Effect of acute parlodel load on the prolactin and STH content in patients with various neuroendocrine diseases

The results are presented of the treatment of 31 females with different hypothalamic-hypophyseal abnormalities: persisting lactorrhea-amenorrhea syndrome, acromegaly, hypothalamic syndrome, lactorrhea syndrome without amenorrhea. The effect of parlodel acute load on STH and the blood serum prolactin content was studied. It was concluded, that parlodel acute load produces a marked decrease in the prolactin level 2 hours after the drug injection both in the patients with an originally elevated prolactin level, and in the subjects, having the prolactin level within normal. Significant changes in the STH level were not observed 2 hours after parlodel load.     

Malondialdehyde concentration in blood plasma of patients with liver diseases]

Malondialdehyde (MDA) level was determined spectrophotometrically with thiobarbituric acid method on 50 healthy persons and 160 patients with alcoholic and nonalcoholic liver diseases. Alcoholics without liver damage show normal plasma MDA values. Alcoholic fatty liver, alcoholic hepatitis and alcoholic liver cirrhosis cause an increase of MDA values. The highest concentrations of MDA were found on patients with acute virus hepatitis. Also noninfectional hepatitis and nonalcoholic liver cirrhosis showed an elevated MDA-Level. Liver damage and lipid peroxidation are considered as closely connected processes.     

Interferon-alpha and gamma product in peripheral blood of patients with thyroid diseases

To investigate the immunological process in various thyroid disease, we measured interferon-alpha, -gamma (IFN-alpha,-gamma, natural killer (NK) activity, and lymphocyte subsets in the peripheral blood of 27 patients with Basedow's disease (BD) (M:F = 9:18), 8 with Hashimoto's thyroiditis (HT) (2:6), 5 with idiopathic hypothyroidism (1HT) (1:4), and normal controls (C). IFN-alpha, -gamma levels were measured by bioassay with Dye-uptake method, and NK activity was measured by the LDH method. The mean +/- SD levels of IFN-gamma in BD, HT, IHT, and C (N = 217) were 173.9 +/- 88.0, 288.0 +/- 134.9, 120.4 +/- 38.0 and 173.9 +/- 88.01U/ml, respectively. The IFN-gamma level was higher in HT (p less than 0.05) than in controls, and lower in BD (p less than 0.02). Moreover, this IFN-gamma level did not correspond with the titers of thyroid hormones; TSH, anti-microsome antibody, and anti-TSH-receptor antibody in peripheral blood. However, IFN-alpha levels and NK activity in the patients of every group were similar to those in controls. The ratios of lymphocyte subsets of peripheral blood were measured by cytofluorometry with monoclonal antibodies. The mean +/- SD levels of T cells in BD, HT, IHT and C were 75.9 +/- 7.0, 83.4 +/- 7.2, 85.2 +/- 5.7, 82.3 +/- 5.8%, and those of B cells were 17.5 +/- 6.1, 10.9 +/- 4.2, 8.0 +/- 5.8, 10.9 +/- 5.0%, respectively. The ratio of T cells was higher in IHT (p less than 0.05) and lower in BD (p less than 0.01) than in controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

Persistence of mortality risk in patients with acute cardiac diseases and mild thyroid dysfunction

IntroductionThere are no studies on the long-term prognostic role of abnormal thyrotropin value in patients with acute cardiac diseases. Aim of the study was to assess the incidence and persistence of risk of cardiac and overall deaths in patients with acute cardiac diseases.MethodsA total of 1026 patients (mean age: 67.7 years) were divided into 4 groups: (1) euthyroid (EU, n=579); (2) subclinical-like hypothyroidism (SLHYPO, n=68); (3) subclinical-like hyperthyroidism (SLHYPER, n=23) and (4) low-triiodothyronine syndrome (LowT3, n=356). Follow-up started from the day of thyroid hormone evaluation (mean follow-up: 30 months). The events considered were cardiac and overall deaths.ResultsSurvival rate for cardiac death was lower in SLHYPO and in LT3 than in EU (log rank test; χ² = 33.6; P < 0.001). Survival rate for overall death was lower in SLHYPO, SLHYPER and LowT3 than in EU (48.3; P < 0.001). After adjustment for several risk factors, the hazard ratio for cardiac death was higher in SLHYPO (3.65; P = 0.004) in LowT3 (1.88; P = 0.032) and in SLHYPER (4.73; P = 0.047). Hazard ratio for overall death was higher in SLHYPO (2.30; P = 0.009), in LowT3 (1.63; P = 0.017) and in SLHYPER than in EU (3.71; P = 0.004). Hazards for SLHYPO, SLHYPER and LowT3 with respect to EU were proportional over the follow-up period.ConclusionIn patients with acute cardiac disease, a mildly altered thyroid status was associated with increased risk of mortality that remains constant during all the follow-up.     

急性缺血性卒中合并心脏病患者血压管理专家共识

急性缺血性卒中的血压管理不同于陈旧缺血性卒中的血压管理。当急性缺血性卒中合并心脏病(如急性心肌梗死或心力衰竭等)时,对于血压管理的要求就变得更加复杂。本共识围绕急性缺血性卒中合并急慢性冠状动脉综合征、合并心力衰竭等临床复杂情况,对降压时机、降压目标、降压用药及处置流程等进行专家意见的总结。     

Effect of prostaglandin E1 on ammonia concentration in blood of patients with hepatic resection

Plasma concentrations of ammonia were examined following prostaglandin E₁ (PGE₁) administration in 16 patients who received hepatectomy for hepatocellular carcinoma. PGE₁ at 0.01–0.04 g/kg/min was administered for approximately 24 hr during the perioperative periods. The ammonia concentration was reduced a day after the operation following intravenous administration of PGE₁ in cirrhotic patients compared to noncirrhotic patients with or without PGE₁ injection. Serum liver function scores, glutamic pyruvic transminase, and total bilirubin concentrations were decreased after PGE₁ administration. A similar ammonia response due to PGE₁ was obtained after operation in cirrhotic patients when PGE₁ 0.5 g/kg was administered intravenously for 30 min. These results suggest that PGE₁ administration is useful in reducing the enhanced ammonia concentration associated with hepatic resection, and it is particularly effective in the case of liver cirrhosis.     

Pentagastrin promotes prolactin release in patients with medullary carcinoma of the thyroid

Both calcitonin and gastrin have been found in the mammalian central nervous system, including the pituitary. Following a pentagastrin infusion in several patients with medullary carcinoma of the thyroid, we noted a coincident increase in plasma calcitonin and prolactin (PRL) levels. In order to evaluate further the influence of pentagastrin on human PRL release, a pentagastrin infusion was administered to 13 patients with active medullary carcinoma of the thyroid (MTC), eight subjects with inactive MTC, eight family members without MTC, and ten normal subjects. Plasma mean +/- SE PRL levels were significantly (P less than 0.01) increased in the active MTC patients from 7.6 +/- 0.5 to 12 +/- 1.4 ng/mL by 15 minutes post pentagastrin. Plasma mean +/- SE calcitonin levels increased in parallel with the plasma PRL levels from 0.28 +/- 0.1 to a peak of 1.9 +/- 0.9 ng/mL at 5 minutes post pentagastrin. A significant (P less than 0.05) correlation was found between the percentage increase in plasma calcitonin concentrations and plasma PRL levels at five and ten minutes post pentagastrin stimulation in this group of active MTC patients. Significant increases in serum calcitonin levels in the other groups post pentagastrin were of lesser magnitude and were not associated with a significant increase in PRL release. This latter observation suggested that neither the stress of the infusion nor the multiple endocrine neoplasia type 2 nor the pentagastrin was responsible for the observed increase in plasma PRL levels in the active MTC patients. These findings suggest, but do not prove, that calcitonin is a PRL-releasing factor in humans.     

Effect of thyroliberin on the prolactin level in the blood serum of primary hypothyroid patients

Results of study of the basic prolactin level and its response to the stimulating action of exogenous thyroliberin in 23 women with primary hypothyroidism are presented; alteration of prolactin secretion in these patients under the effect of replacement thyroid hormone therapy is shown. In the majority of patients with primary hypothyroidism prolactin level was elevated in comparison with the normal, and its secretion in response to TRH was considerably increased. There were no significant differences in the basic prolactin level and in its response to TRG in patients with primary hypothyroidism with or without lactorrhea, and with lactorrheaamenorrhea. Lactorrhea can develop in the patients with increased or with normal blood serum prolactin level. Sensitivity of thyrotrophs and lactotrophs to the inhibitory action of thyroid hormones proved to differ. The efficacy of replacement therapy in patients with primary hypothyroidism combined with lactorrhea-amenorrhea, leading to restoration of the patients' fertility, was demonstrated.     

Effect of captopril on plasma prolactin in patients with essential hypertension

The effects of the angiotensin-converting enzyme inhibitor captopril on blood pressure, heart rate, plasma prolactin, and renin activity were examined in a single-blind, placebo-controlled trial on 30 patients with essential hypertension (15 given drug, 15 placebo). Captopril, 25 mg administered orally, reduced the blood pressure and increased the plasma renin activity. Captopril decreased mean plasma prolactin from 17.5 +/- 1.4 ng/mL to 9.1 +/- 1.0 ng/mL (p less than 0.001). Significant correlation was found between captopril-induced change from control values of plasma prolactin (delta plasma prolactin) vs delta plasma renin activity (r = -0.688, p less than 0.001). These results suggest that acute administration of captopril was accompanied by a reduction in plasma prolactin and that this reduction may be of clinical significance during therapy of hypertension.     

他汀类药物对脑梗死患者急性期血脂和高敏C反应蛋白的影响

目的观察阿托伐他汀对脑梗死患者急性期的临床疗效、血脂、高敏C反应蛋白(hs-CRP)和纤维蛋白原的影响。方法选择急性脑梗死患者161例,随机分为阿托伐他汀组(A组)58例、洛伐他汀组(B组)59例和对照组44例。对照组常规治疗,A组、B组在常规治疗的基础上分别加服阿托伐他汀、洛伐他汀20mg/d,连续治疗3个月。观察3组治疗前后血脂、hs-CRP、纤维蛋白原及美国国立卫生研究院卒中量表评分等指标的变化。结果治疗1周后,A组、B组TC、LDL-C较对照组明显下降(P<0.01),A组TC、LDL-C较B组下降更明显(P<0.05);3组治疗后hs-CRP均明显下降(P<0.01),A组hs-CRP较B组下降更明显,差异有统计学意义(P<0.05)。结论阿托伐他汀较洛伐他汀能更有效快速调脂,降低hs-CRP水平,短期观察神经缺损评分虽无明显改善,但仍可以考虑在脑梗死早期应用以促进神经功能恢复,且安全性好。     

Clinical utility of red blood cell carbonic anhydrase I and zinc concentrations in patients with thyroid diseases

We have recently reported that, in patients with hyperthyroidism, the red blood cell (RBC) carbonic anhydrase I (CAI) and zinc (Zn) concentrations both reflect the patient's integrated thyroid hormone level over the preceding few months. In this study, we evaluated the clinical usefulness of determining the RBC CAI and Zn concentrations in patients with various types of thyroid disease. Six patients with painless thyroiditis (PT) had normal RBC CAI concentrations and the two patients tested had normal RBC Zn levels. In four patients with syndromes of inappropriate thyrotropin (TSH) secretion (SITSH) two euthyroid patients had normal RBC CAI and two hyperthyroid patients had subnormal RBC CAI and Zn. In a patient with Graves' disease whose plasma thyroxine (T4) and triiodothyronine (T3) concentrations changed remarkably because of poor compliance with the regimen, the change in plasma thyroid hormone levels preceded the change in the RBC CAI and Zn concentrations by 2 to 3 months. These observations suggest that the measurement of RBC CAI and Zn concentrations may be useful clinically as follows: (1) in differentiating hyperthyroid Graves' disease from transient hyperthyroidism due to destructive thyroiditis; and (2) in obtaining an accurate estimate of the extent of elevated thyroid hormone levels in hyperthyroid patients over time.     

甲状腺激素对急性ST段抬高型心肌梗死合并急性心力衰竭患者预后的研究

目的:探讨低三碘甲腺原氨酸(T3)综合征,对合并心力衰竭的急性心肌梗死患者预后的影响。方法:前瞻性连续纳入行急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高心肌梗死(STEMI)同时合并急性心力衰竭患者246例,按照是否合并低T3综合征分为两组:低T3综合征组(n=50)和甲状腺功能正常组(n=196)。分别评价患者住院期间的临床、血管造影及超声心动图等相关资料并对患者进行长期随访。平均随访时间为367天,一级终点为全因病死率。结果:在随访期间两组患者在再次血运重建(P=0.037)、新发心力衰竭(P=0.016)和主要不良心脏事件发生率方面(P=0.013)差异有统计学意义。在总病死率方面两组差异无统计学意义(P=0.278)。通过使用Cox比例风险回归分析,发现游离T3水平(HR=0.813,95%:CI:0.725~0.854,P=0.003)是影响患者发生死亡独立的预测因子。结论:行直接PCI的STEMI合并心力衰竭患者,和甲状腺功能正常的患者相比,合并低T3综合征患者具有较高的主要不良心脏事件发生率,但二者长期病死率相似;患者游离T3水平是影响患者死亡的独立预测因素。     

甲状腺疾病患者直肠肛门生理功能异常研究

25例甲状腺功能亢进(甲亢)伴腹泻和14例甲状腺功能减退(甲减)伴便秘患者的直肠肛门生理功能测定显示，甲亢患者肛管静息压和收缩压，排便初始感觉阈值和最大直肠耐受容量明显低于21例正常对照组者。甲减患者这些测定值与对照组差异无显著性。