Biomedical subjects
Publications and source records attributed to H M Allen.
Urine volume and osmolality were studied in two schizophrenic patients with hyponatremia and six normal subjects after they smoked or ingested cigarettes. The results suggest that cigarette use may contribute to the development of hyponatremia by impairing water excretion.
The authors present a review of the toxicology, pathophysiology, and treatment of paraquat, a potent herbicide.
Nephrogenic diabetes insipidus (NDI) is a frequent complication in patients receiving long-term lithium therapy. Both thiazide diuretics and amiloride may reduce the polyuria, but the use of each is associated with problems. We report the results of a clinical trial using the nonsteroidal anti-inflammatory drug indomethacin to treat a patient with well-documented lithium-induced NDI that persisted following cessation of lithium treatment. The administration of a single dose of indomethacin resulted in a dramatic decrease in urine volume and increase in urine osmolality that persisted for several hours, and was independent of renal hemodynamic changes. Subsequently, the patient experienced a sustained, favorable effect on her polyuria during long-term (3 months) indomethacin therapy without a deleterious effect on her renal function. Indomethacin may be a useful therapeutic tool for the amelioration of lithium-induced NDI.
Consumer responses to three cost containment strategies for providing health care are examined. The data come from a random sample of 365 Los Angeles adults interviewed by telephone. It is found that aggregate sample responses are negative toward two strategies (labelled preferred provider and health planning) and positive toward the third (labelled self care). Furthermore, it is found that demographic characteristics that predict approval of one strategy predict disapproval of other strategies. These findings, coupled with models assessing how and why segments of consumers respond as they do, suggest that no one strategy is likely to appeal to all consumers. Implications for the implementation of health care delivery systems inspired by containment strategies are discussed in the context of recent events in California.
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Central venous catheterization is utilized in resuscitation and evaluation of the severely ill patient. It is also employed for total parenteral nutrition. The list of potential complications is extensive and includes catheter malposition, with its attendant morbidity, as the most frequent complication. Inaccurate venous pressure measurements and mediastinal phlebitis have been cited as natural sequelae of inadvertent catheterization of the internal thoracic (mammary) vein (ITV). The histories of four patients who had ITV cannulation are analyzed as to indications for central venous catheterizations, site of insertion, time of delayed recognition, and attendant complications. In addition, the records of 150 consecutive patients who underwent central venous line placement were reviewed to determine the number of lines placed (242), the number and percentage of postcatheterization chest films obtained with standard posterior-anterior (P-A) and lateral technique (70, 29%), the number and incidence of catheterization-associated complications (78, 32%), and the number and incidence of ITV cannulation (5, 2%). No untoward results were seen as a result of this complication in the nine patients discovered, although the potential for morbidity was present. Subtle changes on portable chest films and standard technique P-A and lateral films remain the best protection against complications associated with ITV cannulation.
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We report a case of generalized malignant acanthosis nigricans (AN) secondary to metastasizing squamous cell carcinoma of the cervix uteri. The disease initially manifested in the perineum as condyloma acuminatum-like lesions. Subsequently, most of the cutaneous surface and the mucosa of the vulva, mouth, tongue, and the palpebral conjunctiva became involved. The association of AN with a squamous cell carcinoma is rare, and conjunctival involvement is unusual.
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