Utility of 30 and 60 minute cortisol samples after high-dose synthetic ACTH-1-24 injection in the diagnosis of adrenal insufficiency

BACKGROUND: In clinical practise the high dose ACTH stimulation test (HDT) is frequently used in the assessment of adrenal insufficiency (AI). However, there is uncertainty regarding optimal time-points and number of blood samplings. The present study compared the utility of a single cortisol value taken either 30 or 60 minutes after ACTH stimulation with the traditional interpretation of the HDT. METHODS: Retrospective analysis of 73 HDT performed at a single tertiary endocrine centre. Serum cortisol was measured at baseline, 30 and 60 minutes after intravenous administration of 250 µg synthetic ACTH1-24. Adrenal insufficiency (AI) was defined as a stimulated cortisol level <550 nmol/l. RESULTS: There were twenty patients (27.4%) who showed an insufficient rise in serum cortisol using traditional HDT criteria and were diagnosed to suffer from AI. There were ten individuals who showed insufficient cortisol values after 30 minutes, rising to sufficient levels at 60 minutes. All patients revealing an insufficient cortisol response result after 60 minutes also had an insufficient result after 30 minutes. The cortisol value taken after 30 minutes did not add incremental diagnostic value in any of the cases under investigation compared with the 60 minutes' sample. CONCLUSIONS: Based on the findings of the present analysis the utility of a cortisol measurement 30 minutes after high dose ACTH injection was low and did not add incremental diagnostic value to a single measurement after 60 minutes.

Ms. hebr. oct. 60 - [Sammelband in 2 Teilen: Handschriftenkonvolut]

Vorbesitzer: Abraham Merzbacher

Ms. Barth. 60 - Kanonistische Sammelhandschrift

Vorbesitzer: Bartholomaeusstift Frankfurt am Main;

Soldatens, stecht de Deegens in! Verbrüderte Predigt an die 60,000pfündige Miletär-Batterie in Berlin un Umjejend: Olle Jungens, so is et recht, Arm in Arm wollen wir det schwerenöthsche Jahrhundert in de Schranken fordern ...

Welsch (Projektbearbeiter): "Der Verfasser appelliert an Bürger und Soldaten, Freundschaft miteinander zu schließen. Besonders die Soldaten erinnert er daran, daß sie auch Bürgersöhne sind, und daß sie ihre Gleichstellung mit den adligen Offizieren nur den Berliner Bürgern zu verdanken haben und deshalb nicht gegen sie kämpfen dürfen." [Führer, B.: Das Berlinische im Tagesschrifttum von 1848/49, S. 302]

An die Urwähler des 60. Stadt-Bezirks! Welche traurigen Folgen eine unglückliche Wahl von Volksvertretern nach sich ziehen kann ...

Welsch (Projektbearbeiter): Die bevorstehenden Wahlen sollen Ruhe, Ordnung und Gesetzmäßigkeit zeitigen; das Gleichgewicht zwischen Volk und Regierung nicht durch Übergriffe gestört werden. Daher sollen nur solche Wahlmänner gewählt werden, die für eine konstitutionelle Monarchie und die oktroyierte Verfassung eintreten.

Wahlprogramm: Die unterzeichneten Urwähler des 60. Bezirks, durchdrungen von der hohen Wichtichkeit der bevorstehenden Wahlen ...

Welsch (Projektbearbeiter): Wahlprogramm von fünf Urwählern des sechzigsten Berliner Bezirks: die Verfassung vom 5. Dezember 1848 wird nicht in Frage gestellt, ist aber nur ein Entwurf, der der Weiterentwicklung bedarf. Mängel sind: die fehlende Diätenregelung ermöglicht faktisch nur Reichen die Mitgliedschaft in der ersten Kammer, das Ministerium kann bei Abwesenheit der Kammern Verordnungen mit Gesetzeskraft erlassen, das Steuerbewilligungsrecht der Kammern ist massiv eingeschränkt, Artikel 110 stellt wesentliche Grundrechte (Freiheit der Person, Unverletzlichkeit der Wohnung, Presse- und Vereinigungsfreiheit) zur Disposition. Ablehnung der beiden Extreme des Scheinkonstitutionalismus und der Anarchie.

Post-remission treatment with allogeneic stem cell transplantation in patients aged 60 years and older with acute myeloid leukaemia: a time-dependent analysis

BACKGROUND Acute myeloid leukaemia mainly affects elderly people, with a median age at diagnosis of around 70 years. Although about 50-60% of patients enter first complete remission upon intensive induction chemotherapy, relapse remains high and overall outcomes are disappointing. Therefore, effective post-remission therapy is urgently needed. Although often no post-remission therapy is given to elderly patients, it might include chemotherapy or allogeneic haemopoietic stem cell transplantation (HSCT) following reduced-intensity conditioning. We aimed to assess the comparative value of allogeneic HSCT with other approaches, including no post-remission therapy, in patients with acute myeloid leukaemia aged 60 years and older. METHODS For this time-dependent analysis, we used the results from four successive prospective HOVON-SAKK acute myeloid leukaemia trials. Between May 3, 2001, and Feb 5, 2010, a total of 1155 patients aged 60 years and older were entered into these trials, of whom 640 obtained a first complete remission after induction chemotherapy and were included in the analysis. Post-remission therapy consisted of allogeneic HSCT following reduced-intensity conditioning (n=97), gemtuzumab ozogamicin (n=110), chemotherapy (n=44), autologous HSCT (n=23), or no further treatment (n=366). Reduced-intensity conditioning regimens consisted of fludarabine combined with 2 Gy of total body irradiation (n=71), fludarabine with busulfan (n=10), or other regimens (n=16). A time-dependent analysis was done, in which allogeneic HSCT was compared with other types of post-remission therapy. The primary endpoint of the study was 5-year overall survival for all treatment groups, analysed by a time-dependent analysis. FINDINGS 5-year overall survival was 35% (95% CI 25-44) for patients who received an allogeneic HSCT, 21% (17-26) for those who received no additional post-remission therapy, and 26% (19-33) for patients who received either additional chemotherapy or autologous HSCT. Overall survival at 5 years was strongly affected by the European LeukemiaNET acute myeloid leukaemia risk score, with patients in the favourable risk group (n=65) having better 5-year overall survival (56% [95% CI 43-67]) than those with intermediate-risk (n=131; 23% [19-27]) or adverse-risk (n=444; 13% [8-20]) acute myeloid leukaemia. Multivariable analysis with allogeneic HSCT as a time-dependent variable showed that allogeneic HSCT was associated with better 5-year overall survival (HR 0·71 [95% CI 0·53-0·95], p=0·017) compared with non-allogeneic HSCT post-remission therapies or no post-remission therapy, especially in patients with intermediate-risk (0·82 [0·58-1·15]) or adverse-risk (0.39 [0·21-0·73]) acute myeloid leukaemia. INTERPRETATION Collectively, the results from these four trials suggest that allogeneic HSCT might be the preferred treatment approach in patients 60 years of age and older with intermediate-risk and adverse-risk acute myeloid leukaemia in first complete remission, but the comparative value should ideally be shown in a prospective randomised study. FUNDING None.

Persische Briefe : 60. Brief

Montesquieu

Martin Philippson : zum 60. Geburtstage, 27. Juni 1906

Max Eschelbacher

Gustav Karpeles : zu seinem 60. Geburtstage am 11. November 1908

Josef Lin

Dr. Simon Bernfeld : (zu seinem 60. Geburtstage)

Josef Meisl

Lesser Ury zum 60. Geburtstag : (7. November 1921)

Karl Schwarz

Jeanette Wohl : zu ihrem 60. Todestage, 27. November 1921

Selma Stern