Subject(s)
Heart Valve Prosthesis Implantation/instrumentation , Aortic Valve/pathology , Aortic Valve/surgery , Diagnostic Imaging , Equipment Failure , Heart Valve Prosthesis Implantation/adverse effects , Humans , Male , Middle Aged , Mitral Valve/pathology , Mitral Valve/surgery , Mitral Valve Insufficiency/etiology , Rheumatic Heart Disease/pathologyABSTRACT
Two patients, men aged 77 and 66 years, presented with a vasculitis. Due to an abnormal blood smear they were referred to the internist, who subsequently diagnosed a myelodysplastic syndrome (MDS). They were initially treated with a high dose of corticosteroids and this dosage later became a maintenance dose. Immunological phenomena occur in 10-14% of MDS patients and seem to have a poor prognosis. Most patients respond well to treatment with corticosteroids. Occasionally, favourable haematological responses to corticosteroid therapy are seen, although this was not the case in the two patients described. When patients present with an immunological disorder, such as a vasculitis or an autoimmune disease, it is important to be aware of the possibility of an underlying MDS.
Subject(s)
Anemia, Refractory/immunology , Leukemia, Myeloid, Acute/etiology , Myelodysplastic Syndromes/immunology , Skin Diseases/immunology , Vasculitis, Leukocytoclastic, Cutaneous/immunology , Aged , Biomarkers/blood , Bone Marrow/pathology , Diagnosis, Differential , Glucocorticoids/therapeutic use , Humans , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myelomonocytic, Chronic/diagnosis , Male , Myelodysplastic Syndromes/blood , Myelodysplastic Syndromes/complications , Myelodysplastic Syndromes/diagnosis , PrognosisABSTRACT
OBJECTIVE: To evaluate the relationships between the changes in stroke volume index (SVI), measured in both the aorta and the pulmonary artery, and the changes in intrathoracic blood volume index (ITBVI), as well as the relationship between changes in aortic SVI and changes in the pulmonary artery wedge pressure (PAWP). DESIGN: Prospective study with measurements at predetermined intervals. SETTING: Medical intensive care unit of a university hospital. PATIENTS AND METHODS: One hundred and fifty-four measurements were taken in 45 critically ill patients with varying underlying disorders. Aortic SVI and pulmonary arterial SVI were determined with thermodilution. PAWP was measured using a pulmonary artery catheter. ITBVI was determined with thermal-dye dilution, using a commercially available computer system. RESULTS: A good correlation was found between changes in ITBVI and changes in aortic SVI. However, this correlation weakened when changes in ITBVI were plotted against changes in pulmonary arterial SVI, which was in part probably due to mathematical coupling between ITBVI and aortic SVI. A good correlation between changes in ITBVI and changes in aortic SVI could also be established in most of the individual patients. No correlation was found between changes in PAWP and changes in aortic SVI. CONCLUSION: ITBVI seems to be a better predictor of SVI than PAWP. ITBVI may be more suitable than PAWP for assessing cardiac filling in clinical practice.
Subject(s)
Aorta/physiopathology , Blood Volume/physiology , Critical Illness , Monitoring, Physiologic/standards , Pulmonary Artery/physiopathology , Pulmonary Wedge Pressure/physiology , Stroke Volume/physiology , Catheterization, Swan-Ganz , Humans , Linear Models , Liver Cirrhosis/physiopathology , Monitoring, Physiologic/methods , Predictive Value of Tests , Prospective Studies , Pulmonary Edema/physiopathology , Respiratory Distress Syndrome/physiopathology , Shock, Septic/physiopathology , ThermodilutionABSTRACT
The chance of permanent remission after prolonged drug therapy was investigated in 41 patients with toxic multinodular goiter. For purposes of comparison a group of 41 patients with Graves' disease was also studied. After euthyroidism was achieved all patients received a combination of thionamide and thyroxine for at least 12 months. The minimum follow-up period was 2 yr. Relapse of thyrotoxicosis occurred in 95.1% of patients with toxic multinodular goiter and 34.1% of patients with Graves' disease (p < 0.001). It is concluded that for patients with toxic multinodular goiter early radioiodine therapy or surgery is preferred since prolonged drug therapy seldom produces permanent remission.
Subject(s)
Antithyroid Agents/therapeutic use , Goiter, Nodular/complications , Graves Disease/complications , Hyperthyroidism/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Carbimazole/administration & dosage , Carbimazole/therapeutic use , Drug Therapy, Combination , Female , Goiter, Nodular/diagnostic imaging , Goiter, Nodular/drug therapy , Graves Disease/diagnostic imaging , Graves Disease/drug therapy , Humans , Hyperthyroidism/diagnostic imaging , Hyperthyroidism/drug therapy , Iodine Radioisotopes , Male , Methimazole/administration & dosage , Methimazole/therapeutic use , Middle Aged , Propylthiouracil/administration & dosage , Propylthiouracil/therapeutic use , Radionuclide Imaging , Recurrence , Thyroid Gland/diagnostic imaging , Thyroxine/administration & dosage , Thyroxine/therapeutic useABSTRACT
Two renal transplant patients developed anemia during treatment of hypertension with enalapril medication. Hemoglobin levels normalized after administration of enalapril was stopped. In one patient, it was demonstrated that the discontinuation of enalapril was followed by a decrease in renal blood flow and a significant increase in the plasma erythropoietin levels that preceded the rise in hemoglobin. These observations are consistent with the hypothesis that angiotensin-converting enzyme inhibition may cause anemia by increasing renal blood flow and consequently decreasing erythropoietin levels.
