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Biomedical subjects

N Norman

Publications and source records attributed to N Norman.

At least 19 recordsLinked to original sources
PubMed1992

Prediction of response to controlled ovarian hyperstimulation: a comparison of basal and clomiphene citrate-stimulated follicle-stimulating hormone levels.

OBJECTIVE: To test the ovarian reserve in a high-risk population before controlled ovarian hyperstimulation for in vitro fertilization (IVF). DESIGN: A prospective study comparing the outcome of a clomiphene citrate (CC) challenge test to the outcome of subsequent IVF cycles. SETTING: Unit for assisted reproductive technology in a university hospital. PATIENTS, PARTICIPANTS: Ninety-one infertile women with an age of 35 years or more, who had previous ovarian surgery or who had been diagnosed with ovarian endometriosis. MAIN OUTCOME MEASURE: Relate follicle-stimulating hormone (FSH) levels before and after CC to frequency of cancellation of an IVF cycle because of a poor follicular response. RESULTS: Twenty-one patients had elevated basal levels of FSH. Thirty-seven patients, including 20 with high basal levels, showed an excessive FSH response to CC with an FSH level after CC above the 95% confidence limit. Clomiphene citrate-stimulated FSH levels correlated better than basal levels with response to controlled ovarian hyperstimulation. An excessive FSH response to CC predicted a poor response outcome of subsequent controlled ovarian hyperstimulation for IVF with 85% accuracy. CONCLUSION: Follicle-stimulating hormone response to CC predicts subsequent follicular response to controlled ovarian hyperstimulation.

Adult↗
PubMed1991

Prediction of long-term gonadal toxicity after standard treatment for testicular cancer.

Long-term post-treatment gonadal toxicity was examined (median 3 years after treatment discontinuation) in 125 testicular cancer patients treated with standard regimens: no radiotherapy or chemotherapy (36 patients), infradiaphragmatic radiotherapy (38 patients), and 3-4 cycles of cisplatin-based chemotherapy (51 patients). Radiotherapy and chemotherapy had no impact on serum testosterone, but led to a slight increase in serum follicle-stimulating hormone (FSH). The lowest median value of post-treatment sperm cell count was observed after infradiaphragmatic radiotherapy, the highest value after standard chemotherapy. After more intensive cytotoxic treatment recovery of the gonadal function seemed to be delayed. In testicular cancer long-term post-treatment gonadal toxicity is correlated to the patient's pretreatment gonadal function and age rather than to the standard treatment of the malignancy. In patients with pretreatment normal gonadal function the risk of permanent treatment-induced toxicity is minimal after present standard treatment.

Adolescent↗
PubMed1991

Reproductive hormones during 42 days of maximal physical effort, low temperatures and general hardship.

Four well trained men crossed the inland glacier of Greenland in 1988, retracing the route of the famous arctic explorer Fridtjof Nansen from 1888. They used true copies of Nansen's equipment in all details. Each pulled at sled weighing 130 kg at the start. The expedition lasted 42 days, covered 500 km, highest point 2800 m above see level, coldest temperature -50 degrees C. Serum testosterone, sex hormone bindings globulin (SHBG), luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactine (PRL) were determined at weekly intervals, before, during and after this exceptionally long lasting, physically exhausting and stressful exercise. Testosterone fell to a mean level of 1.8, 2.8 and 3.8 nmol/l during the last two weeks of the expedition (p less than 0.001), and SHBG increased correspondingly from 26.7 nmol/l before start to more than 50 nmol/l (p less than 0.05). PRL levels were significantly decreased (p less than 0.005) at the time point when testosterone was maximally reduced. The normalization of testosterone following the expedition was associated with a significant increase in LH (p less than 0.05). In spite of low testosterone levels, lean body mass increased during the expedition in 3 of the participants.

Adult↗
PubMed1990

[Carcinoma of the adrenal cortex].

We present nine cases of primary adrenocortical carcinoma, collected in our department of medicine and endocrinology over 25 years. In our patients, the most dependable tumor marker was urinary excretion of tetra-hydro-ll-deoxycortisol (THS), and elevated values were found in all cases where it was determined. In addition to surgical treatment, medication with o,p'-DDD was found to be of value for some of the patients. Median tumor weight was 487 g (118-2,085 g). Prognosis is difficult to predict. Median survival time after diagnosis was 34 months, but varied from three to 266 months.

17-Ketosteroids↗
PubMed1990

Platelet release reaction and plasma catecholamines during total hip replacement. No effects of high doses of corticosteroids.

Platelet activation and catecholamine levels during surgery and the effects of corticosteroids on these reactions were examined in fourteen patients operated by uncemented total hip replacement (THR). Beta-thromboglobulin (BTG), released from alpha granules during platelet activation, catecholamines and cortisol were examined in plasma before operation and in the early postoperative period. The patients were randomly divided into two groups, a corticosteroid group where the patients were treated by high doses of methylprednisolone (HDC) and a nonsteroid group. BTG increased about 200% during the operation, and thereafter, decreased to slightly supranormal values after 24 hours. There were no significant differences between the two patient groups. Catecholamine levels were low, and there were only minor changes following surgery. Cortisol increased following THR in the nonsteroid group. A standardized muscle-skeletal trauma in the form of THR caused a significant increase in platelet activation as evaluated by BTG increase during the first 24 hours after the operation. Catecholamines did not seem to be of importance for this activation, neither were the levels of BTG influenced by HDC.

Adrenal Cortex Hormones↗
PubMed1990

Recovery of impaired pretreatment spermatogenesis in testicular cancer.

Light microscopic sperm analysis was done 24 months after treatment or later in 25 patients with testicular cancer with azoospermia or severe oligospermia (sperm cell count less than 10 x 10(6)/mL) after orchiectomy before further treatment. Treatment after orchiectomy consisted of abdominal irradiation, cisplatin-based chemotherapy, retroperitoneal surgery, a combination of the former treatment modalities, or a surveillance policy. At the time of post-treatment reassessment, 15 of the 25 patients had sperm cell concentrations of at least 10 x 10(6)/ml (7 of 14 patients in the azoospermia group; 8 of 11 patients in the oligospermia group). Eight patients fathered a child after discontinuation of treatment for testicular cancer. Recovery of spermatogenesis could be seen after all types of treatment. A highly increased pretreatment serum follicle-stimulating hormone was correlated with lack of sperm cell production recovery.

Adult↗
PubMed1990

Androgens in fetal pigs in relation to sex of neighbour(s).

Concentrations of androgens in blood and/or fetal fluids were determined in pig fetuses 35, 56/58 and 115 days of age. For each fetus the sex of its neighbour(s) in utero was determined. Irrespective of the sex of neighbour(s), no significant differences in testosterone levels were found between the different groups of females, or between the different groups of males. When females and males were compared, significant differences were found. At a fetal age of 35 days testosterone concentrations (mean and SD) in amniotic fluid were 0.17 +/- 0.06 and 0.26 +/- 0.05 nmol/l in females and males, respectively (p less than 0.01). At a fetal age of 56/58 days, the corresponding values were 0.14 +/- 0.04 and 0.21 +/- 0.07 nmol/l (p less than 0.01). At this age testosterone concentrations in mixed umbilical blood plasma were 0.22 +/- 0.08 in females and 1.12 +/- 0.64 nmol/l in males (p less than 0.001). At term the mean concentrations of testosterone were 2.4 and 2.5 nmol/l in mixed umbilical blood plasma and 1.6 and 1.7 nmol/l in fetal fluid in females and males, respectively. The levels of dehydroepiandrosterone in fetal fluid at this stage were 1.6 nmol/l in females and 1.7 nmol/l in males. Concentrations of dihydrotestosterone were below the sensitivity level of the method (less than 0.09 nmol/l) in all samples tested. It is concluded that male neighbours do not influence the androgen levels in blood plasma and fetal fluids of the females.

