33 research outputs found
GONADOTROPHIN RESPONSES TO GnRH PULSES IN HYPOGONADOTROPHIC HYPOGONADISM: LH RESPONSIVENESS IS MAINTAINED IN THE PRESENCE OF LUTEAL PHASE CONCENTRATIONS OF OESTROGEN AND PROGESTERONE
LH pulse secretion changes during the menstrual cycle from a rapid regular pattern in the follicular phase to a slower and irregular pattern in the luteal phase. To determine whether the irregular LH pulse pattern in the luteal phase reflects altered GnRH secretion or altered pituitary responsiveness to GnRH, we gave low dose GnRH pulses (25 ng/kg i.v.) every 2 h or every hour for 10 or 12 d to three women with isolated GnRH deficiency. After 4 d of GnRH alone, oestradiol (E 2 ) was given and after 6 d progesterone (P) was added to mimic the hormonal milieu of the luteal phase. LH and FSH were measured every 4 h throughout and also every 20 min for 6 or 12 h, before and after GnRH alone (day 0 and day 4), after E 2 (day 6), and after E 2 + P (day 10 and day 12). Both GnRH pulse frequencies resulted in a rapid increase in plasma FSH to peaks on day 4 (every 2 h) and day 2 and 3 (every hour). FSH concentrations then declined as plasma E 2 rose to 50â80 pg/ml reflecting the selective inhibitory effect of E 2 on FSH release. Plasma LH was also increased after the hourly GnRH injections and this regimen was associated with a more rapid rise in E 2 reflecting follicular maturation. In contrast to the differences in mean hormone concentrations, administration of GnRH at both frequencies resulted in sustained one-on-one responsiveness of LH that was maintained in the presence of both oestrogen and progesterone at mid-luteal phase concentrations. We conclude that the slow frequency of LH pulses observed during the luteal phase reflects decreased GnRH pulse frequency rather than impaired pituitary responsiveness to GnRH.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74947/1/j.1365-2265.1987.tb00786.x.pd
Spectrum of pheochromocytoma in the 131 I-MIBG era
131 I-metaiodobenzylguanidine ( 131 I-MIBG) scintigraphy allows for both functional diagnosis and anatomical localization of pheochromocytoma. The spectrum of pheochromocytoma since the routine use of preoperative 131 I-MIBG scan was studied. From 1980 to 1986, a total of 34 patients were primarily diagnosed and treated at the University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A. There were 16 males and 18 females. The mean age was 38 years and 4 patients (11.8%) were under 18 years of age. Six patients (17.6%) had family history of pheochromocytoma or multiple endocrine neoplasia (MEN) II syndrome. The presenting symptoms were hypertension in 29 patients (85.3%); attacks of headache, palpitation, sweating, and flushing in 4 (11.8%), and 1 patient presented with a neck mass. Plasma catecholamines were elevated in 97% of patients while urinary catecholamines and metabolites were elevated in 93.5%. 131 I-MIBG was accurate in 82.3%, partly positive in 11.8%, and false-negative in 5.9% of patients. CT scan was accurate in 80%, partly positive in 10%, but failed to show the tumor in another 10% of patients. At operation, extraadrenal lesions were found in 38.2% of the patients and among these, one-third were extraabdominal. Multiple tumors occurred in 5 (14.7%), and bilateral adrenal lesions occurred in 4 patients (11.8%). Malignancy was diagnosed in 3 patients (8.8%) after an average follow-up period of 2 years. We conclude that the use of routine preoperative 131 I-MIBG scanning improves localization of pheochromocytoma and earlier diagnosis is possible in patients with MEN II syndrome. Multiple tumors, extraadrenal and extraabdominal lesions occur more often than commonly believed. The low rate of confirmed malignancy is probably related to the short period of follow-up. La scintigraphie Ă l' 131 I-MIBG permet de diagnostiquer et de localiser les phĂ©ochromocytomes. Toute la gamme de types de phĂ©ochromocytomes reconnu depuis l'utilisation prĂ©opĂ©ratoire systĂ©matique de la scintigraphie Ă l' 131 I-MIBG est prĂ©sentĂ©e. Entre 1980 et 1986, 34 patients ont Ă©tĂ© explorĂ©s et traitĂ©s au Centre MĂ©dical de l'UniversitĂ© de Michigan, Ann Arbor, Michigan. Il y avait 16 hommes et 18 femmes. L'Ăąge moyen Ă©tait de 38 ans, et 4 patients (11.8%) avaient moins de 18 ans. Six patients (17.6%) avaient des antĂ©cĂ©dents familiaux de phĂ©ochromocytome ou de nĂ©oplasmes endocrines multiples (MEN) du type II. Les symptĂŽmes amenant Ă consulter Ă©taient l'hypertension chez 29 patients (85.3%), des crises de cĂ©phalĂ©es, des palpitations et un flush chez 4 patients (11.8%); un patient prĂ©sentait une masse cervicale. Les catĂ©cholamines plasmatiques Ă©taient Ă©levĂ©es chez 97% des patients alors que les catĂ©cholamines et leurs mĂ©tabolites Ă©taient en quantitĂ© Ă©levĂ©e chez 93.5% des patients. La scintigraphie Ă l' 131 I-MIBG Ă©tait positive chez 82.3%, partiellement positive chez 11.8%, et faussement nĂ©gative chez 5.9% des patients. La tomodensitomĂ©trie Ă©tait positive chez 80%, partiellement positive chez 10%, et faussement nĂ©gative chez 10% des patients. A l'intervention, des lĂ©sions extra-surrĂ©nales Ă©taient prĂ©sentes dans 38.2% des cas, et parmi celles-ci, un tiers Ă©taient extra-abdominales. Les tumeurs Ă©taient multiples dans 5 cas (14.7%), et bilatĂ©rales surrĂ©nales dans 4 cas (11.8%). Une tumeur maligne Ă©tait diagnostiquĂ©e chez 3 patients (8.8%), aprĂšs une pĂ©riode de suivi de 2 ans en moyenne. Nous concluons que l'utilisation systĂ©matique de la scintigraphie Ă l' 131 I-MIBG amĂ©liore la localisation des phĂ©ochromocytomes, permettant un diagnostic plus prĂ©coce chez les patients prĂ©sentant un syndrome MEN II. La multiplicitĂ© tumorale et les localisations extra-mĂ©dullosurrĂ©nales ou extra-abdominales se voient beaucoup plus frĂ©quemment qu'on le pensait auparavant. Le taux de malignitĂ© peu Ă©levĂ© Ă©tait probablement en rapport avec la courte pĂ©riode de suivi. La escintigrafĂa con 131 I-MIBG permite tanto la localizaciĂłn anatĂłmica como el diagnĂłstico funcional del feocromocitoma. Las caracterĂsticas o espectro del feocromocitoma a partir del uso rutinario de 131 I-MIBG han sido estudiadas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41282/1/268_2005_Article_BF01655447.pd
Has the Rate of CD4 Cell Count Decline before Initiation of Antiretroviral Therapy Changed over the Course of the Dutch HIV Epidemic among MSM?
Introduction:Studies suggest that the HIV-1 epidemic in the Netherlands may have become more virulent, leading to faster disease progression if untreated. Analysis of CD4 cell count decline before antiretroviral therapy (ART) initiation, a surrogate marker for disease progression, may be hampered by informative censoring as ART initiation is more likely with a steeper CD4 cell count decline.Methods:Development of CD4 cell count from 9 to 48 months after seroconversion was analyzed using a mixed-effects model and 2 models that jointly modeled CD4 cell counts and time to censoring event (start ART
(Cost)-effectiveness of self-treatment of exacerbations on the severity of exacerbations in patients with COPD: the COPE II study.
