The American journal of the medical sciences
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Transesophageal echocardiography has emerged recently as a powerful cardiac imaging tool. The strengths and limitations of transesophageal echocardiography are reviewed. The clinical use of transesophageal echocardiography in aortic dissection, endocarditis, mitral valve disease, prosthetic heart valves, stroke, and miscellaneous other conditions is discussed.
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Randomized Controlled Trial Clinical Trial
Sodium kinetics in white and black normotensive subjects: possible relevance to salt-sensitive hypertension.
The hypothesis that sodium (Na) kinetics are not a first order process was tested. Twelve normotensive white and 12 normotensive black men were given 10, 200, and 400 mmol/d Na as the chloride salt for 7 days in random order. All urine made was collected. ⋯ The data showed that T1/2 increases with increasing Na intake and is, therefore, dose-dependent or "zero" order. The effect of dose is more prominent in blacks than in whites; blacks accumulate more Na with increasing Na intake than whites. These data may have relevance for the pathogenesis of salt-sensitive hypertension in blacks.
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Capillary closure in diabetic retinopathy may be initiated by lumenal occlusion by granulocytes. To determine whether subjects with diabetes mellitus have less deformable granulocytes than healthy subjects, granulocyte deformability was measured by mean entry time into a model capillary system in 16 diabetic-nondiabetic pairs. Granulocyte F-(filamentous) actin content between groups was compared, under basal conditions and after cellular stimulation. ⋯ Deformability was increased in subjects with retinopathy and those with the worst glycemic control (r = 0.61, p = 0.026); both findings were in the opposite direction from that predicted. Basal and stimulated granulocyte F-actin content did not differ between the two groups (p > 0.2 for all assays). Although granulocytes may be important in the pathogenesis of diabetic retinopathy, granulocyte deformability (measured by mean entry time) and F-actin content are not significantly different between healthy patients and those with diabetes.
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Review Case Reports
Southwestern Internal Medicine Conference: Shiga-like toxins in hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura.
The majority of cases of hemolytic-uremic syndrome and a smaller proportion of cases of thrombotic thrombocytopenic purpura have recently been shown to result from a toxin produced by enteric bacteria, referred to as verotoxin, or Shiga-like toxin. The predominant toxin-producing bacterial strain in North America is E. coli O157:H7, which causes hemorrhagic colitis in humans after ingestion of contaminated meat. ⋯ The toxin inactivates ribosomes inside the cells, thereby killing them and producing the clinical manifestations of hemolytic-uremic syndrome. Recognition of the etiology of hemolytic-uremic syndrome may lead to better prospects for prevention and treatment.