Anaphylactic shock induced by diclofenac.
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Biomedical subjects
Publications and source records attributed to S Dux.
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A previously healthy 65-yr-old man developed clinical signs of prepatellar bursitis. Aerobic cultures from fluid aspirated from the inflamed prepatellar bursa were negative. Direct microscopic examination of the fluid showed gram-positive cocci, and anaerobic cultures grew Streptococcus hemalyticus group A. The bacterial etiology of bursitis has recently been emphasized in the literature; in most of our cases Staphylococcus was responsible. Negative cultures were next in frequency. Other microorganisms may indeed be responsible for prepatellar bursitis and should be sought where aerobic cultures are negative.
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A percutaneous renal biopsy was performed on a 50-year-old female with rapidly progressive renal failure. The histologic specimen was characteristic of an immune complex disease, most likely systemic lupus erythematosus. Serologic tests were negative. 8 days after the biopsy, there was a spontaneous rupture of the kidney which necessitated nephrectomy. As no connection was found between the biopsy site and the rupture, it was concluded that the rupture was spontaneous in a patient with an immune complex disease.
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The potency and efficacy of a single dose of a new aldosterone antagonist, potassium 17 a-hydroxy-6 beta, 7 beta-methylene-3-oxo-D-homo-17a alpha-pregna-4,16-diene-21-carboxylate (Ro 12-2503), in reversing the renal effects of exogenous aldosterone were compared to those of spironolactone, and placebo. The study was performed according to double-blind and crossover procedure in six healthy male subjects. Both drugs, spironolactone and Ro 12-2503, did not completely antagonize the effects of aldosterone. The efficacy of Ro 12-2503 in terms of the urinary Na+/K+ ratio and the urinary Na+ concentration was less than that of spironolactone. Spironolactone produced a slightly greater natriuresis, but the difference was not significant. The method described, based on standard bioassay techniques permits a comparison of the two drugs, and may prove useful in the screening and evaluation of aldosterone antagonists.
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The influence of diets containing combinations of high protein and low calcium on discrete stages of bone formation was investigated in 28-day-old rats. A bone matrix-induced bone forming system was utilized to determine the stages of endochondral ossification that were being affected. Mesenchymal cell proliferation as assessed by [3H]-thymidine incorporation and ornithine decarboxylase activity were unchanged in animals fed a high protein (80% casein)/normal calcium (0.61% Ca; 0.40% P) diet. However, osteogenesis was reduced by 78% in the rats fed high protein/normal calcium as measured by 45Ca incorporation. Alkaline and acid phosphatase activities in bone were increased 2.5 and 2.3 times, respectively, reflecting increased matrix turnover induced by the high protein availability. Bone that did form was not remodeled nor was there evidence of marrow formation. The animals were normocalcemic and normophosphatemic and showed no evidence of acidosis. A combination diet of high protein and low calcium resulted in a 62% reduction of cell proliferation and chondrogenesis and a 98% inhibition of bone formation. High dietary protein-induced osteoporosis in animals is due to a failure of osteogenesis of the stage of ossification possibly a result of restricted availability of calcium at the site of mineralization.
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Review of 3,680 abdominal operations performed in our department during a 10 year period revealed that 95 patients (2.6 percent) required relaparotomy because of surgical complications during the same hospitalization. Of these, 37 patients died, a mortality of 38 percent, which is approximately 10-fold that for similar operations in which reintervention was not necessary. The mortality was greater in male patients and was very high (64 percent) in those over the age of 70 years. The most common complication necessitating relaparotomy was peritonitis (0.9 percent of the total series), followed by intestinal obstruction (0.8 percent) and wound disruption (0.7 percent). The frequency of bleeding requiring reoperation was low (0.1 percent). Intestinal operations were associated with the highest incidence of complications (6.2 percent), followed by gastric operations (4 percent). Assessment of the time interval between the development of the surgical complication and reoperation in each case indicated that there had been an unjustifiably long delay in reaching the correct diagnosis, in performing reoperation or both in 26 percent of this series (40 percent of the cases of peritonitis). This delay was usually greater with early than with relatively later complications. However, our findings failed to support a detrimental effect of this delay and even showed a tendency toward better results and a lower mortality when conservative treatment was prolonged before reoperation was performed.