摘要:

Chronic alcoholism has been reported to be associated “with a reduced carbohydrate content of transferrin (TF), particularly, its reduced sialylation state. Low sialylation state of TF now serves as an objective marker of chronic alcohol abuse. To investigate the patho-physiological significance of this finding in relation to hepatic siderosis, also commonly associated with chronic alcoholism, the authors have investigated the effect of ethanol on the uptake, binding, and desialylation of transferrin by isolated rat liver endothelium in vitro. In pulse-chase experiments, transferrin labeled with either125I (protein-labeled) or 3H (sialic acid-labeled) was incubated with isolated, fractionated liver endothelium with and without ethanol, and the supernates were subjected to column chromatography using RCA 120− agarose. Incubation of the endothelium with increasing concentrations of ethanol resulted in a progressive increase in the desialylation rate of transferrin which was maximal when 160 mM concentration of ethanol was used. These data indicate that ethanol significantly promotes the desialylation of transferrin by rat liver endothelium. The implications of these findings in the pathogenesis of hepatic siderosis of the alcoholic are discussed.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Hyperventilation produces small decreases in blood pressure in normal subjects and larger decreases in patients with autonomic failure. The authors studied the mechanism for this observation by measuring mean arterial pressure (MAP) and arterial blood gas (ABG) changes in eight patients with severe primary autonomic failure after various maneuvers designed to alter PaCO2, PaO2, and pH. Maneuvers included voluntary hyperventilation, breathing a 5% CO2/95% O2mixture, breathing 12% O2, breathing through a 1 meter tube to increase dead space, breathing 100% O2, and infusion of 120 mEq NaHCO3over 30 minutes. All maneuvers led to expected changes in ABGs. Voluntary hyperventilation lowered MAP by 23 ± 4 (p <0.01) mm Hg but MAP was raised 11 ± 3 and 7 ± 1 mmHg by hyperventilation resulting from increasing breathing dead space or from breathing 5% CO2, respectively. Breathing 100% O2or 12% O2had no significant effect on MAP, and NaHCO3infusion raised MAP by 8 ± 4 (p <0.05) mmHg. With all maneuvers, change in MAP correlated with change in PaCO2(r = 0.72, p <0.001) and change in pH (r = −0.57, p <0.01) but not with PaO2. Multiple regression analysis showed that only changes in PaCO2predicted the change in MAP for all maneuvers. The authors conclude that a decrease in PaCO2causes the observed decreases in MAP with hyperventilation. This most likely represents a direct peripheral vasodilator effect of hypocarbia rather than a reflex or centrally-mediated mechanism since our patient population is characterized by inadequate or absent autonomic cardiovascular reflex responses.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To determine the long term effects of a protein sparing fast on serum thyroid hormone levels, the authors studied 38 obese patients ingesting a diet of 320 kcal for up to 13 weeks. The high baseline serum triiodothyronine (T3) levels decreased significantly by the first week, further decreased by the third week, and this lower level persisted for the duration of the fast until realimentation. Serum free T3index followed the same general pattern as did serum T3levels. Serum reverse T3increased significantly by the first week, but by week three, the reverse T3level had begun to fall, although still significantly increased above baseline. By week seven, reverse T3had decreased to almost baseline and remained not significantly changed from the baseline to 13 weeks. Serum thyroxine (T4) increased significantly by the first week in all patients, but by the third week had returned to baseline levels which persisted to 13 weeks. The free T4index and free T4concentrations showed the same increment at week one and then returned to baseline levels. There were no significant changes in serum thyroxine-binding globulin (TBG) or thyroid-stimulating hormone (TSH) concentrations. The changes in serum T3and reverse T3levels are attributable to alterations in peripheral 5′-monodeiodination of T4 and reverse T3induced by the protein sparing fast.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Hypercalcemia is a common complication of certain advanced malignancies and although not therapeutically difficult, its presence raises complex ethical issues. Treatment of this condition is most easily justified when the patient is not terminal, the benefits are tangible, and the patient agrees with therapy. Withholding treatment is defensible medically, legally, and morally when a terminal situation is present, when drawbacks exceed the benefits, and when an informed patient declines therapy. Hypercalcemia is one of a number of conditions of dying that can be controlled by the physician. The physician's decision to treat such a condition, in part, depends upon his or her view of a good death. Further study is needed to clarify and avoid those situations of dying which involve suffering. Physicians must begin this difficult analysis and dialogue if they are to fulfill their obligation to minimize suffering in all patients.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A 62-year-old man was admitted because of nausea and vomiting. Severe hyponatremia with renal sodium loss was found. Endocrinological studies revealed that the patient had isolated adrenocorticotropin (ACTH) deficiency and secondary adrenocortical insufficiency. Furthermore, an inappropriate secretion of antidiuretic hormone (ADH) in relation to the low plasma osmolality was observed at an early stage of hyponatremia. Hydrocortisone therapy effectively corrected his hyponatremia. Following the correction of hyponatremia, the value of free water clearance increased and the level of the plasma ADH decreased. Thus, the present case indicates that ACTH deficiency can cause the syndrome of inappropriate secretion of ADH.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Skeletal lesions are not uncommon in von Recklinghausen neurofibromatosis. Most of them are considered to be dysplastic in nature. Association of osteomalacia or rickets with neurofibromatosis has been documented only rarely. Reported herein is a 40-year-old woman with known von Recklinghausen neurofibromatosis who presented with bone pain, multiple pseudofractures, marked increase in osteoid by bone biopsy, and hypophosphatemia with renal phosphate wasting. Treatment with oral phosphate and vitamin D was effective. A survey of the literature revealed that 34 similar cases have been reported in the past. Although the exact pathogenetic mechanism remains to be determined, osteomalacia in neurofibromatosis appears to be distinct from more common dysplastic skeletal affections of this disease, being characterized by later onset in adulthood as a rule, renal phosphate loss with hypophosphatemia, multiple pseudofractures in typical cases, and response to treatment with pharmacological dose of vitamin D with or without phosphate supplement.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The authors report a case in which a small cryptococcal pleural effusion preceded the development of severe cryptococcal meningitis in an HIV-positive patient. The appearance of an isolated transient pleural effusion is a very unusual presentation for AIDS-related complications. The authors suggest that cryptococcal infection be considered in this setting.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Thrombocytopenia associated with sarcoidosis is an uncommon, yet potentially lethal, complication. The traditional treatment for the thrombocytopenia has been steroid therapy followed by splenectomy if steroid therapy fails. The use of human immunoglobulin as a potential therapy in a patient afflicted with thrombocytopenia and sarcoidosis is reviewed.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Bacterial myonecrosis is a medical and surgical emergency and prompt surgical intervention is critically important. A variety of microorganisms have been isolated from patients with necrotizing soft-tissue infections. These infections are frequently polymicrobial in etiology, but occasionally a single microorganism is isolated. This report describes a case of crepitant myonecrosis from infection with Salmonella serogroup B.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Multidisciplinary efforts have defined a number of prognostic factors and newer strategies to improve the outcome of patients with breast cancer. Conservative surgery has led to improved functional and cosmetic results. The development of a number of effective adjuvant regimens has led to improved survival. In patients with stage I disease, several biological characteristics of tumor have been identified that are associated with increased risk of relapse. A multimodality approach to patients with locally advanced disease and inflammatory cancer has resulted in improved survival. A number of hormonal and cytotoxic drug contaminations can palliate metastatic disease, with a small fraction of patients remaining in extended remission. Dose-intensive programs may lead to further improvements in survival of selected patients with this disease.

ISSN:0002-9629    

出版商:OVID    

年代:1991

数据来源: OVID