ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In vitro determination of brain glucose metabolism in the temporal cortex from patients with Alzheimer's disease showed a marked decrease when compared with nondemented, age-matched control subjects. Additional determinations on normal human temporal cortex obtained at autopsy demonstrated an age-dependent decline in the rate of glucose use. These data provide an in vitro correlate for positron emission tomography studies that suggest decreased brain glucose use in Alzheimer's disease.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The current study was designed to determine the role of sodium–proton (Na+/H+) exchange in blood pressure regulation in sodium chloride (NaCl)-sensitive and NaCl-resistant spontaneously hypertensive rats and control Wistar-Kyoto rats (WKY) using 5-(N,N-hexamethylene) amiloride (HMA), a potent and selective inhibitor of Na+/H+exchange. The response of mean arterial pressure to intravenous infusion of HMA was examined in conscious, unrestrained male rats maintained on normal (1%) or high (8%) NaCl diets for 3 weeks beginning at age 7 weeks. The HMA significantly increased mean arterial pressure in NaCl-sensitive spontaneously hypertensive rats and NaCl-resistant spontaneously hypertensive rats that were fed 1% NaCl, but not in WKY rats that were fed 1% NaCl; the 8% NaCl diet enhanced this pressor response in all 3 strains. The pressor response was accompanied by significant increases in plasma norepinephrine levels in NaCl-sensitive spontaneously hypertensive rats on both diets, but not in NaCl-resistant spontaneously hypertensive rats or WKY rats on either diet. There were no differences in steady-state levels (30–60 nM) of plasma HMA between diet groups in any strain. Therefore, administration of HMA in a dose at which it is highly selective for the Na+/H+exchanger (Ki = 160 nM) caused a systemic pressor response in spontaneously hypertensive rats that was enhanced by dietary NaCl supplementation. With these data, it is suggested that inhibition of Na+/H+exchange in vivo has a pressor effect greater in spontaneously hypertensive rats than in WKY rats and is further enhanced by NaCl supplementation.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Esophago–respiratory fistulas (ERF) do not close spontaneously and are uniformly fatal. A somatostatin analogue (octreotide acetate) was used in three consecutive patients to promote the closure of ERF. In 2 patients with esophageal cancer, treatment with octreotide acetate was associated with fistula closure in 30 and 46 days, respectively. In a third patient with virally-induced ERF, treatment was associated with improvement of the inflammation of the fistula before the patient's death from pulmonary aspiration after 40 days of treatment. These preliminary observations suggest that octreotide acetate treatment of ERF should receive further investigative scrutiny.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The availability of techniques such as surgical reperfusion, angioplasty, and thrombolysis for the treatment of acute myocardial infarction (AMI) has revived interest in seeking an early detectable biochemical marker diagnostic for AMI. Therefore, we investigated whether an unidentified oxidase that is released by activated neutrophils at the onset of AMI could be used as an early diagnostic assay. The conversion by plasma oxidase of 1 μM of adrenaline to 1 μM of adrenochrome represents the plasma oxidase activity (POA) of 1 U/L. Fifty patients suspected of having AMI, 40% of whose electrocardiograms were nondiagnostic for AMI, were admitted to the coronary care unit, and venous blood samples were obtained for determination of the POA and creatine phosphokinase-MB levels. Healthy volunteers (n= 12) served as control subjects, and 8 patients with pneumonia whose leukocyte counts were greater than 15,000 μL were included in the study. In those with AMI (n= 22), as determined by serial creatine phosphokinase-MB, the mean POA (± standard error of the mean) was 233 ± 13 U/L, and in those with angina and no AMI (n= 28) was 127 ± 5 U/L (P< 0.0001). In the control group, mean POA (± standard error of the mean) was 84 ± 5 U/L (control versus angina;P< 0.01) and for those with infection was 214 ± 10 U/L. At admission, the creatine phosphokinase-MB was diagnostic for only 12 of the 22 patients with AMI (sensitivity rate of 54%), whereas in 21 of those patients, the POA values were diagnostic for AMI (sensitivity rate of 95%). Determination of POA may represent an alternative sensitive method to screen for AMI or ischemia in patients with anginal symptoms and no evidence of acute infection.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Affiliations between Department of Veterans Affairs [VA] medical centers and colleges of medicine are important to both parties. Recently, the values and costs of these relations have come under increasing scrutiny. In this study, the authors attempted to determine the attitudes of local VA medical center leadership members toward these affiliations. A mail survey of directors, associate directors, and chiefs of staff of VA medical centers was undertaken. Respondents were asked to score their agreement or disagreement with each of eight statements defining various features and values of VA–medical school affiliations. Scores were reported on a Likert scale of 1 (strongly agree) to 7 (strongly disagree). Strongly positive general attitudes toward VA–university affiliations were found from the results. Mean scores averaged 2.02. However, responses to statements identifying specific concerns with these affiliations (eg, diversion of resources away from VA toward university goals and the lower status of VA-based faculty) were less positive. More positive general attitudes and less negativity about specific concerns were expressed by chiefs of staff than by medical center directors or associate medical center directors and by leaders of highly affiliated medical centers than by leaders of other types of centers. Therefore, local VA medical center leaders have very positive general attitudes toward university affiliations. However, specific problem areas do exist. These issues and attitudes are important for leaders of both the VA health-care system and academic medical centers to consider when developing and implementing local and national policies.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors studied 15 patients at risk for central adrenocortical insufficiency to evaluate the role of naloxone in establishing the integrity of the hypothalamic–pituitary–adrenal axis. Each patient was admitted to the General Clinical Research Center for 2 days. Naloxone, 125 μg/kg body weight, was administered intravenously, and plasma adrenocorticotropic hormone (ACTH) and cortisol concentrations were measured at −15, 0, 30, 45, 60, 90, and 120 minutes. Metyrapone, 30 mg/kg body weight, was administered orally at 11 PM on the second day of hospitalization. Plasma ACTH, cortisol, and 11-deoxycortisol concentrations were measured at 8 AM pre- and postmetyrapone. The results of the metyrapone test were used to distinguish patients who had central adrenal insufficiency from those who were normal. In 11 patients who had a normal metyrapone test, the plasma ACTH level increased from 6 ± 1 pmol/L at baseline to 11 ± 2 pmol/L 30 minutes after naloxone administration. The plasma cortisol increased from 191 ± 21 nmol/L at baseline to 379 ± 47 nmol/L 45 minutes after naloxone administration. In four patients with central adrenal insufficiency, the plasma ACTH and cortisol concentrations did not increase after naloxone administration. Reliance solely on the individual ACTH and cortisol responses to naloxone would have permitted a correct decision regarding glucocorticoid replacement therapy in 14 (93%) of 15 patients. Naloxone stimulation testing may have a role in the clinical evaluation of patients with suspected central adrenocortical insufficiency.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Rheumatoid arthritis is a multisystem disease. Pulmonary manifestations and complications include pleural disease, pulmonary infections, pneumonitis and interstitial pulmonary fibrosis, bronchogenic carcinoma, arteritis with pulmonary hypertension, obliterative bronchiolitis, bronchiectasis, and amyloidosis. Pulmonary rheumatoid nodules, including rheumatoid pneumoconiosis (Caplan's Syndrome), can result in spontaneous pneumothorax. In this article, the authors present a patient with rheumatoid arthritis and recurrent spontaneous pneumothorax. Through investigation, a bronchopleural fistula caused by a rheumatoid nodule was revealed. The authors also discuss the potential pitfalls caused by a lung nodule in a patient with rheumatoid arthritis, including the overlap with bronchogenic carcinoma and confusion with tuberculosis.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The relation between hypercalcemia and pancreatitis, first described in patients with hyperparathyroidism, is controversial. Other causes of hypercalcemia also have been associated with pancreatitis. In this report, the authors describe a patient with pancreatitis and the milk–alkali syndrome who had the classic triad of hypercalcemia, alkalosis, and renal insufficiency. The authors also review the literature for all the reported cases of pancreatitis associated with hypercalcemia.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID