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Biomedical subjects

A C Chester

Publications and source records attributed to A C Chester.

At least 37 records · Page 2Linked to original sources

Early diagnosis of polycystic kidney disease.

Polycystic kidney disease is the most prevalent hereditary renal disorder, accounting for over 5 percent of patients on chronic hemodialysis. Early diagnosis can aid in family planning, and "preventive therapy" may prolong useful life and defer dialysis. Intravenous pyelography with nephrotomography has been the standard procedure for definitive diagnosis, but ultrasonography, radionuclide scanning and computerized tomography have become increasingly useful. Ultrasonography is particularly valuable because it is free of radiation hazards. Impaired urinary concentrating ability is a frequent early sign of the disorder.

Adult↗

Tubulointerstitial diseases.

This group of disorders has a number of causes. Early in the course of the disease, tubular malfunction is out of proportion to glomerular disease. The early presentation may be inability to concentrate urine, salt wasting, distal or proximal renal tubular acidosis and/or Fanconi's syndrome. With early diagnosis and treatment, progression of the renal disorder can be prevented or at least delayed. One can easily discontinue the antibiotic or analgesic, remove the heavy metal, treat the electrolyte abnormality, lower the uric acid or remove the genitourinary tract obstruction.

Analgesics↗

Hemodialysis in the eighth and ninth decades of life.

In a review of 45 patients who started receiving hemodialysis (HD) after the age of 70 years (mean, 75 years), compared with a control of 70 HD patients (mean age, 42 years), the two-year survival for elderly patients was 42% and 58% for controls. In the elderly group, age did not correlate with survival. Nine elderly patients were over 80 years old and had a two-year survival of 41%. The elderly patients had a significantly lower mean predialysis blood pressure (BP) (142/73 +/- 3/1 mm Hg) than the controls (158/88 +/- 2/1 mm Hg) (P less than .001). Only 13% of the elderly patients received antihypertensive medication, compared with 41% of controls (P less than .01). The BP showed a significant negative correlation with age in both elderly ( r - .41, P less than .01) and control (r = .35, P less than .001) patients. Glomerulonephritis was less common in the elderly (9%) than control (31%) groups, and pyelonephritis was more common (29% vs 16%).

Aged↗

Hypersensitivity to salicylazosulfapyridine: renal and hepatic toxic reactions.

Salicylazosulfapyridine has been used for a number of years as therapy for ulcerative colitis. Reported toxicities are usually minor. This case report represents an acute allergic reaction to the drug. Characterized by fever, rash, eosinophilia, nephritis, and hepatitis. Resolution occurred with discontinuation of salicylazosulfapyridine. Although similar reactions have been reported with the antimicrobial sulfonamides, none has been fully described with salicylazosulfapyridine, a combination of a sulfonamide and salicylate.

Adult↗

Right ventricular infarction.

Serial hemodynamic measurements were made in a patient with a massive infarction of the right ventricle complicated by cardiogenic shock, right ventricular failure, and tricuspid insufficiency. A favorable hemodynamic response was obtained by reducing afterload with administration of sodium nitroferricyanide (nitroprusside) while maintaining preload with infusion of fluids.

Blood Pressure↗

The kidney and pregnancy.

Many clinical parameters and biochemical values normally change as a result of the profound effect of pregnancy on the kidney. These changes include hydronephrosis, decreased BUN and uric acid, proteinuria and glycosuria (70 percent one time), frequency, nocturia, edema (80 percent) and reductions in blood pressure. "Normal is abnormal." A BUN of 20 mg. percent is the equivalent of 40 mg. percent in a nonpregnant woman, and a blood pressure of 120/80 in the 24th week of preganancy may be hypertensive.

Blood Pressure↗

Polycystic kidney disease.

This autosomal dominant disorder usually appears in middle life. The most common findings are proteinuria, abdominal pain and palpable kidneys, followed by hematuria, hypertension, pyuria, uremia and calculi. In 15% of patients, death is due to cerebral aneurysm. Family counseling and the detection of "at risk" family members are important elements of management. Statistically, half of the offspring of one affected parent will have the disease.

Adult↗

Hypothesis: the nasal fatigue reflex.

Natural selection results in adaptations. I suggest that unexplained fatigue may be an adaptive response to nasal impairment. For macrosmatic animals, intact olfaction is necessary to detect predators. In such animals, any reflex (e.g., fatigue) triggered by nasal dysfunction that limited exposure would offer great survival advantage. The "fatigued" animal would remain in its protected environment, unexposed to hungry carnivores, while the nose healed. In humans, clinical syndromes associated with unexplained fatigue (chronic fatigue syndrome, tension fatigue syndrome, allergic fatigue, neurasthenia, etc.) are characterized by symptoms that, in part, are nasal in origin. The older medical literature does describe the resolution of fatigue in neurasthenia after nasal treatments. Nasal reflexes in animals do cause significant systemic effects, including an inhibition of muscle action potentials that is, perhaps, analogous to the "heavy-limbed" sensation of those with fatigue. Furthermore, reflexes similar to the one proposed do exist in humans: the diving reflex presumably served our amphibian ancestors well as an oxygen conserving technique with submersion, but serves no known useful function now. Other human nasopharyngeal reflexes with profound cardiovascular and systemic effects are well described but only occasionally studied. The proposed nasal fatigue reflex should be examined as a possible ancient adaptive response to nasal malfunction.

Animals↗

Sick-building syndrome fatigue as a possible predation defense.

Sick-building syndrome is an illness characterized by fatigue, headache, and upper-respiratory complaints. It is usually associated with modern office buildings, structures with an impervious outer shell and inoperable windows. Poor air quality, specific pollutants, and inadequate ventilation are considered common causes. The ability to smell faint odors requires air that is free of contamination. Human evolutionary ancestors depended on odors for survival. Even the slightest increase in the ability to smell a predator conveyed a distinct, immediate survival advantage. Conversely, an enormous survival advantage would also accrue to the animal that sought protection or avoided activity when this vital olfactory information was unavailable. Such would be the case with fire on the savannah. The foraging, olfactory dependent animal, unable to smell predators because of contaminated air, would be quickly snatched by a keen-sighted carnivore. There exist, however, well-described reflexes from the nose mediated through the trigeminal nerve that discourage activity when these free nerve endings are irritated. This mechanism may serve as a defense against predation. In adulterated atmosphere the animal, subdued by these reflexes, would be less likely to venture forth and, therefore, less vulnerable to predators. Similar reflexes may persist in humans, activated by poor air quality, air ill-suited for the dissemination of odors. I suggest that the human perception of these inhibitory reflexes is the feeling of fatigue associated with the sick building syndrome.

Air Pollution, Indoor↗

Chronic fatigue syndrome criteria in patients with other forms of unexplained chronic fatigue.

To determine the prevalence of chronic fatigue syndrome (CFS) criteria in other forms of unexplained chronic fatigue, 297 consecutive outpatients under the age of 40 from a general medicine practice were studied. After excluding the three with chronic fatigue syndrome, the remaining 294 individuals were divided into those with unexplained chronic fatigue (64 patients) those without (the remaining 230 patients). Chronic fatigue syndrome criteria noted to be significantly more common in those with unexplained fatigue compared to those without include: fever, painful adenopathy, muscle weakness, myalgia, headache, migratory arthralgia, neuropsychologic symptoms, and sleep disorder. Like chronic fatigue syndrome, unexplained chronic fatigue often started suddenly. I conclude that the CFS criteria are noted more commonly than expected in other forms of unexplained chronic fatigue.

Adult↗

The natural history of concurrent sick building syndrome and chronic fatigue syndrome.

An outbreak of chronic fatigue syndrome linked with sick building syndrome was recently described as a new association. Whether chronic fatigue syndrome acquired in this setting tends to remit or, as sporadic cases often do, persist, is unknown. To clarify the natural history of chronic fatigue syndrome in association with sick building syndrome the 23 individuals involved in the outbreak were interviewed four years after the onset. In the previous interview one year after the onset of symptoms, 15 (including 5 with chronic fatigue syndrome and 10 with idiopathic chronic fatigue) of the 23 noted fatigue. Three years later 10 of the 15 were "fatigue free" or "much improved". Five were only "some better", "the same", or "worse". Three of the five people previously diagnosed with chronic fatigue syndrome were "much improved" (two) or "fatigue free" (one). The remaining two were seriously impaired, homebound and unable to work. The 10 individuals with substantially improved fatigue (three of the five with chronic fatigue syndrome and seven of the 10 with idiopathic chronic fatigue) were more likely to have noted improvement in nasal and sinus symptoms, sore throats, headaches, and tender cervical lymph nodes when compared to those with a lingering significant fatigue (p < 0.001). Upper respiratory symptoms and headaches improved in those with reduced fatigue but remained problematic in those with persisting significant fatigue. We conclude that the fatigue related to sick building syndrome, including chronic fatigue syndrome, is significantly more likely to improve than fatigue identified in sporadic cases of chronic fatigue syndrome.

Fatigue Syndrome, Chronic↗