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81807.pdf (publisher's version ) (Closed access)BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic disease with a high prevalence and rapidly increasing incidence rates. The effect of self-treatment of COPD exacerbations on the severity of exacerbations during a 1-year period was examined and a cost-effectiveness analysis was performed. METHODS: Patients were randomly allocated to four 2-hour self-management sessions, with or without training in self-treatment of exacerbations. Patients in the self-treatment group received an action plan with the possibility to initiate a course of prednisolone (with or without antibiotics). During follow-up, all participants kept a daily symptom diary. These provided the data to calculate the frequency of exacerbations, the number of exacerbation days and mean daily severity scores. RESULTS: Data were analysed for 142 randomised patients (self-treatment: n = 70; control: n = 72). The frequency of exacerbations was identical in both study groups (mean (SD) 3.5 (2.7)). Patients in the self-treatment group reported fewer exacerbation days (median 31 (interquartile range (IQR) 8.9-67.5) in the self-treatment group vs 40 (IQR 13.3-88.2) in the control group; p = 0.064); the difference was significant in the group of patients with a high number of exacerbation days per year (>137 (90th percentile of the whole study population); p = 0.028). The mean severity score of an exacerbation day was equal in both groups. No between-group differences were found in health-related quality of life. Cost-effectiveness analyses showed that applying self-treatment saved euro154 per patient, with a trend towards a lower probability for hospital admissions (0.20/patient/year in the self-treatment group vs 0.33/patient/year in the control group; p = 0.388) and a significant reduction of health care contacts (5.37/patient/year in the self-treatment group vs 6.51/patient/year in the control group; p = 0.043). CONCLUSION: Self-treatment of exacerbations incorporated in a self-management programme leads to fewer exacerbation days and lower costs
Evaluation of the Replaceable Peritoneal Catheter âRepl-A-Cathâ: A Prospective Study
Predictors of patient adherence to COPD self-management exacerbation action plans
Objective Identifying patient characteristics predicting categories of patient adherence to Chronic Obstructive Pulmonary Disease (COPD) exacerbation action plans. Methods Data were obtained from self-treatment intervention groups of two COPD self-management trials. Patients with â„1 exacerbation and/or â„1 self-initiated prednisolone course during one-year follow-up were included. Optimal treatment was defined as âself-initiating prednisolone treatment â€2 days from the onset of a COPD exacerbationâ. Predictors of adherence categories were identified by multinomial logistic regression analysis using patient characteristics. Results 145 COPD patients were included and allocated to four adherence categories: âoptimal treatmentâ (26.2 %), âsub optimal treatmentâ (11.7 %), âsignificant delay or no treatmentâ (31.7 %), or âtreatment outside the actual exacerbation periodâ (30.3 %). One unit increase in baseline dyspnoea score (mMRC scale 0â4) increased the risk of âsignificant delay or no treatmentâ (OR 1.64 (95 % CI 1.07â2.50)). Cardiac comorbidity showed a borderline significant increased risk of âtreatment outside the actual exacerbation periodâ (OR 2.40 (95 % CI 0.98â5.85)). Conclusion More severe dyspnoea and cardiac comorbidity may lower adherence to COPD exacerbation action plans. Practice implications Tailored self-management support with more focus on dyspnoea and cardiac disease symptoms may help patients to better act upon increased exacerbation symptoms and improve adherence to COPD exacerbation action plans
Definitions of exacerbations: does it really matter in clinical trials on COPD?
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80076.pdf (publisher's version ) (Closed access)Many definitions of COPD exacerbations are reported. The choice for a definition determines the number of exacerbations observed. However, the effect of different definitions on the effect sizes of randomized controlled trials is unclear. This article provides an overview of the large variation of definitions of COPD exacerbations from the literature. Furthermore, the effect of using different definitions on effect sizes (relative risk and hazard ratio) was investigated in a randomized controlled discontinuation trial of inhaled corticosteroids. The following definitions were applied: (1) unscheduled medical attention, (2) a course of oral corticosteroids/antibiotics, (3) deterioration in two major or one major and one minor symptom according to Anthonisen (referenced later), (4) a change in one or more symptoms, (5) a change in two or more symptoms, and (6) a combination of numbers 2 and 4. Relative risks for the exacerbation rate ranged from 1.19 to 1.49, and hazard ratios for time to first exacerbation ranged from 1.36 to 1.84 for the various definitions, varying from nonsignificant to significant. Because the definition of a COPD exacerbation has an impact on the effect size of interventions, there is an urgent need for concerted attempts to reach agreement on a definition of an exacerbation. Also, the exact definition to be used in a study should be specified in the protocol
(Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT
Background and objective Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up. Methods Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. Results Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32â115) compared with the CG (82, IQR: 22â186) (Pâ=â0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2â68.6 vs CG: 55.9, IQR: 31.2â96.8) (Pâ=â0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28â1.79) and 2.27 (95% CI: 1.11â4.62), respectively. Direct medical costs per patient over 2 years were âŹ1078 lower in the STG. Conclusion Self-treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings