Biomedical subjects
P Daggett
Publications and source records attributed to P Daggett.
Severe hypernatraemia in adults.
In a prospective study of abnormalities of plasma sodium concentration carried out over one year 20 patients were identified who had a concentration exceeding 154 mmol(mEq)/1. Of these, eight patients had diabetes mellitus, eight had primary intracranial disorder, and four had become dehydrated. Five of the eight diabetics presented with hyperosmolar, non-ketotic precoma, and in all eight hypernatraemia developed despite treatment with hypotonic (0.45%) saline. There was a good correlation (r = -0.93) between the rates of change of plasma sodium and blood glucose concentrations, and thus a rise in plasma sodium concentration appeared to be a consequence of the treatment. In the early phase of treatment urinary sodium loss was extremely low despite a brisk diuresis, the infused sodium then predisposing the patients to hypernatraemia. All of the eight patients with intracranial disorders showed evidence of abnormal production of the antidiuretic hormone, six having frank diabetes insipidus. Severe hypernatraemia in this group was associated with a high mortality, fluid balance being difficult to maintain. Two of the four patients who had become dehydrated had had a recent gastrointestinal haemorrhage. In these patients infusion of 0.9% saline contributed to the hypernatraemia since urinary sodium loss was low. Severe hypernatraemia in adults is uncommon, but in established cases plasma and urinary biochemical indices should be measured frequently. Monitoring of the central venous pressure is usually necessary, and patients are best managed in an intensive care unit.
Endocrine emergencies.
Endocrine and metabolic emergencies, although generally uncommon, produce characteristic clinical pictures which should allow rapid diagnosis. The results of confirmatory investigations are often no available in the acute situation, but it is important that the relevant samples should be taken before starting therapy. These are summarized with a synopsis of the recommended treatments for the various conditions in Table 1.
Intraoperative management of phaeochromocytoma with sodium nitroprusside.
Sodium nitroprusside (SNP) is a powerful, peripherally acting hypotensive agent with a rapid onset but short duration of action. It is highly effective for hypertensive episodes in patients with a phaeochromocytoma and may be used safely with adrenoceptor-blocking agents. Two cases are described that illustrate its effectiveness in this condition, even in the presence of exceptionally high circulating concentrations of catecholamines. A simple and reliable regimen for preparing these patients for surgery may be based on oral adrenoceptor-blocking medication (phenoxybenzamine and propranolol) to provide "background" hypotensive and antiarrhythmic cover. SNP by infusion is then used as the principal intraoperative hypotensive agent, dysrhytmias being controlled with additional intravenous propranolol if required.
Endocrine aspects of bromocriptine therapy in Parkinsonism.
Plasma growth hormone (GH) concentrations in Parkinsonian patients following 3 months optimum therapy with bromocriptine showed no significant change from pretreatment values, whilst plasma prolactin concentrations were uniformly suppressed. Pretreatment GH and prolactin levels were unrelated to clinical disability, and no correlation between hormonal changes and therapeutic response was found. These results suggest the presence of different dopaminergic receptor mechanisms for GH and prolactin release as well as between the extrapyramidal and neuroendocrine systems.
Integrated concentrations of catecholamines in phaeochromocytoma.
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Steroid responsiveness in phaeochromocytoma.
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Improvements in skin reactions to insulin, produced by a highly purified preparation.
A group of 14 patients with skin reactions to insulin have been treated with highly purified insulin over a period of 5--14 months while continuing to inject into the abnormal areas. Fat atrophy improved in all cases, coincident with a reduction in insulin requirement and insulin binding capacity. The response of patients with fat hypertrophy was less predictable, but there was an improvement in 3 out of 6 cases. Measurements of insulin binding capacity of the plasma suggested that fat atrophy and hypertrophy are immunologically distinct and some explanations for this are discussed. It is concluded that highly purified insulin benefits some patients with skin reactions to insulin.
An investigation of renal function in chronic bronchitis.
An investigation has been made into various parameters of renal function in patients with chronic bronchitis and in a group of hypoxic controls. Abnormalities of glomerular filtration rate and of water handling have been demostrated in chronic bronchitic patients but not in hypoxic controls. The abnormalities are related to the arterial Pco2. A hypothesis is presented as to the role of CO2 in causing abnormalities of renal function in chronic bronchitis.
Effects of highly purified insulin on dosage requirements.
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Integrated concentrations of catecholamines in phaeochromocytoma.
The measurement of integrated concentrations of catecholamines has been made possible by a new blood-sampling system. Information about the behaviour of phaeochromocytomas obtained in three patients suffering from this condition suggests that catecholamine crises are caused by active synthesis of hormones, rather than release from a stored pool.
Intestinal obstruction complicating orphenadrine treatment.
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A system for the measurement of integrated concentrations of hormones in the blood.
The study of integrated concentrations of hormones in the blood can be used to assess accurately the activity of endocrine diseases. A system for making such measurements is described, based on a new pump and double lumen catheter. The properties of this system are discussed and previous systems from the literature are reviewed.
A large intrathoracic parathyroid adenoma.
A case is described in which an unusually large parathyroid adenoma was visible on the plain chest radiograph taken during the investigation of hypercalcaemia. This was diagnosed preoperatively and a scheme is suggested whereby such a disgnosis can now readily be made. The differential diagnosis is discussed ant the literature is reviewed.
Primary thyroid failure presenting as a pituitary tumour.
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