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Biomedical subjects

T Tulassay

Publications and source records attributed to T Tulassay.

At least 91 records · Page 5Linked to original sources
PubMed1991

Urinary catecholamine in children with diabetic ketoacidosis.

Urinary excretion of norepinephrine, epinephrine and dopamine was investigated in children with diabetic ketoacidosis. Besides pronounced hyperglycemia and metabolic acidosis, severe hypovolemia was also observed. At the onset of the study, urinary excretion of norepinephrine, epinephrine and dopamine was markedly elevated. Fluid replacement decreased urinary catecholamine excretion. Norepinephrine: 996 +/- 97 vs. 253 +/- 29; dopamine: 5,108 +/- 480 vs. 3,175 +/- 715; epinephrine: 402 +/- 81 vs. 77 +/- 200 pmol/min/1.73 m2. During ketoacidosis, there was a significant negative correlation between urinary norepinephrine excretion and endogenous creatinine clearance. Urinary output of both norepinephrine and dopamine correlated significantly with diuresis, while sodium excretion only correlated with dopamine excretion. Our data suggest that in diabetic ketoacidosis increased urinary excretion of norepinephrine may participate in renal hypoperfusion and hypofiltration. Elevated renal dopamine production contributes to sodium loss, characteristic for diabetic ketoacidosis.

Adolescent↗
PubMed1990

[The effect of somatostatin in dumping syndrome].

The effect of cyclic somatostatin on early and late dumping syndrome was studied in 12 patients with gastric resection. Each patient underwent two glucose challenges with 75 grams of glucose administered orally. In the control study isotonic sodium chloride was given, while in the other study cyclic somatostatin in a dose of 250 micrograms bolus injection followed by infusion of 80 ng/kg/min for a period of 270 minutes. In the control study all patients showed subjective symptoms of the early dumping syndrome with significant increases in pulse rate, hematocrit, and vasoactive intestinal polypeptide. Ten patients showed asymptomatic hypoglycemia, as a sign of the late dumping syndrome associated with a significant increases of insulin, gastric inhibitory peptide and glucagon levels. During the administration of somatostatin these changes failed to develop. These results indicate that somatostatin alleviates the symptoms of early and late postprandial dumping syndrome.

Dumping Syndrome↗
PubMed1990

[Atrial natriuretic peptide in dumping syndrome].

The significance of atrial natriuretic factor (ANF) was investigated in the maintenance of the fluid volume in hypovolemia associated with dumping syndrome following gastric resection. The study was performed on 10 patients with Billroth II procedure. Ten age and sex matched patients--without previous gastric surgery served as controls. Each patient underwent oral glucose challenge. The patients following gastric resection underwent an other glucose challenge with intravenous infusion for the maintenance of the fluid volume. All patients with gastric resection showed subjective symptoms of the early dumping syndrome with significant (p less than 0.001) increases in heart rate and in hematocrit, while plasma ANF level decreased significantly (p less than 0.01). Significant negative correlation was found between the changes in hematocrit and the changes in plasma ANF level (r = -0.89; p less than 0.001). Neither the subjective symptoms characteristic for early dumping syndrome, nor changes in the laboratory parameters were noted in the patients during the challenge with infusion. The results show that the hypovolemia in dumping syndrome is associated with significant decreased ANF activity, and in the regulation of ANF release besides the well known stimulating effect of hypervolemia, there exists an inhibition of secretion in volume depleted states.

Atrial Natriuretic Factor↗
PubMed1990

Urinary prostaglandins in hyperglycaemic ketoacidosis of type I diabetes mellitus.

Urinary excretion of various renal prostaglandins was measured by radioimmunoassay and gas chromatography-mass spectrometry in children who had different degrees of metabolic control. Excretion in PGE2 in diabetic children was twice control values irrespective of the presence or absence of diabetic ketoacidosis (DKA). The urinary excretion of PGF2 alpha was significantly increased in diabetic children with ketoacidosis, but not when diabetes was well controlled. The excretion of 13, 14 dihydro-15-keto PGE2, the major metabolite of circulating PGE2, was increased in all diabetic children, and was most elevated in ketoacidosis when it averaged 10 times basal excretion. Urinary excretion of PGF2 alpha and of 6-keto-PGF1 alpha, the metabolite of PGI2, was approximately doubled in DKA compared with values from healthy subjects. Excretion of PGE2 was twice control values in children with stable diabetes, whereas the equivalent value for TXB2, the metabolite of the active vasoconstrictor TXA2, was reduced by approximately 50%. We suggest that the increased excretion of prostacyclin metabolite may result from a protective biological action on the kidney opposing other vasoconstrictor hormone activity. PGE2 appears not to be involved in this process. The highly elevated excretion of PGE2 metabolite may represent an activation of systemic PGE metabolism during DKA.

Adolescent↗
PubMed1990

Reduced glomerular filtration and elevated urinary protein excretion in diabetic ketoacidosis.

Glomerular filtration rate (GFR) was measured by two methods in 9 children with diabetic ketoacidosis (DKA), directly by true creatinine clearance and indirectly by means of serum beta-2-microglobulin levels. We found significantly reduced GFR in the first hours of DKA. The rapid improvement in GFR after fluid and electrolyte replacement indicates that volume depletion is the major cause of low filtration rate. In spite of the reduced GFR we observed pronounced albuminuria and low molecular weight (LMW) proteinuria. We conclude that the pathological albuminuria and microalbuminuria in DKA are caused not by glomerular hyperfiltration but by tubular dysfunction.

Adolescent↗
PubMed1990

Changes in plasma concentrations of atrial natriuretic peptide during exchange transfusion in premature infants.

Plasma concentrations of atrial natriuretic peptide (ANP) and hemodynamic parameters were investigated in five premature infants undergoing exchange transfusion. Baseline values of ANP were 51.7 +/- 21.2 fmol/ml. Volume depletion by withdrawal of 10 ml blood did not cause changes in systolic blood pressure (79.4 +/- 4.3 vs. 71.4 +/- 5.6 mmHg) and heart rate (115 +/- 5.2 vs. 115 +/- 2.4 b/min). ANP levels in plasma remained unaltered (53.4 +/- 24.9 fmol/ml). Replacement of 10 ml blood increased central venous pressure by 33% and ANP concentration in the plasma by nearly 30%, while heart rate and blood pressure remained unchanged. Our data indicate that the heart of the premature infant responded to acute blood replacement with increased ANP-release, while blood removal appeared not to influence hormone regulation.

Atrial Natriuretic Factor↗
PubMed1990

Atrial natriuretic peptide, volume and blood pressure regulation during exchange transfusion of the neonates.

Plasma concentrations of atrial natriuretic peptide (ANP) and hemodynamic parameters were investigated in five premature infants undergoing exchange transfusion. Baseline values of ANP were elevated being 51.7 +/- 21.2 fmol/ml. Volume depletion by withdrawal of 10 ml blood did not cause changes in systolic blood pressure (79.4 +/- 4.3 vs 71.4 +/- 5.6 mmHg) and heart rate (115 +/- 5.2 vs 115 +/- 2.4 l/min). ANP levels in plasma remained unaltered (53.4 +/- 24.9 fmol/ml). Volume load of 10 ml blood transfusion increased central venous pressure by 33 per cent and ANP concentration in the plasma nearly by 30 per cent, while heart rate and blood pressure remained unchanged. Our data indicated that the heart of premature infant responds to acute volume load by increased ANP-release, while volume depletion seems not to influence hormone regulation.

Atrial Natriuretic Factor↗
PubMed1990

Cerebrospinal fluid concentrations of atrial natriuretic peptide in children.

Concentrations of atrial natriuretic peptide (ANP) in plasma and in cerebrospinal fluid (CSF) were measured in preterm neonates, in infants and in children with hydrocephalus. Plasma ANP in preterm neonates were elevated compared to infants and children with hydrocephalus. CSF-ANP in all groups were lower than plasma levels. ANP concentrations in the liquor exhibited higher values in children with hydrocephalus. No correlation was found between plasma and CSF-ANP levels while CSF-pressure and ANP concentration in the liquor correlated positively. Our data provide evidence for the existence of a cerebral ANP system in humans. The CSF-ANP system seems to be independent from the systemic, atrial ANP. CSF-ANP may be of great importance in the regulation of water and ion content of central nervous system and probably liquor formation.

Atrial Natriuretic Factor↗
PubMed1990

Atrial natriuretic peptide in patients with decompensated hepatic cirrhosis.

Plasma concentrations of atrial natriuretic peptide (ANP), aldosterone (PA), vasopressin (AVP) and plasma renin activity (PRA) were measured in 15 patients with decompensated cirrhosis of the liver during a control period and subsequently during intravenous administration of albumin. Infusion of hyperoncotic albumin increased diuresis, natriuresis, stimulated ANP secretion and tended to normalize other vasoactive hormone levels in 9 patients (responders), whereas it had no effect in 6 other patients (non-responders). Responders had significantly lower basal levels of ANP and higher ones of PRA, and AVP than non-responders, suggesting that responders had decreased effective intravascular volume. Our data suggest that cirrhotic patients with ascites formation do not represent a homogenous group. In some patients with decompensated cirrhosis a compromised circulatory state with decreased effective circulatory volume induces compensatory changes in several regulatory hormones. It appears that secondary alterations in the plasma concentrations of ANP of cirrhotic patients may occur according to the suspected change of intravascular fluid volume.

Aged↗
PubMed1989

[Fluid and electrolyte balance in the postoperative period].

