Biomedical subjects
Publications and source records attributed to E M Berry.
Spontaneous remission of the protein-losing gastropathy of Menetrier's disease occurred after four months of disease activity. Because the natural history and cause of Menetrier's disease is unclear, we suggest a more conservative approach to the management of this condition, despite recent publications to the contrary.
Because of intolerance to oral steroids, a patient with Chronic Active Hepatitis and an active gastric ulcer was treated with rectal steroids in addition to azathioprine and carbenoxolone sodium. The liver function tests showed a marked improvement with this therapy, and the gastric ulcer healed. The possible advantages of steroid administration by suppositories are discussed.
We report the findings in a patients with the Wolff-Parkinson-White syndrome (type A) who initially had recurrent fainting episodes. It appeared that they were caused by prolonged posttachycardiac depression of the sinus node, which was induced by treatment with propranolol. The possibility of covert dysfunction of the sinus node in patients with Wolff-Parkinson-White syndrome should be considered before commencing therapy with beta-adrenergic blocking agents.
A clinical report of a 30-year-old woman who developed acute hepatic failure in the fifth month of pregnancy is presented. L-dopa administration resulted in a marked improvement in both level of consciousness and electroencephalogram. The literature dealing with L-dopa therapy in hepatic encephalopathy is reviewed.
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A case of the carcinoid syndrome associated with a proximal myopathy is reported. Histology showed advanced atrophy of type II muscle fibres but no inflammation. Perinuclear acid phosphatase was increased. Electron microscopy revealed persistence of the Z-line until the muscle fibre had been severely disrupted. Similar lesions have been observed in the hereditary muscular dystrophy in mice, and also in these animals and in rats when injected with 5-hydroxytryptamine (5-HT). Treatment with cyproheptadine caused a documented response in the patient's debilitating diarrhoea and also produced symptomatic improvement in her muscular power. We suggest that the myopathy is due to circulating 5-HT or is a non-metastatic complication of the carcinoid tumour.
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The relationship of plasma calcium levels to changes in plasma specific gravity, total protein, and albumin induced by venous stasis was investigated. Factors were derived for adjusting calcium results to offset the effects of variation in protein concentration and thus to make them of increased discriminatory value to the clinician. The validity of an existing specific gravity correction has been substantiated, but a more exact adjustment of 0.23 mg/100 ml of calcium for every 0.001 change in specific gravity is proposed. We recommend for automated laboratories that the factor based on albumin be used: 0.09 mg/100 ml of calcium should be subtracted from the total calcium value for every increase of 0.1 g in albumin above 4.6 g/100 ml, and a corresponding addition should be made for values of albumin below 4.6 g/100 ml.Using a calcium specific electrode, it has been shown that the ionized calcium concentration does not alter with prolonged venous stasis.
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Phosphorus abnormalities among patients suffering from eating disorders, although cited, have received relatively little attention. Studies generally report decreased concentrations of phosphorus for both bulimia and anorexia nervosa. We have recently noted hyperphosphatemia in several consecutive hospitalized bulimic patients who appeared to have normal renal function and calcium levels. Case files of 30 inpatient and outpatient female bulimic patients and 30 sex- and age-matched physically healthy psychiatric inpatients and outpatients were reviewed. Phosphorus and electrolytes related to phosphorus metabolism were compared between the two groups. Twenty-four of 30 bulimic patients (80%) were found to have at least one elevated serum phosphorus concentration, whereas all but one of 30 age-matched controls had values within normal limits. Elevated phosphorus levels were generally in the mild to moderate range. No correlation was found between phosphorus levels and any of the other electrolytes examined in both patients and controls. No correlation was found between phosphorus levels and the reported frequency of bingeing and vomiting or the number of laxatives ingested. Since bulimic patients are generally of normal weight and tend to deny their disturbed eating habits, diagnosis is often delayed. However, bulimia may be suspected from biochemical abnormalities such as hypokalemia, hypochloremia, elevated amylase, and acid-base disturbances. This preliminary study indicates that elevated serum phosphorus levels may serve as an additional objective marker for the presence of bulimia nervosa.
Overgrowth of Gram-negative bacteria as a result of total parenteral nutrition (TPN) and bowel rest could be responsible for the release of a variety of hepatotoxic substances such as endotoxin or tumor necrosis factor (TNF) and the ensuing TPN-associated liver function derangements. Polymyxin B is an effective antimicrobial agent as well as a blocking agent for endotoxin (lipopolysaccharide) activity and TNF production. In the present study we compared the oral and intravenous effects of polymyxin in rats receiving TPN in an attempt to define these two possible mechanisms of action of polymyxin on TPN-associated hepatic steatosis. Both oral, as well as intravenous polymyxin B, significantly reduced total hepatic fat and triglyceride accumulation in TPN rats, more so in the intravenous group exhibiting close to control levels. Both polymyxin-treated groups exhibited significantly lower Gram-negative bacterial counts in the cecum, with the oral group exhibiting a lower count than the IV group. The spontaneous production of TNF by peritoneal macrophages was markedly increased in rats receiving TPN and very close to being undetected in both groups receiving TPN and polymyxin. We believe polymyxin B protects the liver during TPN by both its antimicrobial effect which prevents overgrowth of gut Gram-negative bacteria and the subsequent translocation of endotoxin, and by its specific antilipopolysaccharide activity which, in the present study, completely abolished hepatic steatosis and TNF production during TPN.
Fat-free diet changes the lipid content and the electrophysiological properties of the rat myocardium. Five percent fat supplementation to the diet does not alter the basic electrophysiological properties but still has a biochemical effect on the lipid content of the myocardium. The purpose of this work was to determine whether these biochemical alterations affect the response of the myocardium to quinidine and ischemia, both of which interact with the lipid component of the membrane. We used strength-duration, strength-interval and threshold of ventricular fibrillation to measure the electrophysiological properties of the isolated rat heart at baseline and after 30 minutes of quinidine perfusion or coronary artery ligation. The fatty acid composition of the myocardium was analyzed. We found that a fat-free diet caused essential fatty-acid deficiency, while 5% fat supplementation had a partial protective effect. Quinidine decreased excitability and increased refractoriness in both groups but had more effect on the fat-free diet hearts group. There was no difference in the ventricular fibrillation threshold. Ischemia increased myocardial excitability in the fat-free diet hearts group and had no effect on refractoriness or ventricular fibrillation threshold. These results support the theory that the lipid composition of the myocardial membrane affects its response to lipophilic drugs and ischemia.
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