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Biomedical subjects

J L Schlienger

Publications and source records attributed to J L Schlienger.

At least 109 records · Page 6Linked to original sources
PubMed1995

Nutrition of the elderly: a challenge between facts and needs.

Interactions between nutrition and the ageing process are a fascinating field of research. The assessment of the nutritional status is an important part of medical examination. Generally it is assumed that energy intake and energy expenditure decrease with age. In fact they vary widely and are very different in healthy, in sick or in institutionalized elderly. Nutritional requirements depend on many social and physiological factors in the free-living elderly population. Surveys indicate that dietary requirements are qualitatively grossly comparable to those in middle-aged adults. However the elderly are particularly at risk of marginal deficiencies of vitamins and trace elements. Today the early recognition of malnutrition is an important challenge. Its prevention may influence the evolution of nonspecific intercurrent disease and restore immunocompetence. Another challenge is to promote health by adequate recommendations in order to prevent deficiency diseases and to increase longevity. Some studies suggest that nutrition-based preventive medicine remains useful in the elderly. Caloric restriction, weight loss in case of obesity, decrease in blood lipids, increase in calcium intake which depend mainly of prior nutritional habits may have an effect in the elderly. However, prevention of protein caloric malnutrition is more relevant in the elderly.

Aged↗
PubMed1995

Determination of free triiodothyronine by six different methods in patients with non-thyroidal illness and in patients treated with amiodarone.

We performed a methodological comparison of free triiodothyronine (FT3) estimates in patients with liver cirrhosis and renal failure. Patients were classified in terms of severity of illness on the basis of their total triiodothyronine, total thyroxine and reverse triiodothyronine profiles. FT3 levels, measured in direct dialysis, microchromatography, labelled analogue and two-step immunoextraction assays were significantly (P < 0.01) lower than the control group in all patient categories. However, FT3 measured by a labelled antibody radioimmunoassay was significantly reduced only in the most severely ill sub-group of patients. In a further group of patients on long-term amiodarone therapy for cardiac disease all FT3 methods, with the exception of the labelled antibody radioimmunoassay and an analogue method, yielded significantly (P < 0.01) reduced levels. A significant negative association between FT3 and subject age was demonstrated for all methods except the labelled antibody radioimmunoassay, and a weak but significant negative correlation between log thyrotropin and FT3 was only seen with this assay. Three methods demonstrated a correlation (P < 0.02) with albumin levels in patients with the 'low T3 syndrome'. In this group, albumin had a predictive value (P < or = 0.02) for four out of six assays as determined by stepwise variable selection. Our findings suggest that users of FT3 assays should exercise caution in interpreting results in non-thyroidal illness and amiodarone treated patients, as there are method-related differences in the profiles obtained.

Adult↗
PubMed1995

[Atrophic thyroiditis: an unusual course of a Basedow-like variation of Hashimoto disease. Apropos of a case].

This case concerns a 27-year-old man with a very high level of anti-thyroid antibody and pretibial elephantiasis myxedema which developed progressively over several years following subtotal thyroidectomy for << hashitoxicosis >>. Complementary resection of the thyroid stump was performed ; under microscopic examination this stump presented an aspect of atrophic thyroiditis. This unusual development towards atrophic thyroiditis raises the problem of the relations between the various forms autoimmune thyroiditis.

Adult↗
PubMed1994

Eating behaviour and depression before and after antidepressant treatment: a prospective, naturalistic study.

Eating behaviour of severely depressed patients was assessed before (n = 56), after acute (n = 46) and during maintenance (n = 35) treatment and compared to matched normal controls in order to investigate the behavioural mechanisms underlying the weight gain induced by antidepressants. Assessments included food intake, appetite and food preferences. Before treatment, there was a decrease in appetite and in food intake with a relative excess of carbohydrates and a preference for sweets. Maintenance treatment was associated with substantial weight gain. All differences in eating behaviour between patients and controls disappeared, with the exception of a decrease in appetite in a subgroup of less-improved patients. These results suggest that antidepressant treatment induces weight gain by mechanisms that are largely independent of their action on mood.

Adult↗
PubMed1994

Thyroid hormone status and nutrient intake in the free-living elderly. Interest of reverse triiodothyronine assessment.

Fasting or hypercaloric diets are established methods of inducing low triiodothyronine (T3) levels that resemble the sick euthyroid syndrome in adults, but little is known on the mechanisms of this syndrome in the elderly. Decreasing T3 does not seem to be an unavoidable consequence of ageing, but the role of illness or other factors in this decline remains unclear. The aim of this work was to study the influence of nutritional factors on thyroid hormone levels in free-living elderly subjects. A 3-day dietary survey was conducted in 440 randomized subjects aged between 65 and 96. Cholesterol, apoproteins, prealbumin, hemoglobin, thyrotropin-free thyroxine (FT4), FT3 and reverse T3 (rT3) were assayed in each subject. Only 11 subjects had low FT3 levels, and they also had low levels of cholesterol, prealbumin and hemoglobin and a lower Folstein score compared to the rest of the population. Twenty-one subjects had isolated elevated rT3 levels, they were older and had significantly lower energy and fat intakes than the rest of the population. There was a clear reduction in FT3 levels and an increase in rT3 levels with age, although in the normal ranges, which occurred despite maintenance of a high-energy intake even in the oldest group. The FT3 level was lower in the subjects with poor health status, whereas high rT3 levels were associated with low energy intake in men. Stepwise regression showed that hemoglobin, age and prealbumin were the best predictors of FT3 levels, whereas age and energy intake were the main predictors of rT3 levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Effects of amiodarone on thyroid hormonal profile. Updating based on new assay methods].

Amiodarone (A) treatment alters the levels of thyroid hormones. We investigated whether new hormonal assays are also altered by this drug. Thyroid function was determined in 21 patients chronically treated with A and in 30 controls. TSH was determined with a third generation assay. Free T3 and Free T4 levels were determined by 5 different immunoassays. Equilibrium dialysis (E.D.) was considered as the reference assay for FT3 and FT4. With this method FT3 is diminished, reverse T3 ans FT4 are increased whereas TSH remained normal. Only FT3 determined by an assay using a labelled monoclonal antibody (MAB) appears not modified by A. Other methods (chromatography, chemiluminescence and radioisotopic) give results in agreement with E.D. Some of these alterations may be explained by a marked increase in plasma levels of non esterified fatty acids. Hormonal changes induced by A are typically with all but one assays. Whatever the method used the determination of TSH remains necessary to avoid misinterpretation of the thyroid function tests in A-treated patients.

Aged↗
PubMed1993

[Assay of free thyroxine by immunoenzyme method in general diseases].

In non thyroid illnesses the degree of serum FT4 levels perturbation may be variable according to the assay used. The performance of a new FT4 immunoenzymatic assay (Enzymmum test, BMF) was evaluated in 78 euthyroid controls and in 99 sick patients with renal insufficiency, severe diabetes, hypoalbuminemia, severe general disease or under heparinate treatment. Results were compared to two RIA assays: by immunoextraction (CA2), known to be little disturbed by hypoalbuminemia and considered as a reference method, and by a labelled antibody (MAB, Amerlex) easier to use. In controls mean values and T4 L confidence intervalls were comparable with the three assays. In patients FT4 levels were diminished in case of renal insufficiency but the mean values obtained by BMF and CA2 did not differ. FT4 levels of heparinate treated patients were elevated with BMF and CA2. Generally patients are better classified as euthyroid with the CA2 assay (5.6% misclassification) than with BMF (11.2%) or MAB (12.4%), particularly in case of serious disease. A good linear correlation was found between the three methods. With the new BMF assay results were grossly comparable to those obtained by other assays. However the determination of FT4 levels alone appeared no sufficient to characterize the patients thyroid status.

Evaluation Studies as Topic↗
PubMed1993

The loss of appetite during depression with melancholia: a qualitative and quantitative analysis.

The loss of appetite occurring severe depression was investigated with an experimental method comparing the eating behaviour of 12 melancholic inpatients to 12 matched normal controls. Food intake and appetite, divided into more basic components such as desire to eat, hunger, satiety, prospective food consumption and pleasure from eating, were monitored during a test meal. Patients ate less than controls, but the difference was not significant. The pattern resulting from the temporal tracking of the appetite ratings indicated that patients were disturbed at the beginning of the meal and showed a decreased desire to eat, hunger and prospective food consumption and an increased satiety and that their pleasure from eating was diminished. These findings suggest that the loss of appetite induced by melancholia follows a specific pattern.

Adult↗
PubMed1993

[Pregnancy and the thyroid gland].

During pregnancy the thyroid should adapt itself to the availability of the least quantities of iodides necessary to synthesis hormones and to several other possible modifications such as a rise in the thyroxine-binding globulin and the thyroid stimulating effect of beta-hCG. An increase in size of the thyroid gland is very common. The interpretation of the parameters used to diagnose abnormalities of thyroid function can be carried out. Although the development of the fetal thyroid can take place independently of the maternal thyroid behaviour, an abnormal thyroid function in the mother can not occur without affecting the pregnancy. Grave's disease can cause either fetal or neonatal hyperthyroidism due to a transplacental transfer of thyroid stimulating immunoglobulins or hypothyroidism secondary to the use of too large doses of synthetic antithyroid products. Pregnancy itself favours hyperthyroidism. Maternal hypothyroidism which has not been treated is rarer because of a lack of fertility. It can cause repercussions on the fetus that have probably been over estimated. When pregnancy occurs in a hypothyroid woman who is being treated the dosages of drugs that she is being given should be increased by 20-30%. Providing a good knowledge of the thyroid parameters and keeping the patient preferably euthyroid in cases where thyroid dysfunction can occur, the pregnancy can continue normally whatever the state of the mother thyroid function was. The risks to the fetus are minimal. In women who are at risk it is very important to keep controlling the thyroid state after delivery when there is an immunological rebound which may lead to a relapse in Grave's disease and to post-partum thyroiditis.

Antithyroid Agents↗
PubMed1993

[Left ventricular filling in young insulin-dependent diabetics].

Left ventricular function indices were measured by pulsed Doppler-echocardiography in 17 young patients (mean age: 25 +/- 5) with insulin-dependent diabetes and 17 controls (identical mean age: 25 +/- 5) free of heart disease. All subjects had normal left ventricular systolic function. Twenty three per cent of diabetics showed a left ventricular filling anomaly on the basis of at least two abnormal indices. Isovolumic relaxation time was significantly prolonged in diabetics as compared with normal individuals (83 +/- 7 v. 68 +/- 9 ms, p < 0.00015). Half-pressure time was also prolonged in the patients (46 +/- 9 v. 38 +/- 6 ms, p < 0.01), the same applying to rapid filling deceleration time (158 +/- 32 v. 136 +/- 29 ms, p < 0.05). Peak rapid filling rate, the proportion of total filling accounted for by rapid filling, peak atrial systole velocity and the atrial contribution to total filling did not differ between the diabetics and controls. Systolic blood pressure was significantly higher in diabetics as compared with controls (124 +/- 8 v. 114 +/- 10 mmHg, p = 0.007), although remaining within normal limits. This would not, however, explain the differences seen between the 2 groups regarding left ventricular profile. The filling anomalies reported here were not correlated with the duration of diabetes nor with other parameters such as glycosylated hemoglobin or 24-hour microalbuminuria. Our results suggest that approximately 20 p. cent of young diabetics have sub-clinical left ventricular anomalies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Evaluation of sensitivity of an assay: application to a third-generation thyrotropin (TSH) assay].

The concentration-specific smallest detectable difference (D) between two concentrations (i.e., the sensitivity) was determined from the results of within-run and run-to-run reproducibility studies of a third-generation thyrotropin assay. Only low concentrations were considered (range 0-0.3 m U/l). Assays were performed in singlet or in duplicate. Findings confirmed the value of the assay: the analytic detection limit approximated 0.005 mU/l and the functional detection limit was around 0.01 mU/l. Expressed as a percentage of the concentration, D% was under 20% for levels of less than 0.02 mU/l in within-run studies or of less than 0.03 mU/l in run-to-run studies. With concentrations in excess of 0.05 mU/l, D% was under 10% in within-run studies and slightly above 10% in run-to-run studies. These new detection thresholds for this assay should be taken into account when interpreting clinical results from a single run (TRH test) or from several runs (hormone replacement therapy or suppression test).

Humans↗
PubMed1993

[Relationships between weight and menopause].

Weight gain seen around the time of the menopause justifies a therapeutic action. It seems to be linked more to the effects of age than to the menopause itself. It often causes abdominal obesity which increases vascular risk and predisposes to raised blood pressure. The ability of adipose tissue to concentrate androgens and estrogens probably explains the higher incidence of genital carcinomas in overweight post-menopausal women. Hormone replacement therapy does not seem to have any untoward effects on weight.

Adipose Tissue↗
PubMed1993

[Free triiodothyronine assays using labeled antibody: evaluation and comparison with an analog labeled assay].

We evaluated analytically and clinically two new one-step labelled antibody assays for measuring free triiodothyronine (FT3): the first, radiolabelled with 125I, Amerlex-MAB (MAB) from Kodak Diagnostic, and the second, labelled with peroxidase, Enzymun-test FT3 (BM) from Boehringer Mannheim adapted for the Boehringer ES 600 analyser. The clinical results were compared with those obtained with a radiolabelled analog tracer kit, Amerlex-M (M) from Kodak Diagnostic. The latter kit is known to give low FT3 results in sera with low albumin concentrations. Analytical performances of the automated method (BM) were better than those obtained with the manual method (MAB): intra-assay reproducibility (CV < 3% vs CV about 5%), inter-assay reproducibility (CV < 4% vs CV between 4 and 8%) and mean drift (+1.25% vs -4.3%). The detection limit was low for both kits (< 1 pmol/l). In the euthyroid reference group (n = 98) we observed a significant difference between outpatient and hospitalized patient FT3 concentrations as measured with the M kit only. The reference range was 3.2-6.5 pmol/l for the MAB kit vs 5.4-9.2 pmol/l for the BM kit. This result underlines the problem of standardisation with the FT3 assays. Clinical sensitivity for hyperthyroidism (n = 38) was better for the MAB (92%) than for the BM kit (76%). Specificity in euthyroid L-thyroxine (T4) treated patients (n = 26) was good for both kits (MAB: 92%; BM: 88%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