[Chronic lead poisoning and development of changes in heme metabolism during treatment].
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Biomedical subjects
Publications and source records attributed to J Rico.
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The purpose of this study was to examine the effect of hypotonic saline diuresis on two patients with cystinosis, trying to localize the site of renal sodium loss. At the same time, we have performed the same hypotonic saline infusion under hydrochlorothiazide administration. Results seem to prove the proximal tubular localization of the salt-wasting syndrome in cystinotic patients. On the other hand, these results suggest that hydrochlorothiazide effect can be related to the hypovolemia due to the distal tubular action of hydrochlorothiazide that could inhibit the 'third' natriuretic factor, thus increasing the proximal tubular sodium reabsorption.
In La Paz Hospital, Madrid, recently, vectorcardiograms (VCGs) were performed on 74 patients with aortic insufficiency. These cases presenting electrocardiographic and radiologic signs of left ventricular hypertrophy, were divided into three groups. In 25 patients (Group 1) the QRS loop in the horizontal plane (HP) showed counterclockwise rotation; 43 patients (Group 2) showed clockwise rotation; and 6 patients (Group 3) showed a pattern of left bundle branch block (LBBB). In Group 2, 31 of the 43 patients (group 2-A) had a Qloop of normal orientation and generally increased voltage, and in the remaining 12 patients (group 2-B) the Q loop was absent. All of the patients in Group 2 had severe aortic insufficiency. Thus, that group's valuation of the left ventricular hypertrophy using maximum QRS vector voltage in the HP, was higher than in Group 1 mean 3.75mV in Group 2 versus mean 2.71mV in Group 1 (p less than 0.01). Postoperative VCGs were performed in 12 patients of group 2-A, showing in all of them a clockwise to counterclockwise rotation change of the QRS loop in the HP. On the other hand, this fact was observed in only two of the eight patients in group 2-B. The clockwise rotation of the QRS loop in the HP is an important datum in our report, particularly in the diagnosis of severe aortic insufficiency. Conversely, a clockwise to counterclockwise rotation change would be a positive sign of good post operative evolution. Finally, two reasons are given to explain this anomalous rotation in the horizontal plane: dilatation and fibrosis.
Natural history of pyelonephritis is reviewed through the analysis of 971 cases of urinary infaction diagnosed and treated during the last eight years.
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Previous studies of the relationship between the endogenous opioid system and alcohol consumption have reported contradictory results. To shed light on this connection, we compared plasma concentrations of beta-endorphin, adrenocorticotropic hormone, and cortisol in 70 alcoholic persons after different periods of abstinence and a group of 80 control subjects. Plasma beta-endorphin was decreased in alcoholics (18.61 +/- 1.38 vs. 39.31 +/- 3.44 pg/ml), even after more than 10 years' abstinence. This effect may mediated by the tetrahydroisoquinoline system, and may thus result from chronic alcohol consumption. On the other hand, lowered circulating concentrations of beta-endorphin may be a cause, rather than an effect, of alcoholism. Plasma levels of adrenocorticotropic hormone and cortisol did not differ in alcoholics and controls (19.29 +/- 1.66 vs. 13.27 +/- 1.85 pg/ml for ACTH, 20.37 +/- 0.78 vs. 17.22 +/- 0.64 ng/ml for cortisol), and thus appear to have no relation with chronic alcohol consumption.
Recent findings suggest that a genetic deficit in opioid may be a biological marker of alcoholism. In other words, decreased plasma concentrations of opioids may be a predisposing factor, rather than a consequence, of alcohol consumption. We attempted to classify 88 randomly chosen individuals as alcoholics or nonalcoholics on the basis of plasma concentration of beta-endorphins. This criterion had a sensitivity of 73.30% and a specificity of 79.45%. Its positive predictive value was 42.30%, and its negative predictive value was 93.55%.
We investigated the possible relations between the endogenous opioid system and acute alcoholic intoxication in 21 subjects, of whom 13 were drinkers who came to the emergency service with evident symptoms of drunkenness, and 8 were nondrinkers who consumed 1 g alcohol per kg body weight over a short period. Different patterns of changes were found in the two groups for plasma concentrations of beta-endorphin and adrenocorticotropic hormone. In drinkers, plasma levels of both substances increased, whereas in nondrinkers both concentrations decreased, the declines being especially notable 15, 30, and 45 min after ingestion. We found no differences between the two groups in plasma cortisol concentrations. The different levels of these substances may reflect differences in drinking behavior between the two groups.
INTRODUCTION: The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied. OBJECTIVES: To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure. PATIENTS AND METHODS: We studied the patients with non traumatic rhabdomyolysis (creatinkinase > 1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others. RESULTS: We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%. CONCLUSION: CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.
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The results of percutaneous balloon angioplasty in 9 cases of adult aortic coarctation are described. One case was associated with bicuspid aortic valve and another with organic aortic stenosis. Two of them were female, and the rest were male. The mean age range between 15-26 years (19 +/- 4.2). Pressure gradients fell from 59 +/- 13 mmHg to 15 +/- 11 mmHg postdilatation (p less than 0.0001), and the internal lumen diameters increase from 5 +/- 3 mm up to 13 +/- 2 mm (p less than 0.0001). In one case an intimal dissection appears as complication. At consequence of these results, the percutaneous balloon angioplasty seems to be a good therapeutic procedure in the adult aortic coarctation.
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