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Biomedical subjects

N Finer

Publications and source records attributed to N Finer.

At least 55 records · Page 3Linked to original sources
PubMed1988

Plasma amino acids and insulin levels in obesity: response to carbohydrate intake and tryptophan supplements.

We assessed the plasma amino acids, glucose, and insulin responses of obese and lean control subjects to midafternoon carbohydrate snacks. After a standard 400 kcal lunch, eight lean and nine obese subjects received, at 2PM, a 30 g sucrose snack; blood samples were obtained at hourly intervals until 6 PM. Each subject participated in four similar studies in which the carbohydrate snack was consumed alone or with 250, 500, or 1,000 mg of L-tryptophan (Trp), offered as a capsule. The obese group exhibited elevated plasma levels of the branched-chain amino acids, phenylalanine and tyrosine, and the levels of these amino acids declined much less in response to carbohydrate intake than in lean controls. As a consequence, the plasma ratio of Trp:large neutral amino acids (Trp/LNAA ratio), which normally rises after carbohydrate consumption, showed virtually no change in the obese group. The plasma Trp/LNAA response of this group did not reach control values even when carbohydrate intake was increased to 50 or 75 g. Peak plasma Trp concentrations and Trp/LNAA ratios after 250, 500, and 1,000 mg Trp doses were also significantly lower in the obese. Since brain Trp uptake is strongly correlated with the plasma Trp/LNAA ratio, which in turn determines the rate of brain serotonin synthesis, the blunted Trp/LNAA response to carbohydrate intake in the obese could contribute to alterations in the serotonin-mediated regulation of food intake.

Adult↗
PubMed1988

Family screening in medullary thyroid carcinoma presenting without a family history.

Systematic screening of the families of a series of 39 patients with apparently sporadic medullary thyroid carcinoma detected seven new cases in four families. A negative family history in a patient presenting with medullary thyroid carcinoma is not reliable in excluding familial disease, and family screening should be considered for new patients with medullary thyroid carcinoma.

Adolescent↗
PubMed1988

Effect of 6 months therapy with dexfenfluramine in obese patients: studies in the United Kingdom.

The efficacy of dexfenfluramine in inducing weight loss and its clinical acceptability were assessed in two studies carried out in a hospital obesity clinic and general practitioner's office. Seventeen patients who had gained an average of 0.7 +/- 1.9 kg during 12 weeks treatment with diet and placebo lost a mean of 2.9 +/- 0.5 kg after 12 weeks sequential treatment with dexfenfluramine 15 mg twice daily (p less than 0.001). In a second trial, 29 patients treated for 24 weeks with dexfenfluramine showed significantly increased, and continuing, weight loss after 24 weeks (7.0 +/- 0.8 kg) compared to that after 12 weeks of treatment (5.7 +/- 0.1 kg; p = 0.05). The incidence of side effects in both trials was lower than that reported in previous studies of racemic dl-fenfluramine. The clinically significant weight loss and low incidence of unwanted effects suggest that dexfenfluramine has a role in the treatment of refractory obesity.

Clinical Trials as Topic↗
PubMed1987

The effect of enkephalin analogue on pituitary hormone release in human obesity.

To elucidate further the role of opioid systems in the neuroendocrine alterations associated with obesity, we investigated the effect of the synthetic enkephalin analogue DAMME in 11 obese subjects and 10 lean controls. Prolactin responses to DAMME were similar in lean and obese, even in those obese subjects who had absent prolactin responses to insulin-induced hypoglycaemia. The obese showed impaired growth hormone release after both DAMME and insulin-induced hypoglycaemia compared to the lean subjects. The discordance of prolactin responses to DAMME and insulin-induced hypoglycaemia in the obese suggests that altered opioid systems are unlikely to account for the hypothalamic dysfunction present in obesity.

Adult↗
PubMed1986

The composition of lunch determines afternoon plasma tryptophan ratios in humans.

It is well established that the ratio of the plasma tryptophan concentration to those of the other large neutral amino acids determines the transport of tryptophan into the brain. Brain tryptophan levels, in turn, control production of the neurotransmitter serotonin. Protein-rich meals, when consumed in the morning after an overnight fast, have been shown to decrease the plasma tryptophan ratio, while carbohydrate-rich meals have the opposite effect. We now show that these meals have similar effects when consumed for lunch, even if they are preceded by a small breakfast meal.

Adult↗
PubMed1986

Metabolic rate after massive weight loss in human obesity.

Resting metabolic rate, measured by the ventilated hood technique in 11 obese subjects before weight loss was 6.5 +/- 0.3 kJ/min, not significantly different from the value predicted by regression equations relating metabolic rate to body weight (established from measurements in 106 subjects). After 34.5 kg mean weight loss, and during continued dieting, resting metabolic rate fell an average of 25% to 5.0 +/- 0.18 kJ/min, significantly below that predicted for the new slimmed weight. The fall in metabolic rate, over and above that expected from weight loss alone, suggests that the slimmed obese are hypometabolic compared with subjects of the same weight who have not lost weight. The failure of the slimmed obese to maintain their weight loss is unlikely to be due solely to this excessive fall in resting metabolic rate, since they still had quantitatively higher energy expenditure than lean subjects.

Adult↗
PubMed1986

Responses of neurohypophysial peptides to hypertonic saline and insulin-induced hypoglycaemia in man.

In order to investigate the possible role of oxytocin in osmoregulation and its response to stress, plasma immunoreactive oxytocin was measured during hypertonic saline infusion and insulin-induced hypoglycaemia in a group of normal subjects, four patients with idiopathic diabetes insipidus and one patient with DIDMOAD syndrome (the syndrome of diabetes insipidus, diabetes mellitus, optic atrophy and deafness). The results were compared with those of plasma immunoreactive vasopressin to the same stimuli. As expected, there was a rise in plasma vasopressin in the normal subjects to both tests: this was absent in the patients with diabetes insipidus. Plasma oxytocin did not rise during hypertonic saline infusion in either group of subjects. The response of oxytocin to insulin-induced hypoglycaemia (0.15 U/kg soluble insulin) in normal subjects was much more variable. One highly symptomatic volunteer showed a marked rise in oxytocin. Two subjects also showed a rise when retested with 0.19 U/kg soluble insulin. There was no response of oxytocin to a standard-dose insulin test in the patients with diabetes insipidus. The data suggest that, in man, oxytocin is not involved in osmoregulation but that it may be secreted in response to marked hypoglycaemia.

Adult↗
PubMed1985

Term infants with hypoxic-ischemic encephalopathy: outcome at 3.5 years.

A total of 167 term neonates with a diagnosis of hypoxic-ischemic encephalopathy (HIE) had detailed neurodevelopmental follow-up at 3.5 years of age. All 66 children with mild HIE were free from handicap; all seven with severe HIE were severely handicapped; and of the 94 with moderate HIE at birth, 21.3 per cent were handicapped. Mean IQ was significantly related to the category of HIE. Within the moderate HIE category, the neurological examination at discharge from the Neonatal Intensive Care Unit was more useful than the presence of neonatal convulsions in identifying children with subsequent developmental delay. Abnormalities on this examination related significantly to an increased number of handicapped children, decreased motor and language skills, and lower IQs. Although neonatal convulsions were associated with an increased number of handicapped children, they did not significantly affect most other developmental outcome measures. In term infants with documented HIE at birth, major neurodevelopmental dysfunction at 3.5 years depended more on prospectively established category of HIE than on other perinatal or social factors.

Asphyxia Neonatorum↗
PubMed1985

Pregnancy in a woman with premature ovarian failure.

We report the case of a 32 year old woman with premature ovarian failure associated with ovarian autoantibodies, autoimmune Addison's disease and primary hypothyroidism who became pregnant following the treatment of her thyroid and adrenal deficiencies.

Addison Disease↗
PubMed1985

Suppression of norepinephrine-induced thermogenesis in human obesity by diet and weight loss.

The response of metabolic rate to norepinephrine infusion was studied in seven obese subjects before and after large amounts of weight loss. Resting metabolic rate fell from a mean of 2254 kcal (9.4 MJ) to 1682 kcal (7.0 MJ) per 24 h. The thermic response to norepinephrine infusion was reduced by 50 percent from 7527 (31.5 MJ) to 3369 (14.0 MJ) kcal/24 h/T0-45 following weight loss and on continued diet. This adaptation to weight loss could contribute to the diminished rate of weight loss that occurs with continued dieting. Previous contradictory findings of normal and reduced norepinephrine-induced thermogenesis in human obesity could result from subjects being studied under different dietary conditions.

Adult↗
PubMed1984

Mammary gigantism and D-penicillamine.

Mammary gigantism is a rare complication of D-penicillamine treatment. We report a further case with pathological and endocrine details together with a review of the seven cases previously reported and possible mechanisms.

Adult↗
PubMed1984

Metergoline as an alternative to bromocriptine in amenorrhoea.

The results of this study offer further evidence that metergoline is a valuable alternative to bromocriptine in the suppression of excessive prolactin secretion. Forty-nine hyperprolactinaemic and 44 normoprolactinaemic women with amenorrhoea took part in a double-blind trial to compare the efficacy of metergoline 12 mg/day and bromocriptine 7.5 mg/day in restoring menstruation and ovulation. All the women had normal results on conventional tomography of the sella turcica, normal gonadotrophin levels and normal androgen levels. In the hyperprolactinaemic group, metergoline and bromocriptine were equally effective, with 84 and 75% respectively achieving menstruation, and 76 and 67% respectively achieving ovulation, within 4 months. In the normoprolactinaemic group, 47% menstruated and 40% ovulated on metergoline, against comparative figures of 36 and 21% for bromocriptine and 20 and 13% for placebo, but the differences were not statistically significant. Side effects were not a major problem.

