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Biomedical subjects

H N Hoffman

Publications and source records attributed to H N Hoffman.

16 recordsLinked to original sources

Zinc-induced copper deficiency.

Copper deficiency was found in an adult patient who had received excessive daily oral zinc for 10 mo. The deficiency was characterized by hypochromic-microcytic anemia, leukopenia, and neutropenia. Although initially thought to be caused by iron deficiency, the anemia did not respond to oral or intravenous iron. Cessation of zinc tablets and ingestion of an oral copper preparation daily for 2 mo failed to correct the anemia or leukopenia. It was not until shortly after intravenous administration of a cupric chloride solution during a 5-day period, at a total dose of 10 mg, that serum copper and ceruloplasmin levels increased and the anemia, leukopenia, and neutropenia resolved. These data suggest that the elimination of excess zinc is slow and that, until such elimination occurs, the intestinal absorption of copper is blocked.

Adult

Nonoperative retrieval of an impacted long intestinal tube.

A patient with recurrent intestinal obstruction and jejunocutaneous fistula was referred for treatment of the latter condition. Management with total parenteral nutrition was complicatied by bacteremia. Subsequently, a double-lumen tube was passed via an existing gastrostomy for purposes of aspirating above the level of the fistula and infusing appropriate nutrients and fluids distally. A period of marked clinical improvement was followed by increased fistula output and evidence of intestinal obstruction secondary to gaseous distention of a sealed latex terminal balloon which was retrieved only after percutaneous puncture. The unusual complication of prolonged intestinal intubation is discussed with special reference to this nonsurgical method of managing the impacted balloon and tube. Factors affecting balloon distention are discussed and the necessity of venting intestinal balloons reemphasized.

Female

Untreated gastric pseudolymphoma.

Gastric pseudolymphoma is an inflammatory process that may simulate malignancy. In most reported cases, the initial diagnosis has been malignant lymphoma and treatment has been applied accordingly. We report a case of gastric pseudolymphoma wherein the diagnosis was made from multiple surgical biopsies, and follow-up now exceeds 11 years. To our knowledge no other case of untreated gastric pseudolymphoma has been reported. This case may more closely represent the biologic nature of this presumably benign condition.

Diagnosis, Differential

Total parenteral nutrition.

Total parenteral nutrition (TPN) is a relatively new innovation in patient care which allows us to replace and maintain essential nutrients in patients in whom oral or tube feedings are contraindicated or inadequate. Insertion of a catheter into a large central vein permits one to concentrate hypertonic dextrose calories in normal daily fluid requirements. In addition, TPN solutions contain synthetic amino acids or protein hydrolysates, macroelements, electrolytes, and vitamins. Indications for TPN include intestinal fistulas, severe short bowel syndrome, unresolving pancreatitis, advanced inflammatory bowel disease, delayed postoperative gastrointestinal function, developmental anomalies of the intestinal tract, protracted diarrhea of infancy, and hypermetabolic states. Complications encountered in patients receiving TPN are catheter-related mechanical problems, infections, and metabolic abnormalities. In select patients, who otherwise would require repeated hospitalizations for malnutrition, encouraging results have been achieved by the use of TPN in the home.

Amino Acids

Hemangiosarcoma of the liver. Spectrum of morphologic changes and clinical findings.

Analysis of four cases of hemangiosarcoma of the liver and review of the literature indicate that these tumors are either predominantly cystic and fairly well differentiated or are more solid and poorly differentiated. Well-differentiated hemangiosarcomas may resemble peliosis hepatis or other benign conditions. The tumor was associated disseminated intravascular coagulation and fibrinolysis syndrome in one of our cases. One of our patients had received thorium dioxide (Thorotrast) but none seemed to have been exposed to arsenicals or to vinyl chloride.

Adult