The American journal of the medical sciences
-
Review
The role of genetic and environmental factors in cardiovascular disease in African Americans.
Considerable interest has been focused over the years on estimating the relative importance of genetic and environmental factors on differences in rates of cardiovascular disease in blacks and whites. However, recent advances in molecular science have helped to illuminate the underlying complexity of this problem. Attempts to impute the genetic component from "what was left over" after control for a limited set of environmental exposures is increasingly recognized as naive. ⋯ Although it is obvious that blacks experience not only unique environmental exposures, such as white racism, but more intense exposure to common factors, such as obesity, current methods make it very difficult to summarize these effects. Simpler models, using data from large samples, could provide greater precision and might illuminate the exposure-outcome relationships common to all groups. Meanwhile, efforts to identify genetic underpinnings of complex disorders will have to reach a much higher level of development before useful conclusions can be reached about the magnitude and variation of effects between racial and ethnic groups.
-
Hypertension, left ventricular hypertrophy (LVH), hypercreatininemia, and microalbuminuria (MA) are independent risk factors for cardiovascular disease (CVD). Hypertension increases the risk of CVD by two- to three-fold and LVH (especially concentric) is a risk factor for coronary heart disease, heart failure, stroke, and peripheral arterial disease. ⋯ Impaired renal sodium handling and sodium retention are physiological hallmarks of the very early stages of heart failure. Heart failure is a physiologically delicate condition that can decompensate with excess dietary salt intake or over diuresis, or compensate with cautious therapy designed to block the sodium retention and simultaneously interrupt excessively activated neurohumoral mechanisms.
-
Case Reports
Resolution of adult respiratory distress syndrome after recovery from fulminant hepatic failure.
Adult respiratory distress syndrome (ARDS) complicating the course of fulminant hepatic failure is nearly always fatal without orthotopic liver transplantation. We report the case of a 50-year-old woman with fulminant hepatic failure and ARDS that resolved after her recovery from the acute liver failure without liver transplantation. The pathogenesis is discussed, particularly with regard to liver-lung interactions.
-
Historical Article
The continuing legacy of the Tuskegee Syphilis Study: considerations for clinical investigation.
The Tuskegee Study, an observational study of over 400 sharecroppers with untreated syphilis, was conducted by the U. S. ⋯ The study became the longest (1932-1972) nontherapeutic experiment on humans in the history of medicine, and has come to represent not only the exploitation of blacks in medical history, but the potential for exploitation of any population that may be vulnerable because of race, ethnicity, gender, disability, age or social class. It is important for physicians who will be caring for an increasingly diverse nation to understand the lasting implications of this study for their patients, but the effects of the Tuskegee Syphilis Study are demonstrated most strikingly by unsuccessful attempts at improving representation of minority patients in clinical trials.
-
Review Case Reports
Metabolic acidosis with extreme elevation of anion gap: case report and literature review.
A patient with severe metabolic acidosis and an extremely elevated (57 mEq/L) serum anion gap (AG) is described, and the multiple factors that produced the patient's complex abnormalities are discussed in detail. These include renal failure, rhabdomyolysis, marked hyperphosphatemia, hemoconcentration, and an unidentified organic metabolic acidosis. A review of the literature indicates that the common thread observed in almost each instance of profoundly elevated AG values is a multifactorial pathogenesis that usually includes renal insufficiency, associated with a proven or likely cause of organic metabolic acidosis, or with exogenous phosphate intoxication.