ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In 1961 Dr. John H. Sipple described the concurrence of thyroid cancer, parathyroid adenoma, and pheochromocytoma in a single individual. This has become known as the Sipple syndrome or multiple endocrine neoplasia 2A. We present the C634R mutation of the RET proto-oncogene that is the likely cause of this disorder in the index subject, and we review his kindred.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Metformin hydrochloride (Glucophagefreg], Bristol-Myers Squibb) is a biguanide oral antihy-perglycemic agent effective in treating non-insulin-dependent diabetes mellitus (NIDDM). Although metformin may be added to regimens containing sulfonylureas, it is also highly effective as initial monotherapy in patients with newly diagnosed NIDDM.Metformin reduces hepatic glucose production by decreasing gluconeogenesis, thus reducing hyperglycemia and improving glucose tolerance. It enhances insulin-stimulated glucose utilization in peripheral tissues, particularly skeletal muscle, as well as fat and intestinal tissue, without stimulating insulin secretion.Metformin is superior in efficacy to placebo and comparable in efficacy to the sulfonylureas. However, metformin does not induce hypoglycemia or body weight gain in lean or overweight patients. Metformin reduces insulinemia and has favorable effects on plasma lipid profiles, possibly diastolic blood pressure, and other established cardiovascular disease risk factors.Metformin is well tolerated, with most adverse events being gastrointestinal and transient in nature. Lactic acidosis, a significant risk with phenformin therapy, occurs very rarely with metformin. Thus, metformin is an effective and well-tolerated initial treatment for NIDDM. In addition to having beneficial effects on glycemia and insulinemia, metformin, compared to other antidiabetic therapies, nas a I positive influence on lipid profiles and body weight.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Girls who fail to enter puberty because of hypogonadism, whether caused by hypothalamic-pituitary or by ovarian dysfunction, require estrogen replacement to induce or to complete their pubertal progression. Careful planning of timing of estrogen therapy and of appropriate estrogen dose can result in improved quality of life and in taller adult height compared with the girl who is simply given adult replacement doses. A case is presented illustrating benefits of a conservative approach. The recommendation is to start with a low dose of ethinyl estradiol (100 ng/kg/day), to hold the dose at this level, and only to progress slowly while there is concern about ultimate height.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Diabetic neuropathy encompasses a wide range of subclinical and clinical syndromes. Here we discuss the pathologic and pathogenetic heterogeneity displayed among patients with chronic diabetic neurologic complications. In addition to the traditional approach that associates neuropathy with persistently high blood glucose and/or microvascular insufficiency, the most recent observations related to the role of immune mechanisms and deficiency of neurotrophic factors also are presented. Diagnostic procedures should include a thorough evaluation of clinical, electrophysiologic, and quantitative sensory and autonomic function testing. An important diagnostic element is screening for signs of antineuronal autoimmunity. This may dictate the therapeutic intervention. Immunotherapy in those patients who present with circulating antineuronal antibodies or immunopathologic findings in the nerve that are consistent with immune attack may be appropriate. In addition, we describe algorithms for recognition and management of painful diabetic neuropathy and specialized treatments based on our better understanding of their etiopathogenesis.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The immune system may act as friend or foe. Fortunately, it serves to protect the individual from foreign pathogens. During development, the immune system is programmed and learns to distinguish self from non-self. Thus, tolerance of self can be denned as a state of antigen-induced unresponsiveness. This process is dependent on an interaction of the major histocompatibility complex plus antigen plus T cell receptor. Under certain conditions, tolerance fails (or breaks down), resulting in a state of autoimmunity. In simple terms, autoimmunity is an immune reaction to self. This article reviews the pathophysiology of autoimmune disease, the major autoimmune polyglandular syndromes that include the ovary, and the autoimmune etiology of ovarian failure.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Peripheral neuromuscular and central nervous system disorders may occur in both hypothyroidism and hyperthyroidism. Myopathy is the most common of the peripheral neurologic manifestations in both hypothyroidism and hyperthyroidism. The creatine phosphokinase is elevated in only the hypothyroid cases. In hypothyroidism, polyneuropathy also occurs but much less commonly than myopathy. Compressive mononeuropathies, namely carpal tunnel syndrome, are a major feature in hypothyroidism. Myasthenia gravis can be accentuated by either dysthyroid state. Hypothyroidism has been reported to cause an array of additional effects on the neuromuscular junction and muscle. At the level of the central nervous system, psychosis, personality change, mood disorder, confusion, dementia, coma, and seizures can occur in either hypothyroidism or hyperthyroidism. Movement disorders occur in hyperthyroidism, whereas ataxia and headaches are associated with hypothyroidism.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Endothelin has extensive effects on coronary VSMCs. Its actions include vasomotor control and growth promotion, thus implicating endothelin in the pathogenesis of various diseases including atherosclerosis, diabetes mellitus, and hypertension. The role of the peptide, with all of its ramifications, is still under investigation, but the advancing knowledge about the mode of action makes it possible to begin further work on the therapeutic applications of agonists and antagonists. ETA and ETB receptor antagonists already exist and have been found to have specific effects in animal models. Further studies should be undertaken to comprehend the physiologic and pathophysiologic roles of endothelin to take advantage of its numerous therapeutic implications.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A 50-year-old woman with a past medical history of steroid-dependent asthma was admitted for exacerbation of her disease. During her hospital stay, a tracheotomy was performed and a thyroid biopsy was obtained because of the purulent appearance of the thyroid gland. Histology demonstrated aspergillus. Initially the patient was euthyroid, but 3 months later she developed hypothyroidism. Thyroid antibodies were negative. There is no previous report of hypothyroidism developing in a patient with aspergillus. The patient was treated with appropriate antibiotics and L-thyroxine. Steroids were tapered down to the lowest possible dose, but hypothyroidism persisted. This case demonstrates that aspergillus can involve the thyroid gland in immunocompromised hosts and that hypothyroidism may develop.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID