摘要:

Summary:A prospective analysis of 17 cases of paroxysmal atrial tachycardia with block was carried out over a five‐year period from June 1968 to June 1973 in a medical unit in Singapore. Seventy‐six percent had prior digitalis therapy, and all except one were more than 50 years old. Of the 17 cases, eight patients (46%) with chronic obstructive lung disease and cor pulmonale developed this arrhythmia after digitalis administration, five had severe chronic ischaemic heart disease, two chronic renal failure, one hypertensive heart disease and one had no apparent organic disease. Digitalis was stopped in all those patients who had received digitalis as it was assumed to be one of the contributing factors which precipitated the arrhythmia. Intravenous potassium chloride was used successfully in nine out of 10 patients. The use of potassium and its dangers are discussed. Intravenous diphenylhydantoin and propanolol were used in three and two patients respectively.Sixteen patients had their arrhythmia terminated but the mortality rate remained high (59%) reflecting the severity of the underlying disease. The incidence of this arrhythmia (1: 2,000 ECGs per annum) in our department was low compared to other ser

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03178.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:Plasma digoxin levels were measured in 22 adults and in 18 infants under one year. Of the adults, 12 had no evidence of toxicity and 10 had clinical and ECG evidence of digitalis intoxication. Mean value of plasma digoxin in the non‐toxic adults was 1.41 (SD ±0.49) ng/ml. and was significantly higher in the toxic group — mean 3.81 ± 1.45 ng/ml. (p<0.001). The mean value in infants, none of whom had clinical or ECG evidence of toxicity, was 3.45<2.09 ng/ml. – significantly higher than non‐toxic adults (p<0.005).In the two adult groups, the higher levels in toxic patients appeared to be related to impaired renal function and not to dosage. Although there was no relationship within the infants between dose and plasma digoxin level, they did as a group have a significantly higher mean plasma level and a significantly higher mean dose of digoxin relative to body weight than did the non‐toxic adult group. Infants were noted to have higher serum potassium levels. Currently accepted adult ranges for differentiating therapeutic from toxic blood levels of digoxin are not applicable

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03179.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:It is proposed that diabetes mellitus, characterised by hyperglycaemia and either relative or absolute insulin deficiency, represents a spectrum of clinical disorders produced by one or more abnormalities at hormone or glucose receptor sites in the membrane of the pancreatic islet beta cell.Separate receptors with finite binding affinity have been described for glucose, glucagon, gastrointestinal hormones and adrenaline. In diabetes mellitus glucose‐receptor binding is always abnormal. In some diabetics, one or more of the hormone‐receptor binding sites may be abnormal in addition. Sulphonylureas such as tolbutamide, act by either altering the properties of the hormone‐receptor binding site or modifying the tertiary structure of the insulinogenic substance to provide tighter or more effective binding—they lubricate the lock.Diabetes mellitus may represent a spectrum of disorders presenting with the same clinical features. The concept of selective receptor involvement may clarify the confusion surrounding the mode of inheritance of the disorder and pro‐vide a rational basis for early diagnosis and effective m

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03180.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:The respective role of alphaadrenergic and beta‐adrenergic receptors in mediating the effect of catecholamines on renin secretion were examined in the isolated perfused rat kidney. Renin secretion was markedly stimulated by isoproterenol, a catecholamine with pre‐dominant beta‐adrenergic activity, but not by methoxamine which has pre‐dominantly alpha‐adrenergic effects. Selective involvement of beta‐adrenergic receptors was further supported by the specific inhibitory effect of dlpropranolol. Norepinephrine, which has combined alpha‐ and beta‐adrenergic activity, only stimulated renin secretion when the alpha‐receptor blocking agent phenoxybenzamine was present. These observations indicate an exclusive role for intrarenal beta‐adrenergic receptors in the stimulation of renin secretion. In contrast, it is apparent that an opposite inhibitory effect on renin secretion follows alpha

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03181.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:Indirect evidence of immunopathy was sought in 32 patients with well documented chronic idiopathic thrombocytopenic purpura (ITP). Immunodeficiency was detected by a reduction in immunoglobulin levels in 27%, and by an impaired lymphocyte mitotic response to phytohaemagglutinin in 67% of the patients tested. Clinical and serological evidence obtained sup‐ports the concept that chronic ITP is an ‘organ‐specific’ autoimmune disease associated with the thyrogastric

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03182.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:Middle‐aged women with a substantiated diagnosis of schizophrenia from Victorian Psychiatric Hospitals were examined for clinical, radiological and serological evidence of rheumatoid arthritis. Clinical or radiological evidence of rheumatoid arthritis was detected in none of the 301 patients studied, where‐as the expected prevalences would be 7.7%; this difference is highly significant (p<0.001). On the other hand, the prevalence of serologically demonstrable rheumatoid factor in the women with schizophrenia was similar to that in subnormal women in hospital under the same conditions and in women from a normal Australian population. The demonstrable polarity of schizophrenia and clinical rheumatoid arthritis in women might be explained either on a genetic basis or through the “protective” effects of one disease, schizophrenia, on the occurrence of the other, rheumatoid ar

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03183.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:Five patients had recurrent ventricular tachyarrhythmias which were abolished by resection of their left ventricular aneurysms.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03184.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:Nephropathy associated with the administration of methicillin and other antibiotics, occurred in four patients. High‐output renal failure, hyperchloraemic acidosis and mild proteinuria were observed typically. Eosinophilia was a characteristic associated feature, and a skin rash was present in two. Recovery occurred in each case, but impairment of renal function was pro‐longed. Renal biopsy performed in two patients revealed marked interstitial infiltration with mononuclear cells and eosinophils, together with patchy tubular necrosis. Follow‐up renal biopsy in one patient at five months revealed residual tubular damage, interstitial cellular infiltration, and areas of interstitial fibrosis.“Methicillin kidney” appears to be a definite clinicopathological entity with features which distinguish it from other causes of renal failure in patients with severe staphylococcal infections. Because prolonged impairment of renal function may occur despite cessation of the drug, steroid therapy may be indicated during the ac

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03185.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:Two cases of systemic cryptococcosis treated with 5‐Fluorocytosine and the insertion of a ventriculostomy reservoir are reported. The effectiveness and complications of this therapy are discusse

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03186.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY

摘要:

Summary:A two‐year‐old, male non‐identical twin with megacolon, hypochondroplasia of bone and absence of a thymus‐dependent lymphoid population is described. No parathyroid dysfunction was detected and humoral immune function was intact, although only an IgM response was elicited by a thymus dependent antigen. Repeated grafting of unmatched thymus tissue from a human foetus of 12–16 weeks gestation has resulted in significant immunological re‐constitution and clinical

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1974.tb03187.x

出版商:Blackwell Publishing Ltd    

年代:1974

数据来源: WILEY