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Evidence that the severity of depletion of inorganic phosphate determines the severity of the disturbance of adenine nucleotide metabolism in the liver and renal cortex of the fructose-loaded rat.

To test the hypothesis that in both the liver and renal cortex of the fructose-loaded rat, severity of depletion of inorganic phosphate (P(i)), and not the magnitude of accumulation of fructose-1-phosphate (F-1-P), determines the severity of the dose-dependent reduction of ATP, we intraperitoneally injected fed rats with fructose, 20 and 40 mumol/g, alone, and at the higher load, in combination with (a) sodium phosphate, 20 mumol/g, administered shortly beforehand or subsequently or, (b) adenosine, 2 mumol/g, administered beforehand. The following observations were made: (a) With fructose loading alone, at the higher load, both P(i) and total adenine nucleotides (TAN) were reduced by one third in the renal cortex and (as previously observed) by two thirds in the liver; and at either load, the reduction of ATP (and TAN) and the accumulation of F-1-P were less severe in the renal cortex than in the liver. (b) Prior phosphate loading largely prevented the reductions of ATP and TAN in the renal cortex and significantly attenuated them in the liver, yet doubled the renal cortical accumulation of F-1-P. (c) Adenosine loading substantially attenuated the reductions of ATP, TAN, and P(i) only in the renal cortex. (d) ATP varied directly with P(i) (P < 0.001, r = 0.98) in the domain of control and reduced values of P(i) taken from both liver and renal cortex. (e) As judged from tissue and plasma concentrations of fructose and glucose, and tissue concentrations of fructose-6-phosphate and glucose-6-phosphate, the rate at which the renal cortex and liver converted fructose to glucose was much lower at the higher fructose load. (f) Prior phosphate loading prevented this decrease in rate in the renal cortex and attenuated it in the liver; adenosine loading attenuated it only in the renal cortex. We conclude that in both the renal cortex of the fructose-loaded rat: (a) Depletion of P(i) is critical to the causation of the reductions in both ATP and TAN and, at the higher fructose load, of a decrease in the rate at which ATP is regenerated. (b) The severity of depletion of P(i) determines the severity of these disturbances. (c) By differentially mitigating the depletion of P(i), prior phosphate loading largely prevents these disturbances in the renal cortex, and attenuates them in the liver; and adenosine loading attenuates them only in the renal cortex. The findings provide some basis for the observation that in patients with hereditary fructose intolerance experimentally exposed to fructose, prior loading with sodium phosphate substantially attenuates the renal but not hepatic dysfunction.

Adenine Nucleotides

Uterine synechiae: variations in severity and some conditions which may be conducive to severe adhesions.

Considerable variability in the severity of Asherman's syndrome was observed, and a high incidence of other gynecological disorders was discovered, mainly by endoscopy, in patients with intrauterine synechiae. Fifty-seven cases were reviewed in an attempt (1) to discover factors contributing to severity, (2) to examine possible relationships between other pelvic pathologies and the development of synechiae, and, subsequently, (3) to revise methods of treatment. Thirty-nine women underwent some form of pelvic visualization; twenty-seven (69%) were found to have other gynecological disorders. Forty-six patients had had a recent D & C. Signs of pituitary hypogonadotropism appeared in five of the 17 women with severe adhesions, suggesting that severity of adhesions developed after D & C may be increased in the presence of a concurrently existing hypoestrogenic state.

Abortion, Habitual

Variations in adrenocortical responsiveness during severe bacterial infections. Unrecognized adrenocortical insufficiency in severe bacterial infections.

Plasma cortisol levels and their response to .25 mg synthetic A.C.T.H. (Cortrosyn) were studied in 26 septic patients. Four (15.4%) of these patients appeared to have greatly increased adrenocortical activity with plasma cortisol levels averaging 65.4 +/- 14.8 microgram/dl (normal = 8-18 microgram/dl. All four of these patients were agonal and died within five days. Seventeen (65.4%) of these 26 patients appeared to have an appropriate adrenocortical response to severe infection in that their plasma cortisol levels increased (averaging 19.2 +/- 6.0 microngram/dl) following synthetic A.C.T.H. The remaining five patients, who constituted 19.2% of the 26 patients studied, appeared to have some impairment of adrenocortical function. In spite of severe bacterial infections and no history to support Addison's disease, their plasma cortisol levels (averaging 13.8 +/- 3.3 microgram/dl) were not increased above normal and their response to Cortrosyn was much less than would be expected; the increase in plasma cortisol levels in these patients following the synthetic A.C.T.H. averaged 1.1 +/- 3.6 microgram/dl. It is reemphasized that patients with severe sepsis who are not responding adequately to standard therapy should be suspected of having adrenocortical insufficiency and treated accordingly.

Adrenal Cortex

[A case of extremely severe chest injury with fracture of several ribs (author's transl)].

A 72-years old man was severely injured when a lorry rolled back and pinned him down, causing contusion of the chest, fractures of ribs 3-10 on the right and haemothorax. Treatment of the chest injuries was by drainage and by positive end-expiratory pressure ventilation because of the development of severe pneumonia with wet lung. Persistent renal insufficiency, a gastro-intestinal haemorrhage and diabetes also required treatment. The patient developed septic endomyocarditis as a late complication, possibly attributable to the central venous catheter. All pulmonary and extrapulmonary injuries and complications could be set right during the patient's 4-months' stay in the intensive care unit.

Aged

Severe degenerative joint disease. Mild and moderately severe hemophilia A.

Severe degenerative joint disease developed in three adults with mild to moderately severe hemophilia A, as judged by the clinical course and by levels of factor VIII coagulant. Bilateral total hip arthroplasty was required in one patient, unilateral hip arthroplasty in the second, and a recommendation for bilateral knee replacement in the third. The pathogenesis of the arthropathy may be multifactorial and the result of repeated joint hemorrhage that remains unrecognized and inadequately treated. These observations suggest the need for more careful monitoring of patients who have relatively mild hemophilia.

Adult

[Surgical correction of the severed larynx, associated with severe swallowing disturbances (author's transl)].

After complete separation of the larynx from its cranial suspensions, the larynx is displaced caudally and the base of the tongue cranially. This produces an enlargement of the distance between the larynx and the base of the tongue, which can be demonstrated radiographically. Severe dysphagia is the result which may produce complete inability to swallow. Surgical management of this condition consists of mobilization of the laryngotracheal complex and its attachment to the hyoid bone by sutures. Successful results in two cases are described.

Deglutition Disorders