A correctable complication of advanced congestive heart failure

Hyponatremia is a common complication of chronic advanced CHF unresponsive to the usual therapeutic measures. Thus low levels of serum sodium are a significant marker for severe CHF refractory to the more conventional measures. The combined use of ACE inhibitors and diuretics is generally very effective in correcting the hyponatremic state and often helpful in reversing CHF.     

Chronic obstructive pulmonary disease with tracheostomy: report of case involving endodontic treatment

Modern medicine has made many advances in the capability to sustain life. The dental profession needs to keep up to date with these changes and be creative in caring for these individuals who are medically compromised and who require special care.¹¹ This sometimes requires the purchase of new equipment; other times it means modifying that which exists. In all instances, the level of care for these individuals requires a team approach and mandates education of all team members. In the case presented, the medical problems necessitated such a team effort to achieve optimal care.     

Renal magnesium wasting in two families with autosomal dominant inheritance

Hypomagnesemia due to isolated renal magnesium loss was demonstrated in two unrelated families with autosomal dominant mode of inheritance. Magnesium infusions performed in two patients showed not only a reduced renal magnesium threshold but also a lowered renal tubular maximum for magnesium. All members of both families who presented with hypomagnesemia had also a lowered excretion of calcium in the urine, presumably as a consequence of increased reabsorption in Henle's loop.     

The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy

The use of adjuvant radiation therapy in breast cancer patients treated with mastectomy and adjuvant chemotherapy has been controversial. In order to assess the necessity and effectiveness of adjuvant radiation therapy in this setting, we reviewed the results in 510 patients with T1-T3 tumors and pathologically positive nodes or tumors larger than 5 cm and negative nodes who were treated with adjuvant chemotherapy. Patients with four or more positive nodes or at least one positive apical node were randomized to receive either five or ten cycles of cyclophosphamide/Adriamycin (Adria Laboratories, Columbus, OH) (CA) and patients with one to three positive nodes or operable tumors larger than 5 cm and pathologically negative nodes were randomized to receive eight cycles of either cyclophosphamide, methotrexate, and 5-fluorouracil (5-FU) (CMF) or methotrexate and 5-FU (MF) chemotherapy. Two hundred six of these patients were subsequently rerandomized to receive either no further treatment or adjuvant radiotherapy. Thirty-five patients withdrew after randomization, including 34 who declined to receive radiotherapy. Radiation therapy consisted of 4,500 cGy in 5 weeks to the chest wall and appropriate draining lymph nodes. Median follow-up from chemotherapy randomization is 45 months for patients in the CA arm and 53 months for those in the CMF/MF arm. The crude rate of local failure (chest wall or draining lymph node areas) as first site of failure for patients randomized to receive chemotherapy only was 14%; for those randomized to receive both chemotherapy and radiotherapy it was 5% (P = .03). For patients in the CMF/MF arm, the rate of local failure as the first site of failure was nearly the same for patients randomized to chemotherapy only as for those randomized to adjuvant radiotherapy as well (5% v 2%). For patients in the CA arm, the crude rate of local failure was 20% for patients randomized to receive chemotherapy only, and 6% for those randomized to both types of adjuvant treatment (P = .03). Among the 43 patients treated with CA who actually received radiotherapy, there was only one local failure, compared with 12 local failures among the 59 patients (20%) who actually did not receive radiotherapy (P = .007). No significant difference was seen in disease-free survival or overall survival in either the CA or the CMF/MF arm between patients randomized to receive radiation therapy and those randomized to no further treatment.(ABSTRACT TRUNCATED AT 400 WORDS)     

Endothelial cell loss due to repeated traumatic wound dehiscence after penetrating keratoplasty

A patient with keratoconus suffered two traumatic ruptures of her corneal graft wound, both of which were successfully repaired with restoration of graft clarity. There were also two apparently unrelated episodes of rejection. The endothelium was monitored by specular microscopy during this period. Our findings suggest that the insult to a transplanted cornea from an episode of rejection may be greater than that from traumatic wound rupture.     

Use of Telemetered Electrograms in the Assessment of Normal Pacemaker Function

The facility of direct real-time endocardial electrogram recording offered by newer pacemaker models can be helpful in the assessment of normal pacemaker function. Confirmation of the main hallmarks of sensing (amplitude, slew rate, and timing of the electrogram) can be achieved. Assessment of pacing capture also can be made; techniques for further analysis using external signal averaging can enhance this. The measurement of atrial and ventricular electrograms by telemetry has led to alterations in the protocol used at implantation to allow for the input impedance of the sensing circuit of the pacemaker. Accurate measurements of retrograde VA conduction times and confirmation of normal upper rate limit behavior of ODD pacemakers can be achieved simply and reliably using telemetered electrograms from the permanent pacemaker system.