A case of chronic adrenocortical insufficiency with iatrogenic anasarca

The decrease in active hormones that characterizes chronic adrenal insufficiency results in hypovolemia. In some patients, residual adrenal function, mineralocorticoid therapy, and concomitant heart or liver failure, or both, can paradoxically provoke edema. The case report that follows describes a patient with iatrogenically induced anasarca resulting from the unhappy confluence of usually appropriate therapy and coexisting medical conditions.     

老年患者术后肾上腺皮质功能低下的护理

老年患者的肾上腺皮质功能减退,应激能力下降,在进行非肾上腺手术后,易发生急性肾上腺功能低下,而且病情大多凶险,临床表现缺乏特异性,易延误诊治和抢救,给患者带来生命危险。我科1997-2003年有4例老年患者发生了术后急性肾上腺功能低下,其中3例抢救成功,1例死亡,现报道如下。临床资料1.一般资料。4例患者全部为男性,年龄58~76岁,平均年龄66岁。3例患者为良性前列腺增生,其中2例行耻骨上前列腺剜除手术,1例行经尿道前列腺电切术;另1例患者为肾结核行肾切除手术。4例患者中,有1例合并高血压,2例有慢性支气管炎史。手术过程顺利,术中出血不多…     

Iron reserves in patients with chronic renal insufficiency

Hemorrhage values and the amount of iron entering the body with drugs and blood transfusions were determined in 107 patients with the terminal CRF stage. Of them 59 received regular hemodialyses. The level of serum iron and ferritin as well as iron reserves in the body were investigated at the start and end of the study. In the end a histochemical study of the content of hemosiderin in the bone marrow, liver and spleen was performed. A close interrelationship of iron reserves determined with a modified desferal test and the level of serum ferritin (r = 0.94) was established. The highest iron reserves were revealed in the patients receiving blood transfusions and parenteral iron drugs. Criteria for the assessment of iron reserves in patients with renal failure were determined by means of the modified desferal test and investigation of serum ferritin. Normal ferritin reserves in such patients corresponded to serum ferritin values within the range of 50-400 micrograms/l and indices of the modified desferal test ranging from 0.4 to 2.0/0.5 g of desferal. Of a degree of hemosiderosis one could judge on the basis of a histochemical investigation of tissue hemosiderin only. Iron drugs per os were proposed for the prevention of disorders of iron balance in patients with renal failure.     

Effects of sulindac on renal function and prostaglandin synthesis in patients with moderate chronic renal insufficiency

The renal effects of therapeutic doses of sulindac were studied in nine patients with stable renal insufficiency, mean creatinine clearance 37.0 +/- 2.2 ml min-1 1.73 m-2 (range 24.7-54.6 ml min-1 1.73 m-2). Nine days' treatment with sulindac produced a small, but significant, reduction in the mean creatinine clearance (37.0 +/- 2.2 to 34.7 +/- 2.2 ml min-1 1.73 m-2; P less than 0.02) and 99mTc diethylenetriaminepenta-acetate (DTPA) clearance (35.5 +/- 3.4 to 31.4 +/- 3.6 ml min-1 1.73 m-2; P less than 0.02) without altering body weight, effective renal plasma flow [131I]hippuran clearance), plasma renin activity (PRA), 24 h urinary volume or electrolyte excretion. After discontinuation of sulindac, creatinine clearance returned to pretreatment values. In five female patients, pretreatment urinary excretion of the 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha), a stable breakdown product of prostacyclin (PGI2), was significantly reduced (P less than 0.02) when compared with four healthy controls, whereas prostaglandin E2 (PGE2) was unchanged. Administration of sulindac did not significantly alter the excretion rate of PGE2 or 6-ketoPGF1 alpha in this group of patients. In chronic renal disease with moderate renal impairment, reduced renal prostacyclin synthesis may be an important predisposing factor to the renal toxicity associated with the use of non-steroidal anti-inflammatory drugs (NSAID). Short term use of sulindac in therapeutic doses does not appear to influence the excretion of prostaglandins and produces only a minor reversible change in renal function; used cautiously it may have advantages over other NSAID in these patients.     

Risk factors and predictive model of adrenocortical insufficiency in patients with traumatic brain injury

BACKGROUND: Neuroendocrine dysfunction after traumatic brain injury (TBI) has received increased attention due to its impact on the recovery of neural function. The purpose of this study is to investigate the incidence and risk factors of adrenocortical insufficiency (AI) after TBI to reveal independent predictors and build a prediction model of AI after TBI.     

Procalcitonin in patients with acute and chronic renal insufficiency

BACKGROUND: Bacterial infections are associated with a high morbidity and mortality rate in patients with acute and chronic renal failure. Because C-reactive-protein (CRP) is elevated in many patients with renal failure, even in the absence of infection, procalcitonin (PCT) might be useful for the detection of systemic bacterial infections. This cross-sectional observation study measured PCT and CRP in several groups of patients with various types, degrees and treatments of kidney diseases, including patients with sepsis treated with renal replacement therapy. PATIENTS AND METHODS: We determined PCT and CRP in 85 renal patients with different stages and treatments of renal insufficiency: chronic renal failure (CRF) n=23, patients undergoing continuous ambulatory peritoneal dialysis (CAPD) n=20, patients undergoing hemodialysis therapy (HD) n=42 and in a group of 40 patients with septic conditions, including 20 patients with acute renal failure (ARF). The infectious status of the patients was monitored. RESULTS: PCT in serum (reference value in healthy controls < 1 microg/l) was within the normal range in patients with CRF and in patients on both short-term HD (< 1 year) and long-term HD (> 1 year) (median of 0.25 microg/l and 0.61 microg/l). However, PCT was elevated in patients on CAPD (median of 1.18 microg/l). In patients with sepsis, PCT was massively elevated in both the presence and absence of ARF. In contrast, CRP (reference value < 5 mg/l) was markedly increased in patients undergoing short- and long-term HD (medians of 14.5 and 51.1 mg/l) but not in patients on CAPD. In patients with CRF and systemic bacterial infections, both PCT and CRP were markedly elevated (median PCT 63 microg/l, CRP 130 mg/l) but, in contrast to PCT, CRP values overlapped in infected and non-infected patients. There was no relevant decrease in plasma concentrations of PCT by hemofiltration or hemodialysis in patients with sepsis. CONCLUSION: With the exception of CAPD patients, PCT levels were not significantly affected by renal diseases or treatments but were markedly elevated in the presence of infections. Thus PCT is a valuable marker for early diagnosis of systemic bacterial infections in patients with CRF or patients undergoing HD. In contrast, CRP is elevated in several groups with renal diseases and has low specificity for the diagnosis of bacterial infections.     

Stimulation of aldosterone secretion by benzodiazepines in bovine adrenocortical cells

Previous studies have indicated that peripheral benzodiazepine receptor (PBR) ligands inhibit aldosterone secretion in isolated adrenal zona glomerulosa cells although positive responses have been demonstrated in other steroidogenic tissues. In the present study, aldosterone secretion was measured in bovine cells after 6 days of primary culture. At this time, basal aldosterone secretion was very low and cells appeared less sensitive to the steroidogenic effects of extracellular [K+] (maximal response required K+ concentration > 32 mmol/L) but were sensitised to angiotensin II (maximal response achieved with 3 nM) when compared with previous studies with freshly isolated cells. Diazepam concentration in the range 0.1 nM to 1 microM increased basal aldosterone secretion, an effect which was not enhanced by pre-treatment with diazepam. The effects were small compared with those of angiotensin II or K+. Over the same concentration range, diazepam also potentiated the stimulatory effects of sub-maximally effective concentrations of angiotensin II. When cells were treated with high-density lipoprotein (HDL-3) as a source of cholesterol, diazepam and the PBR ligands Ro5-4864 and PK11195 also stimulated aldosterone secretion at nanomolar concentrations. In addition, the conversion of added 11-deoxycorticosterone (DOC) to aldosterone was increased by nanomolar concentrations of diazepam and Ro5-4864 but inhibited by high micromolar concentrations of these drugs (100 microM). We conclude that adrenocortical responses to PBR ligands are complex. At high concentrations, inhibitory effects involving competition for steroidogenic enzymes and calcium channel blockage predominate. At low concentrations, an enhancement of basal, angiotensin-II and cholesterol-dependent aldosterone synthesis is revealed which may involve a PBR-mediated mitochondrial uptake of cholesterol and DOC.     

慢性肾功能不全尿毒症期患者的心理干预

目的 探讨慢性肾功能不全尿毒症期患者心理干预的护理体会.方法 我们采取疏导、倾听、解释等心理干预方法 ,有针对性地进行心理护理.结果 患者能够接受患病的事实,勇敢面对疾病.愿意主动与护士交流、沟通并进行力所能及的日常生理活动.结论 了解慢性肾功能不全尿毒症期患者的心理状况,护理人员及时准确地治疗和护理是十分重要的,通过帮助患者正确认识疾病,使其较好的配合治疗,从而提高治疗效果及生存质量.     

Inactive renin in patients with chronic and terminal renal insufficiency

Active renin (AR) and trypsin-activated inactive renin (IR) were examined in 32 patients with chronic renal failure (CRF). (of these, 25 patients were kept on the programmed hemodialysis) and in 11 normal subjects. As compared with normal subjects, CRF patients manifested a decrease in both AR and IR. A direct correlation was discovered between AR and IR: R = 0.64, P less than 0.01. The simultaneous decrease in IR and AR attests to the impairment of renin synthesis during CRF.     

Intragastric pH-metry in patients with chronic gastritis and secretory insufficiency

A new technique of intragastric pH-metry has been developed and used in patients with chronic anacid gastritis. The technique provides a basal topographic pH-metry with original microtubes which enables one to investigate acidity under easier conditions of gastric intubation.     

On the use of statins in patients with chronic cardiac insufficiency

Today, the necessity to use hypolipidemic agents belonging to the group of statins as means of primary and secondary prevention of coronary artery disease (CAD) and its complications is not doubted. The results of numerous large studies conducted in many different countries during the last 10 to 15 years confirm this statement. The appropriateness of statin application to patients with chronic cardiac insufficiency (CCI) is still under discussion, because there are no sufficient data on whether hypolipidemic therapy is able to improve the prognosis in this category of patients. The authors conducted a long-term research into the use of statins in combination with basic combined therapy in patients with CCI complicating the course of CAD. A reverse correlation between the levels of total cholesterol, low-density protein cholesterol, and the degree of CCI severity was demonstrated. Long-term continuous therapy of CCI patients with a combination of medications including statins did not worsen the clinical symptoms. However, hypolipidemic therapy should be administered to CCI patients on a differentiated basis, taking into account the initial state of lipid profile and the severity of the underlying disease.