摘要:

ABSTRACTSix male patients with severe ethylene glycol poisoning were studied with respect to the origin of the metabolic acidosis. The plasma concentrations of ethylene glycol were 4–41 mmol/l and treatment included alkali, ethanol and hemodialysis. Plasma analysis by isotachophoresis and whole blood lactate determinations showed that glycolate (17.0–29.3 mmol/l), lactate (1.4–6.2 mmol/l) and β‐hydroxybutyrate (≤1.8 mmol/l) were present in elevated concentrations contributing to the acidosis. Oxalate (≤0.33 mmol/l), glyoxylate (<0.2 mmol/l) and formate (<0.4 mmol/l) concentrations were negligible and did not contribute to any significant degree to the acidosis. The elevated plasma glycolate concentration was highly correlated to the anion gap (r=0.923) and the glycolate made up for 96.1% (n=6, range 84.7–108.8) of the increased anion gap. We conclude that glycolate accumulation is the main reason for the metabolic acidosis in ethylene glycol poisoning. The mean dialysator (1.6 m2) clearances of glycolate at a blood flow of 200 ml/min in two patients were 137 ml/min (n=9, SD±8, range 125–149) and 144 ml/min (n=11, SD±8, range 133–158). By applying first order kinetics during hemodialysis a volume of distribution of glycolate of 0.55 l/kg was found, assuming that the dialysator clearance equals the total body clearance of glycolate. Thus glycolate, the probable main metabolite of ethylene glycol, is efficiently rem

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05026.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTIn four hypertensive patients, acute lowering of blood pressure by therapeutic or diagnostic procedures caused visual disturbances ranging from transient visual hallucinations to severe, long‐lasting visual impairment. These symptoms were associated with occipital lobe cerebral infarcts that tended to occur in the border zones between the major cerebral arteries. The infarcts may be seen as the combined result of a “watershed” effect during acute hypotension and the presence of structural hypertensive vascular adaptation. When a hypertensive patient complains of visual disturbances during acute blood pressure lowering, the pressure should be allowed to settle at a level somewhat above n

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05027.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTTwo patients, 15 and 20 years old, were admitted after an overdose of theophylline in a slow‐release preparation. The gradual occurrence of clinical symptoms reflected the slow gastrointestinal absorption of the drug, and therefore active treatment was not started until 10 and 12 hours after intake, respectively. Peak s‐concentrations were 275 and 1295 μmol/l, respectively. One patient was treated with hemoperfusion only, whereas the more severely intoxicated patient was treated with combined hemoperfusion and hemodialysis. Only about 0.2 g theophylline was eliminated by hemodialysis in this patient compared to a calculated amount of 6.9 g by hemoperfusion. Severely theophylline‐intoxicated patients should be treated with supportive therapy and hemoper

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05028.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTA 20‐year‐old man developed pneumonia and glomerulonephritis concomitantly with significantly rising Mycoplasma pneumoniae complement‐fixing antibody titres. Renal biopsy showed mesangiocapillary glomerulonephritis type II (dense deposit disease). Attempts to demonstrate mycoplasmal antigen in the glomeruli failed. This is the third of five previously reported cases of glomerulonephritis associated with Mycoplasma pneumoniae and exhibiting dense deposit di

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05029.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTThree patients suffering from systemic scleroderma and Raynaud's phenomenon in the digits as well as the tongue are reported. Following exposure to cold, a vasospasm was observed in the digits and the tongue accompanied by severe dysarthria. These striking oral symptoms had been overlooked for years in the medical ward. It is recommended to question all patients with Raynaud's phenomenon about visceral manifestations during the digital attacks.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05030.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05031.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTThe natural history of benign monoclonal gammapathy (BMG) has been followed by repeated studies of patients with M components through periods up to two decades. The disappearance of an M component is quite exceptional—in this material only once. Populations with increase in IgG, IgA and IgM have been studied separately. Slow, but steady, increase through many years may be found without development of myeloma (MM). Rapid transition from a steady state of the M component to progression is rare and usually, but not always, indicates the development of clearcut myeloma. Intermediate patterns are not uncommon and make it very difficult in rare individual cases to draw a sharp line between myeloma that should be treated and the benign state that should only be observed. The cause of pain may be difficult to judge. Osteolytic foci in the skull are usually diagnostic for MM, but vertebral fracture may also occur in osteopenia. It is evident that a period of at least three years of close observation without treatment should be the routine. “Prophylactic” treatment of BMG with cytostatic drugs should never be atte

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05032.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTThere is a close connection between molecular changes of the Ig molecule with sinking temperature and the syndrome of hyperviscosity. The cryoglobulins are usually macroglobulins or complexes between IgM and other immunoglobulin classes. Many of these molecules can also be characterized as euglobulins. The connection between precipitation in the cold and in solutions with low electrolyte content is studied. Data on these connections are presented. The dependence of relative viscosity on the temperature has been investigated in a large number of sera from patients with different diseases. It is clear that most of these cold‐sensitive globulins are macroglobulins (IgM). A number of viscosity curves at different temperatures in such sera are given. Also a few sera from patients with IgG myeloma have similar curves. The change in viscosity with lower temperatures implies that relative viscosity has to be determined at 37°C in order to correspond to the condition in the living body. In practice, however, it is usually correct to state that IgM levels above 40 g/l are an indication that plasmapheresis should be considered. The best clinical sign is obtained by ophthalmoscopy. Difficulties with the counting of leukocytes and platelets in electronic counters may be caused by the presence of macroglobulins, usually but not always, cryoglobuli

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05033.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTThe indications for plasmapheresis in the different hyperviscosity syndromes are discussed on the basis of data on relative serum viscosity at 13 and 37°C. Beside monoclonal macroglobulinemia there are conditions with a high content of polyclonal IgM and also of IgG and IgA where hyperviscosity is a dominant symptom. The importance of what may be called macroglobulinemia polyclonalis spuria is stated and a number of patients belonging to this type are discussed. Polyclonal increase in IgG, even at high levels, usually does not cause severe hyperviscosity. Case histories of patients with rheumatoid disease and marked hyperviscosity constitute one group. Another is formed by diseases leading to the development of immune complexes. Such complexes are usually caused by binding of polyclonal IgG to monoclonal IgM, but other combinations are also known. A number of clinical examples of these different disease conditions, some probably indicating intense plasmapheresis, are analyzed. The limited value of plasmapheresis alone without cytostatic treatment is stressed as regards hyperviscosity. Another indication is removal of noxious protein components

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05034.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACTAlcohol‐related disorders belong to the spectrum of major non‐infectious diseases in Western societies which can be prevented by means that have not yet been fully implemented. Total consecutive mortality in a population of 10 353 middle‐age males invited to take a part in a preventive medical population program in Malmö was followed up for 3.5–8.5 years (mean 4.5) after the time of invitation and analysed in relation to participation or non‐participation and forensic or in‐hospital autopsy. Entry characteristics in the 7935 males who attended the screening were compared in order to evaluate risk factor patterns for the major categories of premature death during the follow‐up period. Even in the males participating in the screening, alcohol‐related deaths (ARD) constituted a major mortality category, comprising 55 of 218 cases, whereas cancer comprised 61 and coronary heart disease (CHD) 50 of the premature deaths in this group. Both in the ARD and CHD categories of male premature mortality, significant and distinctly differential risk factor patterns were found; in CHD for smoking, cholesterol, serum triglycerides and systolic blood pressure, and in ARD for γ‐glutamyltransferase, questionnaire alcoholism screening test and, inversely, serum cholesterol and serum creatinine. In both groups of diseases, these risk factors could be combined into highly predictive multiple logistic risk factor functions. The discriminative power of this instrument was even higher in ARD than in CHD deaths. In consequence, these factors may be applied both as indicators of the ARD risk and as signals and instrument for directed preventive measures in analogy with previously well established and tested methods for the regulation of blood pressure, serum lipids, etc. in the conquest of the card

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb05035.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY