Australian and New Zealand journal of medicine
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Hyperamylasemia is found in asymptomatic alcoholics. The aim of this study was to document the incidence of elevations of serum amylase and lipase in asymptomatic alcoholics and to evaluate the contribution of salivary isoamylase to the total serum amylase. One hundred and three patients with acute alcohol withdrawal were studied. ⋯ Thus there was a low but significant incidence of hyperamylasemia which resulted from an elevated salivary isoamylase in the majority of cases. Lipase determination did not assist in defining the origin of the hyperamylasemia and correlated poorly with the other enzymes. It is probably more sensitive than amylase in reflecting the toxic effects of alcohol on the pancreas.
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Lung injury in the adult respiratory distress syndrome (ARDS) may be mediated through a variety of mechanisms and may involve the interaction of a number of systems involved in the inflammatory reaction--complement, granulocytes, prostaglandins and platelets. Studies in animals, involving the infusion of endotoxin, have produced convincing evidence that these agents can cause pulmonary vascular injury and a syndrome resembling human ARDS. Direct evidence of these pathogenic mechanisms in man is lacking, however, but some suggestive clues have emerged in the last few years that support this general scheme. ⋯ Pulmonary sepsis continues to play an important role in ARDS. Patients are frequently infected after the initial pulmonary injury; such patients have a far worse prognosis than those who are not infected. Until ways are established at a cellular level to minimise colonisation of the upper respiratory tract, reliance must be placed on avoidance of cross infection by strict personal hygiene, avoidance of prophylactic antibiotics, and prompt, vigorous treatment of suspected pulmonary infection.
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Case Reports
Reversible parasympathetic dysautonomia following stinging attributed to the box jelly fish (Chironex fleckeri).
Following a box jelly fish sting, a 52 year old Chinese fisherman developed acute abdominal distension, inability to pass urine and failure of erection. Examination revealed gaseous abdominal distension and a distended urinary bladder. ⋯ The patient made a complete recovery. The case highlights the occurrence of reversible parasympathetic dysautonomia following box jelly fish sting.
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A 43 year old female was admitted to hospital with severe pulmonary hypertension and cardiogenic shock. She had a two week history of dyspnea only. Resuscitative measures proved unsuccessful and she died ten hours after admission. Post mortem examination indicated that the pulmonary hypertension and right ventricular failure were due to endarteritis secondary to widespread carcinomatous microembolism from adenocarcinoma of the lung.