摘要:

Background and ObjectivesHypersplenism is frequently seen in patients with cirrhosis. However, it is unclear why some patients with cirrhosis develop marked hypersplenism and others do not. Additionally, the implications of severe hypersplenism are unknown. Therefore, we conducted a study to evaluate the predictors and implications of severe hypersplenism in patients with cirrhosis.Subjects and MethodsAll subjects with cirrhosis who were referred to Indiana University over a 53-month period for liver transplantation were studied. Severe hypersplenism was defined as platelet count < 75,000 per mm3and/or white blood cell count < 2,000 per mm3in the presence of splenomegaly. The outcomes of interest were development of spontaneous bacterial peritonitis (SBP), variceal bleeding, and death. Patients were observed until death, transplantation, or study closure.ResultsThe study group comprised 329 subjects with cirrhosis and their median follow-up time was 450 days (0.25–42 months). The prevalence of severe hypersplenism was 33%. Decompensated liver disease [odds ratio (OR), 2.0; 95% confidence interval (CI), 1.1–3.7] and a history of alcohol consumption (OR 2.3; 95% CI, 1.4–3.8) were independent predictors of severe hypersplenism. The presence of severe hypersplenism independently predicted the development of variceal bleeding [hazard ratio (HR) 4.1; 95% CI, 1.7–10], SBP (HR 8.0; 95% CI, 3.1–20.5), and death (HR 2.0; 95% CI 1.2–3.4).ConclusionsThis study suggests that severe hypersplenism is an independent risk factor for developing variceal bleeding, SBP, and death in patients with cirrhosis. If these observations are confirmed, severe hypersplenism can be considered as an indication for prophylactic measures against variceal bleeding and SBP.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors increase renal blood flow independent of their lipid-lowering properties. In organ transplantation, the calcineurin inhibitor cyclosporine A (CyA) is the immunosuppressant of choice. However, its renal vasoconstrictor properties limit its use. This study aimed to determine the effect of an HMG-CoA reductase inhibitor, simvastatin (Zocor), on renal function in rats after ischemia/reperfusion injury (I/R) with concomitant CyA treatment.MethodsMale Wistar rats (250 g) were anesthetized and the suprarenal aorta clamped for 40 minutes. The right kidney was removed. After recovery, the rats were divided into 5 groups: (1) control rats, no ischemia, no treatment; (2) ischemia with no treatment; (3) ischemia plus CyA only; (4) ischemia plus CyA and low-dose simvastatin; and (5) ischemia plus CyA and high-dose simvastatin. Five to 7 days after I/R injury, glomerular filtration rate (GFR) was determined using urinary iohexol clearance.ResultsThe GFR values (mL/min) for all 5 groups were as follows: (1) 1.23 ± 0.08; (2) 1.05 ± 0.10; (3) 0.44 ± 0.06 (P< 0.05 versus groups 1, 2, and 5; one-way analysis of variance); (4) 0.51 ± 0.04 (P< 0.05 versus groups 1, 2, and 5; one-way analysis of variance); and (5) 0.85 ± 0.11.ConclusionsAfter I/R injury and cyclosporine treatment, simvastatin preserved renal function compared with cyclosporine treatment alone because it may not have a direct vasoconstrictor effect on the renal microcirculation. In fact, it may exhibit vasodilator properties on the renal microcirculation mediated by nitric oxide.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundOccupational exposure to silica could lead to renal histological alterations in the glomeruli and proximal tubules. We investigated urinary excretion of copper and zinc and its possible relationship to renal alterations and work duration among nonsmoking, silica-exposed workers.MethodsThirty-six control subjects (age, 39.08 ± 6.65 years) and 48 silica-exposed workers (age, 36.79 ± 7.33 years) were included in the present study. The exposed workers were grouped into workers with <10 years’ work duration (n = 9; age, 29.0 ± 1.50 years) and workers with ≥10 years’ work duration (n = 39; age, 38.59 ± 6.94 years). Glomerular function was assessed by measuring urinary level of microalbumin, and proximal tubular reabsorption function was assessed by measuring urinary level of &agr;1-microglobulin. Structural integrity of proximal tubules was studied by measuring urinary activity of cytosolic enzyme glutathioneS-transferase (GST). Also, urinary levels of copper, zinc, and creatinine were measured.ResultsAll measured urinary parameters were significantly increased among silica-exposed workers compared with control subjects. A significant correlation was observed between urinary levels of each of copper and zinc with the glomerular and proximal tubular functional and structural urinary parameters as well as work duration.ConclusionOccupational silica exposure may lead to increased urinary loss of copper and zinc as protein-metal complex, and the urinary level of these essential trace elements may be a marker for renal dysfunction. The urinary excretion of GST may be a useful marker for proximal tubular injury.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThyrotoxic periodic paralysis (TPP) commonly precedes the overt symptoms and signs of hyperthyroidism and may be misdiagnosed as other causes of paralysis (non-TPP). Because the cardiovascular system is very sensitive to elevation of thyroid hormone, we hypothesize that electrocardiographic manifestations may aid in early diagnosis of TPP.MethodsWe retrospectively identified 54 patients who presented to the emergency department (ED) with hypokalemic paralysis during a 3.5-year period. Thirty-one patients had TPP and 23 patients had non-TPP, including sporadic periodic paralysis, distal renal tubular acidosis, diuretic use, licorice intoxication, primary hyperaldosteronism, and Bartter-like syndrome. Electrocardiograms during attacks were analyzed for rate, rhythm, conduction, PR interval, QRS voltage, ST segment, QT interval, U waves, and T waves.ResultsThere were no significant differences in age, sex distribution, and plasma K+concentration between the TPP and non-TPP groups. Plasma phosphate was significantly lower in TPP than non-TPP. Heart rate, PR interval, and QRS voltage were significantly higher in TPP than non-TPP. Forty-five percent of TPP patients had first-degree atrioventricular block compared with 13% in the non-TPP group. There were no significant differences in QT shortening, ST depression, U wave appearance, or T wave flattening between the 2 groups.ConclusionRelatively rapid heart rate, high QRS voltage, and first-degree AV block are important clues suggesting TPP in patients who present with hypokalemia and paralysis.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Although oral medication induced esophageal injury (OMIEI), is a well-known and preventable condition, many cases are still missed, particularly in the elderly patients.ObjectiveTo determine the frequency and outcome of oral medication-induced esophageal injury in elderly patients.MethodsRecords of 390 patients aged over 65 years, with diagnoses of dysphagia, odynophagia, and noncardiac chest pain, over the period of 11 years, were selected for a retrospective review. Patients who had barium studies only, in whom endoscopy was not done or was unsuccessful, and those with incomplete data were excluded, leaving 250 patients for further review.ResultsDiagnosis of OMIEI was made in 27% (68 of 250) patients. Fifty-one of 68 (75%) patients with OMIEI responded to conservative management, including H2blockers, proton pump inhibitors, antacids, or sucralfate. The remaining 17 patients (25%) developed esophageal strictures requiring dilation.ConclusionsA high index of clinical suspicion and low threshold for empiric treatment and diagnostic measures (endoscopy, barium swallow study), may be helpful, if indicated, for early diagnosis and prompt therapy of OMIEI.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Cultural competence in the provision of health care is a very important area of investigation and is receiving recognition at multiple levels. Minority groups constitute a significant and growing percentage of our population. However, there has been no commensurate increase in the number of minority physicians. There is a tremendous need for medical professional schools and health care organizations to implement formal cultural competence training for current and future health professionals. In this article, we present the findings of an extensive literature review that describes how several factors have brought the need for cultural competence to the forefront. These factors include a greater appreciation for the impact of culture on health, changes in U.S. demographics, increased awareness in health care disparities, and modifications in legislative and accreditation mandates.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Granulomas have been described in a wide variety of organs in patients with Crohn disease, but not in spleen. This report describes a patient with noncaseating granulomas of the liver and spleen that responded promptly and fully to glucocorticoid therapy.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Secondary amyloidosis is well recognized as a severe complication in the late stages of rheumatoid arthritis (RA). However, there have been few reported cases of secondary amyloidosis developing early during the course of RA. We here report the case of a 35-year-old woman, in whom RA who had been diagnosed 1 year before, with intractable watery diarrhea as a symptom of RA-induced secondary intestinal amyloidosis. Combination treatment with intravenous hyperalimentation, corticosteroids, and methotrexate (MTX) resulted in a dramatic improvement of her symptoms and objective findings of serological abnormalities. Subsequent administration of corticosteroids and MTX resulted in long-term survival without recurrence. This case indicates that we should be alert for the development of secondary amyloidosis, even in patients with a short history of RA, when the disease is active. Furthermore, combination therapy with intravenous hyperalimentation and strong immunosuppressive agents seems to be very efficacious in the treatment of RA-associated secondary intestinal amyloidosis.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A 48-year-old woman was admitted because of spiking high fever, sore throat, and jaundice. A diagnosis was made of adult-onset Still disease (AOSD) presenting with acute hepatitis and very high serum ferritin levels (32,240 ng/mL), and she was treated with 2 courses of pulse therapy of methylprednisolone (2 g/day for 3 days) followed by 40 mg/day prednisolone. Subsequently, the serum level of ferritin decreased, but serum total bilirubin increased to 17.3 mg/dL. Therefore, cyclosporin was administered orally. Within the next 3 months, results of liver function tests, as well as serum levels of ferritin, soluble interleukin-2 receptor, interferon-&ggr;, interleukin-6, and tumor necrosis factor-&agr; gradually returned to within normal limits, and cyclosporin administration was subsequently reduced gradually. The clinical presentation suggests that AOSD should be considered when liver dysfunction is accompanied with high fever and extreme hyperferritinemia, and that treatment with cyclosporin or other immunosuppressive drugs that selectively suppress cytokine production by helper T cells is a valuable option in the treatment of AOSD with very high serum ferritin levels.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Thoracic actinomycosis can resemble bronchogenic carcinoma in its clinical presentation and radiographic appearance. We report a case of pulmonary actinomycosis caused byActinomyces meyeriin which hematogenous dissemination caused multiple brain abscesses resembling metatstatic lung cancer. The correct diagnosis was made by thin-needle aspiration of a pleura-based lung mass. The pathogen isolated was further identified with the use of 16S rDNA sequencing. Antibiotic therapy resulted in rapid improvement of the lung lesion; however, the brain lesions required surgical drainage. Antibiotics were continued for more than a year before magnetic resonance images showed complete resolution of the cerebral abscesses.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID