Levels of serum osteocalcin (OC) are increased in diseases with high bone turnover. We determined OC levels in (1) 15 patients with definite rheumatoid arthritis (RA) in early stages according to Steinbrocker's functional class FC I-II, (2) 40 patients at advanced stages (FC III-IV) and (3) 17 patients with late RA (onset at age of 65 or more). Sixty-two healthy volunteers, divided into 3 subgroups corresponding to the patients, and 19 patients with primary fibromyalgia syndrome (FMS) served as controls. All patients were included in a short term as well as a longitudinal study over one year. Mean OC levels were significantly elevated in patients with late onset RA compared with healthy controls (p = 0.037), while the OC values in early RA FC I-II and advanced RA FC III-IV did not differ significantly from the corresponding control group and the patients with FMS. The late RA group showed a positive correlation between OC and the erythrocyte sedimentation rate (ESR) (r = 0.641, p = 0.007) with a significant decrease of OC (p less than 0.01) as well as ESR (p = 0.047) over one year. We conclude increased OC levels correlate with disease activity in older patients with active RA, suggesting impaired bone turnover. This finding supports the picture of heterogeneity in RA with more late onset patients displaying "high bone turnover."

Adult↗
PubMed1990

Different types of postoperative diabetes insipidus and the relation to basal and stimulated serum prolactin levels in patients with hypothalamo-hypophyseal tumorous lesions.

To evaluate the interrelationships between anterior pituitary function and the antidiuretic system in patients harbouring hypothalamo-hypophyseal tumorous lesions, combined anterior pituitary stimulation tests were performed in the pre (n = 192 patients) and postoperative (n = 151 patients) state. Basal and stimulated plasma antidiuretic hormone, serum as well as urinary osmolality and diuresis were analyzed to determine the residual functional capacity of the antidiuretic system. In 106 patients with non-prolactin (PRL) secreting tumours basal and stimulated PRL secretion of the residual anterior pituitary was studied pre- and postoperatively. It was found that in the preoperative state latent (n = 12 patients) or manifest (n = 10 patients) types of diabetes insipidus (DI) were related to a significant decrease of maximal stimulated levels of thyroid stimulating hormone as well as basal and maximal stimulated levels of follicle stimulating hormone relative to patients without DI. In the postoperative state DI lasting longer than 10 days (n = 51 patients) was associated with decreased basal and maximal stimulated concentrations of cortisol, luteinizing and follicle stimulating hormone, whereas basal and maximal stimulated levels of PRL were significantly increased compared to those patients without DI (n = 61 patients). Decompression (n = 65 procedures) via the transnasal route was related with a lower frequency of the more severe types of DI (n = 7 patients) and a significant decrease of basal and maximal PRL levels in patients with non-PRL secreting tumours. The transcranial approach (n = 86 procedures) caused a higher rate of severe DI types (n = 33 patients) and an increase of PRL secretion from the residual anterior pituitary lobe. Patients without DI or DI of mild severity (n = 50), as a group, had a significant decrease of basal and maximal PRL levels compared with preoperative values (preoperative: basal = 14.3 +/- 1.5 ng/ml, max = 31.4 +/- 1.5 ng/ml, postoperative: basal = 9.6 +/- 1.1 ng/ml, max = 24.9 +/- 2.9 ng/ml). In patients with severer degrees of DI (n = 40) PRL levels were significantly increased, respectively (preoperative: basal = 15.3 +/- 3.1 ng/ml, max = 23.9 +/- 7.6 ng/ml, postoperative: basal = 19.7 +/- 3.4 ng/ml, max = 38.6 +/- 7.9 ng/ml). It was concluded that in the surgical treatment of non-PRL secreting hypothalamo-hypophyseal lesions the results of early postoperative assessment of basal and stimulated PRL levels may predict the type of postoperative DI.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

Osteocalcin serum levels in patients following renal transplantation.

Osteocalcin serum levels reflect bone turnover. In renal insufficiency secondary hyperparathyroidism and reduced renal clearance might be responsible for elevated serum levels of osteocalcin. Renal transplantation might improve renal osteodystrophy and therefore could influence osteocalcin serum levels. We determined the influence of renal transplantation on osteocalcin levels in 37 consecutive patients (25m/12f) by RIA. Blood samples were collected prior to, 3 days, 28 days, 6 months and 12 months after renal transplantation. Prior to renal transplantation osteocalcin levels were significantly elevated (mean +/- s: 23.4 +/- 12.8 ng/ml) compared to healthy volunteers (4.1 +/- 1.4 ng/ml). Following renal transplantation osteocalcin decreased significantly (9.4 +/- 8.9 ng ml) 3 days and (7.1 +/- 7.8 ng/ml) 28 days. However, 6 and 12 months following renal transplantation the mean osteocalcin level increased again (8.3 +/- 5.7 ng/ml, 12.1 +/- 15.4 ng/ml). At 6 months 11 and at 12 months only 6 of 37 patients had osteocalcin levels in the normal range. 12 months following renal transplantation 21 out of 37 patients with elevated osteocalcin levels had parathyroid hormone levels above the normal range. Additionally to increased osteocalcin levels patients prior to renal transplantation had elevated alkaline phosphatase. Alkaline phosphatase had following renal transplantation a similar pattern as osteocalcin with initial decrease and secondary increase 6 and 12 months after renal transplantation. Parathyroid hormone was elevated in all patients before renal transplantation. Following renal transplantation mean parathyroid hormone levels tell significantly, however remained above normal range in 57% of these 37 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Immunohistochemical hormone content in medullary and undifferentiated thyroid carcinoma and prognosis after surgery.

Immunohistochemical determinations in tissue specimens of medullary and "undifferentiated" thyroid carcinomas were carried out with antisera against calcitonin, calcitonin-gene related peptide (CGRP), somatostatin, and also thyroglobulin, using the PAP method. All 8 samples of medullary carcinoma stained positive with antisera against calcitonin and CGRP, 7 samples were also positive for somatostatin. Out of 22 cases initially diagnosed as "undifferentiated thyroid carcinoma" 3 revealed positivity for calcitonin, 2 for CGRP, and 1 for somatostatin. Congo red stain for amyloid, performed several years ago in 2 of these 3 cases, had been negative. The patients with medullary carcinoma survived longer than those with "undifferentiated" carcinoma. One patient of the latter group, but with calcitonin, CGRP, and somatostatin immunoreactivity in the tumour tissue, is now alive and well, more than 4 a after initial treatment.

Amyloid↗
PubMed1988

Studies on the influence of selective adenomectomy on hormone secretion from normal anterior pituitary gland.

In 70 patients with pituitary adenomas combined stimulation tests using releasing factors were performed before and 10 to 20 days after pituitary surgery. Qualitatively, the dynamics of hormone secretion were mostly unaltered after surgery. Quantitatively, the mean amounts of secreted hormones were found lowered after surgery. In some individual patients, however, a postoperative improvement was also observed. Pituitary testing early after surgery proved to be helpful for assessing the definite need for a hormonal replacement therapy.

Adenoma↗
PubMed1988

Treatment of prolactinomas and growth hormone-producing adenomas with an injectable bromocriptine retard preparation and a somatostatin analogue delivered by an implantable pump.

Among 14 patients with prolactinomas a single injection of 50 mg bromocriptine in a retard preparation resulted in a decrease of the initially elevated serum prolactin levels (to 4-62% of the initial value) in 12 cases and in a tumor shrinkage in 9 patients. In 3 out of 4 acromegalics injection and/or infusion of the somatostatin analogue SMS 201-995 (in 2 patients with an implanted Infusaid pump) led to a normalization of growth hormone and somatomedin-C levels.

Acromegaly↗
PubMed1987

[Osteocalcin and bone histology in osteoporosis].

The decoupling of bone formation and bone resorption causes an insidious bone loss that is responsible for the negative skeletal balance in the frequent form of low turnover osteoporosis. The reduction of bone formation can hardly be verified by clinical methods. Osteocalcin, a non-collagenous bone protein, has proved to be a useful new indicator of bone formation. To establish its predictable value, plasma levels of osteocalcin were compared to conventional serological data of bone turnover and to histomorphometric parameters of iliac crest trabecular bone. In cases of osteoporosis with normal bone turnover activity (as confirmed by histomorphometry) no differences were observed in any of our laboratory data including osteocalcin. However, there was a significant lower mean serum level of osteocalcin in a group of patients with histomorphometrically proven low turnover osteoporosis in comparison to those with normal bone turnover. Serum levels of osteocalcin below 2.0 ng/ml seem to indicate a low turnover in the individual case of osteoporosis while this is unlikely when serum levels above 6.0 ng/ml are measured (according to our RIA).

Adult↗
PubMed1987

[Insulin therapy using a new injection device. Experience with 36 type I diabetics].

Thirty-six type I diabetics were switched from conventional insulin therapy to the basic bolus principle (combination of an ultralong-acting human insulin with preprandial old insulin administration) with a new injection device (NovoPen). In the observation period of four months, a better metabolic situation could be attained (HbA1c before switching 9.4%, after switching 8.41%; P less than 0.01) with approximately the same daily amount of injected insulin (before treatment 42.7 +/- 9.3 IU, after treatment 43.5 +/- 7.1 IU) in another distribution and with the injection device. All patients gave a positive appraisal of the handling and technique with the NovoPen. The new treatment principle is to be applied especially in patients with inadequate blood sugar values under conventional therapy as well as in diabetic secondary complications which require optimal compensation. Furthermore, this principle of treatment is also suitable for prevention of secondary lesions owing to diabetes. Under the precondition of more intensive attention of the patient to his metabolic disorder (self-checking of blood sugar, diabetes training), the basic bolus principle provides more freedom in daily routine and thus greater quality of life.

Adolescent↗
PubMed1986

Assay for thyroid growth stimulating immunoglobulins: stimulation of [3H]thymidine incorporation into isolated thyroid follicles by TSH, EGF, and immunoglobulins from goitrous patients in an iodine-deficient region.

Estimations were carried out of [3H]thymidine incorporation during culture of isolated porcine thyroid follicles in the presence of standard TSH or epidermal growth factor (EGF) both alone and together with anti-TSH or anti-EGF serum, and of immunoglobulins fractionated from the sera of patients from our endemic goitre area with iodine deficiency. A significant stimulation of thymidine incorporation was exerted by TSH when thyroglobulin was present in the culture medium, and also by EGF. TSH stimulation was abolished by anti-TSH serum, in contrast to the effect of EGF. Anti-EGF serum, on the other hand, blocked the effect of EGF, but not that of TSH. The sera of 20 out of 72 patients (27%) with euthyroid goitre (not operated on) and of ten out of 26 patients (38%) with recurrent euthyroid goitre contained immunoglobulins stimulating thyroid growth (TGI). There was no correlation of TGI with other thyroid antibodies. TGI have to be regarded as a pathogenetic factor of euthyroid goitre also in patients from an endemic region especially in recurrent cases.

Animals↗
PubMed1986

Dopamine agonists in the treatment of hyperprolactinemia. Comparison between bromocriptine and lisuride.

27 patients (12 women and 15 men) with hyperprolactinemia were treated with the dopamine agonists lisuride (Dopergin) and bromocriptine on a cross-over basis for 3-6 months. By this treatment, plasma prolactin levels were reduced by 83 and 87%, and normalization was achieved in 13 patients in the lisuride group (average dosage 1 mg/d) and in 15 patients in the bromocriptine group (average dosage 10 mg/d). Side effects, consisting of orthostatic hypotension, vomiting and nausea, occurred in 11 patients treated with lisuride and 13 patients treated with bromocriptine, and 2 patients in the lisuride group and one in the bromocriptine group stopped the medication for this reason. There was a good correlation in the doses of both drugs used. There was a tendency for the prolactin-lowering effect of lisuride to last longer upon cessation of therapy which might be related to the higher receptor affinity of both drugs. In general, however, the present results indicate that bromocriptine and lisuride are comparable in efficacy and side effects, but that individual patients respond better to one or the other drug.

Bromocriptine↗