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Biomedical subjects

A C Chester

Publications and source records attributed to A C Chester.

17 recordsLinked to original sources

Giardiasis as a chronic disease.

In an effort to better describe the incidence and characteristics of chronic giardiasis in an urban private practice outpatient setting, we reviewed our experience of 65 cases. In the entire group, the mean duration of symptoms was 1.9 years. A history of foreign travel was described by 45%. No association with homosexuality was noted. Chronic giardiasis, defined as that population symptomatic for six months or longer, constituted 58% of the entire group (38 cases). For these patients the mean duration of symptoms was 3.3 years. When compared to acute giardiasis, an increased frequency of constipation and upper gastrointestinal complaints was noted in the chronic population. Symptomatic cure was obtained in 71% of chronic cases and 93% of acute. Palliative results were noted in 18% of chronic cases and 4% of acute. We conclude that giardiasis is frequently a chronic disease in our population with symptoms lasting years. The incidence is similar in both sexes and a history of foreign travel is often absent. A disproportionate incidence in male homosexuals was not noted in our study.

Adult

Hemodialysis in the eighth and ninth decades of life.

In a review of 45 patients who started receiving hemodialysis (HD) after the age of 70 years (mean, 75 years), compared with a control of 70 HD patients (mean age, 42 years), the two-year survival for elderly patients was 42% and 58% for controls. In the elderly group, age did not correlate with survival. Nine elderly patients were over 80 years old and had a two-year survival of 41%. The elderly patients had a significantly lower mean predialysis blood pressure (BP) (142/73 +/- 3/1 mm Hg) than the controls (158/88 +/- 2/1 mm Hg) (P less than .001). Only 13% of the elderly patients received antihypertensive medication, compared with 41% of controls (P less than .01). The BP showed a significant negative correlation with age in both elderly ( r - .41, P less than .01) and control (r = .35, P less than .001) patients. Glomerulonephritis was less common in the elderly (9%) than control (31%) groups, and pyelonephritis was more common (29% vs 16%).

Aged

Hypersensitivity to salicylazosulfapyridine: renal and hepatic toxic reactions.

Salicylazosulfapyridine has been used for a number of years as therapy for ulcerative colitis. Reported toxicities are usually minor. This case report represents an acute allergic reaction to the drug. Characterized by fever, rash, eosinophilia, nephritis, and hepatitis. Resolution occurred with discontinuation of salicylazosulfapyridine. Although similar reactions have been reported with the antimicrobial sulfonamides, none has been fully described with salicylazosulfapyridine, a combination of a sulfonamide and salicylate.

Adult

Right ventricular infarction.

Serial hemodynamic measurements were made in a patient with a massive infarction of the right ventricle complicated by cardiogenic shock, right ventricular failure, and tricuspid insufficiency. A favorable hemodynamic response was obtained by reducing afterload with administration of sodium nitroferricyanide (nitroprusside) while maintaining preload with infusion of fluids.

Blood Pressure

The kidney and pregnancy.

Many clinical parameters and biochemical values normally change as a result of the profound effect of pregnancy on the kidney. These changes include hydronephrosis, decreased BUN and uric acid, proteinuria and glycosuria (70 percent one time), frequency, nocturia, edema (80 percent) and reductions in blood pressure. "Normal is abnormal." A BUN of 20 mg. percent is the equivalent of 40 mg. percent in a nonpregnant woman, and a blood pressure of 120/80 in the 24th week of preganancy may be hypertensive.

Blood Pressure

Polycystic kidney disease.

This autosomal dominant disorder usually appears in middle life. The most common findings are proteinuria, abdominal pain and palpable kidneys, followed by hematuria, hypertension, pyuria, uremia and calculi. In 15% of patients, death is due to cerebral aneurysm. Family counseling and the detection of "at risk" family members are important elements of management. Statistically, half of the offspring of one affected parent will have the disease.

Adult