Cyproterone acetate, combined with ethinyl estradiol, was administered to 60 women (mean age: 25 years) suffering from hirsutism, acne and alopecia for 3–39 months. The rate of success was 94% for acne, 85% for hirsutism and 55% for alopecia. These results are comparable to those already reported. No correlation was found between the degree of the disease or plasma levels of testosterone, androstenedione, respectively urinary 17-cetosteroids, and the effectiveness of the treatment. Side effects were rare and identical in frequency and nature to those encountered during treatment with estrogen-containing contraceptives.
Recent scientific developments and the medical applications they have engendered, as well as the resulting expectations on the part of the patients and caregivers have shed a drastically modified light on medicine, its goals, the role of doctors and the nature of the relationships entered into and maintained with patients.Curing and preventing the diseases are still the main priorities of medicine, but extending the biological life, enhancing the human capacities, interfacing man and machine, modifying the genome appear to be today objective and realistic goals also, which are susceptible to improve the therapeutic results. Then, the question raised is: are the present goals of medicine still what they should be or should we identify new ones? But, how is the person of the patient perceived in the present medicine? The increasingly slicing up of the patient into systems, organs, receptors and malfunctioning genes tends to favor an analytical approach of the pathologies of the 'sick individual', at the cost of seeing him (or her) as a 'person who is suffering', that is to say, one who is affected by his illness in both body and mind.
Abstract. The parathyroid response to an EDTA infusion was measured in 11 patients with hypoparathyroidism and 22 patients with normocalcaemic tetany, and compared to that of normal controls and of 23 patients with primary hyperparathyroidism. Despite comparable basal PTH values, the patients with hypoparathyroidism and the normocalcaemic patients, with tetany following thyroid surgery, responded less than normals to EDTA, while normocalcaemic patients with tetany due to psychogenic hyperventilation responded more than normals. In hypoparathyroidism, mainly three types of results were observed: no response (total hypoparathyroidism), diminished or delayed response (partial hypoparathyroidism), and discrepant results using different antisera in cases of idiopathic hypoparathyroidism, suggesting the secretion of immunologically abnormal PTH. In tetany due to psychogenic hyperventilation, parathyroid hyperreactivity might be explained by repeated stimulation through respiratory alkalosis. Although the EDTA test rarely improved the diagnostic accuracy of basal PTH measurements in primary hyperparathyroidism, it was useful for differentiating between latent hypoparathyroidism and tetany due to psychogenic hyperventilation, both presenting with normal plasma calcium.
Simultaneous determinations of plasma ACTH, HGH and cortisol were carried out in the course of an insulin tolerance test (ITT) in 7 normal subjects and in different cases of hypothalamic pathology. The parallelism obseIVed in normal subjects between the different hormones disappeared in cases of clinical hypopituitarism with hypogonadotrophic hypogonadism: the HGH response was almost absent, whereas the ACTH response to ITI was above normal. Complete disappearance of the HGH response with very low ACTH levels was obseIVed in 3 cases of chromophobe adenoma and in one case of hypothalamic glioma with diabetes insipidus.
A 35-year-old woman experienced tetanic symptoms when treated with chorionic gonadotrophins or estrogenic oral contraceptives. Persistent hypocalcemia was found, with hyperphosphatemia, normal renal function and low normal plasma parathyroid hormone (PTH), all consistent with idiopathic hypoparathyroidism. During EDTA infusion, no PTH response was measured with a predominantly anti-NH2 -terminal antiserum, but a normal response was found with a predominantly anti-COOH-terminal antiserum. This supposes secretion of an immunologically abnormal and biologically ineffective PTH. Oral administration of ethinyl estradiol caused an impressive hypocalcemia with tetanic symptoms. Estrogens might, therefore, inhibit bone resorption by a specific action on bone, and not by antagonizing the action of PTH.
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