The American journal of the medical sciences
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Recent information has shed a new light on the control of parathyroid hormone (PTH) secretion by calcium and 1,25-(OH)2D. These new data have permitted a better understanding of the pathogenesis and management of secondary hyperparathyroidism in end-stage renal disease. ⋯ Recent insights have been obtained regarding the occurrence of secondary hyperparathyroidism in obese and black subjects, in patients with multiple endocrine neoplasia type I, and in manic-depressive patients receiving lithium therapy. This review examines some of these recent gains in knowledge concerning secondary hyperparathyroidism, as well as their clinical implications.
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Pneumonias in adults due to mycoplasma, chlamydiae, and viruses are a common clinical problem. These microorganisms contribute to the etiologies in 6-35% of all cases of pneumonia and are the sole pathogens in 1-17% of hospitalized cases. Important trends and developments in the field include the emergence of a Chlamydia psittaci strain (TWAR) that is passaged from human to human, causes a mycoplasma-like illness, and that is relatively resistant to erythromycin, the recognition of respiratory syncytial virus as a pathogen in nursing home outbreaks and in immunosuppressed adults, the continuing high lethality of fully developed influenza pneumonia, the efficacy of acyclovir and adenine arabinoside in limiting the complications of varicella-zoster virus infections, and the increasing frequency of pneumonia caused by cytomegalovirus and the severity of this disorder in highly immunosuppressed patients. Developments in the rapid diagnosis and therapy of respiratory syncytial virus infections with an aerosolized antiviral drug in children may pave the way for comparable advances in difficult pneumonias in adult patients.
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This report describes the progression of an acute regional Nocardia pneumonitis to diffuse pulmonary parenchymal disease in a previously healthy man. The pathophysiologic manifestations of disease evolved from that of a severe bacterial pneumonia to the adult respiratory distress syndrome. This progression may be representative of pyogenic bacterial pneumonias, which are associated with the syndrome even when the infections are adequately treated.
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Lipid and lipoprotein levels were measured in undialyzed uremic men and compared with levels of healthy control subjects. The patients had lower high-density lipoprotein (HDL) cholesterol (mean +/- SD, 46.3 +/- 14.8 vs 54.1 +/- 18.2 mg/dl) and increased serum triglycerides (197 +/- 151 vs 142 +/- 87.7 mg/dl). When compared with patients maintained on dialysis, the undialyzed patients had higher HDL cholesterol (46.3 +/- 14.8 vs 30.3 +/- 13.3 mg/dl), serum cholesterol (226 +/- 81 vs 151 +/- 42 mg/dl), and triglycerides (197 +/- 151 vs 146 +/- 105 mg/dl). ⋯ Within the undialyzed patient group, black patients had lower serum cholesterol and triglycerides and higher HDL and HDL3 cholesterol than white patients. Apoprotein A-I levels were higher and apoprotein B levels were lower in the black patients. There was a strong correlation (r = 0.9501) between apoprotein A-I and HDL levels in the black patients, but not in the white patients (r = -0.148).(ABSTRACT TRUNCATED AT 250 WORDS)
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Severe hyperlipidemia was nearly completely corrected in 16 diabetic patients who were treated with regular insulin at breakfast and supper. Serum cholesterol levels fell from 572 +/- 52 mg/dl to 247 +/- 10 mg/dl, and serum triglycerides fell from 6,330 +/- 820 mg/dl to 354 +/- 40 mg/dl over a 4-month period of treatment. Establishment of comparable degrees of control of the fasting blood glucose and hemoglobin A1C levels by NPH insulin did not correct the hyperlipidemia. Regular insulin timed to act for the disposal of ingested substrates appears to provide physiologic actions important in the treatment of diabetic hyperlipidemia.