40 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

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    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 50–80 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

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    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 à l' 131 I-MIBG permet de diagnostiquer et de localiser les phéochromocytomes. Toute la gamme de types de phéochromocytomes reconnu depuis l'utilisation préopératoire systématique de la scintigraphie à l' 131 I-MIBG est présentée. Entre 1980 et 1986, 34 patients ont été explorés et traités au Centre Médical de l'Université de Michigan, Ann Arbor, Michigan. Il y avait 16 hommes et 18 femmes. L'ùge moyen était de 38 ans, et 4 patients (11.8%) avaient moins de 18 ans. Six patients (17.6%) avaient des antécédents familiaux de phéochromocytome ou de néoplasmes endocrines multiples (MEN) du type II. Les symptÎmes amenant à consulter étaient l'hypertension chez 29 patients (85.3%), des crises de céphalées, des palpitations et un flush chez 4 patients (11.8%); un patient présentait une masse cervicale. Les catécholamines plasmatiques étaient élevées chez 97% des patients alors que les catécholamines et leurs métabolites étaient en quantité élevée chez 93.5% des patients. La scintigraphie à l' 131 I-MIBG était positive chez 82.3%, partiellement positive chez 11.8%, et faussement négative chez 5.9% des patients. La tomodensitométrie était positive chez 80%, partiellement positive chez 10%, et faussement négative chez 10% des patients. A l'intervention, des lésions extra-surrénales étaient présentes dans 38.2% des cas, et parmi celles-ci, un tiers étaient extra-abdominales. Les tumeurs étaient multiples dans 5 cas (14.7%), et bilatérales surrénales dans 4 cas (11.8%). Une tumeur maligne était diagnostiquée chez 3 patients (8.8%), aprÚs une période de suivi de 2 ans en moyenne. Nous concluons que l'utilisation systématique de la scintigraphie à l' 131 I-MIBG améliore la localisation des phéochromocytomes, permettant un diagnostic plus précoce chez les patients présentant un syndrome MEN II. La multiplicité tumorale et les localisations extra-médullosurrénales ou extra-abdominales se voient beaucoup plus fréquemment qu'on le pensait auparavant. Le taux de malignité peu élevé était probablement en rapport avec la courte période de suivi. La escintigrafía con 131 I-MIBG permite tanto la localización anatómica como el diagnóstico funcional del feocromocitoma. Las características 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?

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    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

    Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

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    BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

    (Cost)-effectiveness of self-treatment of exacerbations on the severity of exacerbations in patients with COPD: the COPE II study.

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    Contains fulltext : 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

    Relationship between daily physical activity and exercise capacity in patients with COPD

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    BACKGROUND: Exercise training programmes for patients with COPD are effective in improving exercise capacity. The few trials that have investigated the effects of exercise programmes on daily physical activity show contradictory results. AIM: To investigate the relation between daily physical activity level and exercise capacity in patients with COPD using data of a randomised controlled trial in which the exercise intervention was aimed at improvement of both physical activity and exercise capacity (the COPE-II study). METHODS: These are secondary analyses of the COPE-II study, a randomised controlled trial in which a community-based physiotherapeutic exercise programme was evaluated. Daily physical activity was measured with a pedometer (steps/day). Exercise capacity was measured with an incremental maximal cycle ergometer test, the incremental (ISWT) and endurance shuttle walk test (ESWT). Pearson correlation coefficients were calculated. RESULTS: At baseline, correlations between steps/day and VO(2peak), ISWT (m), ESWT (m) and ESWT (s) were 0.54, 0.59, 0.44, and 0.34, respectively (all p < 0.01). In the intervention group, correlations between change in steps/day over 7 months and change in ISWT (m), ESWT (m) and ESWT (s) were 0.47, 0.41, and 0.38, respectively (all p < 0.01). In the control group, these same correlations were weak to non-existent. CONCLUSIONS: A moderate to weak relationship was found between daily physical activity and exercise capacity. These results strengthen our beliefs that exercise interventions need to target not only exercise capacity but also behaviour change with regard to daily physical activity to achieve improvements in both parameters

    Predictors of patient adherence to COPD self-management exacerbation action plans

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    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 ≄1 exacerbation and/or ≄1 self-initiated prednisolone course during one-year follow-up were included. Optimal treatment was defined as ‘self-initiating prednisolone treatment ≀2 days from the onset of a COPD exacerbation’. 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: ‘optimal treatment’ (26.2 %), ‘sub optimal treatment’ (11.7 %), ‘significant delay or no treatment’ (31.7 %), or ‘treatment outside the actual exacerbation period’ (30.3 %). One unit increase in baseline dyspnoea score (mMRC scale 0–4) increased the risk of ‘significant delay or no treatment’ (OR 1.64 (95 % CI 1.07−2.50)). Cardiac comorbidity showed a borderline significant increased risk of ‘treatment outside the actual exacerbation period’ (OR 2.40 (95 % CI 0.98−5.85)). 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
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