Nodular glomerulosclerosis in a non-diabetic hypertensive smoker with dyslipidemia.

Nodular glomerulosclerosis may be idiopathic or develop associated with diabetes mellitus, membranoprolipherative glomerulonephritis, light or heavy chain deposits, amyloidosis, fibrillary or immunotactoide disease, and Takayasu's arteritis. Histological features of idiopathic nodular glomerulosclerosis are similar to the Kimmelstiel-Wilson changes. Recent evidence points to the role of hyperglycemia, hyperlipidemia, hypertension and smoking in the mechanisms of this uncommon condition. The case study of a 65-year-old male presenting recent arterial hypertension and nodular non-diabetic glomerulosclerosis is described, and the possible role of heavy smoking in the pathogenesis of this condition is emphasized.

Transverse leukonychia: a case report.

A case of transverse leukonychia following chemotherapy for Hodgkin's disease in a 17-year-old white male is reported. The patient presented with multiple white bands across the fingernails, which appeared three weeks after the end of chemotherapy. The changes were almost homogeneously spread across the breadth of the fingernail plates, showing smooth borders with a rounded distal edge. Because of Hodgkin's disease in Costwold stage IE, he received sequential chemotherapy with cyclophosphamide, adriamycin, procarbazine, prednisolone, vincristine and bleomycine, and mediastinal mass irradiation. The authors emphasize that white transverse nail banding - Leukonychia striata or Muehrcke lines - constitute an aesthetical unpleasant side-effect of medication, but may represent an easily observed sign indicative of previous use of cytotoxic therapy for malignancy.

Nutritional assessment of vitamin E in malnourished patients with AIDS.

Malnourished patients with acquired immunodeficiency syndrome (AIDS) may have low serum levels and reduced intake of alpha-tocopherol, mainly in the presence of acute-phase response. The aims of this study were to compare intake and serum levels of alpha-tocopherol between malnourished (MN) and non-malnourished (NMN) AIDS patients and to correlate alpha-tocopherol intake and serum levels. Undernutrition was defined as having a body mass index lower than 18. 5 kg/m(2) or a height-creatinine index lower than 70%. A semiquantitative food frequency questionnaire assessed alpha-tocopherol intake. High-performance liquid chromatography determined vitamin serum levels. The patients were divided into MN (n = 14) and NMN (n = 15) groups. There were no statistical differences in relation to clinical findings between MN and NMN, respectively, including moniliasis (7/14 versus 4/15), neurocryptoccocosis and neurotoxoplasmosis (6/14 versus 6/15), pulmonary tuberculosis (4/14 versus 2/15), and fever (1/14 versus 3/15). MN and NMN groups had similar peripheral blood CD(4) levels (111.4+/-87.1 versus 124.4+/-90.9 cells/mm(3)), and both groups had similar and adequate alpha-tocopherol intake (MN = 50.0+/-11.0 versus NMN = 47.2+/-16.5 mg) and serum levels (MN = 17.8+/-7.2 versus NMN = 19.8+/-6.3 micromol/L). Vitamin E intake and serum levels did not show a significant correlation (r = -0.22, P 0.05). Protein-energy nutrition status and acute-phase response were not factors determining vitamin status among AIDS patients.

Hyponatremia in acute-phase response syndrome patients in general surgical wards.

BACKGROUND: In surgical patients, hypoalbuminemia may occur as a component of acute-phase response (APR) syndrome, which we hypothesized could decrease serum sodium levels. AIM: To compare the frequency of hyponatremia in adult surgical inpatients with or without APR syndrome. METHODS: All the simultaneous plasma sodium and albumin results (n = 168), obtained from adults in surgical wards and corresponding to a 6-month period, were searched in the hospital mainframe. Other relevant laboratory and clinical data were also registered. APR was ascertained by the presence of major physical trauma, surgery or infection, plus hypoalbuminemia (serum albumin <3.5 g/dl) and neutrophil left shift (>/=7% of band count) associated with peripheral leukopenia (white blood cells <4, 000/mm(3)) or leukocytosis (WBC >9,000/mm(3)). Hyponatremia was defined by serum sodium concentration <135 mEq/l. RESULTS: APR-positive patients (n = 113) had lower blood hemoglobin (10.92 +/- 2.18 vs. 13.53 +/- 2.30 g/dl), and serum albumin levels (median, range: 2.8, 1.9-3.4 vs. 3.7, 3.5-4.2 g/dl) than APR-negative (n = 55) ones, the same occurring in relation to antibiotics (54.8 vs. 10. 9%) and intravenous 5% dextrose in water (55.7 vs. 20.0%) or isotonic saline (46.0 vs. 9.1%) infusion. The hyponatremia frequency was higher among APR-positive patients (31.0 vs. 10.9%). CONCLUSION: The higher percentage of hyponatremia among APR-positive patients could be attributed to decreased serum albumin levels associated with APR.