Home About us Contact
|
Home About us Contact | ||
|
|
||
Substitution Therapy (substitution + therapy)
Selected AbstractsAcquired von Willebrand's syndrome resulting from untreated hypothyroidism in two prepubertal girlsHAEMOPHILIA, Issue 6 2006A. GALLI-TSINOPOULOU Summary., Acquired von Willebrand syndrome (AvWS) is a rare bleeding disorder associated with a number of different diseases, including hypothyroidism. We describe two prepubertal girls with AvWS and undiagnosed hypothyroidism due to thyroiditis Hashimoto. The patients had neither family history nor symptoms of bleeding disorders. Substitution therapy with levothyroxine led to normalization of the coagulation parameters. We report these cases in order to raise awareness among paediatricians so that the AvWS should be suspected and searched for with the appropriate laboratary tests in all cases of hypothyroidism. Moreover, patients with bleeding diathesis of unknown origin should also be investigated for hypothyroidism. [source] Patients' help-seeking behaviours for health problems associated with methadone and buprenorphine treatmentDRUG AND ALCOHOL REVIEW, Issue 4 2008ADAM R. WINSTOCK Abstract Introduction and Aims. Clients in opioid substitution therapy often have considerable unmet health-care needs. The current study aimed to explore health problems related to opioid substitution therapy among clients on methadone and buprenorphine treatment. Design and Methods. A self-complete, cross-sectional survey conducted among 508 patients receiving methadone and buprenorphine treatment at community pharmacies in New South Wales (NSW), Australia. Results. The most common problems for which participants had ever sought help were dental (29.9%), constipation (25.0%) and headache (24.0%). The most common problems for which participants would currently like help were dental (41.1%), sweating (26.4%) and reduced sexual enjoyment (24.2%). There were no significant differences between those currently on methadone and those currently on buprenorphine for any of the health problems explored, nor differences for gender or treatment duration. Participants on methadone doses 100 mg or above were significantly more likely to want help currently for sedation. Discussion and Conclusions. The considerable unmet health care needs among participants in this study suggest that treatment providers should consider improving the detection and response to common health problems related to opioid substitution therapy. [source] Commentary on Larney (2010): A call to action,opioid substitution therapy as a conduit to routine care and primary prevention of HIV transmission among opioid-dependent prisonersADDICTION, Issue 2 2010SANDRA A. SPRINGER No abstract is available for this article. [source] Influence of factor VIII:C and factor IX activity in plasmas of haemophilic dogs on the activated partial thromboplastin time measured with two commercial reagentsHAEMOPHILIA, Issue 3 2000R. Mischke The present study is based on 145 plasma samples with a reduced activity of factor VIII:C (range: 0.009,0.62 IU mL,1) and 28 samples with a reduced factor IX activity (range: 0.035,0.55 IU mL,1). The samples were collected from dogs with haemophilia A (n=22) or haemophilia B (n=3), some of these during substitution therapy. For all samples the activated partial thromboplastin time (APTT) was measured with two commercial reagents containing kaolin as a contact activator. In each case, the deficiency of factor VIII:C or IX was reflected in abnormal results of the APTT. This was true for both reagents. A significant correlation (P < 0.001) was found between factor VIII:C activity and APTT (reagent 1, Pathromtin®; Spearman's rank correlation coefficient, rS=,0.731, reagent 2, PTT-Reagenz; rS=,0.875) as well as between factor IX activity and APTT (reagent 1, rS=,0.819; reagent 2, rS=,0.955]. In each case, the relationship between coagulation factor activity and APTT could be proven most precisely by geometric regression. The results of this study illustrate the applicability of commercial APTT test kits as a sensitive screening test of factor VIII:C and IX deficiencies in canine plasma. [source] Reconstruction of the pancreatic duct after pancreaticoduodenectomy: A modification of the Whipple procedureJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2001Stylianos Katsaragakis MD Abstract Background and Objectives: Pancreaticoduodenectomy is still associated with high morbidity and mortality even though there has been significant progress in the field of pancreatic surgery and postoperative follow-up. The pancreatoenteric anastomosis, regardless of the technique used, is a major cause for both morbidity and mortality after Whipple procedure. To overcome all problems resulting from anastomotic leakage, we used external drainage of the pancreatic duct. Methods: In 24 patients who underwent pancreaticoduodenectomy in our Department from 1986 to 1995, a modification to the standard Whipple procedure was performed. Instead of pancreaticoenteric anastomosis, external drainage of the pancreatic duct remnant was performed. The pancreatic duct was intubated with a silastic tube, the external end of which was sutured to the skin. All patients received substitution therapy with pancreatic enzymes. Results: Mortality in our group of patients was 4%. No complications due to the external drainage of the pancreatic duct were reported, while no patient developed diabetes mellitus after surgery. Conclusions: External drainage of the pancreatic duct remnant can be used alternatively to pancreatoenteric anastomosis after pancreatoduodenectomy. The technique is safe and simple to perform and appears to reduce overall operative time. It may be an option for patients with significant comorbidity and/or intraoperative hemodynamic instability which mandates expeditious completion of the operation. J. Surg. Oncol. 2001; 77:26,29. © 2001 Wiley-Liss, Inc. [source] 24 Electrogastrography EGG in pancreas diabetesNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2006E SCHAFER Background:, Timing and criteria of testing for gastric dysmotility in pancreatic diabetes is not well established. Aim:, To investigate the pattern of EGG and autonomic neuropathy (AN) in patients with pancreas diabetes mellitus to clarify the relationship between autonomic neuropathy, alcohol consumption, glucose homeostasis, diabetes duration, and EGG. Patients and methods:, Thirty patients with pancreas diabetes mellitus were enrolled into the study. Mean duration of diabetes mellitus was 11 (0,25) years, mean blood glucose levels: 8.13 ± 2.7 mmoll,1, HbA1c 8.3 ± 2.96%; 25/30 patients were treated with insulin, the others were on rigorous diet, all of them received high dose pancreatin substitution therapy. Ten matched controls without diabetes and pancreatic insufficiency were also examined. AN was evaluated by the cardiovascular reflex tests according to the Ewing's criteria (Diab. Care 8 (5): 491,497, 1985.), EGG was monitored for 30,30 min in both fasting and in postprandial states, using a Digitrapper EGG (Synectic Med., Stockholm). EGG rhythm disturbances (bradygastria: 0,2 cpm, tachygastria: 4,10 cpm) and meal evoked EGG signal amplitude (power) changes were determined. Results:, 9/30 pts had mild to moderate parasympathetic AN, 1/30 pts had sympathetic AN, 5/30 pts had both parasympathetic and sympathetic AN; 17/30 pts demonstrated myoelectric abnormalities: 5/30 pts had predominant bradygastria, 3/30 tachygastria, and in other 9/30 pts only an absence of increase in the postprandial signal amplitude was found. Overall, 7/30 pts with abnormal EGG did not demonstrated AN. Abnormal EGG showed no correlation with actual blood sugar values or HbA1c, but it was associated with diabetes duration more than 10 years. Conclusion:, Our results suggest that beside neuropathy other factors such as alcohol toxicity, sympathetic and parasympathetic imbalance or long-term inappropriate glucose metabolism may be involved in the gastric myoelectric abnormalities provoked by pancreas diabetes. [source] Relationship between serum leptin and thyroid hormones in childrenPEDIATRICS INTERNATIONAL, Issue 3 2000MAKOTO UCHIYAMA, Tadashi Asami TATIANA CIOMARTEN Abstract Background: Because leptin decreases food intake and increases energy expenditure, the possible influence of thyroid status on the leptin system has been investigated mainly in adults and animals. However, the data available at present are very confusing. The aim of the present study was to assess the possible interaction of thyroid hormones with the leptin system. Methods: Serum free thyroxine (FT4), a biologically active thyroid hormone, and thyroid stimulating hormone (TSH), a sensitive and reliable index of thyroid status, were examined in 51 children (19 males, 32 females) with mass screening-detected congenital hypothyroidism on continuous L -thyroxine (L-T4) substitution therapy. The subjects were divided into younger (n=35, aged 1 month , 5 years) and older (n=16, 6 years , 11 years) children groups. Serum levels of leptin and thyroid hormones were measured in the subjects. Body mass index (BMI) was estimated by the formula bodyweight (kg)/height`height (m 2), which is known as the Kaup index in younger children and BMI in older children and adults. Results: In the younger children group, serum leptin levels showed no correlation with serum TSH, FT4 or T4. In the older children group, serum leptin concentrations significantly correlated with T4 (r=0.510, P<0.05) and BMI (n=16, r=0.647, P<0.01), but not with TSH or FT4. Conclusion: The role of thyroid hormones in modulating leptin synthesis and secretion seems to have little, if any, clinical or biological relevance. [source] Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy?PRENATAL DIAGNOSIS, Issue 2 2003Jean-Marie Jouannic Abstract Objective The aim of this study was to evaluate the role of amiodarone for the prenatal treatment of hydropic fetuses with supraventricular tachycardia. Methods A group of 26 hydropic fetuses with supraventricular tachycardia was studied retrospectively. Results Twenty-five fetuses received transplacental treatment. The overall prenatal conversion rate was 60%. Nine fetuses were converted to sinus rhythm using either flecainide (n = 7) or amiodarone (n = 2) as first line therapy, whilst digoxin alone or in association with sotalol failed to restore sinus rhythm in all cases. After first-line