摘要:

SummaryTotal body water, exchangeable sodium and exchangeable potassium were repeatedly measured with radioisotope dilution techniques in six patients in the end-stage of chronic renal failure, and maintained alive with repeated dialyses (haemodialysis and peritonea] dialysis). This study attempted to correlate blood pressure with exchangeable sodium in such patients. In lour subjects, which were ultimately submitted to renal transplantation, the effect of bilateral nephrectomy was also examined.In a first group of three patients, exclusively treated by dialysis, hypertension was not severe, and retinal changes were minimal, or absent, or disappeared during chronic dialysis. In these three patients, exchangeable sodium was high, and in two of them a close relationship between blood pressure readings and sodium poof values was observed.In the second group (four patients), hypertension was of the malignant type, with marked retinal changes, heart failure, and/or cerebral dysfunction. In three patients, exchangeable sodium was normal or slightly elevated; it was not measured in the fourth subject. In the four patients, bilateral nephrectomy was followed by dramatic and sustained lowering of the blood pressure. In two of these patients, the normotensive state was not accompanied by any reduction of the sodium pool. In the other patient, the collected data were insufficient to dissociate the effect of nephrectomy from that of a fall of exchangeable sodium.These observations suggest that at least two factors contribute to raise the blood pressure in the terminal stage of Bright's disease : an excessively large sodium pool and some unknown pressor renal activity (renin ?). The respective influence of each of these two factors on blood pressure might vary considerably from one patient to another.

ISSN:1784-3286    

DOI:10.1080/17843286.1966.11716613

出版商:Taylor&Francis    

年代:1966

数据来源: Taylor

摘要:

SummaryThe decrease in plasma potassium level induced by hyperventilation alkalosis is in accordance with the relationship between extracellular K concentration and pH, proposed by Scribner 10 years ago. The purpose of our study was to evaluate the clinical implication of this relationship in anaesthesia and reanimation : a decrease in plasma potassium level is desirable in hvperkalaemia but undesirable in hypokalemic and in digitalized patients.Five patients presenting conditions frequently encountered in réanimation were studied : severe renal failure, neurologic coma, acute repiratory failure. Hyperventilation lasted from 40 minutes to 39 hours. The pH increments ranged from 0.16 to 0.38 unit. The observed plasma potassium concentration changes were not of the same magnitude as those observed in the experimental animal : during the first hour, the plasma potassium level did not change or even increased despite frank alkalosis. Hypokalemia was noted in onlv two cases, where is was moderate and delayed.These results are confronted with the data of the literature : the effect of the respiratory acid-base disturbances on extracellular potassium concentration is smaller, slower and less predictable than that of the metabolic disturbances. The data collected during animal experimentation are more significant than those obtained in studies on normal man and especially on patients. Hypokalemia is very inconstant in anaesthetized and hyperventilated individuals, where respiratory alkalosis eventually induces initial and transient hvperkalaemia.The severity of the illness of the patients herein studied, as well as the inability to maintain constant their hyperventilation explain the discrepancies between our results and those of the literature. The different behaviour of extracellular potassium concentration under the influence of acid-base disturbances of respiratory and of metabolic origins is possibly explained by the slow diffusion of strong acids into the cellular compartment, opposed to the marked diffusihility of C02.It is concluded that hyperventilation does not constitute a safe procedure to treat impending hvperkalaemia. Other means which are safer and faster, are 10 be preferred, such as infusion of glucose-insulin, or alkalinisation with sodium lactate or bicarbonate.

ISSN:1784-3286    

DOI:10.1080/17843286.1966.11716614

出版商:Taylor&Francis    

年代:1966

数据来源: Taylor

摘要:

SummaryThe diagnosis of thromboembolic pulmonary hypertension and an assessment of the gravity of this disease is now possible by the study of the clinical, electrocardiographic and hemodynamic disturbances.The hemodynamic features are similar to those found in cases of peripheral stenoses of the pulmonary arteries. The phonocardiography findings are emphasized, in particular the presence of a continuous murmur which can often be heard over the entire lung and which finds its origin in the post-embolic stenoses of the pulmonary arteries. The therapeutic possibilities are discussed. It should be notetl that no definite data are available concerning the value of anticoagulant therapy.

ISSN:1784-3286    

DOI:10.1080/17843286.1966.11716615

出版商:Taylor&Francis    

年代:1966

数据来源: Taylor

摘要:

SummaryThe combination of various cytostatic products, each with a different mode of action, in the treatment of inoperable bronchia] carcinoma, results in a high percentage of radiological and objective clinical improvements, and seems to influence the survival time favourably. If the patients are controlled carefully side effects remain within reasonable limits. Justification of the selected combination and possible further improvements are discussed.

ISSN:1784-3286    

DOI:10.1080/17843286.1966.11716616

出版商:Taylor&Francis    

年代:1966

数据来源: Taylor