Cortisone and acth1

A new approach to the treatment of rheumatoid arthritis has come from the Mayo Clinic at Rochester. Remarkable recovery of patients suffering from rheumatoid arthritis has been achieved by the daily application of cortisone (a hor­mone produced by the adrenal glands). The administration of this substance has produced a dramatic remission of the di­sease. The duration of the illness in patients who have been treated has varied from a few months to many years. Muscu­lar and articular stiffness improved within 24 hours and this was followed by loss of articular pain and tenderness.

Joint swellings became less and 90 percent had disap­peared within 7 — 10 days. Deformaties due to spasm were relieved. There was improvement in general health and strength, and the increased appetite accompanied by gain in weight was startling. A sense ©f well-being amounting to euphoria was experienced. The anaemia so commonly present and usually resistent to treatment was rapidly cured and finally the sedimentation rate became normal, this being the last sign of the disease to disappear. Within seven days of cessation of treatment there was, however, a relapse in the majority of cases, the deterioration amounting to about 70 percent of the gain. Using cortisone the complications fol­lowing administration are oedema and rounding of the face, acne, slight hirsutism, osteoporosis and amenorrhea. Reports of delayed healing or even breaking down of wounds during treatment have been recorded and prolonged treatment may produce a temporary subhormonal phase on its withdrawal.

The discovery of the action of cortisone and ACTH has thrown light on at least a link in the chain of causation of, not only rheumatoid arthritis, rheumatic fever and spondy­litis, but also on other “stress” diseases such as essential hypertension. It seems that certain diseases can be caused in susceptible subjects by many forms of stress acting through the hypophysis, anterior pituitary (ACTH) and adrenal cor­tex. Stimulation of the adrenal cortex by ACTH produces three types of hormones, the sex hormones, the electrolytic group of mineralocorticoids used in Addison’s disease and the glycocorticoids or carbohydrate group. It is to this lat­ter group that cortisone belongs and it may be because of some antagonism between these various groups — the mineralocorticoids tending to cure it — that much of the confusion in experimental work with adrenal and pituitary extracts has arisen.

Note

*ACTH — adrenocorticotrophic hormone [,sdri:no 'ko:tiko'trofik 'ho:moun] produced by the anterior lobe of the pituitary gland

Task 22. Fill in the blanks with the appropriate words or expressions:

1. The administration of cortisone has produced ... .

2. Stimulation of the adrenal cortex by ... produces three types of hormones. 3. ... became less. 4. The complications following the administration of cortisone are .... 5. Delayed healing or even breaking down of wounds during treatment... .

6. Certain diseases can be caused ... by many forms of stress. 7. ... became normal. 8. A sense of well-being amounting to ... was experienced. 9. Remarkable recovery of patients suffering from ... has been achieved. 10. Muscular and ... improved within 24 hours.

(a — ACTH (adrenocorticotrophic hormone); b — eupho­ria; c — the sedimentation rate; d — articular stiffness; e -it oedema, acne, osteoporosis; f — in susceptible subjects; g — a dramatic remission of the disease; h — have been recorded; i — joint swellings; j — rheumatoid arthritis)

Task 23. You can’t deal with the directions to some medicines without knowing these pharmaceutical terms. Study and use them in speech:

contraindications — inadvisable symptoms, drug action or factors which make the administration of medicine or par­ticular treatment inadvisable idiosyncrasy — an individual reaction to a drug, food, etc.; a rare type of toxic effect that is different from the reac­tion of most people parenteral administration — treatment with the medicine administered by injection into muscle, veins or skin avoiding the digestive tract side effect — a detrimental (harmful) effect which results from the use of a medicine synergism — the simultaneous action of separate ingredi­ents (agencies of a medicine) which, together, have greater total effect than the sum of their individual effects. The combined or correlated action of different organs or parts of the body

sympathomimetic (adrenergic) agents — having an effect similar to that produced when the sympathetic nervoussystem is stimulated. Medicines which mimic the action of sympathetic nerves (epinephrine, adrenaline). They stimulate the amount of epinephrine, noradrenaline, increase heart rate, constrict blood vessels, dilate air passages

Task 24. Read a medicine direction and get ready to explain its indications, dosage and contraindications. Here comes the translation of some expressions to it:

highly purified без будь-яких домішок (добре очищений) radiologically standardized що відповідає стандартам стосовно радіологічних властивостей to induce retention of potassium and phosphorus стимулю­вати накопичення калію і фосфору patients with short stature низькорослі пацієнти

GRORM

Human Growth Hormone

Characteristics and Actions. Grorm contains growth hor­mone of human origin (Human Growth Hormone, HGH, or somatotropin), highly purified free of pyrogens and biologi­cally and radioimmunologically standardized. The human growth hormone increases protein synthesis, influences the metabolism of carbohydrates, the metabolization of fats, Ц also influences the balance of minerals, including a retension of potassium and phosphorus and an increase in excretion of calcium ions. The treatment of patients with short stature with GRORM, in adequate doses and for a sufficiently pro­longed period, induces an increase in growth rate. As GRORM contains human growth hormone of a high degree of purity, the formation of neutralizing antibodies is very unusual. Indications. Short stature due to pituitary insufficiency. Dosage. Dosage should be individualized. Generally, a weekly dose of at least 0.5 I.U. (International Unit) per kg of body weight is suggested. As a practical therapeutic schedule, it is recommended that the treatment be initiated by a weekly dose of 6 I.U. subdivided into three administrations. If, after 6 months of treatment, the growth rate appears inadequate, the dosage may be increased to 12 I.U. or more per week. Contraindications. Diabetes mellitus may be considered a relative contraindication.

Warning. At the beginning of the treatment, anorexia and oliguria may be observed: these symptoms generally disap­pear within a few days after onset of treatment.

5

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4—36

How Supplied. GRORM, in lyophilized powder form, is available in vials.

Packaging. With each vial an ampule containing 2 ml of saline is added.

Stability and Storage. GRORM in lyophilized form is stable for at least 2 years, when stored at 2 to 8°C. Pro­duced in Switzerland.

Task 25. Read the dictionary article and get ready to answer the questions:

Adipsin (from LRONW)

An enzyme present in fatty tissue which appears to have a role in preventing obesity.

Research on mice and rats has revealed an enzyme known as adipsin, a shortage of which could cause obesity. Adipsin, which carves up proteins, should provide many clues to the way fat cells function.

Adipsin is a recent discovery of researchers at the Dana Farber Cancer Institute and Harvard Medical School. The name is based on the term adipose tissue.

1. What is adipsin? 2. What could adipsin cause as a research revealed? 3. Where was adipsin discovered?

Task 26. Read the dictionary article and find out the description of the pituitary hormone and the effects it has in animals during experiments:

Alphaendorphin (from SBD)

Alphaendorphin is a pain-suppressing hormone produced in the pituitary gland.

Roger Guillemin of the Salk Institute went on to isolate two other peptides, as well as beta-endorphin itself, from a mixture of hypothalamus and pituitary tissue from pigs. One of them, named alphaendorphin has a sequence corresponding to amino acids...

Task 27. Read the dictionary article and speak up on the indications of the hormone described:

Cyproterone Acetate (from SBD)

Cyproterone acetate is a drug which suppresses the hor­mone testosterone, used to control sexual hyperactivity in males.

Cyprotcroue acetate was used to treat female patients suffering from severe premenstrual tension, depression and irritability. Daily dosages of the hormone were administered beginning seven days before the onset of menstruation. A marked improvement was noted in 80 per cent of the women.

Task 28. Choose the proper terms for the definitions:

1. An authoritative book containing a list and description of medicines, medicinal products, together with the standards established under law for their production, use, etc. 2. Lo­cated or injected within the Substance of a musclé. 3. One of the ways of taking medicine which requires swallowing. 4. Agents which increase the functions of any organ or sys­tem. 5. Agents which decrease the functioning of an organ or system. 6. Chemical normally released by the adrenal glands and endings of sympathetic nerves. 7. The passing of nutrient material into the blood stream or lymph. 8. The natural or developed ability to endure or resist the harmful effects of the continued or increasing use of a medicine, etc.

(a — tolerance; b — pharmacopeia; c — absorption; d —• depressants; e — stimulants; f — epinephrine; g — oral; h — intramuscular)

Task 29. Read the text which is suggested for your home-reading and pass your judgement upon the situa­tion depicted:

A FAREWELL TO ARMS by E. Hemingway (an extract)

...three doctors came into the room. I have noticed that doctors who fail in the practice of medicine have the ten­dency to seek one another’s company and aid in consulta­tion. A doctor who cannot take out your appendix properly will recomend to you a doctor who will be unable to remove your tonsils with success. These were three such doctors.

“This is the young man,” said the house doctor with the delicate hands.

“How do you do?” said the tall gaunt doctor with the beard. The third doctor, who carried the X-ray plates in their red envelopes, said nothing.

“Remove the dressings?” questioned the bearded doctor.

“Certainly. Remove the dressings, please, nurse,” the house doctor said to Miss Gage. Miss Gage removed the dressings.

I looked down at the legs. At the field hospital they had the look of not too freshly ground hamburger steak. Now they were crusted and the knee was swollen and discoloured, and the calf sunken, but there was no pus.

“Very clean,” said the house doctor. Very clean and nice.” “Um,” said the doctor with the beard. The third doctor looked over the house doctor’s shoulder.

“Please move the knee,” said the bearded doctor.

“I can’t.”

“Test the articulation?” the bearded doctor questioned. He had a stripe beside the three stars on his sleeve. That meant he was a first captain.

“Certainly,” the house doctor said. Two of them took hold of my right leg very gingerly and bent it.

“That hurts, “I said.

“Yes, yes. A little further, doctor.”

“That’s enough. That’s as far as it goes,” I said.

“Partial articulation,” said the first captain. He straighte­ned up. “May I see the plates again, please, doctor?” The third doctor handed him one of the plates. “No. The left leg, please.”

“That is the left leg, doctor.”

“You are right. I was looking from a different angle.” He returned the plate. The other plate he examined for some time. “You see, doctor? He pointed to one of the foreign bodies which showed spherical and clear against the light. They examined the plate for some time.

“Only one thing I can say,” the first captain with the beard said. “It is a question of time. Three months, six months probably.”

“Certainly the synoveal fluid must reform.”

“Certainly. It is a question of time. I could not conscien- tiuosly open a knee like that before the projectile was encys­ted.”

“I agree with you, doctor.”

“Six months for the projectiles to encyst before the knee can be opened safely.”

“I don’t believe it,” I said.

“Do you want to keep your knee, young man?”

“No,” I said.

“What?”

“I want it cut off,” I said, “so I can wear a hook on it;” “What do you mean? A hook?"

“He is joking, “ said the house doctor. He patted my shoulder very delicately. “He wants to keep his knee. This is a very brave young man. He has been proposed for the silver medal of valour.”

“All my felicitations,’’ said the first captain.: He shook my hand. I can only say that to be on the safe¹ side you should wait at least six months before opening such a knee; You are welcome of course to another opinion.”

“Thank you very much,” I said, fl value your opinion.” The first captain looked at his watch.

“We must go,” he said. “All my best wishes and many thanks,”. I said. I shook hands with the third doctor, Cap­tain Varini As Tenente Enry, and they all three went out of the room.

“Miss Gage," I called. She came in. “Please ask the house doctor to come back a minute. ”

He came in holding his cap and stood by the bed. “Did you wish to see me?”

“Yes; I can’t wait six months to be operated on. My god, doctor, did you ever stay in bed for six months?” j

“You wan’t be in bed all the time. You must first have the wounds exposed to the sun. Then afterwards you can be on crutches.”

“For six months and then have an operation?"

“That is the safe way. The foreign bodies must, be allowed to encyst and the synoveal fluid will re-form. Then it will be safe to open up the knee."

.“Do you really think yourself I will have to wait that long?” “That is the safe way.” jj “Who it that first captain?”

“He is a very excellent surgeon of Milan.”

“He’s a first captain, isn’t he?”

“Yes, but he is an excellent surgeon."

“I don’t want my leg fooled with by a first captain. If he was any good he would be made a major. I know what a first captain is, doctor.”

“He is an excellent surgeon and I would rather have his judgement than any surgeon I know.”

“Could another surgeon see it?”

“Certainly, if you wish. But I would take Dr. Varella’s opinion myself.”

“Could you ask another surgeon to come and see it?”

“I will ask Valentini to come.”

... Two hours later Dr Valentini came into the room. He was in a great hurry and the points of his moustaches stood straight up. He was a major, his face was tanned and he laughed all the time.

r

“How did you do it, this rotten thing?” he asked. “Let me see the plates. Yes. Yes. That’s it. You look healthy as a goat. Who’s the pretty girl? Is she your girl? I thought so. Isn’t this a bloody war? How does that feel? You are a fine boy. I’ll make you better than new. Does that hurt? You bet it hurts. How they love to hurt you these doctors. What have they done for you so far? Can’t that girl talk Italian? She should learn. What a lovely girl. I could teach her. I will be a patient here myself. No, but I will do all your maternity work free. Does she understand that? She will make you a fine boy. A fine blonde like she is. That’s fine. That’s all right. What a lovely girl. Ask her if she eats supper with me. No, I won’t take her away from you. Thank you very much, miss. That’s all.”

■" “That’s all I want to know.” He patted me on the shoul­der. “Leave the dressings off.”

“Will you have a drink, Dr Valentini?”

“A drink? Certainly. I will have ten drinks. Where are they?”

“In the armoire. Miss Barkley will get the bottle.” “Cherry oh. Cherry oh. Cherry oh to you, miss. What a lovely girl. I will bring you better cognac than that.” He wiped his moustaches.

“When do you think it can be operated on?”

“Tomorrow morning. Not before. Your stomach must be emptied. You must be washed out. I will see the old lady downstairs and leave instructions. Good-bye. I see you to­morrow. I’ll bring you better cognac than that. You are very comfortable here. Good-bye. Until tomorrow. Get a good sleep. I’ll see you early.” He waved from the doorway, his moustaches went straight up, his brown face was smil­ing. There was a star in a box on his sleeve because he was a major.”

Keys Task	4.	1	- 2; 2 - 1; 3 - 2; 4	— 1; 5'“- 2 (salivery); 6 — 2
		7	- 1
Task	5.	1	— g; 2 — a; 3 — d; 4 —	b; 5 — f; 6 — e; 7 — c; 8 — j
		9	“ h; 10 - i.
Task	6.	1	— j; 2 — i; 3 — a; 4 —	k; 5 — b; 6 — h; 7 — c; 8 — d
		9	- e; 10 — f; 11 - g.
Task	7.	1	— j; 2 T- i; 3 — a; 4 —	h; 5: — g; 6 — c; 7 — d; 8 — e:
		9	- f; 10 - b.
Task	8.	1	— g; 2 — f; 3 — e; 4 —	d; 5 — h; 6 — c; 7 -r- b; 8 — a.

Task	10.	1 - b; 2 m	a; 3 — d; 4	c
Task	14.	1 — 2; 2 - 8-4; 9 S	- 1; 3 tt.,5; 6; 10 7.	4 - 10; 5 -	9; 6 -‘|	3; 7 - 8;
Task	15.	1 - g; 2 - 9 - c; 10 -	d; 3 — e; 4 - b.	— h: 5 — j; 6	— i; 7 —	f; 8 — a;
Task	16.	l - j; 2 — 9 - f; 10 -	i; 3 — h; 4 a.	^ g; 5 - b; 6	— c; 7 —	d; 8 — e;
Task	18.	1 - c; 2 - 9 — e; 10 —	1; 3 — m; 4 a; 11 -7 b;	— k; 5 — j; 6 12 - n; 13 -	- d; 7 - f; 14 I	i; 8 — o; U 15 - g.
Task	19.	1 ^ g; 2 « 9 — e; 10 —	h; 3 - f; 4 - i.	- j; 5 -»a; 6	b; 7 -	c; 8 — d;
Task	22.	l - g; 2 - 9 - j; 10 -	a; 3 — 4 d.	— e; 5 — h; 6	— f; 7 —	c; 8 — b;
Task	28.	1 — b; 2 ->	h; 3 - g; 4	— e; 5 — d; 6	- f; 7 -	c; 8 — a.