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Biomedical subjects

J H McDermott

Publications and source records attributed to J H McDermott.

14 recordsLinked to original sources
PubMed2005

Hypogonadism in hereditary hemochromatosis.

Hypogonadism, usually hypogonadotropic in origin, is the most common nondiabetic endocrinopathy in hereditary hemochromatosis (HH). Early studies, usually evaluating small numbers of patients with advanced HH, report prevalence rates of 10-100%. The clinical presentation of HH has changed in recent years as a result of increased awareness and screening. We assessed the prevalence of hypogonadism in a large group of patients with HH diagnosed in a single center over the past 20 yr, the period of follow-up spanning the time before and after widespread screening was introduced and the HFE gene was recognized. Abnormally low plasma testosterone levels, with low LH and FSH levels, were found in nine of 141 (6.4%) male patients tested. Eight of nine (89%) had associated hepatic cirrhosis; three of nine (33%) had diabetes. Inappropriately low LH and FSH levels were found in two of 38 females (5.2%) in whom the pituitary-gonadal axis could be assessed. This is the largest detailed study of hypogonadism reported in HH. The lower prevalence of hypogonadism compared with other reported series reflects the earlier diagnosis of HH in an unselected group of patients attending a single center. Patients with lesser degrees of hepatic siderosis at diagnosis are unlikely to develop hypogonadism.

Adult↗
PubMed2005

Celiac disease presenting as resistant hypothyroidism.

The high prevalence of celiac disease in patients with autoimmune hypothyroidism, compared to the general population, has been well documented but screening for celiac disease is not recommended as yet in otherwise asymptomatic hypothyroid patients. In recent years the high prevalence of undiagnosed celiac disease in the general population, largely as a result of the many atypical manifestations of the disease, has become apparent. We report the case of a 58-year-old woman with autoimmune hypothyroidism who was initially suspected of having celiac disease on the basis of apparent resistance to levothyroxine therapy, and who had no other clinical or laboratory clues to suggest the diagnosis. Cases of undiagnosed celiac disease causing levothyroxine malabsorbtion have previously been described, but all previous cases had other obvious manifestations of the disease. We believe that this atypical presentation of celiac disease warrants further attention, and that the diagnosis of celiac disease should always be considered in patients requiring higher than expected doses of thyroid hormone replacement, even in patients with normal bowel habit, and no other apparent manifestations of the disease.

Autoimmune Diseases↗
PubMed1999

Inaccuracies in patient medical histories.

Of patients who completed the same medical history questionnaire twice within a certain time period, 66% had at least 1 significant omission in their history. Consideration is given to the merits of a national medical history computerized database.

Breast Diseases↗
PubMed1998

Plasma c-erbB-2 levels in breast cancer patients: prognostic significance in predicting response to chemotherapy.

PURPOSE: To determine the significance of plasma c-erbB-2 levels to assess the extent of disease spread and to predict the response to chemotherapy in node-positive breast cancer patients. METHODS: We determined plasma levels of c-erbB-2 in 79 stages II and III breast cancer patients who received cyclophosphamide, methotrexate, and flourouracil (CMF)/cyclophosphamide, methotrexate, fluorouracil, vincristine, and prednisone (CMFVP) chemotherapy. All patients had a minimum follow-up of greater than 60 months or until disease recurrence. Plasma samples were obtained before and after chemotherapy. Plasma c-erbB-2 levels were quantified by enzyme-linked immunoassay. c-erbB-2 levels were analyzed in relation to the patients' axillary lymph node status, menopausal status, disease status, disease-free survival (DFS), and steroid receptor status of tumor. RESULTS: Plasma c-erbB-2 levels varied widely in breast cancer patients. In general, when all patients were included in the analyses, plasma c-erbB-2 levels before chemotherapy correlated significantly with the number of positive axillary lymph nodes and with postchemotherapy c-erbB-2 levels. No association was observed between pre- or postchemotherapy c-erbB-2 levels and other variables (patients' age at diagnosis, receptor status of the tumor, or disease status). The prognostic significance of different factors (ie, nodal status [one to three v > three positive nodes], menopausal status [pre- v postmenopausal women], estrogen receptor [ER] status [ER+ v ER-], and pre- and postchemotherapy c-erbB-2 levels) in predicting DFS was determined in all study patients. Among the variables examined, nodal status was the strongest predictor of DFS in these patients. The second most significant prognostic marker was postchemotherapy c-erbB-2 level. Prechemotherapy c-erbB-2 levels showed prognostic significance for DFS in a subset of breast cancer patients (ie, patients with > three positive nodes). Patients with greater than three positive lymph nodes and those with greater than 100 fmol/mL of plasma c-erbB-2 levels before therapy had significantly shorter DFS than did those patients with 100 fmol/mL or less c-erbB-2 levels. CONCLUSION: In breast cancer patients, determination of c-erbB-2 levels before therapy is an important biomarker to assess the extent of disease spread in the lymph nodes. Postchemotherapy c-erbB-2 levels are also a prognostic indicator for DFS in patients who receive chemotherapy. Finally, in a subgroup of patients with greater than three positive nodes, prechemotherapy c-erbB-2 levels are a prognostic marker for response of patients to standard chemotherapy.

Adult↗
PubMed1992

Dentures and denture care.

It is unfortunate that some of us are unable to maintain our natural teeth for our entire lives. Loss may occur because of diseases we have, medicines we are taking, or the basic lack of good oral hygiene program. Some patients feel that dentures will make oral care easier, with little or nothing to do since cavities are no longer a threat. Unfortunately, this is not entirely true. Proper cleaning of your dentures and mouth and regularly scheduled visits to your dentist can keep your mouth healthy and the dentures fitting properly for a long time to come.

Denture Cleansers↗
PubMed1982

Computed axial tomography in musculoskeletal trauma.

In the evaluation of patients with musculoskeletal trauma routine X-ray studies are often limited by difficulty in delineating overlapping structures and tissues of similar density. Computerized axial tomography (CT) has proven to be of great value in many diagnostic situations in orthopaedic surgery, particularly in the evaluation of mass lesions. This new technique resolves many of the problems of standard X-rays. It is noninvasive, and can be safely employed in the evaluation of critically ill patients. To assess the usefulness of this technique to trauma, computerized axial tomography has been employed in the diagnosis of injuries of the spine and acetabulum. CT studies of 26 patients with spinal injuries demonstrated accurate localization of displaced bone fragments and other elements of fracture anatomy, obviating the need for myelography. CT scanning of 28 fractures of the acetabulum defined intra-articular fragments and precise details of fracture lines. The additional data provided by CT scanning in these patients was a major asset in the management of their injuries. It influenced the decisions in regard to the need for surgery, and when surgery was indicated, the data helped to define the most appropriate operative approach. Use of the CT did not delay therapy or cause any complications. This experience with spinal injuries and fractures of the acetabulum indicates that computerized axial tomography is a valuable adjunct to the management of musculoskeletal trauma.

Acetabulum↗
PubMedDate not supplied

A case of Resistance to Thyroid Hormone without mutation in the thyroid hormone receptor beta.

BACKGROUND: Resistance to Thyroid Hormone (RTH) is a condition caused by tissue hyposensitivity to the effects of circulating thyroid hormone, and may be misdiagnosed as hyperthyroidism. AIMS: We report the first case of RTH in an Irish patient highlighting the clinical features and the pathophysiological mechanism underlying the characteristic laboratory abnormalities found in the condition. METHODS: We describe an isolated case of RTH initially misdiagnosed as hyperthyroidism, and detail the investigations which ultimately led to the correct diagnosis. Genetic screening of the thyroid hormone receptor beta gene was performed. RESULTS: Thyroid function tests including T3 suppression test and TRH-stimulation test suggested a diagnosis of RTH. Genetic testing failed to demonstrate a mutation in the thyroid hormone receptor. CONCLUSION: RTH is a rare inherited condition that may be misdiagnosed as hyperthyroidism. The case we describe most likely results from a de novo mutation in an as yet undiscovered gene. RTH should be considered in patients with elevated thyroid hormone levels and normal TSH so that unnecessary and potentially harmful treatment can be avoided.

Adult↗
PubMedDate not supplied

Antioxidant nutrients: current dietary recommendations and research update.

OBJECTIVE: To review the importance of antioxidant nutrients in the maintenance of health and the prevention and treatment of disease, with a focus on data pertaining to vitamin C, vitamin E, selenium, and carotenoids. A secondary objective was to discuss the new Dietary Reference Intakes released by the Institute of Medicine (IOM) for these nutrients. DATA SOURCES: IOM reports on the use of antioxidant vitamins were reviewed for nutrient recommendations. In addition, a MEDLINE search was performed to identify recent research and review articles on the topic, which were analyzed to identify key research findings in the area. DATA SYNTHESIS: The review discusses the biologic processes of oxidation reactions and antioxidants in biologic systems, provides an overview of information on selected antioxidant nutrients, and explores their role in the prevention and treatment of cancer, cardiovascular disease, ocular disorders, and respiratory disorders. CONCLUSION: There appear to be significant health benefits from dietary antioxidants, as can be found in fruits and vegetables. Some prospective assessment of the effect of supplemental antioxidants also suggests benefit, especially for vitamin E; however, there are conflicting results in this area. Overall, it appears that antioxidant nutrients, especially those from food sources, have important roles in preventing pathogenic processes related to cancer, cardiovascular disease, macular degeneration, cataracts, and asthma, and may enhance immune function.

Antioxidants↗