Biomedical subjects
Publications and source records attributed to A J Roncoroni.
Pulmonary arterial hypertension and compulmonale were found in a woman with inactive systemic lupus erythematosus (SLE). The patient died of right heart failure 5 years later. Postmortem study showed SLE reparative lesions, plexogenic arteriopathy and vasculitis in the lung vessels. Since no active SLE was found, the pulmonary vasculitis was attributed to plexogenic arteriopathy.
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Pulmonary arterial hypertension (PAH) and cor pulmonale were found in a patient with paroxysmal nocturnal hemoglobinuria (PNH). Autopsy revealed widespread thromboses in pulmonary microvasculature. Vascular thromboses attributed to hypercoagulability have been found in PNH in many organs, including the lungs. PAH has not been reported, however. This disease should then be considered a rare cause of PAH.
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We describe an 18-year-old man with a renal transplant who developed septic metacarpophalangeal arthritis due to Mycobacterium gastri. He had several episodes of crystal induced synovitis, and treatment with intraarticular steroids was complicated 3 months later by iatrogenic septic arthritis. Appropriate treatment based on in vitro drug susceptibility was successful. This seems to be the first case of articular infection and the third report of human infection caused by this atypical mycobacteria.
In ten lightly anaesthetized dogs breathing spontaneously, we studied diaphragmatic force generation (Pdi 10, 30, 100 Hz and single twitch) and ventilatory control (P 0, 1, Vt/Ti and respiratory frequency). We found CO2 retention proportional to hypothermia (Fig. 3). The TP was not changed while VMxA and VMxD decreased (Table 1). High frequency fatigue and low frequency potentiation were found (Fig. 1, 2). These changes do not explain CO2 retention which correlated with fall in central drive (P 0, 1, Vt/Ti, Fig. 3, 4) and respiratory timing (respiratory frequency, Fig. 4).
A giant pleural fibrous mesothelioma was the cause of severe nonobstructive ventilatory incapacity, myocardial restriction with congestive failure and hypoglycemic episodes in a 58-year-old man. Surgical resection resulted in complete recovery of respiratory function and disappearance of hypoglycemic episodes.
In the case reported here, a patient with severe Plasmodium falciparum infection with 20% of erythrocytes parasitized was cured by exchange transfusion in conjunction with classical drug therapy.
A 42 year old pregnant woman was admitted in acute respiratory failure. Viral pneumonia was suspected and oxygen therapy, CPAP, water restriction and diuretics were started with good response. She remained febrile and had an abnormal chest X-ray, a diagnosis of miliary tuberculosis was confirmed by transbronchial fibreoptic lung biopsy.
Blood gases and acid-base balance were measured in a group of patients in status asthmaticus. Simple or combined metabolic acidosis was found in 37.9% of the patients. In 25 of these, lactic acid (LA), pyruvic acid (PA) and LA/PA were increased. Increased glycolysis and anaerobic respiratory muscle glycolysis during extreme airways obstruction may be instrumental in these changes. Base deficit, not accounted for by organic acid increase, may be dependent on previously present hypocapnic hyperventilation. Possibly hyperlactemia provoked by hyperventilation may be exaggerated in severe asthma.
1 - Five patients with severe metabolic acidosis secondary to methanol poisoning were studied before and after receiving 6.7 to 10 mEq NaHCO3/kg body weight. 2 - Two thirds of the infused HCO3- left the extracellular space and, since its apparent volume of distribution was much larger than under normal conditions, it largely overestimated HCO3- needs. On the contrary, the volume of distribution of the buffer base excess was found to be more stable and little affected by the acid-base status. 3 - Based on these observations, a simple method for estimating HCO3- needs in severe metabolic acidosis is proposed, requiring only the initial excess buffer base space which is calculated from body weight and blood buffer base excess values obtained before and after a first dose of bicarbonate.
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A 37 year-old man was admitted in severe acute respiratory failure after a surgical procedure. He was ventilated mechanically (FIO2 - 0.60), and had a Pa,O2 of 34 mmHg. Continuous positive-pressure ventilation was started and the Pa,O2 rose to 74 mmHg. This procedure was required for 18 days. During the period of the greater derangement of gas exchange, the venous admixture on inhalation of 40% oxygen was 80% and later 43%, whereas on inhalation of 100% oxygen it was 52% and later 35%. He was weaned from the respirator on the nineteenth day. If unevennes of ventilation--perfusion due to regional hypoventilation disappear on inhalation of 40% oxygen, a decrease of shunt on inhalation of 100% oxygen suggests impairment of diffusion.