Is transseptal catheterization necessary?
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Biomedical subjects
Publications and source records attributed to M Dunn.
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We evaluated praziquantel for therapy of active Schistosoma mansoni infection in 15 rural Egyptian males with hepatosplenic schistosomiasis. Criteria for inclusion in this study were two pre-treatment S. mansoni egg counts with a mean of greater than 100 eggs g-1 faeces and an enlarged spleen. Fourteen of 15 patients had hepatomegaly, five had ascites, and six had serum albumin below 3 g dl-1. Schistosoma haematobium infection (less than 10 eggs ml-1 urine) was present in three patients. Praziquantel was administered in a single oral dose of 30 mg kg-1 body weight. Eight of the 15 patients (53%) had mild and transient reactions in the form of fever (usually one day), gastrointestinal symptoms, headache and skin rash. Criteria for parasitological cure were the absence of live eggs in two stool samples and a negative rectal snip biopsy three months after therapy. Ten patients ceased to pass live eggs (cure rate 67%). For the five who were still passing live eggs there was a mean egg reduction of 95%. The three patients with S. haematobium demonstrated parasitological cures. We conclude that praziquantel is an effective and well tolerated drug for treatment of S. mansoni infection in patients with advanced hepatosplenic schistosomiasis, and it is the drug of choice for patients with coexisting S. haematobium infection.
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This study was carried out on 55 diabetic patients, 20 of whom had diabetic nephropathy, and 10 controls. Glycosylated haemoglobin, glycosylated serum protein, glucoprotein, serum protein electrophoresis, blood urea, serum creatinine and beta 2-microglobulin were measured. A significant increase of glucoprotein was observed in patients with diabetic nephropathy. No correlation was found between glycosylated serum protein and glycosylated haemoglobin and duration of diabetes. Glycosylated serum protein showed a positive correlation with beta 2-microglobulin, indicating a link between renal involvement and the rise in glycosylated serum protein. Whether there is a pathogenic relation between glycosylated serum protein and the development of nephropathy awaits further evidence.
Amiodarone is unique among the antiarrhythmic agents. Despite its unusual pharmacokinetics and its potential toxicity, it is successful in managing both supraventricular and ventricular arrhythmias. Therefore, it is destined to become an important drug in our antiarrhythmic armamentarium.
With a randomized clinical trial, the possibility was assessed that a tracheal instillation of pulmonary surfactant prior to the first breath might prevent the development of some of the signs of neonatal respiratory distress syndrome. Of the 72 infants in the trial, all born at a gestational age of less than 30 weeks, 39 received 3 or 4 mL of surfactant, prepared from the lipids extracted from calf lung lavage. The treatment resulted in a significantly improved gas exchange during the first 72 hours of life. On the average, the arterial/alveolar PO2 ratio was 0.15 higher for the treated infants, and only about half as much extra oxygen had to be supplied. The respiratory support (peak inspiratory pressure X frequency) could be lowered significantly. Pulmonary interstitial emphysema occurred in 13 of the 33 control infants, but in only three of the 39 treated infants. Six of the control infants died in the neonatal period, but only one treated infant died. It is concluded that surfactant supplementation prior to the first breath is feasible and is of value as protection against the respiratory distress syndrome and the negative effects of hypoxia and ventilatory support.
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On February 2, 1980, a riot broke out among the 1,157 inmates at the New Mexico State Penitentiary and 139 people were injured. Of these, 33 died. Survivors had a variety of problems resulting from blunt or penetrating trauma, acute intoxication with drugs, or smoke inhalation. Fourteen percent of the casualties arrived at local hospitals in serious or critical condition. A study of the injury patterns revealed a significant difference (P less than .001) in the incidence of severe head trauma in those who had died compared to those who survived. Most of the seriously or critically ill survivors suffered from acute poisoning or from penetrating wounds.
Two cases of unexplained severe pulmonary hypertension were seen in the older age group. Although classified as primary pulmonary hypertension, the clinical course of these patients was very unusual because of their age and relatively long duration of diseases. The long period of follow-up allowed assessment of both the difficulties of making a definite diagnosis of primary pulmonary hypertension in the older age group and the noninvasive methods which were particularly helpful. Making the diagnosis of primary pulmonary hypertension in the older age group is important because there are now drugs which can ameliorate the severity of pulmonary hypertension.
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We saw three cases of severe reversible azotemia secondary to captopril therapy in hypertension. All patients had extensive peripheral vascular disease involving the renal arteries, and two patients (patients 2 and 3) had high levels of peripheral plasma renin activity. The azotemia occurred approximately two weeks after exposure to captopril, and fever, a maculopapular pruritic cutaneous rash, and eosinophilia developed in two patients (patients 2 and 3). The cause of the azotemia in our patients is not clearly known, since renal biopsies were not performed. The most likely cause for the azotemia was volume contraction with reduction in the glomerular filtration rate, although a direct insult to the kidney could not be excluded.
Fifty men with spinal cord injuries (SCI) were asked to complete a questionnaire concerning their sexuality before and after injury. Medical examination confirmed the location and completeness of the injury and extracted information about genitourologic status. The respondents rated sexuality highly as a concern in living, and a wide variety of sexual techniques were reported. A marked decrease in sexual activity, satisfaction, and feelings of sexual adequacy was reported after injury, as compared to retrospective "before injury" responses, lack of opportunity being reported as causative by 66% of the subjects and insufficient personal satisfaction by 59%. Seventy-five percent of the subjects experienced sexual arousal from genital stimulation, and several methods of eliciting erection were cited. Orgasm was described by a variety of terms. Significant differences were found between quadriplegic and paraplegic patients in answers to several items, though there was generally no difference between cervical and thoracic groups, which were more specifically broken down with respect to motor or sensory/complete or incomplete lesions. Plasma testosterone levels were found to fall well within the normal adult male range, as were levels of free testosterone and serum sex binding protein. The resulting information demonstrated more sexual concern among men with SCI than the literature previously indicated.
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One hundred and forty-three children with vesicoureteric reflux were treated conservatively at first. This retrospective study showed that the results of conservative treatment of severe reflux (Grade III) were poor and compare with other series. It is established that reflux of infected urine can cause scarring and there is increasing evidence that severe reflux of sterile urine can produce renal damage and stunt physical growth; once reflux ceases, or is corrected, renal function and growth as well as physical growth recover. We strongly urge that severe reflux (Grade III) should be treated aggressively and by antireflux surgery at an early stage. We concur that mild reflux (Grades I and II) can be successfully managed conservatively.
Spontaneous conversion to sinus rhythm after prolonged atrial fibrillation is uncommon, with only 11 recorded cases to our knowledge in the English language literature. We report four cases of spontaneous conversion to an organized atrial rhythm (either sinus rhythm or atrial tachycardia with block) after nine to 16 years of established atrial fibrillation. One case was due to a toxic reaction to digitalis. In the other three cases there was no apparent reason. M-mode and two-dimensional echocardiography in three patients showed an akinetic and noncontractile left atrium in each case. This lends support to an earlier hypothesis that complete fibrosis of the left atrium may be responsible for the conversion from atrial fibrillation.