Amniotic Fluid↗
PubMed1990

Serum follicle stimulating hormone--predictor of cancer in the remaining testis in patients with unilateral testicular cancer.

In 10 of 13 patients with unilateral testicular cancer and subsequent invasive cancer or carcinoma in situ in the remaining testis, the follicle stimulating hormone (FSH) level was elevated after the first orchiectomy and before further treatment. In only 4 of 26 comparable control patients was the FSH level raised. This may be because elevated serum FSH often reflects disturbances in spermatogenesis and fertility, the latter being a known risk factor for testicular cancer. An elevated FSH level that occurs after orchiectomy for unilateral testicular cancer and before further treatment identifies patients at high risk of developing a tumour in the remaining testis.

Adolescent↗
PubMed1989

[Investigation of Cushing's syndrome. The diagnostic value of the dexamethasone suppression test, the metopirone test and the CRF test].

We describe thirty-one patients with Cushing's syndrome, with the object of evaluating the relative merit of the Dexamethasone suppression test, Metyrapone test and Corticotrophin Releasing Factor (CRF) test in classifying the syndrome. Bilateral adrenocortical hyperplasia (Cushing's disease) was present in sixteen patients. Three had bilateral macrodular hyperplasia of the adrenal cortex, six had adrenocortical adenoma, four had adrenocortical carcinoma, and two patients presented ectopic ACTH-syndrome. The diagnosis was surgically verified in every case. The Metyrapone test was found to give the safest classification in patients with Cushing's syndrome. The Dexamethasone test will diagnose Mb. Cushing reliably when suppression of serum cortisol is present following the large dose of Dexamethasone, but failure to suppress does not exclude the diagnosis. The CRF test is easy to perform and distinguished reliably between Mb. Cushing and other causes of the syndrome in eight out of ten patients in whom it was performed. Outpatient examination including the CRF test and CT-scanning of the pituitary and adrenal glands is advocated as a preliminary step in the classification of biochemically and clinically suspected cases of Cushing's syndrome.

17-Hydroxycorticosteroids↗
PubMed1988

Lack of gonadal protection by medroxyprogesterone acetate-induced transient medical castration during chemotherapy for testicular cancer.

The serum FSH levels were analysed in 24 testicular cancer patients 3 to 9 years after intensive chemotherapy. Sperm cell counts were performed in 12 patients. In all cases a temporary medical castration had been achieved during intensive chemotherapy by the use of medroxyprogesterone acetate (MPA) (500 mg daily per os). The hormone treatment was initiated on day 1 of the first chemotherapy cycle. Thirteen additional patients did not receive this hormone treatment but were treated by similar chemotherapy. The latter patients served as a control group. There was a tendency towards higher FSH levels in the MPA-treated patients than in the controls. Following treatment, serum testosterone was significantly lower in patients who had received MPA during their intensive chemotherapy than in the controls. There was no difference between the groups with regard to recovery of sperm cell production after chemotherapy. An MPA-induced medical castration during intensive chemotherapy in testicular cancer patients is ineffective in protecting the remaining testis against treatment-induced damage to spermatogenesis, at least if hormone treatment is started simultaneously with chemotherapy.

Adult↗
PubMed1987

Decreased central dopaminergic activity in essential hypertension.

Baseline serum prolactin (PRL) was found to be similar in 35 men with untreated essential hypertension (149 +/- 2/98 +/- 1 mmHg; means +/- s.e.) and 44 healthy normotensive men (126 +/- 1/80 +/- 1 mmHg), all 40 years old. A correlation between baseline PRL and aldosterone was found in the normotensive (r = 0.534, P less than 0.001), but not in the hypertensive group (r = -0.011, NS). Ten subjects from each group received intravenous metoclopramide, a competitive dopamine antagonist, while another 12 normotensive subjects were given saline only, and the effect on PRL, vasopressin (AVP) and catecholamines was followed. An exaggerated PRL response to metoclopramide was observed in the hypertensive group compared with the normotensive (P less than 0.05), and the mean normotensive peak value never exceeded the hypertensive. Plasma noradrenaline increased significantly compared with baseline (P less than 0.05) and the control group (P less than 0.001), concomitant with increased heart rate (P less than 0.05), after the administration of metoclopramide both in the hypertensive and normotensive group. After intravenous injection of metoclopramide, forearm blood flow increased significantly by 50% in the hypertensive (P less than 0.001), and 80% in the normotensive group (P less than 0.001) compared with the control group. Mean blood pressure remained unchanged as did plasma AVP, dopamine and adrenaline. The present study indicates an altered central dopaminergic activity in essential hypertension. Even at rest, endogenous dopamine exerts a modulating effect on noradrenaline release in both hypertensive and normotensive men.

