Biomedical subjects
Publications and source records attributed to N A Ridgeway.
Two inmates of our county jail suffered painful, life-threatening illness, and our taxpayers had considerable financial loss, as the result of self-inflicted rhabdomyolysis. We found reports of three similar cases from other states. Since prisoners are treated in a variety of medical facilities, this illness may be more common than reports indicate. It can be prevented by education and supervision of prisoners.
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BACKGROUND: This study was done to determine the efficacy and ease of administration of education/behavior modification classes, provided by a nurse and a dietitian in a primary care clinic for improving control of type 2 diabetes mellitus. METHODS: Patients were divided randomly into two groups. Eighteen patients completed 6 months of structured, office-based classes, and 20 similar patients served as control subjects. All were patients of the same group practice and had their usual office visits. Glycemic control, lipid levels, body weight, knowledge about diabetes, medication requirements, and symptoms were monitored during the 6 months, with follow-up at 12 months. RESULTS: At the end of 6 months, the intervention group had significant reductions in mean fasting blood glucose, glycosylated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) values. Their mean body weight was significantly reduced at 12 months, and their knowledge of diabetes was improved. Control patients had significant improvement only in glycosylated hemoglobin and body weight at 6 months. Minimal physician time was required. CONCLUSION: The education/behavior modification program was clinically worthwhile, and it was easy to administer.
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A 41-year-old man presenting with unstable angina was found to have diffuse coronary ectasia with a partially occluding thrombus in the proximal left anterior descending artery. Anticoagulation with heparin followed by warfarin resulted in relief of angina and resolution of thrombosis at follow-up angiography 3.5 months later. The patient remains well after three years. Nonatherosclerotic ectatic coronary arteries are prone to thrombosis possibly because of spasm, intimal damage, and blood current eddies. We believe that chronic warfarin therapy may be indicated in many patients with coronary ectasia.
Body temperatures exceeding 41.1 degrees C (106 degrees F) occur with relatively few conditions. In the unusual case reported here, the patient's temperature reached 42.3 degrees C (108.2 degrees F) during intravenous administration of bretylium for refractory ventricular fibrillation. The temperature started to drop as soon as the infusion was stopped and was close to normal within four hours. This appears to be the first report of extreme pyrexia resulting from use of this agent.
Thiazide diuretics frequently cause a decrease in serum potassium levels. In this study, 34 percent of patients taking hydrochlorothiazide had serum potassium levels below 3.5 meq/liter. The response of the serum potassium level was studied after treatment in 56 patients was switched from 50 mg of hydrochlorothiazide daily to either two capsules of hydrochlorothiazide/triampterene (Dyazide), or one tablet of hydrochlorothiazide/amiloride (Moduretic) daily, over nine to 15 months. The 24 patients whose treatment was changed to Dyazide had a rise in serum potassium levels from a mean of 3.56 meq/liter to 4.17 meq/liter in two to three weeks. The 32 patients whose treatment was changed to Moduretic had a rise in serum potassium levels from a mean of 3.76 meq/liter to 4.14 meq/liter in two to three weeks. The resultant rise in potassium levels was stable throughout the follow-up period in both groups. Patient acceptance of this change was excellent.
Ventricular tachycardia may be caused by temporary cardiac pacing, especially when there is acute inferior myocardial infarction with significant right ventricular extension. Correction of hypoxemia, electrolyte imbalance, and drug excess, and the use of a unipolar lead with proper sensing and pacing settings may prevent this complication.
We evaluated the polyethylene glycol precipitation test (Gastroenterology 83: 378-382, 1982), looking for macroamylase in the serum of 66 patients whose values for serum amylase were above normal. Three patients (4.5%) were identified by this method as having macroamylase , and this was confirmed by gel-filtration chromatography and electrophoresis. We find this to be the test of choice as a screening procedure for macroamylasemia because of its speed, simplicity, and apparent reliability. Diagnosis of macroamylasemia is important in preventing needless treatment and investigation for pancreatitis.
A group B Streptococcus caused epiglottitis with abscess formation in an adult with diabetes mellitus. Group B streptococci are being more commonly isolated from adults, and epiglottitis is another infection in which this organism has been implicated.