摘要:

Purpose: To characterize the prevalence of hypothyroidism in a population with primary pulmonary hypertension (PPH).Methods: Retrospective record review of 41 patients with PPH seen between 1991 and 1997 at a tertiary care center. Data abstracted included: history of previous thyroid disease, intake of thyroid supplement, and thyroid function tests. Hypothyroidism was defined as a serum thyroid stimulating hormone (TSH) level higher than 5.5 U/L, intake of thyroid supplement, or low serum thyroxine level.Results: Of the 40 patients with PPH included in the study (11 men and 29 women), ages ranged from 11 to 76 years (mean 43.5 years). The mean pulmonary artery pressure was 58.7 mm Hg. Thirty-three patients had normal serum TSH levels (3 of whom were on levothyroxine supplement); 1 had low TSH; 5 had high TSH (range, 6.8–9.9 U/L, mean 8.4 U/L), and 1 had low thyroxine (T4< 1.0 &mgr;g/dL). Nine of 40 patients (22.5%) had evidence of hypothyroidism, whichis much more than expected in the general population of similar age range (2.8% in men, 7.5% in women) (p= 0.002).Conclusions: The prevalence of hypothyroidism in patients with PPH is high (22.5%). Patients with PPH should be investigated for the possibility of coexisting hypothyroidism.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveOur objective was to study the effects of extreme obesity on pulmonary function tests and the effects of smoking on these variables in a population group larger than has previously been reported.Design:Retrospective data analysis.Setting:Academic medical center.Patients:Forty-three patients with extreme obesity [ratio of weight in kilograms to height in centimeters greater than 0.9 (W/H)] who underwent pulmonary function testing at Cedars-Sinai on an out-patient or in-patient basis during the period of 1979 to 1997.Measurements and Results:Patients underwent standard pulmonary function testing. The patients were divided into 2 groups based on the W/H ratio: group A (0.9–0.99) and group B (greater than 1.0). Chart review was performed to identify pertinent history/co-morbidities. The independent effects of smoking between each group’s patients were assessed. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), expiratory reserve volume (ERV), functional residual capacity (FRC), maximum voluntary ventilation (MVV), and forced expiratory flow during midexpiratory phase (FEF25–75%) were significantly reduced in both groups. Single-breath diffusing capacity for carbon monoxide (DLCO) and the volume of gas into which the single-breath of carbon monoxide and helium was diluted were not elevated. Smoking did not account for the results in group A but did seem to partially explain the decrease in FVC, FEV1, and FEF25–75%in group B.Conclusions:Extreme obesity is associated with a reduction in ERV, FVC, FEV1, FRC, FEF25–75%, and MVV. However, contrary to prior reports, DLCO is not elevated. These effects are only partially explained by smoking.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundThe hemodynamic and autonomic abnormalities in idiopathic orthostatic intolerance (IOI) have been studied extensively. However, the mechanisms underlying these abnormalities are not understood. If genetic predisposition were important in the pathogenesis of IOI, monozygotic twins of patients with IOI should have similar hemodynamic and autonomic abnormalities.Methods:We studied two patients with IOI and their identical twins. Both siblings in the first twin pair had orthostatic symptoms, significant orthostatic tachycardia, increased plasma norepinephrine levels with standing, and a greater than normal decrease in systolic blood pressure with trimethaphan infusion.Results:Both siblings had a normal response of plasma renin activity to upright posture. In the second twin pair, only one sibling had symptoms of orthostatic intolerance, an orthostatic tachycardia, and raised plasma catecholamines with standing. The affected sibling had inappropriately low plasma renin activity with standing and was 8-fold more sensitive to the pressor effect of phenylephrine than the unaffected sibling.Conclusions:We conclude that in some patients, IOI seems to be strongly influenced by genetic factors. In others, however, IOI may be mainly caused by nongenetic factors. These findings suggest that IOI is heterogenous, and that both genetic and environmental factors contribute individually or collectively to create the IOI phenotype.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundMost transplant centers in the United States immunize patients awaiting liver transplantation against hepatitis B to prevent acquisition of hepatitis B through transplantation (de novo hepatitis B). A recent study showed that only 16% of patients with cirrhosis awaiting liver transplantation responded to single-dose recombinant vaccine.Methods:We studied the immunogenicity of double-dose recombinant vaccine in patients with cirrhosis awaiting liver transplantation.Results:Over a 4-year period (January 1994 to December 1997), 140 patients with cirrhosis without past or current hepatitis B infection were given double-dose recombinant vaccine (40 &mgr;g of Engerix B; SmithKline Beecham, Philadelphia, PA) at 0, 1 to 2, and 2 to 4 months. Hepatitis B surface antibody (HBsAb) was measured 1 to 3 months after completing vaccination. The response rate was 37%. However, HBsAb titers became undetectable in 35% of the responders during the post-transplant follow-up period. One hundred and thirty-seven patients underwent 144 liver transplantation procedures during the study period, and 3 patients developed de novo hepatitis B (2.2%). Livers transplanted from hepatitis B core antibody (HBcAb)-positive donors was the source of de novo hepatitis B in all cases. Two of the 3 patients who developed de novo hepatitis B were immunized before transplantation and one of them was a responder.Conclusion:Although the response rate to double-dose recombinant vaccines is higher than the previously reported response to single-dose vaccine, it still is less than optimal.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundPretreatment with interleukin-1 (IL-1) induces resistance to lung injury from hyperoxia exposure and to cardiac dysfunction after ischemia-reperfusion in animal models. In contrast, IL-1 pretreatment did not produce tolerance to ischemia-reperfusion injury and did not seem to alter antioxidant enzyme activities in the kidney. Recently, we determined that mitochondria scavenge superoxide anion via a nonenzymatic mechanism and that this newly identified intracellular antioxidant function was inducible in the lung. Based on these observations, we hypothesized that organ differences after IL-1 pretreatment between the lung and the heart, which become tolerant, and the kidney, which does not become tolerant, were a consequence of differential responses in mitochondrial superoxide scavenging.Methods:Rats were given IL-1&agr; (50 ng intratracheally, 36 hrs before assay) and lung and kidney mitochondria were isolated. Mitochondrial scavenging of superoxide anion was then determined by using an assay that we developed and published previously. We then tested the effects of IL-1 pretreatment on lung mitochondrial scavenging of superoxide after hyperoxia exposure.Results:We found that intratracheal administration of IL-1 did not affect lung mitochondrial superoxide scavenging but decreased kidney mitochondrial superoxide scavenging by 75%. In addition, IL-1 pretreatment preserved lung mitochondrial superoxide scavenging in rats exposed to hyperoxia (95% O2for 24 hours) compared with untreated rats exposed to hyperoxia in which lung mitochondrial superoxide scavenging was decreased by more than 50%.Conclusions:We conclude that IL-1 pretreatment has divergent effects on mitochondrial antioxidant function in the lung and the kidney and speculate that this may reflect previously unidentified tissue-specific differences in mitochondrial function during systemic inflammation. This study offers new insights into why the lung, but not the kidney, acquires tolerance to subsequent oxidative injury after IL-1 pretreatment.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundMeasurements of total glycohemoglobin (glycoHb) or hemoglobin A1c are routinely used to evaluate intermediate-to-long term glycemic control in patients with diabetes. However, despite the recent availability of more rapid methods for glycohemoglobin determination, it remains difficult in many institutions to obtain same-day glycoHb determinations in time to assist physicians with management of outpatients with diabetes. Hence, we investigated whether fructosamine, which reflects very recent (2 to 3 weeks) glycemic control and which can be assayed more rapidly in our laboratory, could serve as a useful adjunct to glycoHb for management of these patients.Methods:Diabetes control in outpatients managed using fructosamine, fasting serum glucose, and glycoHb (concentrations from the prior visit) was compared with that for outpatients monitored using fasting serum glucose and prior glycoHb alone. The relative usefulness of fructosamine, current and prior glycoHb, and “fasting” serum glucose for evaluation and management of outpatients with diabetes was compared. In addition, the acceptance of fructosamine by physicians was evaluated by a questionnaire.Results:Same-day fructosamine concentrations correlated better with current glycoHb than did either prior glycoHb or current fasting serum glucose concentrations. However, the availability of same-day fructosamine results did not objectively improve diabetes control compared with that obtained using only fasting serum glucose values and prior glycoHb concentrations. Nonetheless, most examining physicians stated that same-day fructosamine concentrations helped them significantly with diabetes management, primarily because many patients do not adequately monitor home blood glucose levels.Conclusions:Fructosamine may be a useful adjunctive test for management of outpatients with diabetes in situations where it is not practical to obtain same-day glycoHb concentrations, for patients less compliant with home glucose monitoring, or where recent changes in insulin dose or clinical presentation might not be reflected in the glycoHb levels.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundIt is well known that prolonged anemia causes atrophy of tongue papillae, glossal pain, and dysphagia, but it is uncertain whether iron (Fe) deficiency induces glossal pain without any objective manifestation. To resolve this matter, the relationship between Fe deficiency and glossal pain was examined.Methods: Eighteen patients with Fe deficiency and 7 anemic patients manifesting spontaneous irritation or pain of the tongue without any objective abnormalities participated in this study. To ascertain the cause of glossal pain and the oral pathophysiology in Fe deficiency and anemia, peripheral blood was examined and the glossal pain threshold and salivary flow rates (SFRs) were estimated along withCandida albicanscell culture tests.Results:Compared with patients with Fe deficiency, those with anemia had a longer history of tongue pain. In patients with anemia, painful areas of the tongue were more numerous than in patients with Fe deficiency. Pain thresholds were decreased in the painful portions, and both nonstimulated and stimulated SFRs were suppressed. Each patient was treated with oral Fe; within 2 months, most patients exhibited increased serum ferritin level (P< 0.02, paired t-test), pain threshold (P< 0.05) and salivation (P< 0.05) and glossal pain subsided.Conclusions:Fe deficiency causes glossal pain and the degree of glossal pain increases as Fe deficiency advances to anemia, manifesting hyposalivation and abnormalities of glossal papillae.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundEarlier studies have indicated that the atrial natriuretic factor prohormone fragment 31–67 (Pro ANF31–67) has important effects for the promotion of sodium excretion and vasodilation in several animal species. However, the mechanisms for the natriuretic actions of Pro ANF31–67are not completely defined. In the present study, the effects of synthetic Pro ANF31–67on renin secretion were examined in sodium-depleted, anesthetized dogs with a single intact kidney (n= 5).Methods:After 3 20-minute control renal clearance periods, synthetic dog Pro ANF31–67was given intrarenally at a sustained dose of 0.03 &mgr;g/kg/min for 3 20-minute experimental intervals, and after discontinuation of the peptide infusion, 3 final 20-minute recovery periods were determined.Results:Sustained intrarenal infusions of the Pro ANF31–67produced striking decrements (p<0.05) in renin secretion, from a control value of 1418 ± 243 to 401 ± 223 ng of angiotensin I/min. This 66% fall in renin secretion was associated with significant (P< 0.05) increases in creatinine clearance (40%), renal blood flow (8%), urine flow (50%), and sodium excretion (17%).Conclusions:It is suggested that this inhibition of renin secretion was mediated, at least in part, in response to a ProANF31–67-induced increment in the sodium load delivered to the macula densa. An interaction of the peptide with the renal vascular receptor for suppression of renin release is also possible. ProANF31–67may represent an important hormonal mechanism involved in the regulation of body-fluid balance.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 32-year-old woman presented with severe headache, photophobia, fever, nausea, vomiting, and worsening vision. She had also noted several months of amenorrhea. She was febrile to 38.9°C. Laboratory evaluation revealed a markedly elevated erythrocyte sedimentation rate. Lumbar puncture revealed a cerebrospinal fluid lymphocytic pleocytosis and an elevated protein level. Endocrine studies revealed evidence of panhypopituitarism without diabetes insipidus. A magnetic resonance imaging study showed a 2-cm pituitary mass with optic chiasmal compression. The patient had a trans-sphenoidal resection of the mass. Pathology revealed multinucleated giant cells in necrotic debris, but no evidence of pituitary tumor. Studies looking for evidence of systemic granulomatous disease were negative. The patient was considered to have idiopathic giant-cell granulomatous hypophysitis. After surgery, the patient’s vision improved and hormone replacement therapy was initiated. This case illustrates that idiopathic giant-cell granulomatous hypophysitis should be considered in the differential diagnosis of a patient presenting with a pituitary mass, hypopituitarism, and meningitis-like symptoms.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID