摘要:

Myxedema coma is a medical emergency which requires prompt action to avoid an almost uniformly fatal outcome. The condition may begin insidiously when an elderly patient, who has been hypothyroid for a long time, lapses into coma, or it may occur dramatically in mildly hypothyroid people following therapy with tranquilizers, narcotics, or sedatives. Anesthesia or infections may also precipitate the coma. Usually CO2retention, somnolence, hyponatremia, bradycardia, hypotension, or hypothermia precede the onset of the coma.Prevention of coma consists of lifelong maintenance of thyroid hormone replacement therapy in the hypothyroid subject. In the untreated hypothyroid subject, one must heed those conditions which presage the onset of coma and institute thyroid replacement promptly. Once coma has occurred, therapy consists of the rapid replacement of large amounts of thyroid hormone and of supportive measures to counteract the complications of coma. The management of CO2retention by establishing an adequate airway and the administration of adrenal steroids are important adjuncts to therapy.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Forty-one consecutive patients with clinical acute meningococcal infections were treated with antibiotics and rapid volume expansion. Prophylactic low dose heparin (0.5 mg/kg intravenously every four hours) was given to 38 patients, and one additional patient received a higher dose of heparin. Of the 38 patients who were normotensive when therapy was instituted, none developed hypotension or consumption coagulopathy. Of three patients who were hypotensive, one had consumption coagulopathy initially, one developed consumption coagulopathy during the first 12 hours of therapy, and one never developed consumption coagulopathy. Both patients with consumption coagulopathy ultimately had reversal of the consumption coagulopathy and hypotension with therapy which included volume expansion and increasing the dose of heparin.Two patients developed evidence of fluid overload. Hemorrhagic complications in patients receiving prophylactic heparin included gross hematuria in five patients with indwelling urinary catheters, gross hemoptysis in three patients with pulmonary infiltrates, epistaxis in one patient with a nasogastric tube, and melena and hematoma of the neck in one patient who received an overdose of heparin. There was no mortality or permanent sequelae in the 41 patients.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

In sera of diabetics (115 patients) the activity of the lysosomal enzyme betaglucuronidase was found increased by 63 per cent (p<0.001) compared to normal individuals (75 subjects). The enzyme level seemed correlated to both the degree of glucose metabolic disorder and the vascular lesions. In fact, among the patients without vascular complications, beta-glucuronidase activity was roughly parallel to glycemia (r=0.647, p<0.001), reaching very high values (about four times the normal) in six decompensated ketoacidotic patients, while in diabetics with essentially similar glycemia, the enzyme was higher (p<0.005) in subjects with vascular complications, either microangiopathic or macroangiopathic in nature.Since lysosomal enzymes are capable of degrading various molecules, the increase of serum beta-glucuronidase in diabetics was regarded as an index of involvement of lysosomes in tissues, leading to activation of lysosomal hydrolases, apparently in response to the metabolic need of degrading either compounds which have accumulated in tissues, such as mucopolysaccharides and glycoproteins in diabetics with vasculopathies, or various constituents of cells themselves in a context of increased tissue catabolism, as occurs in diabetics with severe metabolic disorder.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Iodides may cause high fever, rigor, and leukocytosis, a combination of findings which mimics severe bacterial infection. Described herein are three such patients seen during a period of two years. This reaction was probably due to hypersensitivity to an iodide plasma protein complex. Awareness of this not uncommon reaction may prevent protracted hospitalization, costly and potentially hazardous tests, and therapeutic trials.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Platelet retention by glass-bead columns was measured in 174 patients undergoing coronary arteriography. Coronary lesions were found in 116 patients; 58 did not have visible lesions. Patients were further subdivided on the basis of age, sex, glucose tolerance, and serum lipoprotein pattern. No differences in mean platelet adhesiveness were found on the basis of age or coronary artery disease. A trend toward higher platelet adhesiveness was seen in patients with either type IV hyporlipoproteinemia or with abnormal glucose tolerance. Platelet adhesiveness was higher in all male subgroups except for a female subgroup with abnormal glucose tolerance. Mean platelet adhesiveness in this group was significantly higher than in female patients with normal glucose tolerance and equaled levels found in male patients with abnormal glucose tolerance. The results of this study are consistent with earlier investigations which found a disproportionate risk for the development of atherothrombotic events among female patients with diabetes mel itus.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Symptomatic thrombocytopenia is reported in a patient with sickle cell-beta thalassemia. Recovery following removal of a large, congested, and multiply infarcted spleen documented its hypersplenic origin. Three other noteworthy features of sickle cell-beta thalassemia were demonstrated by a study of this case. First, recognition was aided by isoelectric focusing in polyacrylamide gel, a new technique for hemoglobin analysis. Second, the patient had an unusually low percentage of sickle hemoglobin, yet moderately severe symptomatology. Finally, family study revealed no genetic recombination in the six offspring of the propositus and of her similarly affected sister, further documenting the close linkage of the locus for beta thalassemia and the structural locus for the beta chain.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Case Report:A patient with hypothyroidism is described who demonstrated a normal response in radioactive iodine uptake after thyrotropin (TSH) administration but who showed elevated levels of plasma TSH. Other evidence suggested that the underlying diagnosis was Hashimoto's thyroiditis. The findings indicate the lack of accuracy for the TSH stimulation test and confirm the superiority of elevated TSH levels for diagnosis of primary thyroidal failure.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

A middle-aged female became hypothyroid seven years after the onset of diffuse toxic goiter and 1½ years after a third course of propylthiouracil. The thyroid was not palpable. No long-acting thyroid stimulator (LATS) or abnormal thyroid antibodies were detected. Serum thyroid-stimulating hormone (TSH) was moderately elevated and other pituitary hormones were intact. TSH stimulation tests on two occasions produced complete and remarkably sustained clinical and laboratory remissions lasting from three to six months. After five years of thyroid replacement all medication was stopped. The serum thyroxine fell to 0.5 µg/100ml, the serum TSH rose to 81 µU/ml, and there was no longer any response to TSH stimulation. The final stage of glandular failure was thus preceded by an intermediate stage with features of both primary and secondary hypothyroidism and an unusual responsiveness to exogenous TSH.

ISSN:0002-9629    

出版商:OVID    

年代:1972

数据来源: OVID