Letter: Consultants reporting to patients.
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Ethics, Medical↗
Biomedical subjects
A Meisel
Publications and source records attributed to A Meisel.
Influence of volume expansion, serum sodium, and fractional excretion of sodium on urate excretion.
The relative contributions of volume expansion and increased fractional excretion of sodium to the uricosuria of saline infusion were assessed in 19 subjects by volume expansion with rapid infusion of 21 of hypertonic saline (3%), isotonic saline (0.9%), or hypotonic saline (0.45%). Urate excretion increased 385 mug/min (P less than 0.01) with hypertonic, 145 mug/min (P less than 0.05) with isotonic saline, and 294 mug/min (P less than 0.001) with hyptonic saline. When 150 meq of sodium chloride was administered as appropriate volumes of hypertonic, isotonic of hypotonic saline, the magnitude or uricosuria was correlated with volume load (r = 0.66, P less than 0.002). fractional excretion of sodium correlated with infusion volumes for all studies taken together (r = 0.35, P greater than 0.1). The relationship between fractional excretion of sodium and fractional excretion of urate was entirely attributed to their correlation with infusion volume. Both post-pyrazinamide urate excretion and pyrazinamide suppressible urate excretion increased with volume expansion.
Adolescent↗
Hyperuricosuria and increased tubular secretion of urate in sickle cell anemia.
Seven young adults with uric acid overproduction due to sickle cell anemia were normouricemic with a mean serum uric acid level of 4.9 mg/100 ml. Urate clearance was greater in these patients than in normal subjects or in patients with primary hyperuricemia due to uric acid overproduction. The increase in urate clearance was entirely accounted for by increased pyrazinamide suppressible urate clearance. Pyrazinamide administration abolished the uricosuric response to ribonucleic acid (RNA) feeding in these patients with sickle cell anemia, and maximal uricosuric response to the administration of probenecid was similar in the patients with sickle cell anemia and in normal subjects suggesting that reabsorption of both filtered and secreted urate was not impaired in sickle cell disease. Pyrazinamide suppressible urate clearance at maximal uricosuric response to probenecid was increased in patients with sickle cell disease suggesting increased tubular secretion of urate. This increase in urate secretion permits most young adults with urate overproduction due to sickle cell anemia to remain normouricemic and may account for the low frequency of secondary gout in this disease.
Adolescent↗
Rights of the mentally ill: the gulf between theory and reality.
Within the last few years several lawsuits have significantly increased both the procedural and the substantive rights of mental patients; among them are Lessard v. Schmidt, in which the court held that persons facing involuntary civil commitment are entiltled to dueprocess safeguards, and Wyatt v. Stickney and Donaldson v. O'Connor, concerned with the right ot adequate treatment. The author draws on the problems of implementing the landmark decree of Miranda v. Arizona, guaranteeing the rights of criminal suspects, in discussing the difficulties of translating rights promulgated in the courts into reality. He believes that enofrcement of patients' rights depends not on the law alone but also on the sensitivity and good faith of mental health workers.
Attitude of Health Personnel↗