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Biomedical subjects

J Pichl

Publications and source records attributed to J Pichl.

At least 19 recordsLinked to original sources
PubMed1991

Recurrence following transsphenoidal surgery for acromegaly.

The long-term results of transsphenoidal adenomectomy and the incidence of possible recurrences were studied in 61 patients who had normal basal serum growth hormone (GH) levels 1 week after surgery. The patients were followed up for an average of 6.0 years (range: 1.5-14.0 years) by repeated measurements of GH, oral glucose tolerance testing (OGTT) and at the last follow-up visit also by assaying somatomedin C levels. In 4 of the patients, the basal GH levels had increased to values above 5 ng/ml. In 43 patients, a normal suppression of GH during an oral glucose load was observed shortly after surgery. In only 2 of these cases did a transiently inadequate suppression develop during the follow-up period, although clinical acromegaly did not recur and the somatomedin C levels remained normal. It is concluded that recurrence of active acromegaly is unlikely to occur in patients who achieve a normal glucose-induced suppression of GH levels shortly after adenomectomy. As such, an OGTT provides better prognostic information than basal human GH level measurements and may give a clearer and earlier indication of surgical success.

Acromegaly↗
PubMed1990

[Endocrinologic diagnosis in hirsutism and androgenetic alopecia in women].

In women, hirsutism and male pattern baldness are due to an enhanced effect of androgens on the hair follicle, which in turn can be caused by an increased supply of bio-available androgens and/or an increased sensitivity of the target organ to androgens. There are no definite correlations between circulating androgens and the degree of their biological effects. Although in most cases the hyperandrogenemia is not severe, the patients should be treated with antiandrogens in order to avoid progression of the disturbance and its consequences on metabolism and fertility. Sometimes hirsutism can be observed as a clinical sign of a defect in the steroid biosynthesis or of Cushing's syndrome. In severe hyperandrogenemia with a testosterone level of more than 2 ng/ml and a DHEA-S level of more than 8000 ng/ml, tumors of the ovaries or the adrenal glands have to be excluded.

Androgens↗
PubMed1990

[Internal and external therapy with corticoids].

The toxicological, pharmacological, and clinical properties of corticoids are well understood. As their main actions are based on an uniform mechanism, it is impossible to separate beneficial effects from side effects. Therefore, any augmentation of the therapeutic activity is associated with an increased risk of side effects in systemic as well as in topical use. The topical application of highly potent corticoids also bears the risk of systemic side effects, especially those with prolonged activity. In addition, it has to be kept in mind that apart from the skin, the functions of various organs can be unfavorably affected when corticoids are systemically applied.

Administration, Oral↗
PubMed1989

Results of dynamic endocrine testing of hypothalamic pituitary function in patients with a primary "empty" sella syndrome.

A total of 52 patients (38 women, 14 men) with a primary "empty" sella syndrome underwent dynamic endocrine testing consisting of insulin-induced hypoglycaemia and a combined anterior pituitary stimulation test utilizing GnRH and TRH. The diagnosis of an "empty" sella turcica was made on the basis of thin collimation CT reconstructions and in addition either metrizamide cisternography or magnetic resonance (MR) imaging. Only 16 of the patients presented with endocrine problems. Hyperprolactinaemia was the most common endocrine disturbance detected, and was found in 17 individuals. Panhypopituitarism was found in 3 patients. Nine other patients had some degree of partial pituitary insufficiency, but only two of them required replacement therapy. However, 31 patients had no evidence of endocrine dysfunction.

Adult↗
PubMed1988

Urinary factors of kidney stone formation in patients with Crohn's disease.

An increased frequency of kidney stone formation is reported in patients with inflammatory bowel disease. In order to investigate its pathogenesis, the concentrations of factors known to enhance calcium oxalate stone formation (oxalate, calcium, uric acid) as well as of inhibitory factors for nephrolithiasis (magnesium, citrate) were determined in the urine of 86 patients with Crohn's disease and compared with those of 53 metabolically healthy controls. Six patients with Crohn's disease already had experienced calcium oxalate nephrolithiasis. Patients with Crohn's disease had significantly higher urinary oxalate and lower magnesium and citrate concentrations. Among all patients magnesium and citrate were significantly lower in those with a positive history of kidney stones. Our results demonstrate that the increased propensity for renal stone formation in patients with Crohn's disease is a result not only of increased urinary oxalate, but also of decreased urinary magnesium and citrate concentrations.

Adult↗
PubMed1988

Fate and effects of the alpha-glucosidase inhibitor acarbose in humans. An intestinal slow-marker perfusion study.

The alpha-glucosidase inhibitor acarbose has been successfully used in diabetic patients to decrease the postprandial rise in blood glucose. The aim of the present experiments was to investigate the fate and effects of acarbose along the small intestine using a slow-marker perfusion technique. In 8 healthy volunteers, jejunal and ileal loads of acarbose, glucose, and total carbohydrates were determined following a liquid, 400-kcal formula meal containing either 200 mg of acarbose or placebo. Preprandial and postprandial plasma concentrations of glucose and several polypeptide hormones were determined. Recovery of acarbose during 4 h was 65% +/- 9% (mean +/- SEM) of ingested dose in the ileum but 94% +/- 9% in the jejunum, indicating that the compound was neither degraded nor absorbed by the intestine to a major degree. After acarbose administration, ileal loads of glucose and total carbohydrates were considerably higher, whereas postprandial plasma concentrations of glucose, insulin, and gastric inhibitory polypeptide were lower when compared with placebo. The retardation of carbohydrate digestion to be inferred from these findings is confirmed by significantly elevated plasma concentrations of enteroglucagon after acarbose administration compared with placebo administration.

Acarbose↗
PubMed1988

[Correlations between clinico-psychiatric findings and the dexamethasone suppression test in depression].

A study on 50 patients with endogenous and non-endogenous depression yielded a sensitivity of 64% and a specificity of 77% for the dexamethasone suppression test (DST). Endogenous depressive patients recovering from depression within one week mostly showed sufficient cortisol suppression. "Loss of feelings" was associated more frequently with cortisol nonsuppression, while a certain relationship between psychogenic induction of the present depressive episode and adequate suppression could be demonstrated. In conclusion, the diagnostic utility of the DST is of minor importance. However, in certain cases the DST could be recommended as a predictor of clinical course.

Adolescent↗
PubMed1987

Factors interfering with the 1 mg dexamethasone suppression test in depression.

The 1 mg dexamethasone suppression test (DST) was performed in 50 depressive inpatients in order to investigate factors which might interfere with its sensitivity and specificity for endogenous depression: improvement within one week after the test, recent admission to a psychiatric ward, and weight loss. Four out of five endogenous depressive patients whose depression improved within one week after the test had normal suppression, thus supporting the assumption that normalization of the DST may precede the improvement in depression. Nonendogenous depressive patients had an accumulation of pathologic test results on the day after admission that may be due to "admission stress". However, in endogenous depressives this effect was not observed. An influence of weight loss on the percentage of suppressors and nonsuppressors was not demonstrable. It is concluded that in the evaluation of DST results time parameters should be considered to a greater degree.

Adult↗
PubMed1987

Prolactin response to dexamethasone: a study on normal controls and depressed patients.

Pre- and post-dexamethasone prolactin and cortisol levels of 40 endogenous and non-endogenous depressive patients and of 20 controls were studied. Dexamethasone had a suppressive effect on prolactin levels, which was expressed more in normal controls and in non-endogenous depressive patients than in endogenous depression. A "prolactin suppression test" by dexamethasone was constructed and provided comparable results to the usual DST. However, it failed to be a specific marker for endogenous depression. There are close relationships between various endocrine axes, which might be altered in depression.

Adolescent↗
PubMed1987

Can the outcome after trauma or sepsis be predicted from biochemical or hormonal parameters?

The severity of shock of 36 surgical ICU patients was classified using the Injury Severity Score (N = 20) and the Sepsis Score (N = 16). A great number of laboratory parameters were repeatedly determined on 5 days following the trauma or the onset of septic symptoms. Blood lactate, C-peptide, BUN, osmolality, and thyroid hormones were most closely related to the severity of the disease. This correlation was, however, less pronounced in the trauma than in the septic patients. Lactate and thyroid hormones showed a typical course in the non-survivors and may therefore be valuable as prognostic indices.

Adolescent↗
PubMed1986

[Rebound hypertension after controlled hypotension and its prevention by captopril].

In 27 patients undergoing ear, nose and throat surgery, the problem of post-hypotensive hypertension (rebound hypertension) following vasodilator-induced controlled hypotension was studied, together with prevention by the ACE inhibitor captopril. Hypotension was induced by sodium nitroprusside (SNP) in seven patients (group 1) and by nitroglycerin (NTG) in ten patients (group 3). Ten patients (group 2) received 25 mg captopril given orally, together with the preanaesthetic medication, as well as SNP. The degree and duration of the decrease in blood pressure did not differ significantly between groups. After discontinuation of the respective vasodilators, blood pressure had increased to above prehypotensive levels in both group 1 (SNP) and group 3 (NTG) 30 min afterward and, to a more marked extent, 60 min afterward. In these groups plasma renin activity (PRA) increased continuously during the hypotensive period up to 11.4 +/- 2.4 and 19.5 +/- 4.5 ng/ml/h, respectively, and had not yet reached its prehypotensive value 60 min after discontinuation. In group 2 (captopril/SNP) there was no overshoot hypertension on discontinuation of SNP, and the average infusion rate of SNP was reduced. PRA was markedly higher than in groups 1 and 3 (peak level 27.9 +/- 6.5 ng/ml/h) due to inhibition of the feedback mechanism in the renin-angiotensin system. From the results it may be concluded that both SNP and NTG can cause rebound hypertension, the extent of which depends on the level of hypotension previously achieved and the infusion rate of the vasodilator. Pretreatment with captopril prevents the rebound and reduces the dosage of vasodilator required and, therefore, may be considered an alternative to the well-documented beta-adrenergic blockers.

Adult↗
PubMed1985

[Reduction of insulin reserves and exocrine pancreatic secretion in chronic pancreatitis].

In 11 persons with normal pancreas function and 21 patients with chronic pancreatitis serum levels of insulin and C-peptide were measured under basal conditions and after maximal stimulation with glucose-tolbutamide-glucagon. Patients with the highest excretory deficiency in the secretin-pancreozymin test had the most marked impairment in endocrine function. In patients with manifest diabetes the exocrine capacity was reduced to an average of 10% of normal. The endocrine parameters correlated linearly with the exocrine ones, most markedly C-peptide reserve with pancreatic enzyme secretion.

Adult↗