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Biomedical subjects

L Favre

Publications and source records attributed to L Favre.

9 recordsLinked to original sources

Twenty-four hour blood pressure and heart rate profiles of diabetic patients with abnormal cardiovascular reflexes.

Twenty-four hour ambulatory blood pressure and heart rate profiles of 24 patients with diabetes were monitored in order to assess the effect of autonomic neuropathy on 24-h haemodynamic profiles. Eighteen patients had abnormal cardiovascular reflexes. Mean arterial pressure rose at night in six of the patients with autonomic neuropathy and fell by less than or equal to 5 mmHg in seven. In the remaining five patients with autonomic neuropathy and in the six diabetic patients with normal cardiovascular reflexes, the fall in nocturnal mean arterial pressure was comparable to that of 11 non-diabetic patients with essential hypertension. Median 24-h mean arterial pressure was similar in all four groups of diabetic patients. Prevalence of autonomic symptoms was not related to the change in blood pressure in those with autonomic neuropathy. Twenty-seven months after monitoring, three fatal and five severe non-fatal cardiovascular or renal events had occurred in four of the six patients with a rise in nocturnal blood pressure, compared with one non-fatal event in those with a small fall and no severe events in those with a pronounced fall (p = 0.02). Blood pressure rises at night in certain diabetic patients with abnormal cardiovascular reflexes and the nocturnal rise appears to be associated with a poor prognosis.

Adult

[Bartter's syndrome: Recurrence in the course of a treatment inhibiting prostaglandin synthesis].

Two adults with Bartter's syndrome were treated first with propranolol and a potassium-sparing diuretic and then with indomethacin for 22 months. Inhibition of prostaglandin synthesis by indomethacin, confirmed by a fall in urinary excretion rate of prostaglandins E2 and F2 alpha, induced a marked decrease in plasma renin activity and aldosterone excretion rate and an increase in plasma potassium. While the first patient was well controlled by this therapy, the second had elevation of prostaglandin excretion after 8 months associated with a relapse of symptomatic hypokalemia. Reintroduction of propranolol in addition to indomethacin led to renormalization of plasma potassium. A therapeutic trial with another prostaglandin synthesis inhibitor, meclofenamate, also produced partial correction of hyperreninemia and hypokalemia but only for a short time. From these observations it is concluded that (1) inhibition of renal prostaglandins by indomethacin or meclofenamate represents an effective but transient therapy for Bartter's syndrome, and (2) while prostaglandin secretion may elude pharmacological inhibition, the addition of propranolol restores complete inhibition and the therapeutic benefits of the previous treatment.

Adult

Gigantism associated with a pituitary tumour secreting growth hormone and prolactin and cured by transsphenoidal hypophysectomy.

An 18-year old male is reported who presented with a history of a growtn spurt over the year preceding his admission. His height was above the 97th percentile, and he had incompletely developed secondary sexual characters. Pituitary evaluation demonstrated a moderately elevated level of growth hormone (hGH) not suppressible by a glucose load and not stimulable by TRH or by L-DOPA. Serum prolactin (PRL) concentration was also increased while gonadotrophin, thyroid and adrenal function were all subnormal. There was clear radiological evidence of a large pituitary tumour with suprasellar extension and transsphenoidal total hypophysectomy was performed. A mixed chromophobe and acidophilic adenoma was found and both growth hormone and prolactin were demonstrable in different cells of the tumour by the immunoperoxidase technique. Post-operatively the patient has hypopituitarism and levels of growth hormone and prolactin have remained low or undetectable after 6 months. Thus early diagnosis and surgical treatment of gigantism of this mixed hGH-PRL secreting pituitary tumour was associated with a cure, which contrasts with the unfavourable outcome of many of the patients previously reported.

Adenoma, Acidophil