Biomedical subjects
Publications and source records attributed to M Markowitz.
Circadian rhythms of ionized calcium and phosphate concentrations have been demonstrated in human blood. A computer-derived model curve representing the 24-hour fluctuations in ionized calcium cannot be correlated consistently with curves for total calcium or phosphate. Knowledge of these circadian rhythms provides a physiological basis for further understanding the interactions between blood minerals and calcium-regulating hormones.
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Rheumatic fever is no longer a significant health problem in socioeconomically advanced countries, but it still causes 25% to 40% of all cardiovascular disease in the rest of the world, including tropical countries where it was once believed to be rare. Differences in clinical manifestations may have obscured the rheumatic fever syndrome in the past, but there is reason to believe that the incidence of the disease has increased with urbanization. In any event, carditis is severe and frequently leads to advanced heart disease. Rheumatic fever is, to a large extent, preventable. Obstacles to effective prevention programs are discussed.
Many new antibiotics and countless formulations of old ones have been introduced during the past three decades. None has supplanted BPG. It remains the only drug that can provide antibiotic blood levels for several weeks following a single intramuscular injection. This property makes BPG the ideal preparation for treponematoses and group A streptococcal infections in patients who are not allergic to penicillin and for whom single-session therapy is desirable or necessary. Sensitivity reactions from BPG are less frequent and less severe than those from aqueous or procaine penicillin G. In certain situations, such as the prevention of rheumatic fever and rheumatic heart disease, the fear of a reaction in a patient with a negative past history of penicillin allergy is no justification for withholding BPG when it is clearly the drug of choice.
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Rheumatic fever has decreased in frequency and severity, but the disease has not been eradicated in this country, especially in low socioeconomic populations. Carditis is less common, and changes in the frequency of other rheumatic manifestations such as chorea has made the clinical diagnosis more difficult. Streptococcal antibody tests are still the most useful laboratory aid, but care must be taken against overinterpretation. The search for the answer to the pathogenesis puzzle continues. Until the nature of the disease is better understood, it is unlikely that rheumatic fever will be eradicated. In the meantime, however, the incidence of the disease can be reduced further by improved medical care for deprived populations.
Two cases of bilateral Wilms' tumor are presented with discussion of angiographic features. Emphasis is placed on selective angiography in addition to inferior vena cavography for complete evaluation. Because of the incidence of bilateral disease, and the highly vascular nature of the tumor, selective angiography of the contralateral side should be considered in the initial evaluation of unilateral Wilms'tumor. Evaluation of the interface between tumor and normal parenchyma is extremely important in bilateral disease, in anticipation of partial nephrectomy.
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