The American journal of the medical sciences
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The kidneys play a pivotal role in causing some forms of hypertension and probably a permissive role in most, if not all, forms of hypertension. This concept of the critical role of the kidneys has been postulated for many years but has been solidified by the molecular unraveling of several monogenic forms of hypertension such as Liddle's syndrome, apparent mineralocorticoid excess and glucocorticoid-remedial aldosteronism. ⋯ Some disorders of salt wasting and relative hypotension such as Bartter's syndrome, Gitelman's syndrome and pseudohypoaldosteronism also localize to Na transport abnormalities in the distal nephron. Hypertensive in the general population may also result from subtle abnormalities in sodium balance resulting from alterations in the distal nephron.
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Infection is a frequent cause of death in patients with systemic lupus erythematous (SLE) admitted to the intensive care unit (ICU). Complicated clinical features of SLE patients may delay or cause inadequate antimicrobial treatment. This study aimed to determine if inadequate antimicrobial treatment is an independent risk factor for mortality in SLE patients in the ICU. ⋯ SLE patients in the ICU receiving inadequate antimicrobial treatment or with prior prolonged hospital stay have a higher risk of mortality. Clinical efforts should ensure adequate antimicrobial treatment in SLE patients with prior prolonged hospital stay before ICU admission.
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Familial nonmultiple endocrine neoplasia medullary thyroid cancer accounts for 10% to 15% of hereditary medullary thyroid carcinoma and is characterized by lack of accompanying endocrine or nonendocrine diseases. Simultaneous occurrence of medullary and papillary thyroid carcinoma in the same patient is rare and known as collision tumor. ⋯ Histopathologically, she also had Hashimoto thyroiditis in the remaining thyroid tissue and medullary thyroid carcinoma metastasis in 3 cervical lymph nodes. This case is the first in the literature to report coexistent familial nonmultiple endocrine neoplasia medullary thyroid cancer and papillary thyroid carcinoma related with a RET polymorphism (S904S in exon 15).
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Congestive heart failure (CHF) is the most common discharge diagnosis in the United States and accounts for greater than 1 million hospital discharges annually. CHF is associated with many serum electrolyte abnormalities, the most common and perhaps most significant of which is hyponatremia. CHF with hyponatremia makes the already high morbidity and mortality of CHF even more unfavorable. ⋯ The high morbidity and mortality with CHF and hyponatremia are not improved with the usual treatment with diuretics or ultrafiltration. This article provides an overview of the pathophysiology of hyponatremia in CHF. In addition, the authors will explore the various treatment options that are available and the evidence to support their utility.