Erythrocytosis associated with the nephrotic syndrome.

A 23-year-old-man had true erythrocytosis and the nephrotic syndrome. A renal biopsy specimen showed focal sclerosing glomerulonephritis and nephrosclerosis. Both serum and urinary erythropoietin levels were increased, and plasma renin activity was in the high normal range. The association of erythrocytosis and glomerulonephritis with the nephrotic syndrome is reviewed, and the uniqueness of this association is proposed. Finally, a dissociation between these hormones was demonstrated using water immersion to the peck as a suppressive maneuver.

Renal acidification in hypothyroid man.

The role of thyroid hormone in renal hydrogen ion secretion remains largely unknown, and there is only limited information on renal acidification in hypothyroid patients. In the present study two of five adult male patients with untreated primary hypothyroidism and without clinical evidence of systemic autoimmune disease were unable to lower their urine pH appropriately after short duration acid-loading. Since, prior to acid-loading, their arterial blood gas values were within the normal range and urinary bicarbonate excretion was trival, the findings are consistent with the incomplete syndrome of distal renal tubular acidosis. Although the mechanism of this abnormality remains unknown, thyroxine deficiency per se may in part be responsible.

Human pesticide poisonings by a fat-soluble organophosphate insecticide.

In five cases of dichlofenthion poisoning due to suicidal ingestions, unusual toxicologic features were encountered. Initial symptoms were mild or delayed and severe cholinergic crises did not appear until 40 to 48 hours after ingestion. Two patients died, and in the three survivors, cholinesterase symptoms persisted for five to 48 days. An almost total inhibiton of both cholinesterase enzymes continued in one patient for 66 days, and prolonged antidotal therapy was required. Residues of the intact pesticide were detected in fat after 54 days in one patient, and in the blood for 75 days in another patient. The partition coefficient of dichlofenthion in fat was 20 times greater than parathion, and exceeded only by leptophos. Considering the chemical and toxicologic properties of this compound, we postulated that the mechanism of protracted intoxication is a slow release from adipose reservoirs.

[Contusion of the abdominal aorta and massive embolization from the use of a seat belt. A clinical case]. / Contusión de la aorta abdominal y embolización masiva por uso de cinturón de seguridad. Caso clínico.

Abdominal aortic lesion following blunt abdominal trauma is infrequent. Parmley quotes 347 cases of aortic lesion among 8710 necropsies. Of these, only 4.6% involved the abdominal aorta. Probably less than 100 cases have been reported afterwards. We report a case associated to the use of safety belt, who developed the serious complication of massive embolization.

Peer review checklist: reproducibility and validity of a method for evaluating the quality of ambulatory care.

This report describes the construction and evaluation fo a 35-item checklist used in performing peer review of ambulatory medical records. Scores obtained by using the checklist were evaluated for reproducibility. Ten reviewers, reviewing ten records on each of two occasions judged the records consistently item by item, 74 per cent of the time; 53 per cent greater than expected by chance (p less than 0.01). Pairs of reviewers, reviewing the same ten records, were consistent with one another, item by item, 72 per cent of the time; 35 per cent greater than expected by chance (p less than 0.05). Ten sick call patients were reexamined by an especially trained Reevaluation Physician who evaluated the quality with which they had been managed at the time of sick call. The medical records of the same ten patients were then reviewed with the Peer Review Checklist. The correlation between the quality scores obtained by the two methods were 0.72 and 0.74 on two trials. A correlation coefficient of 0.44 was found between the two evaluation methods when 89 cases were reviewed by a Peer Review panel composed of 10 different physicians. Peer Review Checklist scores correlated positively with scores obtained by using a series of disease specific protocols with explicit criteria. The correlations varied from 0.28 to 0.63 with six different disease specific protocols.

Urinary carbon dioxide tension in lithium carbonate-treated patients.

Renal acidification was studied in 12 lithium carbonate-treated psychiatric patients. The urinary Pco2 response to oral sodium bicarbonate loading, a qualitative index of distal hydrogen ion secretion, was evaluated in all patients and the results were compared with those obtained in 10 control subjects. The average maximal urine to arterial blood Pco2 difference (U-A Pco2) in the psychiatric patients [26 +/- 3 (S.E.) mm Hg] was significantly lower (P less than .001) than that of control subjects (51 +/- 3 mm Hg) and only three patients had values greater than 31 mm Hg (2 S.D. below the mean control value). Eight of these patients were also evaluated with NH4CL acid loading. Seven of eight patients had a minimal urine pH less than 5.30 after NH4CL administration; only one of the seven had a normal U-APco2 after bicarbonate loading. Three patients were evaluated prior to treatment and after 2 weeks of lithium administration. Pretreatment U-APco2 values were normal. After therapy the values were lower in all three patients becoming definitely abnormal in two. The present investigation, in concert with previous animal studies, demonstrates that chronic lithium carbonate therapy in man may result in decreased U-A Pco2.

[Treatment results in 588 patients with multiple trauma]. / Resultados del tratamiento de 588 pacientes con trauma múltiple.

BACKGROUND: Ten to fifteen million wounded and 700,000 deaths each year, around the world, are the consequences of accidents, according to the World Health Organization. In Chile 2,269 deaths occur each year due to accidents. The successful treatment of these patients requires a schematized initial management, that is taught in the Advanced Trauma Life Support Course. AIM: To review the results of trauma treatment using this model at Hospital del Trabajador in Santiago. PATIENTS AND METHODS: A retrospective review of patients with trauma treated between 1984 and 1994. The severity of trauma was classified according to the Injury Severity Score. RESULTS: Five hundred eighty eight patients (60 female) aged 35.4 +/- 14 years old were treated in the period. Vehicular accidents accounted for 62% of trauma. The most frequently injured corporal segments were limbs and pelvis in 79%, head and neck in 66% and thorax in 44%. There were 2.45 lesions per patient. Mortality was 8% and, among survivors, 79% had a complete recovery and were reintegrated to their usual activities. Fifteen percent of patients were severely injured. Among these, mortality was 28% and 43% of survivors had some sequel. Head injuries had a predominant role in mortality and post traumatic disabilities. CONCLUSIONS: These results confirm the efficacy of Advanced Trauma Life Support system in the treatment of patients with multiple trauma.