摘要:

The hospital records of patients discharged from Presbyterian-University Hospital of Pittsburgh with the diagnosis of superior vena cava syndrome (SVCS) were reviewed in order to determine if diagnostic procedures were associated with an unacceptable risk of complications. Fifty-six cases were reviewed. Symptoms had been present for an average of five weeks. Forty-five patients underwent diagnostic tests including sputum cytology, lymph node biopsy, bone marrow biopsy, bronchoscopy, mediastinoscopy and thoracotomy. The diagnostic yield of these procedures ranged from 28% (cytology) to 100% (thoracotomy). Complications occurred only with mediastinoscopy and none of these were fatal or caused long-term morbidity. We conclude that most patients with SVCS (excepting those with neurologic or respiratory compromise) can tolerate a vigorous pursuit of a histologic diagnosis before therapy is instituted. [Am J Med Sci 1983; 285(3):2–6.]

ISSN:0002-9629    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We have evaluated the endocrine changes in 10 male subjects with hemochromatosis. Two subjects initially had aplastic anemia, and the remainder had idiopathic hemochromatosis. Four of the ten patients had diabetes mellitus. Sexual dysfunction (impotence and/or decreased libido) was observed in 8 subjects. Six patients had subnormal testosterone levels; FSH levels were almost uniformly low, but LH concentrations were more variable. Only three patients had normal testosterone responses to hCG. Hypothyroidism, free T4<0.9 ng/dl, was present in 4 subjects, and the etiology was heterogeneous. Basal prolactin levels were elevated in 2 patients and failed to respond adequately to TRH in 2 other patients. Growth hormone reserve was normal in all but 1 patient, and pituitary-adrenal reserve was normal in all but 1 patient. We conclude that disturbances in both pituitary and end-organ function are observed in hemochromatosis. These central and end-organ defects may exist alone or simultaneously. Hypogonadism is almost universal, and is a consequence of defective function of the hypothalamic-pituitary axis and/or primary Leydig cell disturbance. Other evidences of pituitary disturbance are observed but are rather uncommon. [Am J Med Sci 1983; 285(3): 7–13.]

ISSN:0002-9629    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To determine the interrelationships of serum lipoproteins and body weight changes with insulin therapy, 55 diabetics (mean age 52.0±2.2 years), had measurements of body weight, sum of skinfold thickness, fasting serum glucose, serum high density (HDL-C) and low density (LDL-C) lipoprotein cholesterol and serum triglycerides before and 6 weeks after beginning insulin. At entry HDL-C had a significant (p<0.05) negative correlation with indices of body weight-body mass index, relative weight and a significant positive correlation with serum triglycerides but no significant association with sum of skinfold thickness, fasting serum glucose or LDL-C. The relationships were seen mainly in patients who previously had not been receiving oral hypoglycemic medications. Insulin significantly increased HDL-C and body weight, and decreased glucose, triglycerides and LDL-C. Changes in HDL-C showed a significant inverse association with changes in triglycerides and direct correlation with changes in body weight, but no significant association with changes in fasting serum glucose or LDL-C. Thus, insulin therapy of diabetes mellitus favorably affects HDL-C concentration perhaps by altering triglyceride metabolism and represents a unique situation where increases in body weight are associated with increases in serum HDL-C concentration. [Am J Med Sci 1983; 285(3):14–201.]

ISSN:0002-9629    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A 51-year-old woman with a 5–1/2 year history of primary biliary cirrhosis (PBC) developed interstitial lung disease (ILD). The initial pulmonary infiltrate consisted of unilateral nodules mimicking neoplastic disease and later progressed to involve both lungs with a diffuse interstitial process. Tissue obtained by open lung biopsy was compatible with lymphoid interstitial pneumonia. The pulmonary infiltrates cleared spontaneously but recurred on two more occasions with subsequent resolution. This pulmonary disease activity appeared unrelated to the chemical activity of the PBC, which progressed to a fatal termination. The association of ILD, especially of a recurrent nature, with PBC is rare. [Am J Med Sci 1983; 285(3):21–27.]

ISSN:0002-9629    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Three cases of presumed respiratory syncytial virus (RSV) pneumonia in immunocompromised adults are described. Two patients had symptoms of cough, fever, and malaise, following completion of a course of combination chemotherapy for the treatment of acute lymphoblastic leukemia. The third patient, a juvenile onset diabetic, developed similar symptoms while hospitalized for severe hyperglycemia. Chest roentgenograms showed lower lobe infiltrates in both leukemic patients and a bilateral non-confluent bronchopneumonia in the diabetic patient. All patients had a marked rise in complement-fixing antibody titres to RSV, suggesting a concurrent infection with the virus. Extensive microbiological investigations failed to reveal any other etiologic agent. Nosocomial infection was considered possible. RSV is not considered a cause of pneumonia in compromised adults. Our three cases suggest that there may be a higher incidence of RSV pneumonia in compromised patients, than previously recognized. [Am J Med Sci 1983; 285(3):28–33.]

ISSN:0002-9629    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A 52-year-old man with lactic acidosis and severe hypoglycemia was fully conscious and alert with a blood sugar of 8mgs%. We believe normal level of consciousness was maintained due to the presence of hyperlactatemia. We show experimental evidence to suggest that lactate prevents the development of insulin-induced seizures in rats. [Am J Med Sci 1983; 285(3):34–37.]

ISSN:0002-9629    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1983

数据来源: OVID