Authors investigated the concentration changes of arginine vasopressin (AVP) and of atrial natriuretic peptide (ANP) in plasma. The renal characteristics of water- and sodium metabolism in the first 24 hours of the postoperative period in 11 children operated with acute appendicitis have been studied. Crystalloid infusion was applied in 60 ml/kg/24 h dose, in 5 cases however, 1 g/kg albumin vas also administered during the operation. In children getting crystalloid infusion (group "A") the initial AVP value was 29.9 +/- 8.8 pg/ml, which further increased to 58.2 +/- 15.2 pg/ml (p 0.05) by the 6. postoperative hour and even in the 24. hour it remained above the physiological value (19.9 +/- 5.3 pg/ml). During the observation time significant Na- and water retention developed. The albumin administration (group "B") stopped the further increase of AVP values, the Na-household remained in equilibrium and the water retention developed only in smaller degree. The ANP plasma concentration of both groups was in the normal range and did not change during observation time. Our data show that for the postoperative water retention first of all the increased AVP activity is responsible. The more intensive AVP secretion may be induced by the relative intravascular hypovolemia since by enhancing the plasma volume the further increase of postoperative hormone activity could be prevented.

Female↗
PubMed1989

[Determination of the degree of saturation of calcium hydrogen phosphate in the urine].

Calcium-hydrogen-phosphate (CaHPO4) was considered as one of the main factors governing renal calculus formation. The degree of saturation (expressed as activity product) with respect to this phase was therefore calculated in urines of 36 hypercalciuric children (20 absorptive, 16 renal subtype) with isolated hematuria, 10 renal stone patients, and 30 healthy controls. On low calcium diet 12 children of the absorptive hypercalciuric-, 13 of the renal hypercalciuric and 7 of the renal stone forming children hat their urines in the saturated zone --irrespective of the evolution of hypercalciuria Ca/cr ratio. Thiazide normalised the activity product in all groups. The use of the Ca/cr ratio as the sole parameter in the investigation of children with isolated hematuria and hypercalciuria or calcium nephrolithiasis is therefore insufficient, simultaneous determinations of the state of saturation of urines is recommended. This technique should also allow a quantitative assessment of the various therapeutic regimens recommended.

Adolescent↗
PubMed1989

Long acting somatostatin analogue in dumping syndrome.

The effect of long acting somatostatin analogue, SMS 201-995, on postprandial dumping syndrome was studied in eight patients with Billroth II gastric resection. Each patient was subjected to two oral glucose challenges with 75 g glucose. One challenge was premedicated with 50 micrograms SMS 201-995 subcutaneously 15 min before the oral intake of glucose, the other with placebo. With placebo all patients experienced the subjective symptoms of the early dumping syndrome with significant (P less than 0.001) increases (mean (s.d.)) in pulse rate (from 66 (8) to 102 (10) beats/min), in packed cell volume (from 0.36 (0.05) to 0.43 (0.1) l/l) and in the plasma levels of vasoactive intestinal polypeptide (from 3.0 (0.5) to 10.2 (1.8) pmol/l). During the somatostatin study the subjective symptoms and the changes in the various parameters were not detected. In the control study seven patients showed postprandial hypoglycemia. In these patients significant elevations (P less than 0.001) in the insulin level (from 10 (0.9) to 40 (9.1) microE/ml) and gastric inhibitory peptide (GIP) concentration (from 100 (13) to 220 (41) ng/l) were seen, compared with the initial values. During the application of SMS 201-995 hypoglycaemia did not develop and plasma insulin and GIP concentrations remained unchanged. These results indicate that the long acting somatostatin analogue alleviates the symptoms of early and late postprandial dumping syndromes.

Double-Blind Method↗
PubMed1989

Atrial natriuretic peptide and sodium homeostasis in chronic renal failure.

In order to evaluate the possible role of vasoactive hormones in the mechanism of exaggerated sodium loss due to reduced renal mass we measured plasma concentration of atrial natriuretic peptide (ANP), aldosterone, plasma renin activity (PRA), plasma noradrenaline, and dopamine, in 12 children with advanced chronic renal failure (mean CIn 17.8 +/- 2.6, mean +/- SEM, CPAH 93.5 +/- 17 ml/min per 1.73 m2, FENa 7.0 +/- 0.95%). No patient had clinical signs of volume overload. Plasma concentrations of ANP were not significantly different from those of healthy age-matched controls (29.2 +/- 7.2 vs 23.2 +/- 3.1 fmol/ml) and did not correlate with urinary sodium excretion. Plasma concentrations of aldosterone, PRA and noradrenaline, were also within the physiological range, while plasma dopamine levels were elevated (260 +/- 36 vs 98 +/- 11 pg/ml, less than 0.001). Our data do not support the notion that ANP or the renin-aldosterone axis play a major role in the adaptation of remaining nephrons to maintain long-term sodium balance in normotensive children with chronic renal failure.

Adaptation, Physiological↗