Adult↗
PubMed1987

Gynaecomastia following cytotoxic therapy for testicular cancer.

Sixteen patients in complete remission after chemotherapy or radiotherapy for testicular cancer developed gynaecomastia which appeared 2 to 9 months after the end of therapy and had a mean duration of 4.8 months. These patients had statistically significant higher levels of oestradiol, FSH and oestradiol/testosterone ratio than a control group without gynaecomastia that had received similar treatment. Both groups tended to have testosterone levels in the lower normal range and all patients had normal levels of beta-HCG, prolactin and progesterone. The gynaecomastia in our patients was probably the result of an absolute increase in oestradiol or an increase relative to testosterone. Cytotoxic therapy affects both spermatogenesis and Leydig cell function, with a resultant rise in gonadotrophins which may in turn increase testicular oestrogen secretion. In testicular cancer patients, gynaecomastia may be a sign of tumour activity but it may also be caused by hormonal changes resulting from cytotoxic therapy. It is our experience that the latter treatment-related type is harmless, transient and unrelated to the patient's prognosis.

Adolescent↗
PubMed1987

Endocrine effects of ovarian electrocautery in patients with polycystic ovarian disease.

The mechanism by which ovarian electrocautery induces regular ovulatory cycles was studied in 16 women with polycystic ovarian disease (PCO) and compared with 25 normal fertile women who were undergoing sterilization by tubal electrocautery. Gonadotrophins (LH and FSH), prolactin, androgens, oestrogens, 17-hydroxyprogesterone and progesterone were determined immediately before operation and 24 h later. Following the sampling of blood for these tests, 100 micrograms of gonadotrophin releasing hormone (GnRH) was given intravenously and the LH and FSH responses were measured at 30 min. In the PCO-group, these tests were repeated after the first induced ovulatory cycle. After operation, LH increased only in the patients with PCO and this increase was associated with an enhanced response to GnRH, FSH showed a similar response to GnRH, also confined to the PCO-group. These pituitary responses are best explained by a change in ovarian feedback induced by the direct electrocautery of the glands in the PCO-group. There was little change in serum oestrogen. Prolactin showed an increment in all cases and serum androgens were reduced in all groups, most pronounced in the PCO patients, possibly as a result of the stress of operation. An ovarian factor--released or reduced by the electrocautery--seems to be responsible for the changes.

Adult↗
PubMed1987

Ketoconazole high dose in the hormonal treatment of advanced carcinoma of the prostate. A pilot study.

Five previously untreated patients with advanced carcinoma of the prostate were treated with the non-estrogenic antifungal agent Ketoconazole in high doses. A rapid fall in serum testosterone, adrenal androgens and serum prostatic acid phosphatases was recorded accompanied by a striking clinical response with reduction of skeletal pain and improvement of performance status. In one patient this was dramatically shown by reduction of a large pelvic tumor and associated edema of the left lower limb. Side-effects such as weakness, fatigue and loss of appetite made four of the patients withdraw from the study. Serum testosterone and serum prostatic acid phosphatase initially suppressed, increased slowly during the treatment period. Consequently, Ketoconazole as sole therapy in the treatment of advanced carcinoma of the prostate was stopped. However, the initial rapid decrease in serum testosterone and the striking positive clinical effect may possibly be utilized combined with orchiectomy or treatment with LHRH agonist analogues.

Adenocarcinoma↗