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Biomedical subjects

R M Walter

Publications and source records attributed to R M Walter.

At least 37 records · Page 2Linked to original sources
PubMed1990

Quantitative determination of skin thickness in diabetes mellitus: relationship to disease parameters.

It has been suggested that thick skin on the dorsum of the hands and fingers is a common finding in diabetes mellitus, and that affected persons have an increased prevalence of diabetic retinal microvascular disease. Using high resolution ultrasonography, we were able to quantitatively demonstrate increased skin thickness on the hands and feet of many of our diabetic patients. In our limited series, however, there was no correlation with retinal disease. The general occurrence of thick skin on the extremities of persons with diabetes mellitus is apparently independent from the thick skin syndromes which are associated with disease complications.

Adult↗
PubMed1990

Hypoglycemia: still a risk in the elderly.

Hypoglycemia is an underappreciated and potentially fatal complication of insulin and sulfonylurea treatment of diabetes mellitus in the elderly. After several years of diabetes, patients typically lose glucagon and epinephrine responses to hypoglycemia, resulting in loss of adrenergic warning symptoms, as well as prolongation of hypoglycemic episodes. Also of pertinence to the elderly, renal disease, liver disease, congestive heart failure, hypothyroidism, hypoadrenalism, medications, and inadequate monitoring may also contribute to hypoglycemia. The benefits of tight control can be observed only if it is applied to appropriately selected patients.

Aged↗
PubMed1989

Methimazole-induced agranulocytosis in Japanese patients with Graves' disease.

We reviewed the records of approximately 7000 Japanese patients whose hyperthyroidism was treated with methimazole (MMI) alone. Four patients (Group I) developed agranulocytosis during a second course of MMI therapy and eight patients (Group II) during an initial course. Six patients (three in each group) received less than 30 mg MMI daily. Agranulocytosis occurred after more than 2 months of therapy (12 weeks-1 year) in five patients. Seven patients were less than 40 years of age. One patient displayed a gradual protracted development of agranulocytosis. These results indicate that agranulocytosis after MMI may occur irrespective of dose, age, duration of treatment, and with a second exposure.

Adult↗
PubMed1989

Hemodynamic significance of the paraumbilical vein in portal hypertension: assessment with duplex US.

Hemodynamic evaluation of portal and umbilical venous flow with duplex ultrasound (US) was performed in 11 patients with cirrhosis of the liver and a large umbilical vein. Two of these patients had hepatofugal flow in the umbilical vein exceeding hepatopetal flow in the portal vein. These two patients had no evidence of esophageal varices and bleeding. The remaining nine patients had esophageal varices. In these patients, the hepatopetal flow in the portal vein exceeded the hepatofugal flow through the umbilical vein. The authors conclude that duplex US may help identify the massive hepatofugal flow through a large umbilical vein that may reduce the likelihood of esophageal varices and variceal bleeding.

Adult↗
PubMed1989

Optimal needle size for renal biopsy: in vitro and in vivo evaluation.

To evaluate the success and complication rates of small (16- and 18- gauge) needles in biopsy of the kidney, the authors performed in vitro biopsy in a cadaveric kidney and in vivo renal biopsy in 141 patients. Best results were obtained with a 16-gauge modified Menghini needle. In vitro, 9.7 +/- 5.7 (mean +/- standard deviation) glomeruli were retrieved, and the average length of tissue cores was 17.8 mm +/- 8.2. In vivo, 10.63 +/- 6.64 intact glomeruli were retrieved, and a definitive histologic diagnosis was achieved in 86% of patients. The frequency of major complications with this needle was 3.5%, and of minor complications, 5.8%. No major complications occurred after biopsy was performed with 18-gauge needles of the same design. However, the retrieval rate of glomeruli with these smaller needles was insufficient. An 18-gauge needle with two cutting edges yielded tissue cores of 11.0 mm +/- 3.5 in length. In vitro, 6.6 +/- 2.3 glomeruli were retrieved; in vivo, 9.92 +/- 6.65. A definitive histologic diagnosis was achieved with this needle in 75% of patients, and rates of 7.1% for major complications and 10.7% for minor complications were encountered.

Adult↗
PubMed1987

The mechanism of spontaneous hypothyroidism in patients with Graves' disease after antithyroid drug treatment.

