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  • 1
    ISSN: 1432-1076
    Keywords: Congenital adrenal hyperplasia ; 21-Hydroxylase deficiency ; Active renin concentration ; Plasma renin activity ; Mineralocorticoid replacement therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In congenital adrenal hyperplasia (CAR) due to 21-hydroxylase deficiency, measurement of plasma renin activity (PRA) has been the method of choice in diagnosing salt loss and in monitoring adequacy of mineralocorticoid replacement therapy. Due to methodological problems in PRA determinations, direct immunoradiometric assays for the measurement of active renin concentration have been developed. We measured PRA and active renin concentrations simultaneously in 39 patients with CAH (30 salt-wasting, 9 simple virilizing) to evaluate the potential role of this new method in the management of this disease. PRA was determined with an enzymatic assay (sample volume: 2 × 1000 μl plasma), active renin concentration with a direct immunoradiometric assay (sample volume: 2 × 200 μl plasma or serum). We found a highly significant correlation between active renin and PRA in our patients (P 〈 0.001), as previously shown in healthy subjects. Active renin was as reliable as PRA to assess the quality of mineralocorticoid replacement.
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  • 2
    ISSN: 1432-1076
    Keywords: Key words Congenital adrenal ; hyperplasia ; 21-Hydroxylase ; deficiency ; Active renin concentration ; Plasma renin activity ; Mineralocorticoid replacement therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, measurement of plasma renin activity (PRA) has been the method of choice in diagnosing salt loss and in monitoring adequacy of mineralocorticoid replacement therapy. Due to methodological problems in PRA determinations, direct immunoradiometric assays for the measurement of active renin concentration have been developed. We measured PRA and active renin concentrations simultaneously in 39 patients with CAH (30 salt-wasting, 9 simple virilizing) to evaluate the potential role of this new method in the management of this disease. PRA was determined with an enzymatic assay (sample volume: 2 × 1000 μl plasma), active renin concentration with a direct immunoradiometric assay (sample volume: 2 × 200 μl plasma or serum). We found a highly significant correlation between active renin and PRA in our patients (P 〈 0.001), as previously shown in healthy subjects. Active renin was as reliable as PRA to assess the quality of mineralocorticoid replacement. Conclusion In children, active renin determination is preferable to PRA determination because of methodological advantages and a smaller sample volume. It correlates well with PRA and determines the activation of the renin-angiotensin system as precisely as PRA. Active renin determination is useful in the surveillance of mineralocorticoid replacement therapy in CAH.
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  • 3
    ISSN: 1432-2307
    Keywords: Helicobacter pylori ; Gastritis ; Host response ; Autoimmunity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Colonization of human gastric mucosa with Helicobacter pylori leads to chronic active gastritis and induces the occurrence of an acquired mucosa-associated lymphoid tissue (MALT) in the stomach. This remodelling of the gastric mucosa together with chronic antigen persistence may induce autoimmune reactions. The aim of this study was to investigate humoral autoimmune reactions to human gastric mucosa in H. pylori gastritis and their clinical relevance. Sera from patients with dyspeptic symptoms were tested for presence of IgG immunoglobulins against H. pylori. Gastric infection with H. pylori and alterations of gastric mucosa were demonstrated by histological examination of gastric biopsy specimens. All sera were tested for reactivity against human gastric mucosa by immunohistochemistry. Two different in-situ binding sites of antigastric autoantibodies were observed. Binding to canalicular structures within parietal cells was significantly correlated with antibodies to H. pylori, elevated basal gastrin levels and atrophy of gastric corpus glands. Our data indicate that autoimmune reactions to antigens in the human gastric mucosa occur in H. pylori gastritis and that they may play a role in the pathogenesis of the disease.
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  • 4
    ISSN: 0022-4731
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology
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  • 5
    ISSN: 0022-4731
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology
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  • 6
    ISSN: 1432-1440
    Keywords: Ischemic acute renal failure ; Calcium ; Calcium entry blockers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This presentation briefly reviews the cellular mechanism of ischemic acute renal failure (ARF) with particular emphasis on the role of Ca2+ and calcium entry blockers (CEB). Vascular consequences of an ischemic renal insult including vasoconstriction, diminished glomerular permeability, loss of autoregulation, and hypersensitivity to renal nerve stimulation may relate to increased cellular Ca2+ concentration in the renal afferent arteriole and glomerular mesangial cells. Evidence is also presented that the ischemic injury to tubular plasma membranes is associated with increased Ca2+ uptake. With an ischemic insult of a short duration, the renal mitochondria are able to buffer the increased cellular Ca2+. However, after an ischemic insult of long duration, the Ca2+ overloaded mitochondria deteriorate, adenosine triphosphate (ATP) synthesis decreases, and cell death follows. If a sufficient number of renal tubular cells undergo this cell death, tubular obstruction, i.e. the maintenance phase of ARF, occurs.
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  • 7
    ISSN: 1432-1440
    Keywords: Vasopressin ; Thirst
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied a 41 year old patient who had pathologic fluid intake of 10l/day together with syndrome of inappropriate antidiuretic hormone. Imaging studies revealed a lesion of the anterior wall of the third cerebral ventricle. A review of relevant literature indicated several different disturbances by which alterations of thirst, vasopressin-secretion and abnormalities of anterior third ventricle may be associated. The present case presents an unusual and potentially dangerous combination in this spectrum of changes.
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  • 8
    ISSN: 1432-1440
    Keywords: Renal function ; Congestive cardiac failure ; Renin-angiotensin-system ; Vasopressin ; Atrial natriuretic peptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Congestive cardiac failure is a syndrome in which a decrease of cardiac output triggers a series of neuro-humoral compensatory mechanisms in part involving the kidney. In this response, dysfunction of atrial volume receptors as well as disturbances of the autonomic nervous system have recently been demonstrated and are held responsible for excessive stimulation of angiotensin II, followed by adverse regulatory effects. Renal hemodynamic compensation for heart failure primarily involves constriction of efferent arterioles thereby defending glomerular filtration. In this setting, the occurrance of prerenal insufficiency is indicative of a far advanced reduction in renal blood flow. Apparent diuretic resistance in the treatment of heart failure is usually caused by iatrogenic vascular compromise or by the use of a single diuretic rather than an appropriate combination. Hyponatremia, vasopressin stimulation and elevation of plasma N-epinephrine concentration have been found to be the most reliable indicators of a poor prognosis of heart failure. Atrial natriuretic peptide is stimulated in proportion to the degree of atrial distension in heart failure, however its intrarenal effects are markedly blunted or may even be absent in this particular disease.
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  • 9
    ISSN: 1432-1440
    Keywords: Adrenal tumor ; Cushing's syndrome ; Corticotropin releasing hormone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The purpose of this study was to ascertain whether the pituitary-adrenal responses to human corticotropin-releasing hormone (hCRH) in “non-functioning” adrenocortical adenoma would uncover a functional activity in these adrenal nodules. Eleven patients with incidentally discovered “silent” adrenocortical adenoma and eleven controls were studied. The initial clinical and laboratory examination, including an overnight 1 mg dexamethasone suppression test, revealed no abnormalities in any of the subjects. IR-ACTH and serum steroids (F, S, P, 17OHP, 18OHB, and aldosterone) were normal in both controls and patients. After pulse IV injection of 100 νg hCRH, the cortisol response was significantly exaggerated (P=0.01). Stimulated plasma ACTH levels were, however, significantly lower in patients than in controls (P=0.01), indicating counter-feedback regulation of cortisol. The peak cortisol/peak ACTH ratio (Fmax/ACTHmax) in the patients was significantly elevated (26.8±4.37 nmol/ng vs. 14.6±2.16 nmol/ ng,P=0.02). Two further patients with incidentally discovered “pre-Cushing's” adrenocortical adenoma displayed an even higher ratio (43.5 and 45.5 nmol/ng). In established Cushing's syndrome due to an autonomous adrenocortical adenoma, suppression of ACTH and of the ACTH response to hCRH occurs with a very high basal cortisol/ basal ACTH ratio. Our findings suggest some functional activity even in clinically “silent” adrenocortical adenoma. Response to hCRH uncovers a continuous spectrum between adrenocortical adenoma, “pre-Cushing's”, and Cushing's syndrome.
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  • 10
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Kongenitale Hypothyreose ; Hypophyse ; TSH-Zelladenom ; Key words Congenital hypothyoidism ; Pituitary gland ; TSH-microadenoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A 56 year old mentally disabled woman of short stature was admitted to our hospital because of severe chest pain and dyspnoea. An extended myocardial infarction in the anterior wall was clinically found and confirmed by autopsy. On admission cretinism with massive myxedema was diagnosed, which was confirmed by subsequent laboratory findings. Only at the base of the tongue thyroid tissue 3 mm in diameter was found. In the anterior lobe of the pituitary gland areas with nodular hyperplasia and microadenomas of TSH-producing cells were detected. Thyrotroph adenomas in long standing hypothyroidism are rare. There are only few reports on congenital hypothyroidism as primary underlying disease.
    Notes: Zusammenfassung Eine 56jährige, kleinwüchsige und geistig behinderte Patientin wurde wegen heftiger retrosternaler Schmerzen mit Dyspnoe stationär aufgenommen. Es fand sich ein ausgedehnter Myokardinfarkt in der Vorderwand, der auch autoptisch gesichert wurde. Bei Aufnahme wurde erstmals die Diagnose eines Kretinismus mit ausgeprägtem Myxödem gestellt, was sich durch die weiteren Laborparameter bestätigte. Schilddrüsengewebe war lediglich am Zungengrund in einem Durchmesser von 3 mm nachweisbar. Im Hypophysenvorderlappen ließen sich neben nodulären Hyperplasien auch mehrere Mikroadenome von TSH-produzierenden Zellen nachweisen. TSH-Zelladenome bei Patienten mit einer lange bestehenden Hypopthyreose sind selten. Dabei sind kongenitale Hypoplasien als Ursache bislang nur in einigen wenigen Fällen beschrieben.
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