ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Patients with systemic lupus erythematosus (SLE) (n=194) were analyzed for correlation of clinical features. In addition, the proportions of the two major T cell subsets were determined in 87 subjects. Two patient subgroups were discerned: one in which severe renal disease, leukopenia, and thrombocytopenia predominated, and a second in which sicca syndrome and involvement of the central nervous system, lungs and muscle occurred. The ratio of T helper/inducer to T suppressor/cytotoxic cells was reduced in the first group and increased in the second. We conclude that SLE does not comprise a single disease entity, but rather represents a number of syndromes with overlapping clinical features. The correlation of clinical symptoms with the proportions of circulating T cell subsets suggests that several immunologic mechanisms may underlie the various types of SLE.

ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Type II diabetes mellitus is a heterogenous disease. Selection of either insulin or a sulfonylurea agent in addition to diet is usually made empirically. In patients who fail to respond to either agent alone, the potential benefit of combined insulin and sulfonylurea therapy is unclear. We therefore evaluated nine poorly controlled insulin treated type II diabetic patients after addition of a sulfonylurea agent—glyburide—for four weeks. Glycosylated hemoglobin (HbA1c), serum glucose, and C-peptide responses to oral glucose were evaluated. Based on a reduction of at least 50 mg/dl in the fasting serum glucose (FSG) at the end of the first week of the combination therapy or a FSG of less than 140 mg/dl, two groups were arbitrarily identified: responders (n = 5) and nonresponders (n = 4). Clinical characteristics including mean age, weight, duration of diabetes, daily dose of insulin, and duration of insulin treatment were not statistically different between the two groups. Mean baseline FSG and HbA1clevels were also not statistically different in both groups. An improvement in mean FSG and glucose tolerance occurred in the responders at the end of four weeks of combined therapy (FSG: 291 ± 25 vs. 189 ± 6 mg/dl, p < 0.05; HbA1c10.76 ± 0.80 vs. 9.40 ± 0.21%, p = NS). The nonresponders had no change in glucose tolerance. The mean fasting and stimulated serum C-peptide levels were significantly higher in the responders at week 4 compared with that of the nonresponders. Mean maximum, incremental C-peptide level in the responders was 1.50 ± 0.19 ng/ml at week 0 compared with 0.67 ± 0.28 ng/ml in the nonresponders. At the end of week 4, maximum incremental C-peptide level was 2.72 ± 0.54 ng/ml and 0.60 ± 0.26 ng/ml in the responders and nonresponders respectively (p < 0.001).We conclude that adequate stimulatable endogenous insulin secretion may be an essential prerequisite for improvement in glycemic control with the combination therapy in type II diabetic patients. Further studies are needed to evaluate the role of the combination therapy in type II diabetic patients.

ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We have compared the capacity of major organs to produce lactic acid from endogenous sources relative to their ability to buffer that proton load. We deduced that the ultimate source for the rapid production of a very large amount of lactic acid must be hepatic and/or muscle glycogen or exogenous glucose, because the quantity of endogenous glucose is quite small and the rate of net protein catabolism is too slow. Of the organs examined, only the liver of fed persons can produce sufficient lactic acid to markedly overwhelm its own buffer capacity plus that of the ECF and other tissues. Moreover, it is important to realize that a fasted (low hepatic glycogen) subject who lacks the stimulus for muscle glycogenolysis can only develop a modest degree of acute lactic acidosis owing to a limited precursor availability; under these circumstances, hypoglycemia and/or localized tissue necrosis could be the major threats to that patient. We present two examples with more chronic lactic acidosis without hypoxia emphasizing that tissue catabolism may be necessary to support high rates of lactic acid production, and we suggest that a high plasma lactate concentration need not be present to observe a large turnover of this metabolite.

ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We report the case of a woman with severe hypothyroidism and without concomitant myocardial damage, in whom elevated CK-MB values were measured by radioimmunological and enzymatic methods before and after thyroid replacement therapy. The patient's CK-MB activity was shown to be actually due to an atypical CK band between CK-MM and CK-MB (also termed “macro CK” or “idiopathic serum CK-BB”).

ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We report a patient with severe hypoxemia from a large (41%) right to left shunt through a patent foramen ovale after right ventricular myocardial infarction, and review 18 previous descriptions of patients with right to left shunting through patent foramen ovale. These shunts occur when right atrial pressure is elevated above left atrial pressure, or when the anatomic relationship of the interatrial septum to the inferior vena cava is altered. Since 15–35% of the population have a potentially patent foramen ovale, interatrial right to left shunting may occur more frequently than had previously been recognized, and should be considered in a differential diagnosis of hypoxemia.

ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Thrombocytopenia is a common clinical disorder with a diverse group of etiologies. Traditionally, the approach to identifying the mechanism of thrombocytopenia has been empirical, primarily due to a lack of clear understanding of normal thrombopoiesis and its control. Additionally, readily available clinical measurements that reflect patterns of altered thrombopoiesis are unavailable.Recent experimental and clinical observations permit us to approach this disorder from a kinetic point of view to classify thrombocytopenia by four mechanistic categories: peripheral destruction and consumption, hypoproliferative thrombocytopenia, ineffective thrombopoiesis, and distributional causes. The application of the measurement of mean platelet size, in conjunction with a bone marrow examination, allows the clinician to more readily identify the cause of a low platelet count in a less empirical manner.

ISSN:0002-9629    

出版商:OVID    

年代:1985

数据来源: OVID