Biomedical subjects
Publications and source records attributed to R J Dash.
Melasma in men is much less common than in women. In the present communication, we evaluated circulating levels of LH, FSH, and testosterone in 15 men with idiopathic melasma. When compared with eleven age matched control men, the circulating LH was significantly higher and testosterone was markedly low in the melasmic men. We conclude that male melasma involves subtle testicular resistance.
We describe a patient with primary hypothyroidism due to autoimmune thyroiditis, presenting with acute myoedema and spontaneous rhabdomyolysis. During his hospital stay, he developed altered sensorium due to hypo-osmolal hyponatraemia and later developed bilateral foot drop that responded to appropriate treatment.
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Simultaneous detection of an intracranial meningioma with a pituitary tumour prior to radiotherapy is an extremely uncommon occurrence. Authors have managed an elderly acromegalic lady with an acidophilic pituitary adenoma, who also harboured an asymptomatic anterior third parasagittal meningioma. There were no features of neurofibromatosis. Both tumours were concurrently excised.
We describe a case of follicular carcinoma in a functioning struma ovarii, which presented as an ovarian mass in a patient who had undergone a near-total thyroidectomy for a benign lesion. She underwent bilateral salpingo-oophorectomy and received radiotherapy and L-thyroxine treatment with no evidence of metastases in 4 years follow-up.
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Suprasellar arachnoid cysts (SSAC) are uncommon intracranial lesions. Two patients of SSAC presenting with precocious puberty are described. In both the cases partial excision of the cyst wall, through a pterional craniotomy, establishing communication with the basal subarachnoid spaces was carried out. The endocrinological symptoms regressed after surgery. The clinical presentations of SSAC and the treatment options available are reviewed.
Growth hormone therapy with rhGH (recombinant human growth hormone) has been recommended for treatment of GH deficient short stature in children, repeated hypoglycemias in infancy and early childhood due to GH deficiency, short stature accompanying chronic renal failure prior to renal transplantation and Turner's syndrome. It is now increasingly recommended to adults with GH deficiency following pituitary tumour surgery or irradiation or idiopathic hypopituitarism. There are other indications for its use where evidence for protein catabolism is very strong such as burns injury. The end points of GH therapy in children include achievement of desirable adult height or a growth rate velocity of < 2.5 cm/year. In adults GH deficiency, GH therapy is intended for improvement of general well being, body composition and metabolic markers of GH function.
Evaluation of growth hormone therapy in burns is limited and none is reported from developing countries where burns still carry high mortality. We analysed serial observations on the clinical and biochemical profiles in 13 patients with second and third degree burns who received recombinant human growth hormone (rhGH) (0.5 IU/kg body wt) for 2 weeks in addition to standard conservative treatment and in 9 patients who were managed with standard conservative treatment only. The two groups of patients had burns, comparable in extent and severity. Additional rhGH treatment resulted in improved wound healing (p < 0.001), delayed separation of eschars (p < 0.01), increase in haemoglobin (p < 0.05), serum albumin (p < 0.01), calcium (p < 0.05), phosphorus (p < 0.001), glomerular filtration rate (p < 0.05) and 7 fold elevation in IGF-1. Also, a reduction in weight loss (p < 0.01), nitrogen production rate (p < 0.05), catabolic index (p < 0.01), duration of sepsis (p < 0.01) and hospital stay by 40% (p < 0.01) was noted with rhGH therapy. Transient hypercalcemia (3 patients), albuminuria (2 patients) and elevated blood glucose (one patient) were noted in the rhGH treated group not necessitating any specific therapy. Mortality in rhGH treatment group was 8.3% compared to 44.5% in the "no rhGH" treatment group. These observations suggest significant benefits of short term rhGH treatment in burn patients on conservative management.
We compared cortisol responses to 1 microgram adrenocorticotropic hormone (ACTH), 250 micrograms ACTH and insulin-induced hypoglycaemia (IIH), in patients suspected to have secondary hypocortisolism. Twenty-four patients (16 with hypothalamopituitary disorders and 8 on long-term glucocorticoid therapy) and eight healthy controls, underwent all three test protocols, with intervals of one day between each test. Mean cortisol responses to all three tests were comparable in both groups, but were more closely correlated for IIH vs. the 1 microgram ACTH test (r = 0.96) than for IIH vs. the 250 micrograms ACTH test (r = 0.88). Seven patients had discrepant results; all had a normal peak cortisol response to 250 micrograms ACTH (> 550 nmol/l), but a subnormal response to 1 microgram ACTH. Six of these also had a subnormal response to IIH. Cortisol responses to IIH match more closely those for 1 microgram ACTH in individual instances than those for 250 micrograms ACTH. The standard 250 micrograms ACTH stimulation, being supraphysiological, leads to underdiagnosis of the hypocortisolaemic state. The 1 microgram ACTH stimulation test should replace the standard 250 micrograms ACTH stimulation test in assessing the hypothalamo-pituitary-adrenocortical axis in secondary hypocortisolism.
Melasma is a specific type of facial hyperpigmentation seen in women taking oral contraceptives, in non-pregnant women who have not used oral contraceptives, and in some pregnant women during the progression of gestation, but rarely in men. Circulating LH, FSH, PRL, and E2-17 beta on day 5, 7, 9, and 11 of the menstrual cycle and progesterone (P) on day 17, 19, and 21 were measured in thirty-six ovulating women with melasma (study group) age 25-35 years and twelve healthy controls (control group). Twenty-seven subjects in the study group had normal pregnancies; 9 others were married or single and had no history of contraceptive pill use. Higher levels of FSH on day 7 (p < 0.05); E2-17 beta on 5, 7, 9 (p < 0.05) and LH on day 9 (p < 0.002) were observed in the study group than in the control group. There were no significant differences between the LH/FSH ratio in the two groups. Serum PRL was lower on day 9 in the study group (p < 0.05) than in the control group. Serum P was similar in the patients and the controls. These findings indicate a possible role of high E2-17 beta in the maintenance of melasma.
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The cough reflex, a vagus-mediated respiratory protective reflex, was investigated in diabetics and healthy controls by establishing a cough reflex threshold to increasing concentrations of citric acid aerosol. Diabetics with autonomic neuropathy (n = 20), whether overtly symptomatic (n = 5) or evident only on certain non-invasive cardiovascular autonomic function tests, were found to have significantly (p < 0.05 by chi 2 test) raised cough reflex threshold (range 1 to > 100%, median value 50%) in contrast to either the non-neuropathic diabetics (n = 20) or normal controls (n = 20; range 1-10%, median value 2%). This difference suggests vagal (parasympathetic) denervation of the respiratory tract, with possible serious consequences, hitherto little appreciated.
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T4, T3 and TSH were estimated in 56 bidi and 50 cigarette smokers and their mean estimates were compared with the corresponding values in 25 healthy non-smokers. T4, T3 and their ratios were significantly lower in both bidi and cigarette smokers (p < 0.001). Circulating TSH in both groups of smokers was similar to that in nonsmokers. T4 and T4/T3 were lower in bidi smokers compared to those in cigarette smokers (p < 0.05 and < 0.01, respectively). Severity of smoking affected T4/T3, and TSH in bidi smokers and T4 in cigarette smokers. Normal TSH excluded any significant decrease in thyroid function in smokers. The alterations in circulating T4 and T3 might have been influenced by thyroid hormone production, protein binding as well as peripheral metabolism of T4 by adverse constituents of bidi/cigarette smoke.
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Plasma and urine osmolality were determined in 56 thyroprivic hypothyroid patients before and at 2 and 6 months of eltroxin treatment. Normal range of plasma osmolality (Posm) was defined at 95% confidence limits of values obtained from 25 euthyroid healthy controls. Thirty patients (53%) had lower Posm. The mean Posm in 56 hypothyroid patients increased from 283.4 +/- 2.06 SEM pretreatment, to 295.3 +/- 1.5 at 2 months (p < 0.001) and 296.5 +/- 1.07 at 6 months. The improvements in Posm from those with lower values (30 patients) were more appreciable: 272.3 +/- 1.03 pretreatment, 290.3 +/- 1.9 at 2 months (p < 0.001) and, 296.16 +/- 1.1 at 6 months (p < 0.001). Urine osmolality also increased from a low normal mean of 477.04 +/- 29.64 to 582.48 +/- 28.67 at 2 months (P < 0.05) and 651.46 +/- 28.35 at 6 months (P < 0.001) of eltroxin treatment. Plasma and urine osmolality correlated positively with the clinical severity of hypothyroid state (plasma T3,T4,&TSH) (P < 0.001). These observations suggested a positive influence of thyroid hormones on plasma and urine osmolality and that plasma and urine osmolality increased with achievement of euthyroid state.