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Biomedical subjects

T Rosenthal

Publications and source records attributed to T Rosenthal.

At least 217 records · Page 12Linked to original sources

Blood kinin system in renal hypertensive patients administered with SQ 20881.

The i.v. administration of 0.25 mg/kg SQ 20881 to eight renal hypertensive patients caused blood pressure fall and in five of them also reduced heart rate. The latter was attributed to increase in vagal tone. Peripheral and renal blood samples taken at the nadir of the hypotensive response showed considerable inhibition of plasma kininase activity, rise in free kinin level and reduced kininogen content. This reduction was not due to increased consumption as shown by in vitro experiments. PGE2 and PGF2 alpha levels in kidney blood of three patients remained practically unchanged. Plasma renin activity was augmented to a larger extent in blood of kidney with stenotic artery than in the one with patent vessel. It is concluded that the action of SQ 20881 on human blood kinin system, besides inhibition of kininase, involves also reduction of kininogen, the mechanism of which remains to be clarified.

Aldosterone↗

Changes in plasma noradrenaline concentration following sympathetic stimulation by gradual tilting.

Plasma noradrenaline concentration was determined by a radioenzymatic method in 10 normal individuals who were subjected to a stepwise tilt through 45 degrees. A gradual increase in noradrenaline was observed with maximal values occurring in most subjects following the full 45 degrees of tilt. Maximal levels were sustained for up to 30 min. In two subjects who fainted, the syncopal episode followed an initial sympathetic postural response as shown by a rise in plasma noradrenaline. For the remaining subjects a significant correlation was found between changes in plasma noradrenaline and mean arterial pressure.

Adult↗

Poisoning caused by inhalation of hydrogen chloride, phosphorus oxychloride, phosphorus pentachloride, oxalyl chloride, and oxalic acid.

Eleven people accidentally inhaled a significant amount of a gaseous mixture of hydrogen chloride, phosphorus oxychloride, phosphorus pentachloride, oxalyl chloride, and oxalic acid. Clinical observations and laboratory tests were recorded from the time of admission throughout hospitalization. The main abnormalities were found in the respiratory tract and consisted of clinical and physiologic evidence of obstruction of the airways, mild interstitial and alveolar edema, a defect in diffusion, and inequalities of ventilation and perfusion that produced hypoxemia. All of these cleared within a short time.

Accidents, Occupational↗

Minoxidil-induced bullous eruption.

A previously unreported side effect--serosanguineous bullae--was found in one patient receiving minoxidil. The eruption disappeared with cessation of the drug and reappeared on rechallenge. The question arises whether continuation of minoxidil treatment could have led to vasculitis.

Aged↗

Renal involvement in Behçet's syndrome.

A retrospective study of 77 cases of Behçet's syndrome showed that, of the 33 patients in whom urinalysis was done (including three with systemic amyloidosis reported earlier), 17 had pathological results. A prospective study of 51 of these patients uncovered eight additional subjects with urinary abnormalities, bringing the total to 25. The urinary abnormality was, as a rule, discrete, consisting of proteinuria and/or microhematuria. These occurred in some patients persistently, in some intermittently, in some alternatingly, and in some simultaneously. The initial finding was proteinuria in 10 patients, hematuria in 11, and both in 4. Over the years, eight showed only hematuria, seven only proteinuria and ten, both. The urinary sediment contained neither leukocytes nor casts. Pyelographies were unrevealing when performed and rectal biopsies uncovered no new instance of amyloidosis. These data suggest that a benign renal lesion occurs in Behçet's syndrome, whose pathological substrate, though not yet defined, is not amyloid deposition.

Adolescent↗

Endocarditis and ventricular septal defect: surgical vs. conservative treatment.

Three patients with ventricular septal defect and bacterial endocarditis are reported. Because of the very frequent spontaneous closure of the defect, especially in children, and the rarity and benign nature of bacterial endocarditis superimposed on ventricular septal defect, it is suggested that the condition be treated conservatively. An exception to this is the rare case with recurrent endocarditis, mainly in older individuals, in whom surgery may be contemplated.

Adolescent↗

Familial hyperpotassemia and hypertension accompanied by normal plasma aldosterone levels: possible hereditary cell membrane defect.

Hypertension and hyperpotassemia that were accompanied by normal plasma aldosterone and low renin levels and were responsive to chlorothiazide administration were found in a 29-year-old patient and two decades later in his 21-year-old son. Their renal function is normal, including response to sodium sulfate, mannitol, and aldosterone infusions. Adrenal insufficiency was excluded. The renin-aldosterone system was proved intact by physiological and pharmacologic stress and angiotensin-II infusion. Also normal were values for blood counts, blood volumes, and erythrocyte and exchangeable body potassium. The postulation of a defective cell membrane impeding potassium influx is supported by the failure of glucose and insulin infusions to substantially reduce hyperpotassemia. In the context of a hereditary disorder (the pedigree, compatible with autosomal dominant inheritance, includes five affected in two generations), hypertension is a second phenotypic character of a single defective pleiotropic gene although its pathogenesis remains unclear.

Adult↗

Murine typhus and spotted fever in Israel in the seventies.

One hundred and eleven cases of rickettsial disease-100 cases of murine typhus and 11 cases spotted fever--seen over a four year period at the Chaim Sheba Medical Center are reviewed. The clinical picture of murine typhus (caused by Rickettsia mooseri and transmitted by Xenopsylla cheopis) could not be distinguished from that of spotted fever (caused by a Rickettsia similar to Rickettsia conori and transmitted by Rhipicephalus). Some quite severe cases of murine typhus and some relatively mild cases of spotted fever were seen.

Adolescent↗

Fatal undiagnosed tuberculosis in hospitalized patients.

Thirty-seven cases of active tuberculosis were misdiagnosed in Chaim Sheba Medical Center in the years 1964-1974. The diagnosis was made only after death. Twenty-one patients were over 60 years of age. Eleven had hematological disorders, and 12 received steroids (sometimes with immunosuppressive or cytotoxic drugs). Misdiagnosis of miliary tuberculosis is a growing problem and demands special attention. The postmortem examination must be systematic and must include bacteriological and histological studies for establishment of the correct diagnosis.

Adolescent↗

Dissecting aneurysm of thoracic aorta: reappraisal of radiologic diagnosis.

In a series of 24 cases of acute dissecting aneurysm of the aorta (not including Marfan's disease) the diagnosis was usually suspected on the basis of the clinical picture and plain chest roentgenograms. The most consistent clinical sign was severe pain. Absent pulses and a neurological deficit were each noted in only five patients. In many cases there was no correlation between the clinical picture and the type or the extent of the dissection. Widening of the aortic arch and obliteration of the aortic knob with displacement of the trachea to the right are the most common signs in plain chest roentgenograms. A barium swallow examination in these cases reveals an elongated compression and displacement of the esophagus by the aortic arch. Calcification in the area of the aortic arch is the exception rather than the rule in dissecting aneurysms. Angiography is essential for the definitive diagnosis of dissecting aneurysms. The diagnosis is based on the demonstration of two channels, either by the presence of a linear radiolucency separating the two lumens, or by differences in flow that present as delayed opacification or delayed washout. If only the true lumen is opacified, widening of the outer extraluminal border of the aorta or narrowing of the lumen indicates the presence of a dissection. Abnormal catheter recoil and position were helpful in only two cases, and are not informative when the false lumen is catheterized. Failure to visualize main aortic branches was not always due to involvement by the dissection. It can also be caused by reduced flow due to severe proximal compression of the main lumen. The exact location of the intimal tears is usually not demonstrated unless additional injections are made in the area assumed to contain the tear. If only the false lumen is opacified in the ascending aorta, this can be recognized by the demonstration of a blind end, by failure to visualize the sinuses of Valsalva, from flattening of the medial border of the opacified channel, and from delayed washout in the blind end.

Aged↗

Systemic amyloidosis in Behçet's disease.

Clinical features in two patients with Behcet's disease were dominated by "minor" manifestations of the disease--arthritis and central nervous system involvement in one, chronic stasis ulcers complicating thrombosis of the inferior vena cava in the other. In a third patient, the dominant clinical features were coincidental obstructive airway disease and cor pulmonale. Two patients developed a nephrotic syndrome; the third had intermittent trace proteinuria. Amyloidosis was proved by histologic examination in all three. The two patients examined post-mortem had no focus of chronic suppuration. There is a possibility that systemic amyloidosis is an intrinsic feature of Behcet's disease.

Adolescent↗