therapy, supraventricular tachycardia persisted in 10 fetuses. Nine fetuses received amiodarone alone or in association with digoxin as second-line therapy, five of whom were converted to sinus rhythm. Among the 11 live neonates treated by amiodarone in utero, 2 (17%) presented an elevated thyroid stimulating hormone at day 3,4. These two infants received thyroid hormone substitution therapy and had a normal outcome. Conclusion When first-line therapy fails to restore sinus rhythm in hydropic fetuses with supraventricular tachycardia, amiodarone therapy should be considered as it allows a substantial number of fetuses to be converted prenatally. Copyright © 2003 John Wiley & Sons, Ltd. [source] Decreased drug-cue-induced attentional bias in individuals with treated and untreated drug dependenceACTA NEUROPSYCHIATRICA, Issue 4 2009Simona Gardini Objective: The present study investigated the attentional bias induced by drug-related stimuli in active abusers; abstinent abusers on opioid substitution therapy; and abstinent drug-dependent patients in recovery on a community-based non-pharmacological therapy programme. Drug-dependent groups included both cocaine and heroin abusers. Methods: Classical and emotional Stroop tasks were used to test all drug-dependent patients and controls with no history of addiction. Response times were recorded. An interference effect was obtained by comparing the congruent and incongruent conditions in the classical Stroop version. An attentional bias towards drug cues was derived by comparing latencies in the neutral and emotional conditions of the emotional Stroop. Results: No between-group differences were found in the classical Stroop. In the emotional Stroop, active drug-dependent patients showed higher attentional bias (i.e. longer response times to drug-related words) than any of the other three groups. Conclusion: The attentional bias induced by drug cues in patients with addiction disorder might change depending on the patients' clinical status. All treated patients, whether on opioid substitution therapy or on community therapy, showed less attentional bias towards drug-related stimuli than active drug users, although the observed smaller bias was most likely induced by therapy acting through different mechanisms. Although drug-cues response is influenced by other multiple variables, e.g. motivation, craving, classical conditioning and substance availability, these data lend support to the hypothesis that treatment might contribute to decrease the attentional bias towards drug cues, which seems to play a critical role in achieving a positive outcome in the treatment of addiction. [source] Adiponectin levels are high in children with classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiencyACTA PAEDIATRICA, Issue 5 2009Thomas MK Völkl Abstract Objective: It has been shown that adiponectin serves as an insulin-sensitizing adipokine. Serum concentrations of adiponectin are low in children with obesity, and increase with fat mass loss, indicating that adiponectin can serve as a biomarker. Since the prevalence of overweight and obesity is increased in children with congenital adrenal hyperplasia (CAH), our study aimed to evaluate serum levels of adiponectin in a cohort of CAH children and adolescents, and their associations with clinical parameters such as chronological age (CA), body mass index (BMI), Tanner stage (TS), medication and metabolic control. Patients and methods: We studied 51 patients, aged between 5.6 and 19.6 years (median 11.8; 30 females, 21 males), cross-sectionally. All patients had genetically confirmed CAH and received standard steroid substitution therapy. Adiponectin was measured by an enzyme linked immunoassay. Since BMI SDS of the CAH cohort were significantly higher compared to the reference population, we built matched pairs with healthy Caucasian subjects from a normal representative cohort for sex, Tanner stage, chronologic age and BMI. Results: Adiponectin concentrations were significantly higher in CAH patients (median 11 ,g/L) compared to the matched controls (6.7 ,g/L, p < 0.0001). Correlation analyses in CAH patients revealed a significant inverse relationship between adiponectin and CA, TS, BMI, serum DHEAS and serum testosterone, but no correlation with hydrocortisone and fludrocortisone dosage. Conclusion: Currently, the importance of the elevated adiponectin concentrations in CAH children for risk assessment is not clear. However, our data imply that besides adequate metabolic control of glucocorticoid substitution, a long-term follow-up of other metabolic markers of insulin resistance should be conducted in CAH patients. [source] Effects of T4 replacement therapy on glucose metabolism in subjects with subclinical (SH) and overt hypothyroidism (OH)CLINICAL ENDOCRINOLOGY, Issue 6 2008Ammon Handisurya Summary Objective To evaluate ,-cell function and insulin sensitivity in subjects with overt (OH) and subclinical hypothyroidism (SH) before and after T4 replacement therapy. Background Disturbances in glucose metabolism have been observed in hypothyroid states. However, the clinical significance and potential reversibility of these alterations by T4 replacement therapy remain to be elucidated especially in patients with SH. Design and patients Parameters of glucose metabolism have been investigated in subjects with OH (n = 12) and SH (n = 11). Insulin sensitivity has been assessed by the euglycaemic,hyperinsulinaemic clamp technique and ,-cell function by mathematical modelling of data derived from an oral glucose tolerance test. Results Fasting and dynamic glycaemia as assessed by the AUCGlucose remained unaltered following substitution therapy (P > 0·05). Insulin sensitivity significantly improved only in subjects with OH (P < 0·05). Fasting insulin and proinsulin concentrations increased proportionally in both groups (P < 0·05) with the proinsulin : insulin ratio remaining unchanged (P > 0·05). Total insulin secretion was higher in OH before initiation of therapy (P < 0·05). In both groups, dynamic parameters including total insulin secretion, hepatic insulin extraction and the adaptation index were significantly attenuated (P < 0·05) after restoration of thyroid function, whereas the disposition index and the basal insulin secretion rate remained unaltered (P > 0·05). Conclusion In summary, SH and OH are characterized by attenuated basal plasma insulin levels and increased glucose-induced insulin secretion. T4 replacement therapy partially ameliorates the insulin secretion profile and reduces the demand on pancreatic ,-cells after glucose challenge to an extent that exceeds any effect attributable to the improvement in insulin sensitivity. [source] Effects of 10 years of growth hormone (GH) replacement therapy in adult GH-deficient menCLINICAL ENDOCRINOLOGY, Issue 3 2005Lucia I. Arwert Summary Objective, GH-deficient adults have changes in body composition, bone mineral density (BMD) and lipid profile that can be altered by GH substitution. However, long-term data on GH substitution (up to 10 years of follow-up) are limited. Design, The effects of 10 years of GH replacement therapy on BMD, body composition, bone parameters, serum lipids and glucose metabolism were studied. Patients, Twenty-three childhood-onset GH-deficient men (mean age at baseline 28·6 years) were studied during 10 years of GH substitution therapy. A group of 19 age-matched healthy men served as a control group for BMD measurements at baseline and after 10 years. Results, BMD of the lumbar spine increased during the 10 years of GH therapy. Bone markers and BMD in the hip increased during the first 5 years of GH therapy, but were not different from baseline after 10 years. BMD changes over time in the lumbar spine and femoral neck were significantly different in the patients compared to the controls. After 10 years the difference between the groups had decreased, but BMD was still higher in the controls than in the patients. Lipid profile had improved after 10 years of GH therapy, but body mass index (BMI), waist,hip ratio (WHR), fasting glucose and glycosylated haemoglobin (HbA1c) had increased compared to baseline. Conclusions, This long-term follow-up study found that 10 years of GH substitution in GH-deficient men causes sustained improvements in BMD in the lumbar spine and lipid profile but not in body composition. [source] Comparisons of leptin, incretins and body composition in obese and lean patients with hypopituitarism and healthy individualsCLINICAL ENDOCRINOLOGY, Issue 1 2003H. Mersebach Summary objective To identify possible abnormalities specific for obesity in hypopituitary patients. study design Cross-sectional case,control study. measurements and study subjects Body composition (DEXA) and measurements of fasting plasma levels of glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptides (GLPs), insulin, C-peptide, glucose, leptin and lipids were performed in 25 hypopituitary patients (15 obese, 10 normal weight) and 26 BMI and age-matched healthy controls (16 obese, 10 normal weight). All hypopituitary patients had GH deficiency and received adequate substitution therapy on this and other deficient axes (3 ± 1). results Fasting GIP-levels were significantly higher in obese hypopituitary patients compared to lean hypopituitary patients (P < 0·01), while the fasting concentrations of GLP-1 and GLP-2 were comparable between obese and lean hypopituitary patients. The same trend was seen in obese healthy controls vs. lean controls. No differences were observed in glucose, insulin or C-peptide between the hypopituitary patients and the controls. Leptin levels were increased in obese hypopituitary patients compared to lean hypopituitary patients when adjusted for gender. At least a 2-fold higher level of leptin was observed in women compared to men in both patient groups and healthy controls. Lean female hypopituitary patients had higher leptin levels than matched controls. conclusions Fasting levels of GIP were elevated in obese substituted hypopituitary patients, while fasting concentrations of GLPs were similar. Obese hypopituitary patients had the same degree of hyperinsulinaemia, affected glucose tolerance, dyslipoproteinaemia and central obesity as obese healthy controls. Further studies are required to identify the possible biochemical reasons for obesity in patients with apparently well-substituted hypopituitarism. [source] | ||||||||||