Internal medicine
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We encountered a case of malignant hyperthermia caused by intravenous lidocaine which had been administered as treatment for a ventricular arrhythmia. The patient, a 72-year-old male, was admitted with chronic renal failure and aortic valvular stenosis. His chronic renal failure progressed, and congestive heart failure developed, and ventricular arrhythmias occurred frequently. ⋯ This abnormally high fever was relieved only by dantrolene sodium. After we made a diagnosis of malignant hyperthermia and stopped the lidocaine infusion, the high fever resolved quickly. It is important to note that malignant hyperthermia can be caused by lidocaine and amide-linked local anesthetics.
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We studied the effects of glycated lipoproteins of low- and high-density (LDL and HDL) on platelets and vascular endothelial cells. After pretreatment for 5 minutes at 37 degrees C, the thrombin-induced synthesis of thromboxane B2 in washed platelets was significantly increased by glycated LDL as compared with native LDL (198.9 +/- 16.2 vs 90.3 +/- 29.4 ng/10(9) platelets, n = 8, p less than 0.01). ⋯ Abnormalities in the release of 6-keto prostaglandin F1 alpha and lactate dehydrogenase from vascular endothelial cells were also induced by glycated LDL and/or HDL. These observations suggest that abnormalities induced in platelets and vascular endothelial cells by glycated lipoproteins may play an important role in the development of atherosclerosis in patients with diabetes mellitus.
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The effects of the metabolic changes of type 2 diabetic patients on ventricular function, especially diastolic ventricular function were investigated. An examination was performed before and after treatment of 18 diabetic patients divided into 3 groups: insulin therapy, oral hypoglycemic drugs and diet therapy (6 patients each). The results indicated that both systolic and diastolic ventricular dysfunctions observed were improved by the correction of hyperglycemia. Therefore it is necessary to treat diabetes mellitus as early as possible for the prevention of both cardiac dysfunction and microangiopathy.
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Comparative Study
Analysis of IgA antibody to Pseudomonas aeruginosa in sera and sputa of patients with chronic airway diseases.
The change of IgA system for Pseudomonas infection was examined by enzyme-linked immunosorbent assay of the system in sera and sputa of patients with chronic airway diseases. The anti-Pseudomonas total IgA antibody titers in both sera and sputa were not elevated in group I with no infection (mainly chronic bronchitis) and group II infected with bacteria other than Pseudomonas, but were elevated in group III colonized transiently with Pseudomonas [diffuse panbronchiolitis (DPB) and bronchiectasis] and group IV colonized persistently with Pseudomonas (mainly DPB). The elevation in the sera and sputa were mainly due to monomeric IgA and polymeric IgA (S-IgA), respectively, and values were significantly higher in group III than in group IV only in the sera. These results indicate that the IgA system is enhanced in advanced DPB and bronchiectasis complicated by Pseudomonas infection, and that the anti-Pseudomonas IgA antibody titer in serum is more useful than that in sputum for the diagnosis of respiratory Pseudomonas infection.
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Case Reports
Hemoglobin Andrew-Minneapolis (beta 144 (HCl) lysine----asparagine) in a Japanese family.
Hemoglobin Andrew-Minneapolis, an abnormal hemoglobin with an asparagine residue substituted for a lysine at position 144 of the beta-globulin chains, was identified in three members of two generations in a Japanese family. The carriers of hemoglobin Andrew-Minneapolis showed false high levels of hemoglobin A1c, as measured by the standard cation exchange high performance liquid chromatography, and a moderate tendency for erythrocytosis. This family is the first report of this abnormal hemoglobin in Japan.