The American journal of the medical sciences
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Review Case Reports
Southwestern Internal Medicine Conference: Shiga-like toxins in hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura.
The majority of cases of hemolytic-uremic syndrome and a smaller proportion of cases of thrombotic thrombocytopenic purpura have recently been shown to result from a toxin produced by enteric bacteria, referred to as verotoxin, or Shiga-like toxin. The predominant toxin-producing bacterial strain in North America is E. coli O157:H7, which causes hemorrhagic colitis in humans after ingestion of contaminated meat. ⋯ The toxin inactivates ribosomes inside the cells, thereby killing them and producing the clinical manifestations of hemolytic-uremic syndrome. Recognition of the etiology of hemolytic-uremic syndrome may lead to better prospects for prevention and treatment.
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In diabetic ketoacidosis, a mixed acid-base disorder is suggested when the anion gap increase (delta AG) does not equal the bicarbonate decrease (delta HCO3), or when the delta AG/delta HCO3 ratio does not equal 1.0. It is widely assumed that delta AG/delta HCO3 is significantly different from 1.0 when it is less than 0.8 or greater than 1.2. The validity of these ratio limits were examined by analyzing a normal control group of 68 subjects and 27 diabetic ketoacidosis admissions that had no evidence of mixed disorders. ⋯ In contrast, the ratio limits of 0.8 and 1.2 suggested 56% of the pure anion gap acidoses, and 94% of the control group, had mixed disorders. It was concluded that mixed disorders are overdiagnosed by the ratio limits of 0.8 and 1.2. Mixed disorders are more accurately detected by noting whether delta AG and delta HCO3 differ by more than 8 mEq/L.
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Review Comparative Study
Cultural issues in serving minority populations: emphasis on Mexican Americans and African Americans.
Patients' cultural beliefs may affect acceptance of health care, compliance, and treatment outcomes. This article discusses cultural views of health and illness, folk beliefs and customs, cultural barriers to care, and alternative health-care systems, with particular emphasis on Mexican Americans and African Americans, including curanderismo, rootwork, and voodoo. Physicians who wish to provide appropriate and acceptable care in a cross-cultural setting should integrate these beliefs with conventional medicine.
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In 1950, Carl John Wiggers, philosopher and physiologist, wrote, "Reactions to definite types of stimulation may be observed or recorded, and concealed phenomena may be revealed by the use of apparatus that transforms them into forms that are recognizable by human senses. But complete understanding of physiological reactions often necessitates extensive operative procedures and sometimes the ultimate sacrifice of life. ⋯ Use of animal model systems led to this greater understanding and is currently at the heart of evaluating the new therapeutic agents. This review briefly addresses the contribution animal model systems have made to what appear to be a watershed in attempts to obviate the effects of this mortal condition.