The American journal of the medical sciences
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To identify factors that contribute to patient death within 48 hours of admission to the emergency department. ⋯ Our study found a considerable concordance between the presumed antemortem cause of death and the postmortem findings. Although the mean age of death caused by myocardial infarction in our study was 52.45 years, MI caused a significant number of deaths among adults younger than 40 years of age.
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Body fluid regulation is affected by gravity. The primary mechanisms of the etiology of hypovolemia found in simulation studies on earth and after space flight are different. The increased diuresis after increase of central blood volume postulated by Henry Gauer could not be found. ⋯ Additionally, loss of erythrocytes reduces blood volume. The attenuated diuresis during space flight can be explained by increased retention after stress-mediated sympathetic activation during initial phase of space flight, stimulation caused by reduced red cell mass, and activation after fast blood volume contraction. Additionally, the relation between plasma osmolarity and vasopressin release might be disturbed in microgravity.
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Case Reports
A possible hypophosphatemia-induced, life-threatening encephalopathy in diabetic ketoacidosis: a case report.
Hypophosphatemia, a common metabolic disorder, is usually silent and diagnosed by blood tests. However, misdiagnosis may result in delayed phosphate repletion, responsible for significant morbidity and potential mortality. We report an exceptional case of hypophosphatemia-related, life-threatening encephalopathy. ⋯ Prompt phosphate repletion resulted in progressive and complete recovery. This observation allowed us to study the relations between the coma depth, the electroencephalographic findings, and the serum phosphate concentrations. Our data strongly suggest that phosphate depletion-induced encephalopathy probably originates from direct impairment of cerebral electrophysiological activity rather than from cardiac flow alteration.
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The insulin resistance/metabolic syndrome is characterized by the variable co-existence of hyperinsulinemia, obesity, dyslipidemia (small dense low-density lipoprotein, hypertriglyceridemia, and decreased high-density lipoprotein cholesterol), and hypertension. The pathogenesis of the syndrome has multiple origins. ⋯ The scope of this review is to examine the differences in prevalence of the metabolic syndrome in various groups (eg, according to age, sex, ethnicity, social status, or presence of obesity) that could help with the better understanding of the pathogenesis of this syndrome. This review also considers the impact of metabolic syndrome on cardiovascular disease.
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Stroke is the third leading cause of death in the United States. We investigated racial differences in death after hospital discharge for ischemic stroke in a large cohort of Veterans Health Affairs (VHA) stroke patients. We hypothesized that having access to VA care would ameliorate the excess stroke mortality rates in African-Americans (AA) reported in non-VA studies. ⋯ Despite having similar severity of illness and adjusting for other clinical differences, mortality rate was marginally lower in AA after being discharged from VA hospitals after ischemic strokes. This is contrary to prior reports from non-VA hospitals and suggests the possibility of access to care playing a role in stroke deaths.