The American journal of medicine
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The clinical course of 40 patients with significant quantities of mixed cryoglobulins, but without lymphoproliferative, collagen-vascular or chronic infectious diseases, is presented. These cases comprise 51.3 percent of all mixed and 31.7 percent of all types of cryoglobulins evaluated by us over the period 1960--1978. A characteristic clinical syndrome, consisting of recurrent palpable purpura (100 percent), polyarthralgias (72.5 percent) and renal disease (55 percent), was seen. ⋯ Follow-up for periods up to 21 years from onset of symptoms revealed that renal involvement has a deleterious effect on prognosis. Postmorten examinations of nine patients demonstrated widespread vasculitis in addition to renal involvement. Preterminal infection was found in eight.
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Comparative Study
Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women.
Twenty postmenopausal women were monitored for disordered breathing (apnea and hypopnea) and oxygen desaturation during one night's sleep. These women were compared with 18 premenopausal women previously reported to have a low incidence of sleep-disordered breathing and nocturnal oxygen desaturation. Twelve of the 20 postmenopausal women had 102 episodes of sleep-disordered breathing and 118 episodes of oxygen desaturation, compared with only six episodes of apnea in two premenopausal women (P less than 0.01). ⋯ Duration of sleep, and increased age and weight: height ratios, correlated significantly with the incidence of desaturation (P less than 0.01--P less than 0.05). Postmenopausal women resemble men with respect to disordered breathing during sleep and nocturnal oxygen desaturation. Protection from these sleep events in premenopausal women might be afforded by the respiratory stimulant effects of circulating progesterone.
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Seven definite and three probable cases of pyogenic sacroiliitis are presented and compared to 72 cases found in the English literature. Patients may present with a subacute localized or an acute systemic illness. Six of our patients were parenteral drug abusers. ⋯ Gram-negative organisms, group B streptococci and a Staphylococcus were isolated. Antibiotic treatment for four to six weeks was uniformly successful. Surgery should be reserved for abscess or sequestrum formation, neither of which were encountered in this series.
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Herbal teas occasionally produce toxic reactions. Unwitting use of the foxglove plant for brewing tea resulted in cardiac glycoside toxicity in an otherwise healthy man. Potentially toxic plants are omnipresent whereas herbal tea imbibing has had an enhanced popularity. Physicians will have increasing contact with patients who have inadvertently poisoned themselves with such concoctions.