摘要:

Although hyperlipidemia has been associated with the progression of glomerulosclerosis, little attention has been directed toward the use of lipid-lowering agents in altering diabetic nephropathy. We tested the hypothesis that lovastatin and the combination of lovastatin and enalapril would preserve renal function in streptozotocin-induced diabetic Wistar rats. Five groups of animals were studied: group 1, nondiabetic (n = 10); group 2, diabetic, insulin only (n = 12); group 3, lovastatin, (15 mg/kg/day, n = 13); group 4, enalapril, (50 mg/L drinking water, n = 10) and group 5, lovastatin plus enalapril, (n = 14). After 8 weeks of treatment, glomerular filtration rate (GFR, insulin clearance) was measured in anesthetized animals. The diabetic group was characterized by a GFR of 0.18 ± 0.03 ml/min/g of kidney weight (gKW), a blood glucose level of 441 ± 36 mg/dL, plasma cholesterol and triglyceride levels of 64 ± 6.0 and 103 ± 26.0 mg/dL. Lovastatin preserved GFR, 0.52 ± 0.06 ml/min/gKW compared with the diabetic control subjects (P < 0.05). Enalapril also maintained GFR (0.42 ± 0.06 ml/min/gKW, P < 0.05). In the lovastatin plus enalapril group, GFR (0.62 ± 0.05 ml/min/gKW) was greater than in the enalapril group (P < 0.05), but was not different from the lovastatin group. Plasma lipid levels were not altered in any of the groups. Assessment of the kidneys by histology after treatment showed that the mesangial matrix injury score was better in the lovastatin, enalapril, and lovastatin plus enalapril groups compared with the diabetic group (P < 0.05). Lovastatin, enalapril, and lovastatin plus enalapril abrogated the decline in GFR and glomerular injury in diabetic rats. Lovastatin's direct renal protective effect seems to be independent of its lipid-lowering properties.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:In some patients with bacterial pneumonia, the resolution of chest radiograph shadows are delayed. There have been many clinical and pathological studies on delayed-resolution pneumonia (DR). However, there are no reports concerning inflammatory cell findings of bronchoalveolar lavage (BAL) fluid in patients with DR. We compared the BAL fluid cell findings in patients with DR with those in patients with complete-resolution pneumonia (CR).Methods:The subjects included six patients whose chest radiograph shadows were completely resolved within 2 weeks after an appropriate antibiotic administration (CR), and nine patients whose chest radiograph shadows were unresolved more than 2 weeks after the treatment (DR). BAL was done 2-3 weeks after the antibiotic treatment in both groups. We compared differential counts and lymphocyte subsets in BAL fluid among patients with CR, patients with DR, and asymptomatic subjects.Results:There were no significant differences in BAL fluid cell findings between CR groups and asymptomatic groups. On the other hand, the percentages of lymphocytes, neutrophils and eosinophils in DR group were significantly increased compared with those in CR and normal groups. There was no significant difference in the CD4+/CD8+ ratio of BAL lymphocytes among the three groups.Conclusions:It is suggested that infiltration of inflammatory cells in the lung exists in DR, despite the disappearance of inflammatory reaction in the peripheral blood.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:The aims of this study were to determine the electrogastrogram (EGG) changes and gastric emptying rates in diabetic patients and to investigate the correlation between upper gastrointestinal symptoms, fasting blood glucose, and gastric myoelectrical abnormalities.Methods:Fourteen patients with long-standing type 1 diabetes mellitus and dyspepsia symptoms participated in the study. EGG recordings were obtained 30 minutes before and during a 2-hour radionuclide gastric emptying test for a solid meal. Fasting blood glucose was determined immediately before the gastric emptying study. Symptoms of nausea, vomiting, early satiety, abdominal bloating, and pain were rated from 0 to 3.Results:Nine patients (64%) had delayed gastric emptying with 84.6 ± 4.5% retention at 2 hours. Seven patients (50%) had abnormal EGG findings. The postprandial power change in the EGG of the patients with delayed gastric emptying (-0.48 ± 0.16 dB) was decreased compared with patients with normal gastric emptying (4.7 ± 2.6 dB) (P = 0.079). In patients with abnormal EGGs, the mean symptom score was significantly higher than patients with normal EGGs (2.42 ± 0.13 versus 2.0 ± 0.16; P < 0.05). Compared with normal gastric emptying patients, patients with delayed gastric emptying had higher but not significantly different symptom scores (2.31 ± 0.11 versus 2.08 ± 0.30; P = 0.225). There was no significant difference in fasting glucose levels in delayed (252 ± 61.2 mg/dl) versus normal (378 ± 82 mg/dl) gastric emptying or abnormal (288 ± 86.4 mg/dl) EGGs versus patients with normal (304 ± 57.6 mg/dl) EGGs.Conclusions:Overall, 78% (11 of 14) of patients with diabetes had either gastric motility or myoelectrical abnormalities. Patients with abnormal EGGs had more severe symptom scores. In diabetic patients with symptoms of gastropathy, an EGG may provide an important screening test for diagnosing abnormal gastric motility.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Systolic blood pressure is well known to increase significantly with age and is strongly correlated with stroke and coronary artery disease. We and other investigators have reported a low prevalence of hypertension in subgroups of patients with HIV infection. In the present study, we examined an ambulatory population of patients with HIV infection to determine whether in the outpatient setting they may lack an age-related increase in systolic blood pressure.Methods:In an ambulatory outpatient practice, medical records of 178 consecutive patients with HIV infection and those of 200 control subjects were examined. Systolic and diastolic blood pressure and other clinical and laboratory variables were recorded. Scatter plots were generated to compare age with systolic blood pressure. Spearman rank correlation analysis was carried out to determine the relationship between systolic blood pressure and age and other variables.Results:Patients ranged in age from 13 to 69 years. There was only a very slight increase (which did not achieve statistical significance) in systolic blood pressure with aging in the patients with HIV infection, in contrast to the control population, in which an age-related increase in systolic blood pressure was seen that was comparable to published Framingham data. Mean systolic blood pressure for the group as a whole was 118.2 ± 1.1 mm Hg. Mean serum albumin was 4.2 ± 0.04 g/dL and was only slightly diminished in older patients. Mean serum cholesterol was 176.8 ± 3.4 mg/dL and this bore no relationship to aging. More advanced stages of HIV infection also did not correlate with the lack of age-associated systolic hypertension.Conclusion:The present population of ambulatory patients infected with HIV seem to lack an age-related increase in systolic blood pressure; this may be caused by such variables as autonomic dysfunction or factors that may attenuate the development of atherosclerosis.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:The clinical manifestations and outcome of all adult patients with polyarteritis nodosa (PAN), allocated during a 15-year period in the largest medical center in Israel, were examined.Methods:A retrospective analysis of patients with PAN who fulfilled the American College of Rheumatology (ACR) 1990 Classification Criteria and were either biopsy- or angiography-proven.Results:Nine patients were included in the report. The clinical and laboratory manifestations were similar to those in previous studies. All patients were treated with combinations of cyclophosphamide and corticosteroids. There were two (22%) deaths, 2 and 5 months after initiation of treatment in patients who probably had microscopic polyangiitis (MPA) rather than classical PAN. Considering the patients with a complete follow-up, 71% had a complete and long-term remission. Moreover, by exclusion of the two patients with probable MPA who died, all of the five patients with classical PAN were alive and well as of this writing. Two patients (22%) had a long history, since childhood, of familial Mediterranean fever (FMF).Conclusions:The clinical presentation and course of PAN in Israel patients is comparable with reports elsewhere. However, a distinction should be made between PAN and MPA. The present report emphasizes the good long-term prognosis of patients with typical PAN who are treated adequately. In addition, a possible association of PAN with FMF in Israeli patients is suggested.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Evidence-based medicine (EBM) is becoming an accepted educational paradigm in medical education at a variety of levels. It focuses on identifying the best evidence for medical decision making and applying that evidence to patient care.Methods:Three EBM journal clubs were developed at the West Virginia University School of Medicine. One was for senior medical students, another for residents, and the third for primary care faculty members. In each, the sessions stressed answering clinical questions arising from actual patient-care issues. The curricular structure and development of the journal clubs are described. Participants anonymously evaluated aspects of the journal clubs regarding their educational value with Likert scale questions.Results:Faculty members and residents generally gave high evaluations to all aspects of the EBM journal clubs. Student evaluations were more mixed. For each of the evaluation questions, the student means were lower than those of faculty and residents. However the differences reached statistical significance only in the responses to the usefulness of the sessions in understanding the medical literature (P < 0.01). Residents and faculty rated the EBM sessions more favorably than grand rounds or the resident lecture series.Conclusions:The establishment of evidence-based medicine journal clubs is feasible, and learners seem to value the sessions. More developed learners may gain more from the experience than those earlier in their medical education.

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

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Metabolic acidosis from accumulation of lactic acid is a relatively common condition, whereas its causation by thiamine deficiency is not.Methods:We studied a pregnant alcoholic patient who presented with hyperemesis and a high anion gap acidosis.Results:Lactic acidosis and thiamine deficiency were confirmed. The patient's symptoms and acidosis resolved with thiamine administration.Conclusions:Lactic acidosis caused by thiamine deficiency must be suspected when pregnant patients at risk for thiamine deficiency present with a high anion gap acidosis. A large dose of thiamine must be administered immediately.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Bacillus popilliae,a fastidious, aerobic, gram-positive, spore-forming bacillus, has never been reported as a pathogen in human infectious diseases. We report the first case of a human infected by the pathogenB. popilliae,which presented as endocarditis involving the bicuspid aortic valve and complicated with prolonged (> 30 days; to our knowledge, the longest in the literature) complete heart block. Although surgery may be warranted by previous reports, the patient was successfully managed by medical treatment instead, because of the absence of evidence from various approaches that support the existence of perivalvular extension of infection.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID