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Biomedical subjects

R N Alsever

Publications and source records attributed to R N Alsever.

18 recordsLinked to original sources
PubMed1995

Specialist versus primary care: not an easy question.

The central focus in the debate to reform our nation's health care system is on cost, quality, and access. There is general agreement that there are too many specialists in the wrong places, which is said to contribute to the rising cost of health care. Physician profiling has supported the concept that some specialists are more costly than primary care physicians, although the severity of illness in patients treated by specialists may often be greater. Increasing the number of primary care providers may be a solution to reduce costs and will clearly improve access. The study reported in this article was carried out to examine the efficiency of primary care physicians and endocrinologists, a specialty that has been cited as one in which resource utilization is high, in caring for hospital inpatients with diabetic ketoacidosis.

Diabetic Ketoacidosis↗
PubMed1978

Failure of medullary carcinoma of the thyroid to respond to doxorubicin therapy.

We describe 3 patients with metastatic medullary carcinoma of the thyroid who were treated with doxorubicin hydrochloride (Adriamycin). Serum calcitonin was measured before and after doxorubicin therapy. Doxorubicin failed to arrest the progression of the disease in any of the patients. Although serum calcitonin levels dropped in 1 patient during therapy, they remained markedly elevated in all 3 patients. From the present series it appears that medullary thyroid carcinoma often does not have a response to doxorubicin.

Adult↗
PubMed1976

Clinical correlations of serum proinsulin-like material in islet cell tumours.

To examine the possibility that the concentration of circulating proinsulin-like material (PLM) might be helpful in evaluating the therapeutic response of patients with islet cell tumours, serum levels of PLM in three patients with islet cell tumours were correlated with hypoglycaemic symptoms and plasma glucose concentrations before and after treatment. In two patients ranges of fasting PLM concentration were 0.21-0.29 and 0.91-0.93 ng/ml, respectively, before treatment. After surgical excision of their islet cell adenomas, PLM concentrations decreased to 0.06-0.09 and 0.03-0.05 ng/ml. Insulin concentrations were low preoperatively in both patients and were unchanged postoperatively. The resulting relief from hypoglycaemia was paralleled by a reduction of PLM, with no significant change in insulin. In a third patient, treatment with streptozotocin resulted in marked symptomatic improvement, a 65% reduction in PLM concentration, but no significant change in insulin levels. Relapse was associated with increasing frequency of hypoglycaemic symptoms and increasing PLM concentrations. These findings suggest that changes in the levels of serum PLM may prove to be a sensitive indicator of the response of islet cell tumours to therapy.

Adenoma, Islet Cell↗
PubMed1976

Effect of contraceptive steroids on arginine- stimulated glucagon and insulin secretion in women. II. Carbohydrate and lipid physiology in insulin-dependent diabetics.

The effect of contraceptive steroids on aminogenic glucagon secretion was studied in six insulin-dependent diabetic women. After 2 wk treatment with combined mestranol (80 mug) plus norethindrone (1 mg) daily, the mean peak plasma glucagon response to arginine infusion was suppressed to one-fourth of control levels. This was associated with a small but significant decrease in mean basal plasma cholesterol concentrations. There were no changes in basal plasma triglyceride, free fatty acid, glucose, insulin, or alpha-amino nitrogen concentrations or in daily insulin requirements during mestranol plus norethindrone treatment. These results confirm previous reports of no consistent changes in the insulin requirements of insulin-dependent diabetic women using contraceptive steroids and suggest that these women may not experience dramatic changes in their lipid metabolism during contraceptive therapy.

Adolescent↗
PubMed1975

Effect of contraceptive steroids on arginine-stimulated glucagon and insulin secretion in women: I-Lipid physiology.

To evaluate the effect of contraceptive steroids on endogenous glucagon and insulin secretion, theta-arginine was infused intravenously in normal young women before and during selective steroid treatment. The effect of the combination of an estrogen derivative (mestranol), plus norethindrone (Norinyl, Syntex) was compared to the effect of ethinyl estradiol alone and to norethindrone alone. All three steroid schedules resulted in suppression of aminogenic insulin secretion. However, glucagon secretion was reduced only with ethinyl estradiol alone or the combination of mestranol plus norethindrone. In accordance with previous reports, treatment with an ethinyl estradiol derivative alone or in combination with norethindrone resulted in a tendency for elevated serum lipid concentration, while norethindrone alone resulted in a significant reduction in serum lipid concentration. These observations suggest an inverse relationship between aminogenic glucagon secretion and serum lipid concentration as influenced by contraceptive steroids. It is suggested that the metabolic effects of these steroids may be mediated in part by the associated alterations in pancreatic hormone secretory capacity.

Adult↗
PubMed1975

Growth hormone release after synthetic 1-24 ACTH: effects of estrogen and sex.

