Biomedical subjects
Publications and source records attributed to T Svoboda.
The authors report a case of an unusual abdominal tumor-mesenteric cyst. When it is found active surgical approach is recommended. Laparoscopic resection of the cyst is considered as the method of choice.
The authors present an account on the use of an intraluminal intestinal stent to treat early postoperative ileus. They demonstrate on a case-history the possibility to combine the tube inserted via jejunostomy and with laparostomy. In the discussion they deal also with the historical development of intubation of the small intestine and support of controlled adhesion formation.
The authors stress on the academic surgical departments the necessity of the development of both traditional and minimally invasive techniques of the groin hernia repair. They suggest to make patient selection based on the hernia type (Nyhus Classification) and patient's will and take account of an internal-anesthesiologic aspects. From four currently most often applied minimally invasive techniques they bring attention to the hernioplasty by exclusively extraperitoneal approach, till now seldom used by us.
It was the aim of this study to test for a possible effect of the new non ergot dopamine agonist CV 205-502 on plasma growth hormone (GH) concentrations in acromegaly. 10 acromegalic patients received a single oral dose of 150 micrograms CV 205-502 after an overnight fast. As a control group 7 acromegalic patients undertook the same procedure without receiving any drug. Blood samples were drawn hourly up to 7 hours thereafter for determination of GH. Plasma growth hormone concentrations decreased by 48.8 +/- 8.7%. The nadir was observed 3 hours after CV 205-502 was administered and GH concentrations remained suppressed throughout the 7 hours of the test period. In contrast GH plasma concentrations in the control group remained stable. We conclude that acute administration of CV 205-502 suppresses GH secretion in acromegalic patients and thus could serve as an alternative therapy in acromegaly.
Over the past decades, strong evidence has accumulated that growth hormone (GH) has immunostimulatory properties. Therefore, an investigation was conducted on 10 acromegalic patients and 9 age- and sex-matched healthy controls to determine whether plasma GH concentrations correlate with changes in several immune parameters, including serum concentrations of immunoglobulins, lymphocyte subsets, lymphocyte transformation with phytohemagglutinin (PHA), natural killer (NK) cell activity as well as phagocytic and metabolic burst activity. While NK cell activity, serum concentrations of immunoglobulins (IgG, IgM, IgA) and metabolic burst activity were within the normal range in both groups, a significantly enhanced phagocytic activity was observed in the acromegalic patients. Surface markers on T lymphocytes (CD3, CD4, CD8), B lymphocytes (CD19) and NK cells (CD16/56) were normal in both groups; however, in the acromegalic subjects, CD4+ and CD8+ cells showed a significant higher expression of transferrin receptors (CD71), indicating enhanced T-cell activity. The lymphocyte transformation response to PHA at the highest concentration tested showed a tendency to be elevated in acromegalics; however, the difference failed to be significant. Long-lasting and pronounced elevation of GH in acromegaly induces significantly enhanced phagocytic activity, but only negligible changes in most patients in lymphocyte phenotype and in the lymphocyte response to PHA.
The established pre-operative therapy for severe hypercalcemia caused by primary hyperparathyroidism (pHPT), i.e., rehydration with saline in combination with furosemide, calcitonin and hydrocortisone, rarely leads to satisfactory results. We examined the effect of pamidronate (APD, 45-60 mg), a diphosphonate of the 2nd generation in 6 patients (4 female, 2 male) with severe hypercalcemia caused by pHPT. Prior administration of saline, furosemide, calcitonin and oral diphosphonates of the 1st and 2nd generation had failed and the patients still suffered from symptoms of hypercalcemia. APD reduced serum calcium levels in all patients: values reached the normal range (2.1-2.6 mmol/l) in 3 patients, the upper normal range in 2 patients and fell transiently into the subnormal range in 1 patient. In parallel to the decreasing calcium levels a marked increase in PTH was registered in 4 out of 6 patients. One patient with an adenoma showed no change in PTH levels, whereas one patient with hyperplasia of 5 parathyroid glands showed a significant decrease in PTH. These results confirm the potent hypocalcemic effect of pamidronate even in patients whose serum calcium could not be reduced by other conservative therapeutic strategies. Thus, pamidronate is an effective drug in the treatment of the pre-operative phase of hypercalcemia caused by pHPT.
To assess the effect of chronically elevated plasma growth hormone (GH) levels on bone metabolism and bone mineral density (BMD), 16 patients (10 females and 6 males) with a mean age of 49.1 +/- 13.2 years (range 33-68) with active acromegaly were studied and compared to a control group of 16 sex- and age-matched subjects. BMD of the lumbar spine and two different sites of the proximal femur were measured by dual-energy x-ray absorptiometry (Norland XR-26). In the acromegalic patients the mean plasma GH concentration was 30.1 +/- 11.1 micrograms/liter, and the mean plasma somatomedin C (SMC) concentration was 6.5 +/- 1.5 U/liter. Mean serum osteocalcin (OC) levels (14.3 +/- 1.1 versus 7.2 +/- 0.4 ng/ml, p < 0.001) as well as the urinary hydroxyproline excretion (OHP; 8.8 +/- 1.4 versus 2.7 +/- 0.3 mg, p < 0.0001) were significantly higher in the acromegalic patients than in the control subjects. In the acromegalic patients BMD was significantly elevated in the two examined regions of the proximal femur, that is, the femoral neck (1.06 +/- 0.05 versus 0.86 +/- 0.03 g/cm2, p < 0.05) and Ward's triangle (0.92 +/- 0.06 versus 0.76 +/- 0.03 g/cm2, p < 0.02), whereas the BMD of the lumbar spine was not significantly different from that of control subjects. Among the patients with acromegaly a significant positive correlation between serum OC concentrations, on the one hand, and urinary OHP excretion (r = 0.7, p < 0.004) as well as BMD in the proximal femur (r = 0.64, p < 0.007), on the other hand, could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Prolonged decrease of elevated serum calcium levels after treatment with diphosphonates in patients with primary hyperparathyroidism (pHPT) is very rare. A patient with water clear cell hyperplasia and five enlarged glands is presented who received diphosphonates (day 1 through day 8 dichloromethylene diphosphonate orally and a single dose of 60 mg pamidronate on day 8 intravenously) leading to a significant fall in serum calcium levels. Surprisingly, there was no reactive increase in intact parathyroid hormone (PTH) in the following 18 days. Patients with missing PTH regulation to hypocalcemia after diphosphonates who need a period of stabilization prior to parathyroid surgery might benefit most from this therapy.
The successful therapeutic use of interferon-alpha (IFN-alpha) in myeloproliferative disorders offered the possibility to test its acute and long-term effects on the hypothalamic-pituitary-adrenal (HPA) axis in humans. ACTH and cortisol plasma concentrations were measured in 8 patients hourly starting from 4 p.m. through 12 p.m. on three occasions. The first time all patients were studied before initiation of therapy, when the vehicle was injected alone. The patients were studied again on day 1 of IFN-alpha therapy (5 million units) and once more after 3 weeks of therapy. On the control day, plasma concentrations of ACTH and cortisol were in the range expected for this time of day. In contrast, after the first administration of IFN-alpha a significant stimulation of the HPA axis was observed. After 3 weeks of IFN-alpha therapy, no significant stimulation of the HPA axis occurred after administration of IFN-alpha. IFN-alpha-induced adaptive changes in the HPA axis were also indicated by a significantly enhanced ACTH and cortisol response to exogenously administered supramaximal doses of corticotropin-releasing hormone (CRH) when the patients had been on IFN-alpha treatment for 3 weeks. To determine the exact locus of the IFN-alpha action, in vitro experiments were performed using rat hypothalamic organ and primary pituitary and adrenal cell culture systems. Thereby a significant stimulation of hypothalamic CRH secretion and rat adrenal corticosterone production was observed after INF-alpha at concentrations of 5 x 10(-8) M or 10(-7) M respectively. In contrast, no direct IFN-alpha effect on pituitary ACTH secretion could be observed in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)
Acromegaly is regarded as a cause for secondary osteoporosis, whereas recent papers suggest that growth hormone increases bone mineral density (BMD). In 16 patients with active acromegaly we found an increased BMD compared to normal controls in the lumbar spine and the proximal femur by means of dual energy X-ray absorptiometry. This increase in BMD was statistically significant in the femoral neck and in Ward's triangle (P = 0.05). Moreover, no signs of osteoporosis were found radiologically.
Plasma concentrations of Epidermal Growth Factor (EGF) in healthy control persons do not change significantly during adult lifetime and no diurnal changes could be detected. In addition, no alterations of plasma EGF concentrations occur during acute and chronic stress and in all three trimesters of pregnancy. Thus, the previously suggested theories that EGF might play a causative role in the activation of the hypothalamic-pituitary adrenal axis during the stress reaction and in the prevention of peptic ulcers in pregnancy could not be confirmed by the present data.
In vitro and in vivo studies in rodents and human suggested an immunostimulatory effect of prolactin. The aim of the present study was to determine the impact of chronically elevated serum prolactin concentrations on the immune system in patients with prolactinomas. For this purpose parameters of the humoral and cellular immune system were studied in seven patients with prolactinomas on two occasions (1) when their serum prolactin concentration had been normalized through treatment with dopamine agonists and (2) when their serum prolactin concentration was high. Serum concentrations of immunoglobulines, interleukin 1, 3 and 6, TNF-alpha, interferon-gamma and the soluble interleukin 2 receptor, leukocyte subsets and the natural killer cell activity were found to be within the normal range on both occasions, i.e. at normal and at high serum prolactin concentrations. The assumption could be made that long-lasting elevation of serum prolactin concentration induces adaptive changes when the acute stimulatory effects of prolactin on several parameters of the immune system have subsided.
The effect of acute exercise at three graded intensities on plasma growth hormone (GH) and prolactin (PRL) concentrations was examined in three groups of healthy male volunteers. According to their training status these subjects were divided into untrained, moderately trained and highly trained. A clear response of GH to exercise was registered already at an intensity of 50% of maximal oxygen uptake (VO2max) with a maximal response at 70% VO2max and no further effect at 90% VO2max. In contrast, no PRL response was observed at 50% VO2max, a small PRL rise was seen at 70% VO2max and the highest response occurred at 90% VO2max. Basal and exercise-stimulated plasma GH and PRL concentrations were similar in the three groups tested at similar relative workloads, suggesting that physical training induces adaptive changes whereby higher absolute workloads induce similar hormonal and metabolic changes. To examine a potential causative role of lactate in inducing the GH and PRL responses, sodium L-lactate was infused intravenously to normal sedentary volunteers at doses producing plasma lactate concentrations within the range of those seen between 70 and 90% VO2max. This resulted in a significant elevation of plasma GH and PRL concentrations, which, however, were smaller than those obtained at an exercise-induced matched plasma lactate concentration. We conclude that physical training causes adaptive changes in highly trained runners so that identical GH and PRL responses to exercise are recorded at higher absolute workloads. Lactate may be involved in the exercise-induced GH and PRL response; however, it does not appear to play an exclusive role.
The objective of the present paper was to obtain haematological and biochemical parameters of calves during their milk feeding. Another goal was to compare a current feed ration containing the commercial feed mixture Biosan with two alternative rations comprising skimmed milk and fat supplement. The effect of milk drink acidification and the effect of the physical form of fat added to skimmed milk were investigated. the calves were divided into six groups, by 6 to 8 calves each (P1-Biosan, PP1-acid variant, P2-skimmed milk+fat concentrate powder KMKS, PP2-acid variant, P3-skimmed milk+fat paste, PP3-acid variant). The highest average daily liveweight gains were recorded in calves fed on unacidified skimmed milk with fat paste supplement (1.074 kg)-Tab. I. The highest average daily liveweight gains were observed in calves fed on fat paste enriched milk drink (P3) while the calves administered milk with fat concentrate powder (P2) had only slightly higher average daily weight gains than the calves on Biosan diet (group P1). The growth of daily weight gains as a result of diets containing acidified milk (PP1 and PP2) is also a positive finding; this growth is even statistically significant in the former case (P < 0.05). The calves showed hypohaemoglobinaemia from the beginning of the experiment (51.3-69.0 g/l) and the low haematocrit value (0.29-0.43 l/l), Tab. II, while the plasma iron level was paradoxically high (Tab. V).(ABSTRACT TRUNCATED AT 250 WORDS)
Eleven patients (6 men, 5 women, mean age 42 [25-65] years) with prolactinomas were treated for 4-16 months with a new dopamine agonist (CV 205-502), at a daily dose of between 0.075 and 0.45 mg. All patients had previously undergone surgery and/or been treated with bromocriptine or lisuride, but had not tolerated this therapy well, and/or had not shown sufficient suppression of serum prolactin levels. Baseline prolactin levels were between 149 and 4120 ng/ml. During treatment, levels fell significantly in all patients, to between 2.0 and 683 ng/ml, and to within the reference range in five patients. In seven patients, the adenoma size decreased by 10 to greater than 50%. Adverse reactions were less frequent and less marked than with the prior therapy. The new dopamine agonist is an alternative treatment for prolactinomas where other therapies have been unsuccessful.
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Amylin is a 37-amino acid pancreatic polypeptide, probably involved in the pathophysiology of Type 2 (non-insulin-dependent) diabetes mellitus. We have determined amylin in human plasma by extraction-based radioimmunoassay (Sep-Pak C18). Of 23 healthy control subjects plasma amylin was determined as 11.9 +/- 3.5 ng/l. Of 27 patients with Type 2 diabetes receiving insulin the amylin levels were lower, and in 16 patients with Type 2 diabetes on oral medication they were higher than in the control subjects; 8.2 +/- 4.4 ng/l (p less than 0.01) vs 18.8 +/- 9.9 ng/l (p less than 0.05). In 14 Type 1 (insulin-dependent) diabetic patients we found extremely low mean amounts of amylin: 2.9 +/- 1.9 ng/l (p less than 0.002). Thus, basal amylin appears to be associated with the capacity to release insulin. An oral glucose load stimulated the release of amylin, this was more pronounced in patients with Type 2 diabetes than in healthy subjects. An excellent correlation of mean amylin with mean insulin concentrations was obtained (r = 0.949). In patients with Type 2 diabetes amylin was reduced congruent to decreases in C-peptide during a hyperinsulinaemic, euglycaemic glucose clamp experiment (r = 0.971 for linear correlation between C-peptide levels and amylin). We conclude, that amylin and insulin are co-secreted in humans, and that the amylin release is under feedback-control by insulin.
The purpose of this research was to establish the influence of 3 j Cx cellulase applied per gram of COT concentrate mixture, fed in combination with a milk diet acidified by formic acid to the value of pH 4.6, on calf growth performance in one metabolism and two field experiments. In the metabolism experiment two groups of calves, with six animals in each, were fed acidified whole milk, which was diluted stage by stage till weaning at 60 days of age. The average live weight gain in the control at the end of the milk feeding period, i.e. from 14 to 60 days of age, was 29.90 kg. This corresponds to a daily live weight gain of 0.650 g. The total live weight gain of male calves in the experimental group was 29.30 kg, corresponding to a daily live weight gain of 0.638 g (Tab. I). Tab. II shows the average feed and nutrient intakes per kg live weight gain. The calves which received the enzyme supplement tend to have the higher feed conversion rate. During the forage feeding period, i.e. from 61 to 90 days of age, the average daily live weight gains were 1.10 kg and 0.980 kg in the control and experimental groups, respectively (Tab. III). The average live weight of 90 days old male calves was 107.70 kg and 103.90 kg in the control and experimental groups, respectively. The amount of consumed nutrients (digestible protein and starch units); in relation to the total feed intakes, is lower in the experimental groups, which proves the higher feed conversion rate (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)