摘要:

Background:Hepatic dysfunction occurs commonly among persons successfully treated for acute leukemia, and iron overload is a possible cause of hepatic and other abnormalities in these patients.Methods:We identified 5 adults 40 ± 13 (mean ± S.D.) years of age who developed transfusion iron overload in association with successful chemotherapy of de novo acute leukemia. None had evidence of hemochromatosis, viral hepatitis, or other primary hepatic disorders.Results:The mean serum ferritin concentration of our patients was 1531 ± 572 ng/mL. Other abnormalities associated with transfusion iron overload were increased stainable iron in bone marrow macrophages, elevated serum concentrations of hepatic enzymes, hyperpigmentation, hyperferremia, elevated iron saturation of serum transferrin, and increased stainable iron in Kupffer cells and hepatocytes. Rheumatologic, endocrinologic, or cardiac abnormalities attributable to iron overload were not observed. Therapeutic phlebotomy was initiated after chemotherapy; recovery of hemoglobin concentrations after phlebotomy permitted weekly treatment in each case. This yielded an average of 28 ± 9 units per patient (range 15–35 units). Abnormalities associated with transfusion iron overload resolved after iron depletion therapy. The mean leukemia-free survival of our patients is 96 ± 36 months (range 40–125 months).Conclusions:Our data and those of others suggest that 15 to 20% of adults who are long-term survivors of acute leukemia develop iron overload, often with hepatic abnormalities. Iron overload is a relatively common sequela to successful management of acute leukemia in adults for which routine evaluation should be performed and for which therapeutic phlebotomy should be used as treatment.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:The prototypic acute phase reactant, C-reactive protein (CRP), is a serum soluble, cyclic pentameric protein, the concentration of which increases markedly within hours of any tissue-damaging, inflammatory event. However, upon dissociation of its pentameric quaternary structure, CRP subunits undergo a spontaneous and irreversible conformational change. The resulting molecule, termed modified CRP or mCRP, has reduced aqueous solubility and a propensity to aggregate into a matrix-like lattice structure.Methods:Using monoclonal antibodies, normal human tissues were immunohistochemically screened for the presence of CRP as well as mCRP antigens.Results:Significant levels of mCRP were detected in the walls of blood vessels associated with normal human tissues. These data indicate that mCRP is a naturally occurring form of CRP and that it is a tissue-based rather than serum-based molecule.Significance:This report describes the localization of a stable form of CRP, mCRP, in blood vessels associated with normal human tissues.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:It has been shown that insulin resistance syndrome, including glucose intolerance, dyslipidemia, and hypertension, is frequently associated with coronary artery disease (CAD). However, their relative contributions and predictive power in the development of CAD are still unclear, particularly in persons without diabetes.Method:We examined these risk factors between 96 patients without diabetes but with angiographically documented CAD and 96 age-, sex-, and body mass index-matched healthy control subjects. Fasting plasma lipoprotein, glucose, and insulin concentrations in response to a 75-g oral glucose tolerance test were determined, and insulin sensitivity was measured by the insulin suppression test.Results:Patients with CAD had significantly higher values of fasting glucose, glucose and insulin responses to oral glucose tolerance test, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride and decreased high-density lipoprotein (HDL) cholesterol concentrations compared with those of healthy people (P< 0.02–0.001). Although the steady-state plasma insulin values were similar in both groups, the steady-state plasma glucose (SSPG) concentrations were significantly higher in patients with CAD (12.2 ± 0.4 versus 8.1 ± 0.4 mmol/L,P< 0.001) compared with healthy subjects. When HDL < 0.9 mmol/L, LDL cholesterol ≥ 4.1 mmol/L, triglyceride ≥ 2.3 mmol/L, SSPG ≥ 10.5 mmol/L, and presence of hypertension were defined as separate risk factors for CAD, significantly higher odds-ratio values were observed in patients with CAD compared with healthy people. From logistic multiple regression analysis, SSPG was the strongest risk, followed by lowered HDL cholesterol, elevated triglyceride and LDL cholesterol, and hypertension, to predict CAD. These 5 factors accounted for 36% of total risk for development of CAD in persons without diabetes.Conclusions:Patients without diabetes with CAD have abnormal glucose metabolism, hyperinsulinemia, and insulin resistance. Degree of insulin resistance (SSPG values), plasma lipid values, and history of hypertension together accounted for one third of all risk for CAD, although degree of insulin resistance was the strongest risk factor.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Many patients with chronic fatigue syndrome (CFS) have neurally mediated hypotension when subjected to head-up tilt, suggesting autonomic nervous system dysfunction. Some Gulf War veterans have symptoms similar to CFS. Whether they also tend to have neurally mediated hypotension is unknown.Methods:We performed 3-stage tilt-table testing on 14 Gulf War veterans with chronic fatigue, 13 unfatigued control Gulf War veterans, and 14 unfatigued control subjects who did not serve in the Gulf War. Isoproterenol was used in stages 2 and 3 of the tilt protocol.Results:More fatigued Gulf War veterans than unfatigued control subjects had hypotensive responses to tilt (P< 0.036). A positive response to the drug-free stage 1 of the tilt was observed in 4 of 14 fatigued Gulf War veterans versus 1 of 27 unfatigued control subjects (P< 0.012). Heart rate and heart rate variation during stage 1 was significantly greater in the fatigued group (P< 0.05).Conclusion:We conclude that more fatigued Gulf War veterans have neurally mediated hypotension than unfatigued control subjects, similar to observations in CFS. Autonomic nervous system dysfunction may be present in some fatigued Gulf War veterans.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Methods:Several anecdotal reports indicate that cancer may occasionally remain in a dormant state for prolonged periods in patients with hypothyroidism. Once the hypothyroid state is recognized and supplementation therapy with thyroid hormones is initiated, disease progression occurs. In this experiment, 6-n-propyl-2-thiouracil (PTU) was added to the water of athymic nude mice. The animals were subsequently inoculated with cells from a human prostate cancer cell line.Results:The growth rate of subcutaneously implanted prostate xenografts was significantly slower in mice treated with PTU compared with mice that did not receive PTU. In a separate experiment, tritiated thymidine incorporation assays were performed in DU145 and PC3 human prostate cancer cells with and without PTU. No significant differences were observed, indicating that PTU did not exert any antitumor effect in vitro.Conclusions:Our study demonstrates that PTU inhibits the growth of human prostate tumors in nude mice via an indirect effect. This antitumor effect may be caused by hypothyroidism. This is the first in vivo study suggesting potential therapeutic applications for thyroid hormone manipulations in human cancer of the prostate. Further studies will determine growth kinetics of xenotransplanted prostate cancer in vitro and in vivo. PTU-induced hypothyroidism may be further explored in conjunction with other antineoplastic therapy.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:The causes of glossodynia in the absence of objective abnormalities range widely and differential diagnosis of glossodynia is very difficult.Methods:Based on the examination results of peripheral blood, stimulated and nonstimulated salivary flow rate (SFR), glossal pain threshold, andC albicanscell culture and the response to treatment, we identified the cause of vague pain of the tongue in 98 patients who lacked objective findings and identified candidiasis as the cause of glossodynia in 26 patients.Results:These patients revealed hyposalivation and decreased glossal pain thresholds andC albicanscell overgrowth. Pain thresholds in the painful portion (54.6 ± 2.9°C) were significantly decreased compared with those in the painless portion (57.7 ± 3.4°C) (P< 0.05) and the pain thresholds were largely increased after treatment (57.2 ± 1.6°C). Nonstimulated SFR before treatment was lower than that of age- and gender-matched healthy people, although stimulated SFR was decreased only slightly.C albicanscell overgrowth was detected by the number ofC albicanscolonies that formed in Sabouraud’s agar plate (539.3 ± 198.4/dish). After the subsidence of glossal pain by mouth washing with a 3% amphotericin B solution, theC albicanscolonies were decreased to 31.5 ± 19.3/dish, which was almost same as the control level, 14.1 ± 8.4/dish.Conclusion:These results indicate that candidiasis in conjunction with hyposalivation may induce pain in the tongue without manifestation of objective abnormalities.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Educational experiences in ambulatory medicine vary by site.Purpose:To evaluate variations in patient mix and challenges in patient care at 3 ambulatory training sites.Methods:Patients (n=123) receiving care at a VA medical center (VA), an urban academic medical center’s primary care center (PCC), and a community group practice (CGP) were evaluated.Results:Patients at the VA (n=55), compared with those at the PCC (n=44) and the CGP (n=24), were older, more likely to be male, and white (allP< 0.05). Patients at the VA and the PCC reported difficulty with functional and health status more frequently than those at the CGP (allP< 0.05). Common medical diagnoses varied across sites and comorbidity scores were ≥ 2 in 48% of VA subjects compared with 16% at the PCC and 29% at the CGP (P< 0.05). Challenges most frequently cited were administrative issues at the VA (44%), patient-physician communication at the PCC (39%), and medical decisions at the CGP (50%) (P< 0.05).Conclusions:Ambulatory training sites can differ greatly with respect to characteristics beyond diagnosis. Plans for increased and improved ambulatory training of internal medicine residents should include attention to these issues to ensure exposure to an adequate patient spectrum.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A 78-year-old man admitted with clinical jaundice and pelvic pain had a total bilirubin level of 6.56 mg/dL, an alkaline phosphatase level of 855 U/L, and a prostate specific antigen (PSA) level of 9996 ng/mL. A computed tomogram demonstrated marked retroperitoneal, peripancreatic, periceliac, and periaortic lymphadenopathy. A bone scan revealed increased radiolabeled technetium uptake in the pelvis, vertebral column, parietooccipital region, ribs, and appendiceal skeleton. A biopsy of one pelvic lesion revealed metastatic prostate cancer. This man’s obstructive jaundice and bone pain had a dramatic response to treatment with a gonadotropin-releasing hormone analog (leuprolide) and antiandrogen (bicalutamide). All bone pain and clinical signs of jaundice disappeared in 1 week. His total bilirubin decreased to 0.84 mg/dL by 2 weeks. His PSA values reflected this clinical response, decreasing to 4022 ng/mL in 1 week, 2680 ng/dL after 2 weeks, and 1028 ng/mL after 1 month of the above therapy.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Evidence suggests that the bacteriumChlamydia trachomatiscan cause asymptomatic genital infection in persons at risk for acquisition of the organism. We employed 2 independent molecular screening systems to assess such inapparent cervical chlamydial infections in low-risk female patients attending general (non-STD) clinics in 2 locations.Methods:Three hundred seventy-five cervical swab samples were obtained in duplicate from patients attending a general women’s clinic (278 samples) and a colposcopy clinic (97 samples). One set of samples from the general clinic was screened by a highly-specific molecular hybridization system, using a probe targeting the chlamydial 16S ribosomal RNA; the other set was screened with the use of the Chlamydiazyme test. Samples from the colposcopy clinic were screened using a sensitive and specific polymerase chain reaction (PCR) assay system targeting chlamydia; the duplicates were assayed by direct fluorescent antibody assay (DFA).Results:Of the 278 patients screened by RNA-directed hybridization, 6.5% were positive forC trachomatis, in contrast to screening of duplicate samples via Chlamydiazyme, which indicated that 3.6% were infected. PCR-based screening of the additional 97 patients gave a positivity rate of 17.5% for the organism, whereas DFA on duplicate samples from this group showed only 7.5% positive.Conclusions:These observations suggest that the level of asymptomatic cervicalC trachomatisinfection is significant even in women who are at low risk for such infections; the data also indicate that results from standard laboratory screening for chlamydia should be viewed with caution.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID