Biomedical subjects
M L MacDougall
Publications and source records attributed to M L MacDougall.
Effective use of streptokinase for peritoneal catheter failure.
The fibrinolytic enzyme streptokinase (streptase) was infused into the peritoneal catheter in 19 episodes of catheter failure in 16 patients. Intraabdominal bleeding prior to infusion was seen in seven of these episodes. Fibrin strands and clots were present in four additional successful cases. Streptokinase successfully relieved the obstruction in 13 episodes in 11 patients. The procedure failed in two cases of omental ingrowth and in another with catheter malposition. Streptokinase infusion also failed in two patients with Pseudomonas aeruginosa and one patient with Staphylococcus epidermidis peritonitis. Intraperitoneal streptokinase infusion is simple and free of side effects. Its use should be considered in peritoneal catheter failure, particularly in cases where bleeding or fibrin accumulation may play a role.
Legionnaires' disease associated with rash and renal failure.
Legionnaires' disease is recognized as a multisystemic illness. Afflicted patients may have pulmonary, gastrointestinal tract, and central nervous system complications. However, dermal involvement is not well documented and renal insufficiency is uncommon and usually of mild severity. We report two consecutive cases of proven Legionella infection that were unusual in that a macular rash and profound renal failure requiring hemodialysis were noted. Skin biopsy specimens of the rash and autopsy findings suggest that these atypical features may have been mediated by the Legionella infection. Although it is not entirely clear from these two cases, we suggest that the skin and renal involvement may have been mediated by either a "toxin" elaborated by the organism, an immunologic response of the host to the organism, or some other unidentified mechanism.
Genital herpes simplex in the female 1968 to 1973.
One hundred and twenty-nine female patients with genital herpes simplex infection are considered. Diagnosis and management are discussed, and the importance of excluding other sexually transmitted diseases is emphasised.
Separation and quantitative analysis of furosemide and 4-chloro-5-sulfamoylanthranilic adid (CSA) by high pressure liquid chromatography.
After extraction by ether from acidified plasma or urine and concentration into basic phosphate buffer, furosemide and 4-chloro-5-sulfamoylanthranilic acid (CSA) were separated on a high pressure liquid ion-exchange system and measured fluorometrically. Sensitivity is 0.2 mug/ml of ether compound in plasma and 0.1 mug/ml in urine with an 8% coefficient of variation. Interference by porphyrins in urine was eliminated by subtracting a second fluorometric measurement at a different wave-length from that used for furosemide. No quenching at this wave-length is seen with concentrations of furosemide up to 50 mug/ml. Standard curves of furosemide and CSA are linear from 0.2 mug/ml to 50 mug/ml.
The effect of water loading on albumin excretion in type I diabetes mellitus.
An increased albumin excretion rate is recognized as an important early marker for incipient kidney disease in patients with diabetes mellitus. Many different techniques have been used, and a single void technique has been proposed as the simplest method for screening for increased albumin excretion. We evaluated a previous observation that single void samples during water diuresis yield increased albumin excretion rates. Timed day, night, and 24 hour albumin excretion rates (AER) were obtained in 35 patients with Type I diabetes mellitus. This was followed by examination of 8 consecutive half-hour specimens obtained during continued water diuresis. We compared 26 patients with low AER (less than 20 micrograms/min/24 hr sample) to 9 patients with high AER (greater than 20 and less than 200 micrograms/min/24 hr). Sampling began 60 min after the initiation of the waterload. At first, the AER in the low AER group was significantly higher than it was at night, but it decreased over 60 to 90 min of sampling to levels comparable with daytime AER. This was paralleled by a similar pattern in urine flow rate, sodium, and solute excretion. The AER in the high AER group did not increase with the water load and remained high throughout the study periods. The pattern of urine flow rate, sodium, and solute excretion was similar to that of the group with low AER. The study demonstrates that early sampling after water-induced diuresis leads to overestimation of AER in patients with low AER as compared to patients with high AER.(ABSTRACT TRUNCATED AT 250 WORDS)