摘要:

The failure to respond normally to parathyroid hormone (PTH) administration has been reported in patients with severe hypomagnesemia. A patient with hypoparathyroidism and a markedly decreased serum concentration of magnesium (0.7 mEq/liter), but a normal red blood cell magnesium level, is described who increased serum calcium concentration and decreased per cent renal tubular reabsorption of phosphate when parathyroid extract was given. It is suggested that PTH responsiveness in hypomagnesemic patients may, at least in part, be dependent upon the adequacy of intracellular magnesium stores. This interpretation is supported by the normal cellular (red blood cell) magnesium concentrations observed in this patient and in comparable studies in which PTH responsiveness in the presence of hypomagnesemia was demonstrated. In addition, a failure of optimal renal conservation of magnesium was noted to occur in this patient since, despite hypomagnesemia, urinary magnesium excretion was greater than the 1 mEq/day loss that is seen when magnesium conservation is induced by means such as dietary restriction.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The relationship between marrow distribution as imaged with99mTc sulfur colloid and histologic estimate of bone marrow cellularity was examined in 101 patients. The patients were divided into three groups according to marrow cellularity: normocellular, hypercellular or hypocellular marrow. The marrow distribution of these patients was graded as extended, not extended or not visualized. A general association between marrow cellularity and marrow distribution was found. Seventy-seven per cent of patients with normocellular marrow had limitation of marrow within normal sites and a similar number of patients with reactive hypercellular marrow had marrow extension. On analysis of the patients that were exceptions to this generalization the following observations were made. In patients in whom the marrow is hypercellular and infiltrated with abnormal cells or tissue the marrow distribution may not be visualized with radiocolloid. Stimulation of hematopoiesis may result in marrow hypercellularity without marrow extension beyond the usual sites. Stimulation of one or more hematopoietic cell lines may result in marrow extension without marrow hypercellularity, suggesting an impairment of hematopoietic cell response. Peripheral marrow extension as observed with radiocolloid, therefore, is not simply a reflection of marrow hypercellularity but probably represents a response of the bone marrow stroma to situations in which one or more hematopoietic cell lines is stimulated.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Three-hundred and forty-nine cases of acute bacterial meningitis treated during a 25-year period (1949 through 1973) were reviewed to determine the prognostic significance of initial historical, physical and laboratory findings. A poor prognosis was associated with age ≥ 40 years (p<0.01), presence of predisposing illness (p<0.01), associated illness (p<0.01), absence of nuchal rigidity (p<0.05), and derangement of cerebral function (p<0.01). The effects of predisposing illness and moderate cerebral dysfunction were dependent upon age. In contrast, the effects of associated illness, mild or severe cerebral dysfunction, and absent nuchal rigidity were independent of age. Laboratory studies associated with a poor prognosis included an elevated cerebrospinal fluid (CSF) protein (p<0.05), a positive CSF smear (p<0.05), or culture (p<0.01), or bacteremia (p<0.01). No prognostic significance could be attributed to race (p>0.05), sex (p>0.05), prior antibiotic therapy (p>0.05), duration of illness before institution of adequate therapy (p>0.05), CSF leukocyte count (p>0.05), frequency of polymorphonuclear leukocytes in CSF (p> 0.05), CSF sugar ≤ 40 mg/100 ml (p>0.05), or a CSF sugar-simultaneous blood sugar ratio ≤ 0.40 (p> 0.05).

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

A nationwide study of aplastic anemia in Israel revealed a mean yearly incidence of 7.1sol;1,000,000 in males and 8.7/1,000,000 in females. Twenty-five per cent of the cases reported had an apparent chloramphenicol etiology. Ten patients, five treated with chloramphenicol and five without it, developed acute leukemia. The median survival was 11 months in males and 28 in females. Survival was particularly inferior in chloramphenicol-related cases, suggesting that this group constitutes a specific entity

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Red cell 2,3 diphosphoglyceric acid (DPG), total nucleotide phosphate, inorganic phosphate, and plasma inorganic phosphate were measured at the onset and termination of 22 hemodialyses performed for chronic renal failure in 19 patients. Plasma inorganic phosphate decreased from a mean of 2.05 mM/liter ± 0.14 to 1.26 mM/liter + 0.09 (p < 0.005) while intracellular inorganic phosphate fell from 1.76 mM/liter ± 0.12 RBC water to 1.21 +0.08 mM/liter ( p< 0.005). Mean DPG was 6.37 mM/liter RBC ±0.23 at the start of the dialysis and 6.08 mM/liter ± 0.24 at the termination (p=n.s.). Mean nucleotide concentration was 5.90 mM phosphorous content/liter RBC ± 0.26 at the start and 5.95 mM/ liter ± 0.21 at the end (p=n.s.). Although there were significant decreases in intracellular and plasma inorganic phosphate concentrations immediately following dialysis, neither the DPG nor nucleotide phosphate concentrations were significantly altered by this short-term procedure. Red cell water inorganic phosphorous rapidly attained identical concentration with plasma water inorganic phosphorous.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Amikacin, a new aminoglycoside antibiotic, was utilized in the treatment of 49 cases of infection which occurred in 39 neutropenic cancer patients. Thirty-four patients (69 per cent) responded to this antibiotic. Pneumonia and septicemia were the most common types of infection treated and the response rates were 65 per cent and 75 per cent, respectively. Gram-negative bacilli were responsible for 93 per cent of the identified infections and 74 per cent responded.E. coli, Ps.aeruginosa, and organisms of the Klebsiella-Enterobacter- Serratia group were the most common gram-negative bacilli causing infection. Responses were more frequent among patients who maintained higher serum concentrations of antibiotic, but the differences were not statistically significant. Patients with severe neutropenia <100 neutrophils/mm3) had a response rate of 68 per cent. Toxicity was manifested as azotemia and hearing loss which occurred in 13 per cent and 6 per cent, respectively. However, toxicity was directly related to serum concentration and to the number of treatments with amikacin. This antibiotic is of potential importance because of its efficacy against gram-negative bacilli infections. Best results were obtained when sufficient drug was given as a continuous intravenous infusion to maintain serum concentrations of about 15μ g/ml.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Twelve men suffering from the primary hyperkinetic heart syndrome (PHHS) displayed palpitation, rapid and forceful heart action, increased pulsations of the large arteries, cardiac systolic murmur, and the following circulatory values (averages): systolic arterial pressure (SAP)=154 mm Hg; heart rate (HR) = 91 b/min; cardiac index (Cl) = 5494 ml/min/m2; left ventricular mean systolic ejection rate index (MSEJR) = 227 ml/min/m2; left ventricular mean pre-ejection Δ P/Δ t (Δ P/Δ t) = 1.32 mm Hg/msec. A two-year follow-up during which propranolol was administered (80-160 mg/day) revealed good subjective improvement and disappearance of signs of circulatory hyperkinesis. At the end of this period the hemodynamic functions were as follows: SAP =134; HR = 69; Cl = 3489; MSEJR = 171; Δ P/Δ t = 0.89. Substitution of placebo for the active drug caused prompt re-appearance of symptoms of cardiac overactivity in each patient, and brought the circulatory functions back to these levels: SAP =157; HR = 96; Cl = 5530; MSEJR = 245; Δ P/Δt= 1.33. These findings lend further credence to the concept that the PHHS is, indeed, a definable disease entity; they also document that propranolol ameliorates the symptoms of the disease but is ineffective for the underlying disorder.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Most articles on Friedreich’s ataxia report that cardiac complications are almost universal in patients with this disease. However, the present study of 30 cases, observed for two to ten years, seems to belie the experience of other writers in the field. Only six (20 per cent) of these patients showed electrocardiographic abnormalities. Only one patient had cardiac enlargement and congestive heart failure. One other patient had paroxysmal tachycardia. Seventy-four family members were also studied and the results were similar. It is suggested that this impressive difference may be a racial one and indeed very few reports on Friedreich’s ataxia have come from India. Further study of this group of patients is in progress. The author also includes a review of the literature of neuromyopathic diseases and their relationship to myocardial involvement.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Parathormone (PTH) excess limits renal bicarbonate reabsorption. This may aggravate the acidosis in patients with renal insufficiency and secondary hyperparathyroidism. Why parathormone, the primary action of which is thought to be stabilization of the ionized fraction of calcium, affects acid-base balance remains uncertain. Parathormone not only promotes the release of calcium from bone but also mobilizes bone salts, including bicarbonate and phosphate. Accumulation of these anions in the extracellular fluid would limit the ionization of calcium. Teleologically it is not unexpected to find that, coincident with evolution of a mechanism which permits rapid mobilization of calcium from bone, a system had to develop which removed the byproducts of bone dissolution. If this concept is valid, parathormone-induced depression of renal bicarbonate reabsorption in uremia represents an undesired side effect of an adaptive mechanism. This would extend Bricker’s “trade-off” hypothesis which ascribes metabolic bone disease due to PTH-induced phosphate loss to include metabolic acidosis resulting from diminished renal bicarbonate regeneration. Parathyroidectomy or phosphate restriction have been proposed for correction of the side effects of secondary hyperparathyroidism. These therapeutic manipulations cannot be recommended for general use. A more rational approach for prevention of secondary hyperparathyroidism is the combined use of phosphate restriction with a short-acting vitamin D derivative.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The effects of hormonal manipulation on gonadotropin, androgen, and estrogen concentrations in a patient with testicular feminization syndrome (TFS) were studied to clarify the feedback regulation of gonadotropins. Baseline serum LH concentrations were normal to high and FSH concentrations were normal despite markedly elevated plasma testosterone concentrations, implying the lack of a reciprocal control relationship, and fluoxymesterone administration failed to alter gonadotropin or androgenic steroid levels. Clomiphene administration resulted in a rise in both LH and androgen levels, while moderate doses of exogenous estrogens effected a diminution in testosterone but did not significantly alter the levels of gonadotropins. Following gonadectomy, these same doses of estrogens produced a dramatic fall in the very high postoperative levels of gonadotropins. These results suggest that gonadotropin regulation is mediated by estrogens and not directly by androgens in TFS.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID