Swiss medical weekly
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Swiss medical weekly · Dec 1982
Review[Hyporeninemic hypoaldosteronism and the differential diagnosis of hyperkalemia].
Selective hypoaldosteronism is defined as diminished production of aldosterone, and sometimes also of 18-hydroxycorticosterone, with otherwise intact adrenal function. A decrease in the secretion of potassium and H+-ions and in the reabsorption of sodium in the distal nephron may result and lead to hyperkalemia, hyperchloremic acidosis, and impaired renal sodium conservation. The form of hypoaldosteronism which occurs in the adult is characterized by the following additional features: the aldosterone deficiency is due in the majority of cases to a decrease in enzymatically active plasma renin ("hyporeninemic hypoaldosteronism"), while various endogenous mechanisms as well as certain drugs (prostaglandin inhibitors, beta-blockers) may contribute. ⋯ For treatment, dietary potassium restriction is recommended as a general step. Replacement with the mineralocorticoid fludrocortisone acetate usually reverses the hyperkalemia and acidosis, but may sometimes induce sodium retention and hypertension. Loop diuretics, potassium-exchanging preparations and/or bicarbonate may also be useful as alternatives or additives.
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Swiss medical weekly · Nov 1982
[Clinical relevance of N-acetylglucosaminidase determination in urine of kidney transplant recipients with and without cyclosporin A].
From January to September 1981 urinary gamma-N-acetyl-glucosaminidase (NAG) excretion was measured in 23 cadaver kidney recipients up to 90 days posttransplant. Conventional immunosuppression with azathioprine and prednisone was used in 12 patients, and cyclosporin A (CyA) in 11 patients. The purpose of this study was to assess the clinical value of NAG determinations in the diagnosis of acute rejection episodes and CyA-induced nephrotoxicity. ⋯ Nine out of 11 patients treated with CyA showed one or more increases in NAG excretion, but the number of such episodes did not differ between patients with CyA serum concentrations below 500 ng/ml and those with levels above 500 ng/ml. Histological signs of CyA toxicity in graft biopsies correlated well with increased NAG excretion. It is concluded that increases in NAG excretion are not sensitive and specific enough to be of definite help in the diagnosis of acute rejection and/or CyA-induced nephrotoxicity.
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Swiss medical weekly · Nov 1982
[Harmful interactions of amiodarone and class I anti-arrhythmia agents].
Six patients treated with a combination of amiodarone and class I antiarrhythmic agents for a minor arrhythmia developed atypical ventricular tachycardia "en torsades de pointe". All patients had QT-interval prolongation in the ECG. Combined administration of quinidine and amiodarone in a normal volunteer resulted in an increase in plasma quinidine concentration and in QT prolongation, thus confirming the clinical observation of a clinically relevant interaction between the two drugs.
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Swiss medical weekly · Aug 1982
[Experience with measurements of intracranial pressure in post-hypoxic and post-traumatic coma].
In 27 patients intracranial pressure monitoring (ICP) was carried out for 4-5 days (severe head injury 23, hypoxia after cardiac arrest 3, brain tumor 1). Patients were included who reached a score of 8 or less on the Glasgow Coma Scale and who did not need immediate surgery. The measurements were done with epidural screws (20 patients) and with indwelling ventricular catheters 7). ⋯ Poor Glasgow scores were linked to high mortality. The advantages and disadvantages of the two ICP monitoring techniques are discussed. ICP monitoring is recommended as a useful and safe tool for titrated management of deeply comatose patients.