Recenti progressi in medicina
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Sarcoidosis is a granulomatous disorder of unknown etiology with a multi-disciplinary interest. However, a multiple organ involvement is not always clearly presented. A case of a 62-year-old woman with cutaneous, pulmonary, ocular, cardiac, bone and articular involvement is described.
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To establish the overall frequency distribution and combination of acid-base and electrolyte disturbances as they occur in a general population requiring hospital care, we studied arterial blood gases and plasma electrolytes (sodium, potassium and chloride) in 110 consecutive patients (age = 68 +/- 8 SE; 64 M, 46 F) at the time of admission to a general medical ward. Disturbances were defined on the basis of the standard pH/pCO2 plot and the normal (mean +/- 2 SD) electrolyte range for our laboratory. Sixty-two patients (56%) showed a disturbance in acid base equilibrium: acidosis: respiratory 16, metabolic 6; alkalosis: respiratory 26, metabolic 10; in 4/62 the acid base disturbance was mixed. ⋯ Thus, the total number of mixed acid base equilibrium disorders were eleven. This study emphasizes the frequent incidence of acid base and electrolyte disorders, very often in combination, among unselected adult patients admitted to a general medical ward. In addition it reinforces that a high prevalence of hidden cases of mixed acid base disturbances can be recognized by concomitant analysis of acid base and electrolyte parameters, including anion gap calculation.
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A study of TPA, CEA and IL-2R serum levels was conducted in patients untreated with various histological types of bronchial carcinoma. A total of 43 subjects were evaluated. We have observed a significant correlation between serum levels and stage of the disease for both CEA and TPA markers, whereas for IL-2R an increase was shown for the all patients not correlated with stage.
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The presence of dynamic hyperinflation and intrinsic PEEP is a common and yet too often unrecognized occurrence in patients with airway obstruction both in stable state and during acute exacerbations. Intrinsic PEEP may represent an important load on the inspiratory muscles which are operating at a mechanical disadvantage due to hyperinflation. ⋯ The presence of intrinsic PEEP also has other important clinical ramifications. Prompt recognition of intrinsic PEEP will allow for proper measurement and interpretation of a variety of cardiopulmonary parameters and improved clinical decision making and management of these critically ill patients.
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Case Reports
[Dilated cardiomyopathy secondary to idiopathic hypoparathyroidism in adults. Description of a case].
The authors report the clinical history of a 56-year-old man with cardiomyopathy due to undiagnosed hypocalcemia. Heart dilation and hypokinesia were assessed by echocardiography. ⋯ The pathogenetic mechanisms of hypocalcemic cardiomyopathy are discussed and the importance of considering the possibility of hypocalcemia when dealing with the differential diagnosis of cardiomyopathies is underlined. In the presence of hypocalcemic cardiomyopathy, the correction of calcium deficiency with calcitriol is the treatment of choice.