Search

A 32-year-old woman who abused methylphenidate hydrochloride developed complications including hepatic, renal, pancreatic, pulmonary, and CNS toxicities. These were manifested by abnormal liver function enzymes, poor urine output, hypotension, tachypnea, tachycardia, abnormal blood gases, rising serum BUN and creatinine, and hyperactive deep-tendon reflexes. All were reversible with medication withdrawal and supportive therapy. Toxicities of this medication and their implications are discussed.

I surveyed by telephone 108 potential sources of information on health and travel. I posed as a traveler, and evaluated the information and referrals elicited by comparison to current standards set out by the World Health Organization (WHO) and the U.S. Public Health Service. Only 7.4% potential sources gave correct information, 30.6% gave incorrect information, and 62% gave no information. 74.1% of those surveyed gave correct referrals, 22.2% gave incorrect referrals, and 3.7% gave no referrals.

Hyperventilation syndrome is a common and often disabling condition. Traditional treatment consists of reassurance and anxiolytic drugs. Hyperventilation is known to precipitate an asthmatic reaction. A retrospective review of patients with hyperventilation syndrome was performed to ascertain the frequency of asthma as well as the response to bronchodilator medication. Forty-seven patients were seen. Thirty-eight were tested, and asthma was proved in 36. Two additional patients had positive clinical responses with bronchodilators. Thus, asthma was identified in 38 of 47 consecutive patients seen for hyperventilation syndrome (80 percent), and asthma was proved in 36 of 38 of patients tested (95 percent). Hyperventilation syndrome was eliminated in 29 of 35 patients (90 percent) treated with a combination of explanation and bronchodilator treatment.

The higher incidence of HB8Ag/ayw (71%) in sera collected from acute viral hepatitis cases, as well as from patients with chronic active hepatitis, healthy carriers and blood donors of 20 Romanian counties emphasizes the local prevalence of the ayw determinant in our country.

Sarcoidosis affecting the pleura, pericardium, and myocardium is described in a patient who demonstrated continued disease activity while on therapy with high-dose steroids. Cyclophosphamide was found to be highly effective in suppressing her disease over a period of six years.

Upper extremity thrombosis is responsible for 1-2% of all cases of deep venous thrombophlebitis (DVT). Little has changed concerning the clinical presentation, diagnostic investigation, or treatment of the disorder over the last forty years. However, a changing pattern in the natural history of the disease seems to be emerging with the advent of more invasive procedures and prolonged medical care of critically-ill individuals. Case histories of sixteen (16) patients with seventeen (17) episodes of upper extremity thrombosis are reviewed. Fewer cases of "primary" thrombosis, and fewer acute or chronic sequelae were noted in the present study than would be implied in previous reviews of the subject. It is our opinion that DVT of the upper extremity, especially when due to "secondary" thrombosis, is a more benign and self-limiting disease than has been traditionally reported.

Absorption changes accompanying light-induced P-700 formation and its decay in the dark at 15 K in Photosystem-I particles poised at various redox potentials have been examined. In unpoised samples, the light-induced absorption change is practically irreversible. At increasingly negative potentials, an increasing fraction of the absorption change, proportional to the fraction of bound iron-sulfur protein chemically reduced, becomes reversible, and the titration curve has a midpoint potential of --530 mV (vs. normal hydrogen electrode). At --66 mV, the P-700 absorption change is 97% reversible. The total P-700-signal amplitude decreases over the same potential span and levels off at about 43% (to slightly over 50% at a substantially higher excitation intensity). These results provide additional support to previous suggestions of an existence of an intermediate electron acceptor located between the primary donor, P-700, and the more stable primary electron acceptor (P-430 or bound iron-sulfur protein).

Sarcoidosis is a granulomatous, inflammatory disorder that can affect any organ in the body. The interstitium of the lung is a frequent area of involvement. This tissue comprises the alveolar-capillary unit of the lung with the pulmonary vasculature affected either on a primary or (usually) secondary basis. Measurements of gas exchange across this tissue should be expected to parallel disease activity. Five patients with histologic and/or radiographic evidence of interstitial lung disease were evaluated by serial exercise studies over time with respect to therapy. Preexercise and postexercise values were obtained, for exercise is felt to make these measurements more sensitive to changes in gas transfer. Good correlations were seen in all five patients. Exercise studies are concluded to be of value in patients with interstitial lung disease due to sarcoidosis and may prove to be a sensitive form of follow-up during therapeutic intervention.

250 HBsAg-positive sera from apparently healthy blood donors were tested for HBeAg and anti-HBe by immunodiffusion(ID) and counterelectrophoresis(CEP). HBeAg was identified in 2.4% and anti-HBe in 34% of the sera. After serum concentration a larger rate of both HBeAg and anti-HBe could be detected by ID. There was no difference in sensitivity between ID and CEP techniques in the detection of the e-system. There was no correlation between HBeAg or anti-HBe and HBsAg subtypes. Generally sera containing HBeAg showed higher titers of HBsAg in complement fixation.

Lymphangiomyomatosis is an interesting disease with distinctive clinical and histopathologic findings. We report herein two additional cases of lymphangiomyomatosis, including one with clinical improvement after therapy with progesterone. This case is of particular significance in view of the patient's negative sex steroid receptor analysis. These findings open new avenues for future considerations in the therapy of this unusual but interesting disease.

Pulmonary edema of non-cardiac origin is usually an urgent clinical problem, which has recently increased in frequency throughout the world in the past few years. This is partly due to sociological factors and to pre-eminent advances in industrial technology. Recent severe massive toxic gas explosions have had national and worldwide implications. Therefore, urgent and appropriate therapy is of utmost importance in most of these patients. The use of high flow oxygen with Constant Positive Pressure Breathing are the main inhalational therapeutic approaches. Newer modalities of treatment include: (1) earlier Fiberoptic bronchoscopy in those individuals afflicted with aspiration problems and (2) certain specific chemical blocking agents for the management of phosgene intoxication and hydrogen sulfide toxicity. Preventive environmental measures are also important.

The interhemispheric pathways originating in the hippocampal formation, presubiculum, and entorhinal and posterior parahippocampal cortices and coursing through the fornix system were investigated by autoradiographic tracing in 29 rhesus monkeys (Macaca mulatta). The results revealed that crossing fibers are segregated into three contiguous systems. A ventral hippocampal commissure lies at the transition between the body and anterior columns of the fornix in the vicinity of the subfornical organ and the interventricular foramina of Monro; it is formed by axons arising in the most anterior (uncal and genual) subdivisions of the hippocampal formation. A dorsal hippocampal commissure lies inferior to the posterior end of the body of the corpus callosum; it is formed by axons arising in the presubiculum and entorhinal cortex of the anterior parahippocampal gyrus and the proisocortical and neocortical subdivisions of the posterior parahippocampal gyrus but not in the hippocampal formation. A hippocampal decussation lies between the ventral hippocampal commissure and dorsal hippocampal commissure; it is formed by axons arising in the body of the hippocampal formation. In contrast to the fibers of the ventral hippocampal commissure and dorsal hippocampal commissure, which terminate in contralateral cortical areas, these decussating fibers terminate in the contralateral septum. Thus, the ventral hippocampal commissure and dorsal hippocampal commissure of the rhesus monkey appear to be homologous to similarly designated structures in other mammals. To the extent that these observations also apply to the interhemispheric fibers of the human hippocampal formation and parahippocampal areas, their possible preservation must be considered when interpreting the effect of callosal transection on seizures and the results of "split-brain" studies, since callosal transection may fail to sever the hippocampal commissures in their entirety.