Empyema and splenic abscess in infective endocarditis.
We report a case of empyema secondary to splenic abscess, cured by splenectomy, in the course of an infective endocarditis caused by Streptococcus faecalis.
Biomedical subjects
Publications and source records attributed to G Mayor.
We report a case of empyema secondary to splenic abscess, cured by splenectomy, in the course of an infective endocarditis caused by Streptococcus faecalis.
The effect of aluminum on parathyroid hormone secretion was examined using collagenase-dispersed bovine parathyroid cells. An increase in the medium aluminum concentration over the range of 0.5 to 2.0 mM, in low calcium medium, progressively inhibited the secretion of radioimmuno-assayable hormone. At 2.0 mM aluminum hormone secretion was inhibited by 68% while high medium calcium, without aluminum, maximally inhibited parathyroid hormone secretion only 39%. Individually, 2.0 mM aluminum or 2.0 mM calcium inhibited isoproterenol-stimulated hormone secretion by 43%. Either metal suppressed basal and isoproterenol-stimulated cyclic AMP levels of the parathyroid cells. That the inhibitory effect of aluminum on parathyroid hormone secretion was not due to an irreversible toxic effect was demonstrated by a restoration of normal secretion when cells were returned to 0.5 mM calcium medium without aluminum. The incorporation of [3H]leucine into total cell protein, parathyroid secretory protein, proparathyroid hormone, or parathyroid hormone was not affected by aluminum. The secretion of radiolabeled protein was, however, inhibited by aluminum. These results suggest that aluminum does not affect protein biosynthesis of the parathyroid cell or the conversion of proparathyroid hormone to parathyroid hormone. Aluminum appears to directly affect the secretion of protein from dispersed parathyroid cells.
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The review of 340 own cases of hyperparathyroidism surgery shows, that only the concentrations of calcium and parathormone in serum are of interest for the diagnosis. Further biochemical analyses and function tests are not specific enough to serve as indicators for hyperparathyroidism and serve only as secondary reinforcements of the diagnosis. There are many methods for the preoperative localisation but only the computer tomography with simultaneously given contrast medium or a refined sonography seem to be reproducible. 94% of the cases are cured by surgery. The further development of urolithiasis is certainly reduced after the successful operation, however, in about one third of the cases with normocalcemia, a recurrent and marked increase in size of the stones present was observed postoperatively. The possibility of such a continuous growth gives reason to observe closely the development of urolithiasis in order to be able to react promptly by means of lithotomy.
A patient with fulminant hepatic encephalopathy and acute renal failure progressively deteriorated following daily hemodialysis with a hollow fiber artificial kidney improved dramatically after an initial dialysis with a polyacrylonitrile membrane system. Following repetitive dialysis with this system the patients continued to improve and is well many months following discharge. His course during hemodialysis with membrane systems having different clearances for substances of various molecular weights suggests the hypothesis that a substance(s) with a molecular weight between 1,500 and 15,000 daltons is involved in the pathogenesis of hepatic encephalopathy and offers and additional therapeutic modality for his devastating disease.
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Lacto-ovo-vegetarian women fifty to eighty-nine years of age lost 18 per cent bone mineral mass while omnivorous women lost 35 per cent. This study established that this difference could not be explained by a greater bone density in the lacto-ovo-vegetarians during the third, fourth, and fifth decades of life. The possibility of higher sulfur content in the meat-containing diet, the effect of excess phosphorus, and the effect of an acid-ash diet are discussed. From the standpoint of a general survey, comsumption of calcium-containing foods was not appreciably different in the two groups. It is, therefore, concluded that lacto-ovo-vegetarian diet may be beneficial in extended protective health care in terms of defense against, or control of, bone mineral loss in the later years of a woman's life.
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With 131 operated patients in the University Hospital of Urology in Zurich the indication for surgery in the 4 most frequent groups of adrenal disease is discussed. The preoperative localization of the tumor is exact in 96% of all cases with the serum examination in different stage of the vena cava. The appearance of hypertensive and hypotensive crises during surgery can be prevented with an adequate alpha-adrenergic blockade and volume replacement before and during the operation. In the surgery of Morbus Cushing we prefer the bilateral, dorsal incision on the 11th rib, if we haven't an unilateral adenoma. In the cases of Conn disease the removal of the whole surroundings of the adrenal gland is additionally indicated. The prognosis of the carcinoma of surrenal glands is poor, the adrenalectomy is difficult with regard to the early infiltration, the illness is seldom stopped on account of the frequent metastatic formation.
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The therapeutic management of bladder tumors at the Zurich University Hospital is pointed out. It is to emphasize the important rank of the TNM-classification, which is introduced in the European Association of Urology, for comparing the results of therapy.
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We are of the opinion that for large kidney tumors in the upper region as the afflicted venous portions, the most advantageous incision is a thoraco-retro- peritoneal one. It allows the surgeon total freedom of movement and ensures reliable radical tumor-nephrectomy, as well as reconstruction possibilities in the large vessels. Of course, use of this incision is not without complications. They appear, however, not as often as opponents of this method would suppose. There are other statistics to support our convictions (4). From the check-ups of our thoraco-retroperitoneal nephrectomy patients, we are able to surmise the following: - The post operative mortality rate is not increased with this method. The cause for the mortalities are, as far as one can tell, old age and/or a generally poor condition piror to nephrectomy. - Post operative complications due to access though the thorax are very few. Not one patient had to be re-operated, punctured, or treated using suction drainage. No respiratory difficulties were observed. - Post operative complications from the wound were naturally relative to the extent of the incision. It was also here unnecessary to perform a second operation except in one case of a retroperitoneal hematoma from heparinization. This complication was not the result of this particular incision.
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