Arch Intern Med
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We have seen two patients with systemic lupus erythematosus (LE) and chronic periorbital edema. Periorbital edema occurs frequently in dermatomyositis, but it has rarely been noted in systemic LE. The edema may be associated with facial rash, but it is unrelated to the occurrence of nephrotic syndrome, cardiac and hepatic dysfunction, or edema elsewhere. This complication of systemic LE may be relatively refractory to corticosteroid therapy.
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Comparative Study
Daily spirometric variability: normal subjects and subjects with chronic bronchitis with and without airflow obstruction.
To determine the daily variability of spirometry, we performed spirometry on five consecutive days on 15 normal subjects and on 24 patients with chronic bronchitis. The patients with chronic bronchitis were divided into the following two groups: 13 with chronic airflow obstruction (forced expiratory volume in 1 s [FEV1] 80%, FEV1/forced vital capacity [FVC] ratio less than 75%) and 11 without airflow obstruction (FEV1 and FVC greater than 80%0. ⋯ Our results indicate that the day-to-day FEV1 has to change by 17% and the FCV by 15% in patients with airflow obstruction before the change should be considered significant. In patients with nonobstructive chronic bronchitis or in normal subjects, a greater than 5% change should occur in FEV1 and FVC before considering the change to be significant.
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The clinical courses of 63 survivors of cardiopulmonary arrest were reviewed to determine the incidence and temporal occurrence of noncardiac complications and their relationships to mortality. Complications were grouped as occurring within 48 hours or less, within 48 to 96 hours, or more than 96 hours after cardiopulmonary arrest. ⋯ Pneumonia and liver function test abnormalities were each significantly correlated with increased mortality. Septicemia, acute renal failure, and adult respiratory distress syndrome each occurred in three (5%) to four (7%) of the 63 patients and were always associated with mortality.
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Randomized Controlled Trial Clinical Trial
Phosphate therapy in diabetic ketoacidosis.
To determine the efficacy of phosphate replacement in the therapy for diabetic ketoacidosis (DKA), 44 patients were randomly assigned to three treatment groups: those who received no phosphate replacement, those who received 15 mmole of sodium phosphate at the fourth hour, or those who received 15 mmole of sodium phosphate at 2, 6, and 10 hours. All patients were treated with intravenous insulin injection (0.1 units/kg/hr), fluids, and potassium. ⋯ Phosphate therapy did not affect the duration of DKA, dose of insulin required to correct the acidosis, abnormal muscle enzyme levels, glucose disappearance, or morbidity and mortality. Although theoretically appealing, phosphate therapy is not an essential part of the therapy for DKA in most patients.