Israel journal of medical sciences
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Six patients with carnitine palmitoyltransferase (CPT) deficiency were diagnosed. Five were males aged 12-48 years and one was a 7-year-old girl. Severe myoglobinuria with renal shut-down led to the diagnosis in four, the main cause of myoglobinuria being prolonged exertion. ⋯ CPT activity assayed by the forward assay under standard conditions was normal. CPT deficiency seems to be a common cause of exercise-induced myoglobinuria. Prompt diagnosis can lead to avoidance of risk factors and prevention of rhabdomyolysis and its consequences.
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Randomized Controlled Trial Clinical Trial
Asymptomatic or mildly symptomatic effort-induced myocardial ischemia: plasma beta-endorphin and effect of naloxone.
The hypothesis that endogenous opioids may be involved in reduced exercise-induced ischemic pain or in silent ischemia was tested. Fifteen male patients with coronary artery disease were tested in a randomized, double-blind crossover study. After a preliminary screening effort test they were divided into two groups: the first group of nine patients received an i.m. injection of naloxone 0.4 mg, or saline as placebo, and the second group, comprising six patients, received 4 mg naloxone or saline i.v. ⋯ Beta-endorphin concentrations in plasma were significantly increased following exercise in the second group of patients. The increase in beta-endorphin concentration was larger when the patients were pretreated with naloxone (4 mg) than with placebo. However, chest pain was not significantly altered by either dose of naloxone.
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Review Clinical Trial
Corticosteroids in sepsis and septic shock: has the jury reached a verdict?
Mortality from septic shock remains high, despite early diagnosis, comprehensive care and monitoring, and intensive therapy. The use of high-dose corticosteroids as adjunctive therapy in septic states has been extensively debated in the literature, but no clear consensus has been reached. ⋯ Recently, however, well-designed clinical studies have consistently failed to show a beneficial effect of corticosteroid use in septic states. After re-examining the theoretical basis for the use of steroids, possible side effects, experimental results and clinical trials, it is concluded that, based upon current knowledge, high-dose corticosteroids should not be used as adjunctive therapy in human sepsis and septic shock.
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Mechanical ventilation of newborn infants with respiratory distress is associated with diverse pathology of the lung. Recent reports have focused on a distinct lesion pattern of the tracheobronchial system--necrotizing tracheobronchitis. While many advanced cases of the disease proved fatal secondary to airway obstruction, others were successfully treated by removal of the occlusion. We describe two neonates with necrotizing tracheobronchitis, one of whom had a complete occlusion of the right main stem bronchus that was relieved by curettage during bronchoscopic examination.