The natural course of Graves' disease results in hypothyroidism in up to 20% of patients previously treated with antithyroid drugs. The precise mechanisms are not known, although autoimmune destruction of thyroid tissue has been proposed. We studied sequentially obtained serum samples from three patients with hyperthyroid Graves' disease previously treated with an antithyroid drug who became hypothyroid to determine possible causes of their hypothyroidism. Antithyroglobulin and antithyroid microsomal autoantibodies, TSH binding inhibitory immunoglobulin (TBII), thyroid-stimulating antibody (TSAb), and thyroid stimulation-blocking activity were measured. Autoantibodies were markedly elevated throughout the clinical course in all three patients. Patient 1 had no TBII and blocking activity and extremely high TSAb when she was euthyroid as well as hypothyroid. Hypothyroidism was probably the result of autoimmune thyroid destruction. In patient 2, TSAb disappeared, and TBII and blocking activity increased markedly when she developed hypothyroidism, which thus appeared to result from blocking antibodies. Patient 3 had intermittent periods of hyper- and hypothyroidism before becoming and remaining euthyroid. While initially hypothyroid, TBII was weakly positive, and TSAb was strongly positive; subsequently, when hyperthyroidism recurred, TBII and TSAb were strongly positive. Hypothyroidism appeared to result from focal autoimmune thyroiditis. Patients with hyperthyroid Graves' disease may develop hypothyroidism later by different means. Autoimmune thyroiditis, diffuse or focal, with thyroid destruction is one mechanism. The appearance of antibodies that block TSH stimulation may be another.

Adult↗
PubMed1986

Effect of psychological stress on human growth hormone response to thyrotropin-releasing hormone in normal controls.

Human growth hormone (hGH) responses to thyrotropin-releasing hormone (TRH) were investigated in normal subjects under psychological stress. Fifteen subjects (4 men and 11 women), whose ages ranged from 19 to 22 years, were studied. The mirror-drawing test (MDT) was performed to induce psychological stress. Plasma hGH and prolactin (PRL) were determined serially before, during and after the following tests: TRH alone (500 micrograms synthetic TRH i.v. bolus), MDT alone, and TRH with MDT. The changes in hGH concentrations with MDT alone were not significant. The hGH response to TRH alone also showed no remarkable change; however, hGH responses to TRH combined with MDT were significantly higher than the responses to TRH alone. PRL did not respond with MDT alone but responded significantly with the other two tests. Thus there was a divergence in hGH and PRL secretion to TRH and psychological stress. Significant increases in hGH secretion were observed only when TRH and psychological stress were combined as stimuli.

Adult↗
PubMed1986

Hypothalamic-pituitary-thyroidal dysfunctions in anorexia nervosa.

There are clinical similarities between anorexia nervosa and hypothyroidism. Circulating levels of T4 and particularly T3 have been reported to be low in this eating disorder. Previous reports have, however, shown normal basal levels of serum TSH with normal or delayed responses to TRH. To assess thyroid function and the hypothalamic-pituitary axis in 21 women with anorexia nervosa, serum levels of free and total thyroid hormones, binding proteins, and TSH employing an extremely sensitive assay (detection limit = 0.02 microU/ml) were measured. Serum T4, free T4, T3, free T3, TSH, TBG and TBPA concentrations were significantly lower and rT3 levels were significantly higher in anorexia nervosa patients than in normal controls. A delayed TSH response to TRH was noted in 66% of patients, hyporesponsiveness was seen in another 24%, and a normal response in only 10%. In 10 anorexia nervosa patients studied after weight gain, T4, T3, free T3, TSH, TBG and TBPA were significantly increased, and rT3 was significantly decreased. No change in mean free T4 levels with weight gain was noted. Other parameters of hypothalamic dysfunction in anorexia nervosa have been reported and the present data suggest that apparent hypothalamic hypothyroidism occurs perhaps as an adaptation to prolonged starvation.

Adolescent↗
PubMed1986

Paradoxical responses of plasma cortisol, adrenocorticotropic hormone and growth hormone to thyrotropin-releasing hormone and luteinizing-hormone-releasing hormone in anorexia nervosa patients.

Abnormalities of hypothalamic-pituitary function in patients with anorexia nervosa (AN) have been reported previously. Since atypical responses to thyrotropin-releasing hormone (TRH) and luteinizing-hormone-releasing hormone (LHRH) have been observed in other disease states, hormonal responses to these hypothalamic peptides in 60 otherwise unstressed young women with anorexia nervosa were studied. Sixteen patients demonstrated a growth hormone (GH) response to TRH and 10 showed an increase in GH after LHRH. Five patients had an increase in cortisol after TRH, 2 of whom showed GH response, and 2 patients demonstrated a cortisol response to LHRH, 1 of whom had a GH response. Variable TSH responses to TRH were observed in the study but there was no correlation with the occurrence of GH or cortisol responses. GH responses to TRH and LHRH were typically not seen in the same patients, nor were they predictive of a cortisol response to the same stimulus. These data add to the evidence for an abnormal hypothalamic-pituitary regulation in AN.

Adolescent↗
PubMed1984

Specific binding of 1,25 dihydroxyvitamin D3 in lymphocytes.

We examined ten cellular or tissue sources of lymphocytes for specific binding of 1,25(OH)2D3, the hormonally active form of vitamin D3. A specific-binding protein was found in three of these sources. Scatchard analysis of cytosol from a follicular lymphoma cell line revealed binding sites with a Kd of 7.0 X 10(-11) and a receptor concentration of 6.6 fmol/mg protein. Sucrose density centrifugation of 3H-1,25(OH)2D3 labeled cytosol showed a 3.75 peak which was absent in cytosols incubated with excess nonradioactive 1,25(OH)2D3. The relative amounts of vitamin D3 metabolites required to displace 50% of the specifically bound 3H-1,25(OH)2D3 were 1,25(OH)2D3: 1,24,25(OH)3D3: 25(OH)D3: 24,25(OH)2D3 = 1: 180: 1000: 2700. Excess vitamin D3, cortisol, and estradiol failed to displace 3H-1,25(OH)2D3. Scatchard analysis of spleen cytosol from a patient with prolymphocytic transformation of chronic lymphocytic leukemia demonstrated a binding protein with a Kd of 1.2 X 10(-10) and a receptor concentration of 0.2 fmol/mg protein. DNA cellulose binding confirmed the presence of the specific-binding protein in this cytosol. Specific binding of 3H-1,25(OH)2D3 was also quantitated in a cell line from a patient with Burkitt's lymphoma with a Kd of 0.3 X 10(-10) and a receptor concentration of 29.6 fmol/mg protein. No specific binding of 3H-1,25(OH)2D3 was observed in lymphocytes from seven other malignant and nonmalignant sources. These results are the first to demonstrate a specific-binding protein for 1,25(OH)2D3 in lymphocytes from tissue and from these specific cell lines. The presence of this protein in some lymphocytes but not others may reflect the state of activation of the lymphocytes.

Binding, Competitive↗
PubMed1984

The effects of alcohol on the endocrine system.

Male hypogonadism is the best documented endocrine effect of chronic alcoholism. A reversible clinical syndrome resembling Cushing's syndrome has also recently been described in some chronic alcoholics. The pituitary-thyroid axis is relatively resistant to the effects of ethanol, although mild abnormalities in various thyroid tests are frequently noted in the presence of alcoholic liver disease.

Alcoholism↗
PubMed1983

Paradoxical release of growth hormone during oral glucose tolerance test in patients with abnormal glucose tolerance.

Oral glucose tolerance tests were performed on 24 patients characterized as having abnormal glucose tolerance (AGT) and on 27 control subjects. Serums for glucose, growth hormone and insulin determinations were serially obtained for 4 hr after glucose administration. As serum glucose declined 2 hr or more after glucose ingestion a rise in growth hormone, as has been previously described, was observed in 40% of control subjects and 12% of AGT patients. However, of interest was a paradoxical early increase in growth hormone levels noted in 44% of lean AGT subjects occurring during the first 2 hr of the test with glucose levels rising. This response was seen in only one of 8 obese patients with AGT and in none of the control subjects. An abnormality in the hypothalamic glucose receptors in the ventromedial nucleus is a possible explanation for the changes observed. It is possible that this early inappropriate increase in growth hormone release may in some nonobese subjects with AGT contribute to the abnormal oral glucose tolerance tests observed.

Administration, Oral↗
PubMed1982

Salmonella thyroiditis, apathetic thyrotoxicosis, and follicular carcinoma in a Laotian woman.

A 49-year-old Laotian woman presented with apathetic hyperthyroidism and suppurative thyroiditis from Salmonella cholerae-suis occurring in a multinodular gland with a large right-sided mass. Apathetic hyperthyroidism in this age group is uncommon and Salmonella thyroiditis has been infrequently described. Surgical removal of the mass which had effectively concentrated radioactive iodine cured the hyperthyroidism and permitted the remaining suppressed normal tissue to regain function. Pathologic evaluation of the functioning mass demonstrated nearly total replacement of normal thyroid tissue by follicular carcinoma. No clear evidence of metastatic disease was present. Thyrotoxicosis from follicular carcinoma of the thyroid not resulting from metastases has not been previously described.

Adenocarcinoma↗
PubMed1982

The failure of aminophylline to modulate glucagon release in man.

There are conflicting results regarding the impact of cyclic AMP on pancreatic glucagon release. The effect of aminophylline, a phosphodiesterase inhibitor, on glucagon secretion was studied in four non-obese, non-diabetic, healthy young male volunteers. The subjects received separate infusions of: 1) aminophylline; 2) aminophylline and propranolol; 3) arginine; 4) aminophylline and arginine; 5) insulin; 6) aminophylline and insulin; and 7) aminophylline and isoproterenol. Aminophylline not only failed to alter glucagon levels but also did not affect the glucagon responses observed after arginine and insulin-induced hypoglycemia. The concurrent infusion of isoproterenol and aminophylline also failed to cause a glucagon response. Although glucagon release has been evoked by cyclic AMP in some in vitro system, administration of aminophylline to human subjects does not enhance secretion. These results indirectly suggest that cyclic AMP is of little importance in the control of glucagon secretion in man, though the effects of aminophylline at the cellular level may be complex.

Adolescent↗