Recent reports have demonstrated that growth hormone (GH) is inconsistently released after intravenous administration of synthetic 1-24 ACTH. This study was designed to evaluate the role of estrogens in mediating this response. 250 mug of synthetic 1-24 ACTH were administered to 8 men in 12 studies and 6 women in 11 studies. None of the men exhibited a rise in GH after 1-24 ACTH, while the women exhibited a significant increase. Pretreatment of 5 of these men with 100 mug of ethinyl estradiol daily for 3 days did not alter GH response from the initial studies. Pretreatment with 10 mg of diethylstilbesterol daily for 3 days, however, resulted in a rise in GH which was similar to the female group. It is concluded that the variable GH responses to synthetic 1-24 ACTH may be in part due to prevailing concentrations of sex steroids and their effect on the hypothalamic-pituitary GH release mechanism.

Adrenocorticotropic Hormone↗
PubMed1975

Insulinoma with low circulating insulin levels: the diagnostic value of proinsulin measurements.

Hypoglycemia coexisting with very low plasma immunoreactive insulin concentrations was found in a 78-year-old woman with an insulinoma. However, the absolute proinsulin levels during hypoglycemia were elevated (0.9 to 1.4 ng/ml), accounting for 66.5% of the total circulating immunoreactive insulinlike material. The raised serum proinsulin concentrations together with an abnormal proinsulin:insulin ratio proved to be of critical importance in establishing the diagnosis of an islet-cell tumor in this patient.

Adenoma, Islet Cell↗
PubMed1975

Thyroid-function tests in diphenylhydantoin-treated patients.

We compared the free-thyroxine index in normal adults and in euthyroid patients taking diphenylhydantoin. All subjects had normal serum thyrotropin concentrations. Serum thyroxine concentrations were determined by two commonly used competitive protein-binding assays, which yielded slightly different values, but which consistently showed the same degree of decrease in mean serum thyoxine concentration in drug-treated patients as compared to the normal subjects. When 14C-labeled diphenylhydantoin was added to serum before the assay, it was separated from thyroxine in the Ames method, whereas by the Murphy-Pattee method both drug and thyroxine were extracted together. Thus, the decrease in serum thyroxine concentrations during diphenylhydantoin therapy cannot be the result of drug interference with the binding of thyroxine to binding proteins in the assays. Triiodothyronine uptake, evaluated by two methods, was identical in the two groups. The free-thyroxine indexes for all normal persons were within the manufacturer's normal range, but 21% of the drug-treated patients had subnormal indexes by the Ames method; the indexes as measured by the Murphy Pattee method were in the lower half of the normal range. Because the triiodothyronine uptake was unaffected by the drug treatment, the decreases in the indexes must have resulted from the lower serum thyroxine concentrations. We conclude that the free-thyroxine index may not provide a valid estimate of either the clinical status or the free-thyroxine concentration in patients taking diphenylhydantoin.

Adult↗
PubMedDate not supplied

Primary meningococcal pericarditis: a disease of adults associated with serogroup C Neisseria meningitidis.

Pericarditis due to Neisseria meningitidis is usually a consequence of meningeal disease or meningococcemia. This presentation includes a case report of primary meningococcal pericarditis (PMP) and a review of the clinical and epidemiologic features of 15 previously reported cases. All cases have been reported in the past 15 years. Most patients were older teenagers or adults. The median age and age distribution of PMP cases in the United States were significantly greater than that of patients with other meningococcal diseases reported to the Centers for Disease Control (CDC) (P = .005). Similarly, serogroup C N. meningitidis was isolated from 88% of U.S. patients with PMP, compared with isolation from 22% of patients with other meningococcal diseases reported to the CDC (P = .00016). Culture of pericardial fluid usually yielded meningococci, and most patients presented with signs and symptoms typical of purulent pericarditis. A positive pericardial culture was associated with the development of cardiac tamponade (P = .03). With appropriate antibiotic treatment and drainage of pericardial fluid when indicated, all 16 patients survived and experienced few or no sequelae.

Adolescent↗
PubMedDate not supplied

Cardiac tamponade in myxedema.

Pericardial effusions are frequently found in myxedema and , when present, are asymptomatic and usually of no hemodynamic consequence. We report a patient with ascites and pericardial effusion due to myxedema who developed cardiac tamponade following abdominal paracentesis. This case emphasizes that treatment of patients with myxedematous chronic pericardial effusions should include avoidance of those measurements which may reduce venous filling pressure or effective cardiac output regardless of the thyroid status.

Adult↗
PubMedDate not supplied

Developing a hospital report card to demonstrate value in healthcare.

The Sisters of Charity Health Care Systems, Inc., (SCHCS) developed methods to collect more than 290 data elements from its 15 hospitals to measure community benefit, illness prevention, patient satisfaction, severity of illness, appropriateness, traditional quality measures, outcome measures, maternal/child services, psychiatric services, efficiency, financial performance, and risk management. The data were compiled to produce a report card called the Hospital Quality Profile, which SCHCS hospitals now use for strategic quality planning, assessment, and monitoring. Collaboration between quality management, information systems, and financial department personnel is critical to the success of such a quality database.

Catholicism↗