Case of the month No. 50. Double channel pylorus.
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Biomedical subjects
Publications and source records attributed to J M Levy.
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Patients with chronic hypoxia develop a physiologically appropriate "secondary" polycythemia that improves oxygen carrying capacity. Supplemental iron is often required to maintain this. In severe cases when hematocrit levels approach 70%, iron is withheld in order to avoid dangerously high hematocrit levels and the risks of vascular sludging due to "hyperviscosity." Some patients even require reduction of viscosity by exchange of their polycythemic blood for plasma when symptoms develop. Iron deficiency with microcytic polycythemia can then develop. Management of such patients is unclear. Continued blood withdrawal will worsen the iron deficiency; iron supplementation will increase the hematocrit level and the risks of hyperviscosity. The combination of frequent phlebotomy with oral iron therapy should improve iron stores while safely maintaining a stable hematocrit level in patients with microcytic polycythemia. This combination should also have multiple beneficial effects on tissue oxygen delivery and utilization. This approach has been discussed and used for a patient with microcytic polycythemia due to Eisenmenger syndrome. While on therapy the patient's clinical symptoms decreased, and his serum iron level, hematologic indices, and treadmill tolerance tests all improved.
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Two sisters affected with the same disorder are described. They had webbing of the neck, the antecubital fossae and the popliteal regions, together with flexion deformities of the limb joints and anomalies of the vertebrae. Eight other cases are known. The condition is inherited in an autosomal recessive mode.
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Identifying the demographic factors that affect the likelihood of being allowed disability insurance benefits under the social security program is important in assessing the operation of that program and has been the focus of continuing research. Previous studies in this area, which have been limited to cross-tabular analyses of aggregated data and the examination of a few variables at a time, have uncovered apparently sizable differences in the probability of allowance by age, sex, race, and other demographic characteristics. This article uses a much more rigorous statistical technique--a logit maximum likelihood procedure--to examine the same question. That technique permits exploration of the relationship between a particular characteristic and the probability of allowance while controlling for the effect of other characteristics considered in the analysis. The findings show that cardiovascular primary diagnoses had a higher probability of allowance than did almost all other primary diagnoses. Mobility restrictions, older age at the onset of disability, and residence in States with temporary disability programs also were associated with a higher probability of allowance. Applicants who were black or from the South were found to have a lower probability of allowance. In general, those results applied to both men and women.
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A father and his daughter has the same features: short stature, the distal phalanges, the wrists, the elbows, the feet and the knees were flexed. All other joints had abnormal range of motion. Kypho-scoliosis was present in the father only. Father's family was normal. Upon X-rays examination no abnormalities could be seen. This syndrome is inherited as autosomal dominant.
Transcatheter splenic artery occlusion can be performed rapidly and safely prior to splenectomy. This procedure reduces splenic bulk and decreases intraoperative bleeding. Patients not operated on after transcatheter splenic artery occlusion have had high mortality, and therefore the procedure should probably not be considered unless splenectomy is contemplated. An illustrative case is reported.
A new catheter system is described for permanent percutaneous nephrostomy. The system allows the rapid, single stage placement of a large diameter drainage catheter. The technique avoids several problems associated with previous methods of percutaneous nephrostomy.
An unusual case of a benign adrenal cyst and a parathyroid adenoma occurring in a 59-year-old man with hypercalcemia is reported. Excretory urography, ultrasound, renal aortography, computerized axial tomography and selective thyroid venous sampling were used to establish a diagnosis. Left adrenalectomy was done because of a suspicion of malignancy, which was followed by excision of a retrolaryngeal parathyroid adenoma.
A child is described with features of Robert's syndrome. The mother took clonidine during pregnancy. The question of a relationship between the child's abnormalities and clonidine is raised.
The authors describe a single catheter system which allows rapid, routine abdominal angiography. Selective and subselective studies are easily performed, and the catheter can be used without modification for Pitressin infusion and embolization.
The utility of CT scanners may be further increased by using the computer contained in such scanners for non-CT purposes-the creation of a teaching file in this case. No knowledge of computer programming is assumed on the part of the operator. Directions are given in accessing the computer as well as in programming.
99mTechnetium macroaggregated albumin has successfully been used to define severe postoperative pulmonary vasoconstriction in a four-month-old boy with D-transposition of the great vessels who had undergone a Blalock-Hanlon surgical atrial septectomy. Radionuclide imaging documented clinically suspected pulmonary vasoconstriction and led to the successful use of tolazoline (Priscoline) to reverse the vasoconstriction with improved pulmonary blood flow patterns.
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