Iron Malabsorption in a Patient with Large Cell Lymphoma Involving the Duodenum

Iron malabsorption compounded the anemia in a patient with diffuse large cell lymphoma involving the small intestine. Both upper gastrointestinal series with small bowel follow-through and computerized tomographic scan demonstrated lymphomatous involvement of the duodenum and proximal jejunum by a retroperitoneal mass. An oral iron-loading absorption test was consistent with malabsorption of iron. After two cycles of systemic chemotherapy, the retroperitoneal mass resolved and the iron loading test normalized.     

Accuracy of auscultatory blood pressure measurement with a long cuff

Intra-arterial blood pressure was compared with simultaneous auscultatory measurements in 37 subjects with a wide range of blood pressures and arm circumferences; six cuffs of various lengths and widths were used. Nineteen subjects had an arm circumference of 34 cm or more (mean 40 cm) and the other 18 were considered to be non-obese and had a mean arm circumference of 30 cm. With each larger cuff, in terms of bladder surface area, auscultatory blood pressure decreased a few mm relative to intra-arterial pressure both for systolic and for diastolic measurements. Apart from diastolic pressure measured with the two 12 cm wide cuffs (12 X 23 cm, 12 X 30 cm) in the obese group all other auscultatory measurements differed less than 5% from intra-arterial pressure, albeit with considerable variability among the subjects. The differences in error among measurements with the four largest cuffs in the obese group (13 X 30 cm, 14 X 30 cm, 14 X 38 cm, and a conical cuff) were clinically irrelevant, and there was even less to choose among all six cuffs in the non-obese subjects. These results suggest that auscultatory blood pressure may be measured with acceptable accuracy with a single long bladdered cuff both in subjects with large arms and in subjects with normal sized arms.     

Nicardipine for preservation of myocardial metabolism and function in patients undergoing coronary artery surgery

The present study was designed to evaluate the myocardial protective effect of nicardipine (NIC) in patients with normal left ventricular (LV) function (control vs. NIC treatment group) and impaired LV function (control vs. NIC treatment group) during extracorporeal circulation for coronary artery surgery. NIC infusions were begun approximately 12 min before aortic cross clamping (AoX) at an infusion rate of 5 micrograms.kg-1.min-1 and maintained for 10 min. Prior to AoX an additional bolus of NIC 5 mg was given. Coronary hemodynamics, myocardial metabolic parameters (continuous thermodilution), and regional LV function (two-dimensional transesophageal echocardiography) were measured. At 15 min after discontinuation of AoX, lactate production was found in the two control groups but not in the two NIC treatment groups. In the control groups, lactate production returned to extraction at sternal closure. At that time regional area ejection fraction (RAEF) had significantly improved in both groups with impaired LV function compared with postintubation (baseline) values. In NIC-treated patients with impaired LV function, however, the percentage improvement in RAEF was significantly greater than that in the control groups. Between the groups, there were no differences in the number of patients requiring inotropic support, pacing, and/or diuretics after bypass or postoperatively. There were no significant differences in postoperative creatine kinase myocardial band release or in the incidence of dysrhythmias, myocardial infarction, or mortality. The results of the present study suggest that NIC iv may be used to provide additional myocardial protection during extracorporeal circulation. In addition, in NIC-treated patients with compromised LV function, this may be associated with a more apparent improvement in RAEF than that seen in nontreated patients.