Adult↗
PubMed1981

Estimated cerebral blood flow in term infants with hypoxic-ischemic encephalopathy.

Estimated cerebral blood flow (eCBF) was measured sequentially in seven term infants with evidence of hypoxic-ischemic encephalopathy (HIE) and compared with that of normal-term infants. The eCBF was determined by a noninvasive method involving brief bilateral jugular venous occlusion with simultaneous measurement of occipitofrontal circumference. There was a significant decrease in eCBF on day 2 (30 +/- 4 ml/min/100 g brain weight) and on day 4 (36 +/- 5 ml/min/100 g brain weight) compared with control values (56 +/- 4 ml/min/100 g brain weight; 54 +/- 4 ml/min/100 g brain weight) (P less than 0.01). The alveolar CO2 was significantly lower on days 2 and 4 in the HIE group (P less than 0.001), and these values increased to control values by day 6. There was no significant correlation between estimated cerebral blood flow and alveolar CO2 in infants with HIE. We conclude that term infants with evidence of hypoxic-ischemic encephalopathy demonstrate lowered eCBF in the first 4 days of life.

Asphyxia Neonatorum↗
PubMed1979

Extrapulmonary manifestations of adenovirus type 7 pneumonia simulating Reye syndrome and the possible role of an adenovirus toxin.

Three children developed extensive extrapulmonary disease in the course of fatal adenovirus type 7 pneumonia. Several clinical features, including the unexpected onset of coma, suggested the development of Reye syndrome, but biochemical and histopathologic findings were inconsistent with this diagnosis. Virologic and pathologic studies did not reveal evidence of extrapulmonary adenovirus infection, despite clinical involvement of the liver, skeletal muscle, and central nervous system. The detection in premortem sera from all three patients of adenovirus penton antigen, known to be cytotoxic in vitro, suggests a possible mechanism for the production of extrapulmonary pathology in the absence of extrapulmonary virus infection.

Adenoviridae Infections↗
PubMedDate not supplied

Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance.

BACKGROUND: Sibutramine is a tertiary amine that has been shown to induce dose-dependent weight loss and to enhance the effects of a low-calorie diet for up to a year. We did a randomised, double-blind trial to assess the usefulness of sibutramine in maintaining substantial weight loss over 2 years. METHODS: Eight European centres recruited 605 obese patients (body-mass index 30-45 kg/m2) for a 6-month period of weight loss with sibutramine (10 mg/day) and an individualised 600 kcal/day deficit programme based on measured resting metabolic rates. 467 (77%) patients with more than 5% weight loss were then randomly assigned 10 mg/day sibutramine (n=352) or placebo (n=115) for a further 18 months. Sibutramine was increased up to 20 mg/day if weight regain occurred. The primary outcome measure was the number of patients at year 2 maintaining at least 80% of the weight lost between baseline and month 6. Secondary outcomes included changes in uric acid concentrations and glycaemic and lipid variables. Analysis was by intention to treat. FINDINGS: 148 (42%) individuals in the sibutramine group and 58 (50%) in the placebo group dropped out. Of the 204 sibutramine-treated individuals who completed the trial, 89 (43%) maintained 80% or more of their original weight loss, compared with nine (16%) of the 57 individuals in the placebo group (odds ratio 4.64, p<0.001). Patients had substantial decreases over the first 6 months with respect to triglycerides, VLDL cholesterol, insulin, C peptide, and uric acid; these changes were sustained in the sibutramine group but not the placebo group. HDL cholesterol concentrations rose substantially in the second year: overall increases were 20.7% (sibutramine) and 11.7% (placebo, p<0.001). 20 (3%) patients were withdrawn because of increases in blood pressure; in the sibutramine group, systolic blood pressure rose from baseline to 2 years by 0.1 mm Hg (SD 12.9), diastolic blood pressure by 2.3 mm Hg (9.4), and pulse rate by 4.1 beats/min (11.9). INTERPRETATION: This individualised management programme achieved weight loss in 77% of obese patients and sustained weight loss in most patients continuing therapy for 2 years. Changes in concentrations of HDL cholesterol, VLDL cholesterol, and triglyceride, but not LDL cholesterol, exceed those expected either from weight loss alone or when induced by other selective therapies for low concentrations of HDL cholesterol relating to coronary heart disease.

Adolescent↗