Biomedical subjects
Publications and source records attributed to P S Mehler.
Recently, there has been a resurgence of interest and ideas regarding refeeding in anorexia nervosa. Given the severe morbidity, a subpopulation that appears refractory to treatment, and the very high mortality in an otherwise healthy young population, research studies are needed to define optimal treatment regimens. The authors describe their experience with total parenteral nutrition in the treatment of anorexia nervosa.
A retrospective hospital medical record review was done using 45 diagnoses or laboratory findings that are associated with alcohol abuse. The reviewer assessed the level of documentation of alcohol consumption in relation to alcohol-related disorders before and after an intervention to heighten house staff's recognition of alcoholism. Of the patients with at least 1 alcohol-related disease, 58% were explicitly asked about their consumption of alcohol. The mean number of alcohol-related diseases was 3.8 +/- 2.3 in the group questioned compared with 1.9 +/- 1.4 in the group not asked (P < .01). After the intervention, 90% of patients with at least 1 alcohol-related disease were asked about alcohol consumption. Once again, those asked had an average of 3.9 diseases compared with 2.1 in the other group (P < .01). Only younger age, increased specificity of alcohol-related disease, and the promotion of physician awareness were important factors for influencing documentation. Introducing a program for detecting alcoholism can have a beneficial effect on physicians' identification of alcoholism in patients with alcohol-related illnesses.
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OBJECTIVE: To see whether a cholinomimetic medication would help resolve the parotid gland enlargement associated with self-induced vomiting in bulimic patients. SETTING/DESIGN: The medication was administered on an inpatient eating disorder unit to bulimic patients with refractory sialadenosis. INTERVENTION: Pilocarpine hydrochloride drops were administered orally at a dosage of 1.25 to 5.0 mg/d until the parotid gland enlargement was significantly reduced. RESULTS: There was a marked diminution in the size of the parotid gland enlargement. CONCLUSION: Pilocarpine has proved to be beneficial in the treatment of sialadenosis in bulimic patients.
Anorexia nervosa can have a devastating outcome. There is a high rate of treatment failures and recidivism among anorectic patients. Further, it is generally accepted that unless one can effectuate a significant weight gain in these patients, treatment is even more likely to fail. Total parenteral nutrition (TPN) offers an alternative mode of treatment to be used in the armamentarium to successfully treat anorexia nervosa.
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Many different tumor types have been described in patients with AIDS; carcinoid tumors, however, are a distinct exception to this phenomenon. Our case illustrates the asymptomatic presentation of a large abdominal carcinoid in an HIV-infected man, and further expands the list of neoplasms that have been found in this population.
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A distinctive case of Goodpasture's syndrome characterized by multiple recurrences occurring over 14 years was observed. Each recurrence followed cessation of prednisone and azathioprine therapy, and reinstitution of this therapy resulted in prompt remission. Initially, both glomerulonephritis and hemoptysis were prominent clinical features. In recent years, hemoptysis has been the predominant clinical problem. This and other cases suggest that Goodpasture's syndrome may comprise a wider disease spectrum than generally appreciated.
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Secretion vesicles in anterior pituitary cells and pancreatic islets appear to translocate somatostatin receptors from the cell interior to the plasma membrane. In this study we attempted to localize somatostatin receptors on either the cytoplasmic or the intraluminal surface of the secretion vesicles. 125I-somatostatin binding was determined in intact secretion vesicles and vesicles disrupted either by sonication or solubilization. The binding of 125I-somatostatin was identical in intact and disrupted vesicles, indicating cytoplasmic orientation of somatostatin receptors. Pronase treatment of intact secretion vesicles removed approximately 90% of specific somatostatin binding. Sonication of pronase treated secretion vesicles did not reveal latent somatostatin binding sites. Gold-conjugated somatostatin binds to isolated secretion vesicles confirming the presence of somatostatin binding sites on the outer surface of these vesicles. We conclude that somatostatin binding sites are located on the cytoplasmic surface of secretion vesicles isolated from anterior pituitary cells and pancreatic islets.
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To study the possible role of the secretion vesicle inligant-receptor interaction, somatostatin binding was measured in islets in the presence of various substances known to promote secretion vesicle migration and fusion with the plasma membrane and insulin release. Rat islets were incubated with glucose, 30 and 300 mg/dl, for 60 min. After inculation, somatostatin binding was measured. In islets preincubated with glucose, 300 mg/dl, somatostatin binding was increased 250% when compared with glucose, 30 mg/dl (P < 0.001). Concomitant with enhanced somatostatin binding, insulin secretion was increased. Galactose, 300 mg/dl, did not stimulate insulin release, and somatostatin binding was unchanged from control levels. The increase in somatostatin binding with glucose was accounted for by a 186% increase in receptor concentration with no change in receptor affinity. Tolbutamide increased somatostatin binding by more than twofold, accompanied by a similar increase in insulin release. Secretion vesicles isolated from the islet exhibited somatostatin binding. We conclude that, first, somatostatin binding is increased concomitantly with the migration and fusion of the secretion vesicle with the plasma membrane and/or the release of insulin; second, enhanced somatostatin binding occurs as a consequence of an increased receptor concentration; and third, augmented somatostatin binding occurring with hormone release may provide a critical constraint in the regulation of secretory events.
Diabetic nephropathy is the most common cause of end-stage renal disease in the United States. Hypertension is a major risk factor that predisposes individuals with diabetes to the development of renal disease and is very common in patients with diabetes. The benefit of blood pressure control on the rate of progression of diabetic nephropathy is being increasingly demonstrated in both type 1 and type 2 diabetic patients. Angiotensin converting enzyme inhibitors have proven renoprotective benefits in human studies, but the results of studies with calcium channel blockers are somewhat inconclusive. The other classes of antihypertensives also may have certain indications in the population of patients with diabetic nephropathy. In this paper we will critically review current strategies for the treatment of hypertension in patients with established diabetic nephropathy.