摘要:

Congestive heart failure may induce hepatic congestion with structural and functional derangements. The critical pathogenetic factor appears to be hepatic hypoxia which causes centrolobular damage. This lesion may evolve into cardiac cirrhosis wherein fibrous tissue bands from adjoining centrolobular areas join and encircle relatively normal portal tracts. Hepatic function, however, correlates primarily with centrolobular congestion, not with fibrosis of the liver. Abdominal discomfort, due to stretching of the liver capsule, is the most striking presenting complaint of patients with hepatic congestion. Physical findings include hepatomegaly (95 per cent), ascites (25 per cent), and rarely splenomegaly. Ascites has exudative characteristics in about 30 per cent of patients. Portal hypertension and hepatic coma are rare. The bromsulphalein retention test is the most sensitive assessment of hepatic congestion. Serum bilirubin is elevated in up to 70 per cent of patients, is usually below 5 mg/100 ml, and often contains a high proportion of the unconjugated pigment. Serum transaminases are usually mildly elevated (40 to 80 units) but in about 20 per cent of patients, especially with hypotension, may reach values of 1000 to 2000 units. The prothrombin time is often prolonged. Hepatic congestion does not seem to alter digitalis metabolism but may significantly reduce the clearance of various therapeutic agents (ie, lidocaine) and increase the sensitivity of the patient to anticoagulants.

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A prospective cineradiographic and manometric study of pharyngeal and esophageal dysfunction was performed in 54 patients with rigidly defined scleroderma, poly-myositis, systemic lupus erythematosus, and rheumatoid arthritis. Decreased or absent distal esophageal peristalsis was demonstrated by cineradiography and manometry in 55 and 73 per cent of 22 patients with scleroderma and 13 and 3 per cent of 32 patients with other collagen diseases. This finding showed a highly significant (p <0.001 manometry and p <0.01 cineradiography) correlation with clinically diagnosed scleroderma. This manometric abnormality was seen less frequently (1 of 8) in patients with Raynaud's phenomenon unrelated to scleroderma. This difference was statistically significant (p <0.02).When clearly defined criteria for the diagnosis of the skeletal muscle dysfunction of polymyositis were used, no false positive diagnoses were made and, of the ten polymyositis patients, only two were diagnosed by manometry and one by cineradiography as having this disease. This study thus demonstrated that (1) distal esophageal smooth muscle dysfunction was relatively specific for clinical scleroderma; (2) significant pharyngeal and esophageal skeletal muscle dysfunction was an infrequent finding limited to polymyositis; and (3) manometry was somewhat more accurate and specific than cineradiography in diagnosing these changes.

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Respiratory abnormalities in neurocirculatory asthenia (NCAO were analyzed by spirometry and cineroentgenography of diaphragmatic movement. By means of numerical analysis of spirometric curves, irregular intervals of the respiratory cycle, nonuniform amplitude of respiration, nonlinearity of the level of the respiratory curve, and a sighing pattern were observed as characteristic abnormalities in NCA. In addition, an increase in the amplitude of respiration was observed in the acute type of NCA. Analysis of cineroent-genograms revealed (1) irregular periodicity, (2) a nonuniform magnitude of the diaphragmatic movement, (3) superimposition of smaller movements on the larger movements, (4) chaotic and disorganized movement of the diaphragm, and (5) fluctuation in the baseline level of the diaphragmatic movement. Of these abnormalities observed in the movement of the diaphragm, (1) and (2) could be easily predicted by observations of the spirometric curve, and (5) corresponds to the nonlinearity of the spirometric tracing, while (3) and (4) are not recognized in the spirometric curve and indicate that the movement of diaphragm lacks not only rhythmicity but also coordination. These abnormalities may have a role in the development of the cardiovascular, respiratory and gastrointestinal symptoms in NCA. The increase in the amplitude of respiration, observed in the acute type of NCA, resembled findings in the hyperventilation syndrome. Cineroentgenographic analysis of diaphragmatic movement during an attack of tetany in the latter patients, however, showed regular rhythmicity and coordination in contrast to NCA.

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The patient, a 40-year-old woman had a bleeding diathesis at age nine. Von Willebrand's disease was diagnosed. After age 16, she had multiple surgical procedures and blood transfusions. At age 34 intermittent thrombocytopenia was noted. She required hospitalizations which included exploratory surgical procedures, transfusions, trials of ethinyl estradiol and norethindrone acetate, prednisone, splenectomy, and massive transfusions. Her factor VIII level ranged between 8 and 39 per cent. No gastrointestinal lesion has been identified. The patient's mother had von Willebrand's disease, intermittent thrombocytopenia, and also chronic gastrointestinal bleeding. No underlying disease has been found to account for either the thrombocytopenia or the severe gastrointestinal bleeding.The long survival of both the patient and her mother is attributed to blood transfusions and, for our patient, the arteriovenous shunt which was inserted.

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A 38-year-old white man with systemic lupus erythematosus developed sideroblastic anemia that was refractory to pyridoxine, steroids, and thyroid extract therapy. The association of this type of anemia with systemic lupus erythematosus could be on the basis of an autoimmune mechanism.

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A patient with symptomatic Hodgkin's disease, stage IV B, demonstrated all the features of the syndrome of inappropriate antidiuretic hormone secretion. The syndrome disappeared when he entered a complete remission with therapy.

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Editor's Note: In this issue, THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES begins a series containing articles of noted historical import from the medical literature. First in this collection is Austin Flint's classic paper, “On cardiac murmurs,” which appeared in the Journal in 1862.Austin Flint (1812–1886) was a prolific writer in many areas of medicine. He contributed greatly to the development of physical diagnostic technique, particularly with respect to auscultation of the heart and lungs. His essay entitled “The variations of pitch in percussion and respiratory sounds, and their application to physical diagnosis” won the annual American Medical Association prize in 1852. Flint repeated this honor in 1859 with another pioneering essay, “The clinical study of the heart sounds in health and disease.”Although Flint strongly disapproved of naming physical signs after their original discoverers, his own name came to be associated with the presystolic murmur of aortic insufficiency. Flint describes his first observation of this murmur within the text of the following

ISSN:0002-9629    

出版商:OVID    

年代:1973

数据来源: OVID