ISSN:0002-9629    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

After developing a stable hyponatremia (serum sodium 125-126mEq/liter) a patient was studied during a standard oral water load and during isotonic and hypertonic saline infusions. The patient excreted the water load in four hours, excreted dilute and then concentrated urine in response to isotonic saline, and concentrated her urine in response to hypertonic saline. Normal responses to these maneuvers while the patient was hyponatremic suggested reset of her osmoreceptors at a decreased serum sodium level. Data during the development of the hyponatremia demonstrated negative sodium balance, but neither negative water balance nor a decrease in body weight was seen, suggesting, as did her response to water loading, that the patient was normovolemic. It is proposed that reset does occur and can be demonstrated if hyponatremia develops while intravascular volume is maintained at normal levels.

ISSN:0002-9629    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Ascitic fluid protein of greater than 2.5 gm per cent in hepatic cirrhosis is usually interpreted as evidence of a superimposed neoplastic or infectious process. Two years' experience of the Lemuel Shattuck Hospital Clinical Laboratory were reviewed for patients with uncomplicated hepatic cirrhosis but with high protein ascites. Twenty-one patients with uncomplicated hepatic cirrhosis and an ascitic protein range of 2.6 to 4.1 gm per cent were found. Fourteen of these patients had peritoneoscopic and/or histologic confirmation of normal peritoneum. Five patients were autopsied and 11 followed a mean of 15 months with no cause of high protein ascites found. Ninety-eight consecutive hospital admissions with uncomplicated hepatic cirrhosis and ascites were reviewed to determine the frequency of high protein ascites. Nineteen had ascitic fluid protein greater than 2.5 gm per cent, 12 a protein greater than 3.0. Ascitic fluid protein ranged from 0.1 to 4.3 gm per cent, with a mean of 1.5. High protein ascites is more common in uncomplicated hepatic cirrhosis than has been recognized.

ISSN:0002-9629    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Seventeen insurance company employees were selected consecutively from a list of patients with elevated mean corpuscular volumes on routine automated blood counts. Chronic alcohol consumption was present in 16 patients and was heavy in 11 patients. Nine alcohol consumers had clinical evidence of mild hepatic disease and four had abnormal liver function tests. Mild anemia with a red cell count between three and four million was present in only three patients. Folate deficiency was present in only one and B12deficiency in none of the 15 in whom these parameters were measured. Hemolysis was absent in these patients. There appears to be an unexplained association between macrocytosis and mild alcoholic disease of the liver in usually nonanemic and otherwise healthy subjects. The mean corpuscular volume as determined by routine Coulter counts may be a useful screening procedure for alcohol abuse.

ISSN:0002-9629    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

A patient with systemic lupus erythematosus ingested an overdose of dapsone resulting in methemoglobinemia, decreased red cell glutathione levels, and a Heinz body hemolytic anemia. No intrinsic abnormality of the patient's red cells was observed. Treatment with methylene blue produced an exacerbation of the hemolytic process. It is suggested that this effect of methylene blue is due to its coupled oxidation of reduced nictotinamide adenine dinucleotide phosphate (NADPH), thereby impairing the ability of the red cell to reduce oxidized glutathione in the face of a dapsone-induced Heinz body hemolytic anemia. Methylene blue would appear to be relatively hazardous for the treatment of methemoglobinemia due to drugs which also cause Heinz body hemolytic anemia.

ISSN:0002-9629    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Nine of 34 primary hypertensive men with an electrocardiographic (ECG) pattern of left ventricular hypertrophy showed normalization of the repolarization phase following antihypertensive therapy. A study of the left ventricular load both before therapy, and coincident with the reversion to normal repolarization after treatment, was thought to be a useful means for insight into the mechanisms responsible for the ST-T alterations in hypertension. There was no significant difference in the pretreatment values of arterial pressure, heart rate, peripheral resistance, left ventricular work, pressure-time per beat, and tension-time index between those patients who showed ECG improvement and those who did not. Following therapy, the only significant difference (p<0.01) in the hemodynamic pattern between the two groups was the larger reduction of tension-time index in the responder subjects. Improvement of left ventricular function, which occurred in the responders, was one of the main reasons for the greater decrease in tension-time index. The close relation between the reduction of tension-time index, which is known to be the major determinant of the myocardial oxygen consumption, and reversion to normal of the repolarization supports the possibility that, at least in some patients, the ST-T changes in hypertension reflect an insufficient energy supply in relation to the demand brought about by the high levels of cardiac load.

ISSN:0002-9629    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Renal failure due to uric acid nephropathy is a well-known complication of therapy of chronic lymphocytic leukemia (CLL). In contrast, we report a rarely recognized but potentially lethal consequence of aggressive chemotherapy of this disease. In a patient with progressive CLL, combination chemotherapy resulted in acute but transient azotemia, hyperkalemia, hyperphosphatemia, and hypocalcemia which, surprisingly, were unassociated with a diminution in renal function. Rather, these abnormalities were temporally related to rapid diminution in tumor size and may be attributable to lysis of tumor lymphocytes with release of intracellular constituents into the extracellular space. An increased potassium load due to tumor lysis in the face of volume contraction secondary to azotemia-induced osmotic diuresis could lead to fatal hyperkalemia. Furthermore, symptomatic hypocalcemia could result from acute hyperphosphatemia. Thus, careful attention to state of hydration, blood urea nitrogen levels, and serum electrolytes is required if CLL is to be treated aggressively.

ISSN:0002-9629    

出版商:OVID    

年代:1974

数据来源: OVID