Stimulation Testing (stimulation + testing)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study

A Katsarou-Katsari
Abstract Background, Acquired cold urticaria (ACU) represents a heterogeneous group of disorders that share a common clinical feature: the development of urticaria or angioedema after cold exposure. We present epidemiological and clinical data of subjects with ACU, natural progression and we examine possible parameters that could correlate with disease severity. Methods, During a 10-year period in all subjects with ACU, detailed record of personal history, laboratory testing, cold stimulation testing (CST), atopy assessment and disease severity took place. In a re-evaluation visit at the end of the surveillance period, ACU progression was assessed from patients in a subjective way. Results, Four thousand one hundred fifty-seven individuals with chronic urticaria were referred, and 352 (198 males, 154 females, 8.47% of patients with chronic urticaria) presented definite symptoms of physical urticarias, while 95 individuals (49 males, 46 females, 27% of patients with physical urticarias) were detected with ACU. Sixty-two participants were included in study analysis. Thirty-two patients (51.6%) were female; the mean age was 41.5 15.6 years, while the mean age at disease onset was 32.5 15.6 years; half were , 30 years old at disease onset. The mean duration of surveillance was 9.0 6.9 years. During this time interval, 18 patients (29.0%) showed the same or even worse symptomatology, 26 patients reported some improvement (41.9%), while in 18 patients, symptoms resolved completely (29.0%); the mean time to resolution was 5.6 3.5 years. Disease severity was the only variable statistically significantly related to disease progression (P = 0.004). Conclusions, Cold urticaria is a chronic persistent disorder with occasional severe clinical manifestations. [source]

Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method

Summary Background, Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity, but methods of withdrawal are not well described. Aim, To assess the effectiveness of a corticosteroid withdrawal method. Methods, Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn's disease), median age 53.5 years (range 29,75) were included. IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS) and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean. Results, Median durations for disease and corticosteroid dependency were 21 (range 3,45) and 14 (range 2,45) years respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5,73). Disease flares occurred in two patients, CWS in five and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (P = 0.056). Conclusions, Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients. [source]

Comparison of 2 Doses of Recombinant Human Thyrotropin for Thyroid Function Testing in Healthy and Suspected Hypothyroid Dogs

F.S. Boretti
Background: Various protocols using different doses of recombinant human thyrotropin (rhTSH) in TSH stimulation testing have been described. However, the influence of TSH dosage on thyroxine (T4) concentration has not yet been evaluated in suspected hypothyroid dogs. Objective: To evaluate the effectiveness of 2 doses of rhTSH. Animals: Fifteen dogs with clinical signs consistent with hypothyroidism and abnormal stimulation results with 75 ,g rhTSH and 18 clinically healthy dogs. Methods: All dogs were stimulated with 75 and 150 ,g rhTSH IV in a 1st and 2nd stimulation test, respectively. Blood samples were taken before and 6 hours after rhTSH administration for determination of total T4 concentration. Results: Using the higher dose led to a normal test interpretation in 9 of the 15 dogs, in which stimulation had been abnormal using the lower dose. Based on follow-up information, hypothyroidism was excluded in 7 of these 9 dogs. In all 6 dogs with a blunted response to the higher dose, hypothyroidism could be confirmed. Healthy dogs showed significantly higher post-TSH T4 concentrations with the higher compared with the lower dose. Post-TSH T4 concentrations after TSH stimulation were not related to dogs' body weight in either healthy or diseased dogs. Conclusions and Clinical Relevance: TSH dose significantly influenced test interpretation in suspected hypothyroid dogs. Differentiation between primary hypothyroidism and nonthyroidal disease was improved with 150 ,g rhTSH. Because this effect was independent of the dogs' body weight, the higher dose is recommended in dogs that have concurrent disease or are receiving medication. [source]

Evaluation of Adrenal Suppression of a Lipid Enhanced, Topical Emollient Cream Formulation of Hydrocortisone Butyrate 0.1% in Treating Children with Atopic Dermatitis

Lawrence Eichenfield M.D.
In the pediatric population however, the potential impact of adrenal suppression is always an important safety concern. Twenty boys and girls, 5,12 years of age, with normal adrenal function and a history of atopic dermatitis were maximally treated three times daily with a lipid-rich, moisturizing formulation of hydrocortisone butyrate 0.1% for up to 4 weeks. At the conclusion of the 4-week treatment period, cosyntropin injection stimulation testing showed no evidence of adrenal suppression. In addition, the therapy was noted to be highly efficacious, with a clinical success rate of 80% (Physician Global Score of (0) clear or (1) almost clear). No local side effects associated with prolonged use of topical corticosteroids were reported. In summary, this study supports the contention that this lipid-rich, moisturizing formulation of hydrocortisone butyrate 0.1% was a well-tolerated and beneficial treatment for atopic dermatitis, demonstrating no adrenal suppression in the pediatric population aged 5,12 years. The relevance of these findings for children below 5 years of age, because of difference in body mass/surface area ratios, remains to be determined. [source]

Trilostane treatment in dogs with pituitary-dependent hyperadreno-corticism

Objective To evaluate the efficacy of trilostane in treating dogs with pituitary-dependent hyperadrenocorticism. Design Prospective clinical trial using client-owned dogs with pituitary-dependent hyperadrenocorticism treated at University Veterinary Centre, Sydney from September 1999 to July 2001. Procedure Thirty dogs with pituitary-dependent hyperadrenocorticism treated with trilostane, a competitive inhibitor ,-HSD, were monitored at days 10, 30 and 90 then 3-monthly by clinical examination, tetracosactrin stimulation testing, urinary corticoid:creatinine ratio measurement and by client questionnaire. Results Twenty-nine of 30 dogs were successfully treated with trilostane (median dose 16.7 mg/kg; range 5.3 to 50 mg/kg, administered once daily); one responded favourably but died of unrelated disease before full control was achieved. Conclusion Trilostane administration controlled pituitary-dependent hyperadrenocorticism in these dogs. It was safe, effective and free of side-effects at the doses used. Most dogs were initially quite sensitive to the drug for 10 to 30 days, then required higher doses until a prolonged phase of stable dose requirements occurred. Urinary corticoid:creatinine ratio was useful in assessing duration of drug effect. Some dogs treated for more than 2 years required reduction or temporary cessation of drug because of iatrogenic hypoadrenocorticism. [source]

Relationship of peak growth hormone to cardiovascular parameters, waist circumference, lipids and glucose in HIV-infected patients and healthy adults

Janet Lo
Summary Objective, Relative growth hormone (GH) deficiency is highly prevalent in patients with HIV. The purpose of this study was to investigate relationships of GH to metabolic and anthropometric parameters in HIV patients and non-HIV controls. Design, Peak GH and metabolic parameters were assessed in a cross-sectional study of 191 HIV patients and 62 age and BMI-matched healthy controls. Methods, Peak GH was assessed by GHRH/arginine stimulation testing. Results, HIV patients demonstrated similar BMI, but increased waist circumference (WC) and reduced peak GH to GHRH/arginine compared with control subjects [median = 124 (interquartile range: 63,248) vs. 213 (88, 345) ,g/l, P = 0006, HIV vs. control]. Among HIV and non-HIV groups, peak GH was inversely associated with WC (rho = ,044, P < 00001; rho = ,063, P < 00001; HIV patients and controls, respectively), blood pressure (rho = ,017, P = 002; rho = ,036, P = 0004), triglycerides (rho = ,037, P < 00001; rho = ,043, P = 0001), glucose (rho = ,034, P < 00001; rho = ,030, P = 002), insulin (rho = ,043, P < 00001; rho = ,060, P < 00001) and CRP (rho = ,029, P < 00001; rho = ,059, P < 00001). Among HIV patients, the inverse association between peak GH and fasting glucose remained significant (, = ,0006 mmol/l change in glucose per ,g/l change in GH, P = 0004) controlling for age, gender, race, BMI, WC, protease inhibitor (PI) and nucleoside reverse transcriptase inhibitors. Similarly, the inverse association between peak GH and triglycerides remained significant (, = ,001 mmol/l change in triglycerides per ,g/l change in GH, P = 002) controlling for age, gender, race, BMI, WC, PI and lipid-lowering medications. HIV men with peak GH < 75 ,g/l demonstrated higher BMI, WC, SBP, triglycerides, glucose and CRP. Conclusions, Reduced GH secretion is independently associated with dyslipidaemia and higher glucose, among HIV patients with abdominal fat accumulation. [source]