Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial.

Importance: Low vitamin D status is linked to increased mortality and morbidity in patients who are critically ill. It is unknown if this association is causal.

Objective: To investigate whether a vitamin D3 treatment regimen intended to restore and maintain normal vitamin D status over 6 months is of health benefit for patients in ICUs.

[Addison's disease as a rare cause of chronically elevated liver enzymes].

Common causes of chronically elevated serum liver enzymes include fatty liver disease, chronic viral hepatitis, autoimmune hepatitis, or hereditary metabolic disorders. Adrenocortical insufficiency can also cause elevated liver enzymes. Since 1990 only 11 cases have been reported.

Variable bone mass recovery in hyperthyroid bone disease after radioiodine therapy in postmenopausal patients.

Objectives: Long-term follow-up of postmenopausal hyperthyroid females after radioiodine therapy, since hyperthyroidism is known to cause impressive bone loss which may increase the risk of bone fractures.

Methods: Bone mineral density (BMD) and biochemical parameters of bone metabolism in hyperthyroid postmenopausal patients were investigated before and 2 years after radioiodine therapy and compared with euthyroid age-matched controls.

Results: At baseline, the incidence of low BMD with t-scores more than 2.

Plasma levels of parathyroid hormone-related peptide are elevated in hyperprolactinemia and correlated to bone density status.

Osteopenia is an important clinical manifestation of hyperprolactinemia. Bone loss in these patients has mainly been attributed to concomitant deficiency of gonadal hormones rather than to hyperprolactinemia per se. Parathyroid hormone-related peptide (PTHrP) is expressed in human mammary tissue, and elevated circulating PTHrP levels as well as concomitant hypercalcemia have been described during lactation.

Thyroid hormone excess and osteoporosis.

Current thinking and available clinical data on the relationship between hyperthyroidism and bone disease are discussed. Data are also presented on TSH-suppressive and non-suppressive thyroid hormone therapy and its effect on bone. Although these data are clearly inconsistent, some risk factors for thyroid hormone induced osteopenia seem to be accepted: long standing, clinically manifest hyperthyroidism (a very rare disorder today because of early diagnosis and appropriate therapy), old age, menopause and total thyroidectomy.

The effect of treatment with levothyroxine or iodine on thyroid size and thyroid growth stimulating immunoglobulins in endemic goitre patients.

Objective: We assessed the effect of levothyroxine or iodine on thyroid size and on thyroid growth stimulating immunoglobulins in endemic goitre patients.

Design: Levothyroxine or iodine was given orally in an open randomized prospective study (100 and 200 micrograms respectively).

Patients: Thirty-seven euthyroid patients with diffuse iodine deficiency goitres and thyroid growth stimulating immunoglobulins were studied.

Enhancing in vivo effect of propranolol on human lymphocyte function is not due to stereospecific beta-adrenergic blockade.

Immunoenhancing in vivo effects of beta-adrenergic blockers have been previously ascribed to a reduced beta-receptor-mediated immunosuppression. In the present study using a whole blood stimulation assay, the effects of a five-day treatment with the purified (R)- or (S)-isomer of propranolol (3 x 40 mg/day) on the polyclonal in vitro responsiveness of peripheral blood lymphocytes (PBL) of normothyroid and hyperthyroid persons were assessed. It is shown that both isomers likewise exhibit a significant enhancing effect on the proliferative response of PBL to T and B cell mitogens, which strongly argues for nonspecific effects of propranolol to be responsible rather than a specific beta-adrenergic receptor blockade.

[Clinical value of the various methods of ACTH determination].

We determined 293 plasma-ACTH levels out of 49 patients. In 12 patients with various pituitary diseases 168 samples were collected during a standardized pituitary stimulation test. For this purpose we used the following kits: the DYNOtest ACTH and LUMItest ACTH and Allegro HS-ACTH test.

Involvement of the immune system in iodine deficient goiter.

Iodine deficient goiters were studied by immunohistochemistry and showed extensive presence and typical arrangement of dendritic cells, known to have excellent antigen presenting capacity. These cells were positive for all MHC-class II epitopes and for ICAM-1. Epithelial follicle lining cells were also seen to be class II positive but lacked ICAM-1.

[Kala-azar acquired in Croatia].

Six weeks after his return from a two-week vacation in Croatia a 52 year-old janitor from Graz complained of loss of appetite, fever, headache, and a 9-kg weight loss. The spleen was enlarged to 16cm as measured by sonography. Laboratory tests revealed pancytopenia, a prolonged prothrombin time and elevation of serum LDH concentration.

[Sonography and cytology of cold thyroid nodules].

270 patients with a scintigraphically cold thyroid nodule of sonographically increased (n = 34), diminished (n = 72) or neutral (n = 86) echogenity or cystic criteria (n = 78) were subjected to fine needle aspiration biopsy. This revealed unequivocal malignancy in 8 and follicular neoplasia in another 30 patients, 10 of whom proved to have malignomas on further evaluation. A total of 12 papillary and 2 follicular carcinomas, 2 non-Hodgkin lymphomas, 1 sarcoma and the metastasis of a breast carcinoma were diagnosed.

[Pharmacology and dosage of thyrostatic drugs].

The iodine organification in thyroid gland was inhibited by application of Thyrostatic (Methimazole, Carbimazole) and consequently, thyroid hormone production and excretion were diminished. Carbimazole is converted to Methimazole in vivo and in vitro. Equivalent doses of Carbimazole and Methimazole are 0.

[Successful treatment of autoimmune hemolytic anemia with cyclosporin A].

A sixty-year-old patient suffering from an idiopathic immunohemolytic anemia was treated by 3 plasma exchanges (with 31 exchange-volume) and following by Ciclosporin A (3 mg/kg body weight) after the monotherapy of prednisone has been unsuccessful. Ciclosporin A promptly effected a continuous remission of the autoimmune hemolysis. The mode of action of Ciclosporin A in immunhemolytic anemia depending on incomplete warm-auto-antibodies is discussed.

[Diagnostic significance of immunoradiometric serum TSH determination].

TSH measurements using sensitive TSH-IRMA method makes differentiation of euthyroidism and hyperthyroidism possible without TSH stimulation after TRH. TSH-basal values less than 0.1 mU/L proof pituitary TSH suppression (clinical overt and latent hyperthyroidism, thyroid hormone therapy etc.

[Two generations of FT4-radioimmunoassays--results in euthyroid patients and in patients on thyroid hormone therapy].

In accordance with the TRH-test two generations of FT4-immunoassays were checked in order to find a substitute for the free thyroxine index. The euthyroid reference range of FT4 was between 0.69-1.

Proof of the linearity of the pharmacokinetics of alinidine in man.

The pharmacokinetics of alinidine was investigated in two groups of volunteers: Group I (N=5) received on two occasions single doses of 14C-labelled drug given orally (40 mg) or intravenously (10 mg); Group II (N=6) received single oral doses 10, 30, or 90 mg dissolved in 20 ml water. The samples from Group I were analysed by two different and independent methods (RIA and counting total radioactivity). The results obtained by the two methods were identical, since the compound was not metabolized.

[Growth hormone determination in a combined adenohypophyseal stimulation test (author's transl)].

The authors sought the simplest but still reliable method for evaluation of the functional reserve of the anterior lobe of the pituitary gland. The proposed test is stimulation of those various functions by injection of insulin, gonadotropin releasing hormone (LH-RH = GnRH) and thyrotropin releasing hormone (TRH). The test fulfils the clinical requirements.

[Thyroxine in an amount of 150 micrograms daily for the prevention of the recurrence of goiter].

24 patients, who had undergone a subtotal thyroidectomy, were given 150 micrograms thyroxine daily for 6 weeks for prevention of goiter recurrency. 14 patients had been included in an earlier reported study using 75 micrograms thyroxine daily. Prior to this trial 10 patients had 100 micrograms thyroxine daily; the 14 above mentioned patients had had no therapy for 4 weeks.

[Thyroxine in the treatment of euthyroid goiter and the prevention of goiter recurrence].

Patients with non-toxic goitre, or patients after an operation of non-toxic goitre, were given 75 mug thyroxine daily. The level of TSH decreased significantly only for the non-toxic goitre group. The TSH-TRH-test showed a high percentage of abnormal results, even after several months of treatment.