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Biomedical subjects

J E Naschitz

Publications and source records attributed to J E Naschitz.

123 records · Page 7Linked to original sources
PubMed1983

Reversible diminished insulin requirement during acute renal failure.

Very little is known concerning insulin requirements in diabetic patients who develop acute renal failure, although decrease in daily insulin requirement in patients with chronic renal failure is recognized. A 46-year-old diabetic patient is described, whose daily insulin requirement decreased from 56 to 8 units per day during an episode of acute post-streptococcal glomerulonephritis causing acute reversible renal failure. The insulin requirement returned to its previous level after the patient recovered.

Acute Kidney Injury↗
PubMed1983

Quinidine induced sicca syndrome.

Two weeks after initiation of therapy with 1.2 gm/day quinidine sulphate, a 67 year old patient developed clinical and laboratory features of sicca syndrome. These subsided upon discontinuation of the treatment, but reappeared on a second challenge with this drug. Sicca syndrome represents a previously undescribed hypersensitivity reaction to quinidine.

Aged↗
PubMed1982

Upper gastrointestinal bleeding, aneurismatic dilatation of the thoracic aorta and filling defect on the esophagogram: a diagnostic triad suggesting aortoesophageal fistula.

A patient is described with an aneurysm of the thoracic aorta, which has ruptured into the esophagus. An esophageal X-ray contrast study has revealed a filling defect at the contact site of the esophagus and the aortic aneurysm. The filling defect was due to a clot protruding from the aorta into the esophagus. This unique case calls attention to a diagnostic triad: upper gastrointestinal bleeding, aneurysm of the thoracic aorta, and filling defect in the esophagus at its site of contact with the enlarged aorta. This triad suggested aortoesophageal fistula (AEF) in the patient and could help in the diagnosis of atypical cases of AEF, where thoracic aortography has not been performed initially.

Aged↗
PubMed1982

Electrocardiography vs. vectorcardiography in the diagnosis of left anterior hemiblock associated with inferior wall myocardial infarction: a critical analysis.

The ECG criteria of isolated left anterior hemiblock (LAHB) are well established. However, associated inferior wall myocardial infarction (IMI) can obscure the ECG characteristics of LAHB. In an attempt to evaluate various ECG signs of LAHB in the presence of IMI, three groups of patients were examined. Group I comprised 20 patients with unequivocal vectorcardiographic (VCG) signs of isolated LAHB; Group II included 30 patients with VCG-documented IMI; and the 20 patients in Group III had VCG evidence of IMI with LAHB. Four ECG criteria were evaluated and their average performances in the diagnosis of LAHB were determined. QRS axis above -30 degrees, the presence of terminal S wave in lead II and terminal R wave in lead AVR and delayed intrinsicoid deflection in lead AVL showed average performances of 86.2, 76.7, 68.7 and 60.8% respectively. The ECG criteria in the diagnosis of LAHB are highly sensitive but do not reach the high specificity claimed by other authors.

Adult↗
PubMed1981

Arterial hypoxemia following the administration of sublingual nitroglycerin in patients with ischemic heart disease and pneumonia.

Nitroglycerin (Ng) is a potent and short-acting coronary and systemic vasodilator, widely used in anginal pain treatment. When given to patients with pneumonia or chronic lung disease, Ng was found to cause a further decrease in arterial oxygen tension (PaO2) by increased perfusion of poorly ventilated territories in the lungs. In order to investigate the potential hazard in Ng decreasing the PaO2 in ischemic heart disease patients, who develop acute pneumonia, we administered 0.4 mg Ng sublingually to 11 patients who suffered concomitantly from ischemic heart disease and acute pneumonia. Arterial blood gases were monitored before, 2, 5 and 10 min following Ng administration, as well as a standard 12-lead electrocardiogram that was monitored as the same time. 8 out of the 11 patients showed a decrease in PaO2 which was mild to moderate, during the study period of time, none of them showed an increase, and there was tendency for the lower (less than 60 mm Hg) initial PaO2 to show a lesser decrease in the PaO2 in comparison to the higher (greater than 60 mm Hg) initial PaO2. There was no statistical significant correlation between the decrease in PaO2 and patients' age, sex, coexisting chronic obstructive lung disease and severity of systemic heart failure. Our conclusion is that the hazard in lowering PaO2 by Ng in ischemic heart disease patients who develop acute pneumonia is minimal, but the drug should be used with caution.

Adult↗
PubMedDate not supplied

Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha.

OBJECTIVE: To characterize hepatitis C virus (HCV)-related arthropathy and to evaluate the response to treatment with interferon-alpha (INF-alpha). METHODS: We studied 28 HCV-infected patients with arthritis. All patients underwent complete clinical, laboratory and radiological evaluation, including assessment and follow-up by a rheumatologist. Twenty-five patients were treated with INF-alpha for a median period of 12 months. RESULTS: All patients were HCV-RNA positive (genotype 1b in 65%). The mean duration of arthropathy-related symptoms prior to the diagnosis of HCV infection was 12 months. 19 patients (68%) had symmetric polyarthritis and 19 (68%) had morning stiffness > or = 60 min. None of the patients had erosive disease or subcutaneous nodules. 12 (43%) had detectable cryoglobulin (mean cryocrit: 3.6 +/- 3.5%), 17 (61%) had rheumatoid factor (RF) (median titer: 1:80), and only 15 (54%) had elevated ESR. 14 patients (50%) had > or = 4 ACR (American College of Rheumatology) criteria for the diagnosis of rheumatoid arthritis (RA), 9 of whom were mistakenly diagnosed and previously treated as RA patients. Only 3 patients had a satisfactory response to previous treatment with anti-inflammatory or disease modifying drugs. Complete or partial response of arthritis-related symptoms in INF-alpha treated patients was observed in 44% and 32%, respectively. Cryoglobulin became undetectable in 9 of 12 patients. However, a complete biochemical and virological end-of-treatment response was achieved in only 8 (36%) and 5 patients (20%), respectively. CONCLUSION: HCV arthropathy should be considered in the differential diagnosis of any patient with arthritis, even in the absence of liver disease. Treatment with interferon-alpha may lead to substantial clinical improvement of HCV-related arthritis even without a complete biochemical or virological response.

Adult↗
PubMedDate not supplied

Aortic involvement in rheumatic diseases.

OBJECTIVE: To review the prevalence, mechanisms, presentations and clinical significance of aortic involvement in rheumatic inflammatory diseases. METHODS: The medical literature, available through a PUBMED search was reviewed and the relevant information was summarized. In addition, selected articles related to aortic involvement in rheumatic diseases were included in this review. RESULTS: Rheumatic disorders may be categorized by their propensity to involve the aorta: conditions with a prevalence of 10% and more (Takayasu's arteritis, temporal arteritis, long-standing ankylosing spondylitis, Cogan's syndrome and relapsing polychondritis), disorders with uncommon but well documented aortic involvement and rheumatic conditions with rare case reports of such involvement. Clinical presentation of aortic disease is dependent on the part of aorta involved and may manifest by aortic pain and/or other symptoms caused by aortic dilatation, narrowing or aneurysm. The histopathology of inflammatory aortitis is characterized by lymphoplasmacytic infiltration with or without giant cells or granulomas. On the other hand, non-inflammatory aortic damage in rheumatic diseases may include Marfan-like cystic disintegration of the aortic media as well as accelerated atherosclerosis. Awareness of rheumatic conditions with a high potential for clinically significant aortic involvement may promote referral of such patients for aortic imaging and sometimes surgery before fatal complications intervene. CONCLUSION: Early diagnosis of aortic involvement can be advanced by informed consideration of such a complication in a rheumatic patient.

Aorta↗
PubMedDate not supplied

Thromboembolism. Clues for the presence of occult neoplasia.

It has been stated that it is inappropriate to conduct an extensive search for occult malignancy in patients with thromboembolism, unless there is some more specific indication. The present study defines those specific indices. By analyzing the clinical features of 11 consecutive patients with occult cancer presenting with thromboembolism (TE), criteria which differentiate TE in occult cancer from TE complicating other disorders were defined. These are the absence of an apparent cause for the TE at the time of the patient's admission, age more than 50 years, multiple sites of venous TE, associated venous and arterial TE, TE resistant to therapy with oral anticoagulants, and the presence of associated paraneoplastic syndromes. The incidence of these parameters in case reports from the literature was also analyzed. The six criteria that were prevalent in our series of patients with paraneoplastic TE, were observed to occur with similar incidence in different groups of historical cases. These criteria may be useful for stratification of patients with TE with regard to the probability of the presence of an occult cancer and the indications for further investigations.

Adult↗
PubMedDate not supplied

Incidence and diagnostic significance of paraneoplastic thromboembolism disorders. A survey from a community hospital.

The incidence of paraneoplastic thromboembolic disorders (PTD) at first presentation of cancer and its diagnostic significance as a cancer marker are unknown. Fourteen thousand two hundred and eighty-seven patients were admitted to the department of medicine during the period 1978-1987. Nine amongst those patients had thromboembolic disorders (TE) as the initial clinical disturbance. In another 2 patients TE was the first sign of recurrence in apparently cured cancer. PTD patients were elderly (median age 70 years), the clinical variants of PTD included solitary venous thrombosis in 3, migratory thrombophlebitis in 4, pulmonary TE in 1, arterial occlusion in 2, and associated arterial and venous occlusion in 1 case. PTD antedated the diagnosis of neoplasia by 3-180 days (median 21 days). Analysis of the impact of TE on the initiation of search for occult malignancy (PTD-cancer relevance) and on patient survival (PTD-cancer prognosis) demonstrated high PTD-cancer relevance scores in 9 among 11 cases, but favorable PTD-cancer prognosis scores in only 3 cases. This is consistent with the significance of TE for the earlier diagnosis of a, usually, disseminated cancer. The present study demonstrated a higher than usually stated association of TE with occult cancer (4.6%). It differs from recent studies by including not only venous thrombosis, but a variety of venous and arterial TE disorders as well. By studying the population from a community hospital, we believe that these data would reflect the situation in the general population at large. In this way our study differs from those of tertiary care hospitals in that our patients were not preselected.

Adult↗
PubMedDate not supplied

Treatment of severe, resistant familial combined hyperlipidemia with a bezafibrate-lovastatin combination.

Familial combined hyperlipidemia (FCHL) is a common lipid disorder characterized by high levels of cholesterol, triglycerides, or both. The basic metabolic abnormality is overproduction of apolipoprotein B-100. High atherogenicity has been attributed to all forms of FCHL. We evaluated combined bezafibrate-lovastatin therapy in 10 patients (9 men and 1 woman) with FCHL and markedly high cholesterol and triglyceride levels who were at high risk of coronary artery disease and who had not responded to diet and bezafibrate treatment alone. Eight patients had coronary artery disease, 6 had hypertension, and 3 had noninsulin-dependent diabetes mellitus. Lovastatin 20 mg/day was added to the bezafibrate 600 mg/day regimen for 6 weeks; the lovastatin dosage was then doubled to 40 mg/day for an additional 6 weeks. The addition of 20 mg of lovastatin resulted in decreases of 15%, 20%, and 13% in total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels, respectively. Increasing the dose of lovastatin to 40 mg resulted in further moderate decreases of 4%, 3%, and 8% in total cholesterol, LDL cholesterol, and triglycerides, respectively, compared with the 20 mg/day dosage. Although previous reports have emphasized the potential side effects of combination treatment with lovastatin and fibric acid derivatives, our patients tolerated the regimen well, with no significant subjective complaints or laboratory abnormalities. The bezafibrate-lovastatin combination is a possible therapeutic option for severe, resistant FCHL, but close medical supervision is needed because of potential side effects.

Adult↗