Metabolic mimicry of Bartter's syndrome by covert vomiting: utility of urinary chloride determinations.

Bartter's syndrome characteristically exhibits the constellation of hypokalemic alkalosis with moderate kaliuresis, normotensive hyperreninemia, hyperaldosteronism, urinary hyperexcretion of prostaglandin E (PGE) and vascular hyporesponsivity to pressor agents. We describe precise biochemical mimicry of these metabolic abnormalities in a patient with surreptitious repetitive vomiting, in whom simple urinary chloride excretion data subsequently excluded the diagnosis of Bartter's syndrome.     

Dermatoses among poultry workers: “Chicken poison disease”

To investigate the causes of skin eruptions affecting poultry workers, we reviewed our medical records and surveyed a southcentral Pennsylvania poultry processing plant. Examination of the records of routine patch test clinic patients seen from January, 1981, to July, 1982, revealed three poultry workers with allergic contact dermatitis and one with irritant contact dermatitis. We then examined one hundred fifty workers at a poultry processing plant, noting the presence of occupational dermatoses, with special interest in the occurrence of contact dermatitis. We found thirteen dermatoses in nine workers. These included Candida infections, irritant contact dermatitis, allergic contact dermatitis, abrasions and cuts, warts, and dyshidrotic eczema.     

Co‐inheritance of Hb Hershey [β70(E14) Ala→Gly] and Hb La Pommeraie [β133(H11)Val→Met] in a Sicilian subject

Objectives: This report represents the first observation in Sicily of two rare β‐globin gene variants, Hb Hershey [β70(E14) Ala→Gly] and Hb La Pommeraie [β133(H11)Val→Met], found in a 35‐year‐old male patient from Messina, in the north‐east of Sicily during population screening for hemoglobinopathies. Methods: The occurrence of the Hb variants was assessed by cation exchange chromatography while complete blood counts were obtained using automatic cell counters. Red cell lysates were analyzed by electrophoresis at alkaline and acid pH. Stability of hemoglobin was checked by the isopropanol precipitation test and by the heat tests while inclusion bodies and reticulocyte count were determined by incubation of blood samples with brilliant cresyl blue. Molecular analysis was performed by DNA sequencing of β‐ and α‐globin genes. Results: We observed an abnormally high performance liquid chromatography elution with a slight reduction in mean corpuscular volume and mean corpuscular haemoglobin parameters and mutations at codon 70 G C C→G G C (Hb Hershey) and at codon 133 G TG→ A TG (Hb La Pommeraie) in β‐globin gene. Conclusion: Family analysis of three generations demonstrated the presence of these two mutations in trans. So it was possible to describe the phenotypes of these variants in a heterozygous state and in double heterozygous state.     

Nifedipine therapy for stable angina pectoris: preliminary results of effects on angina frequency and treadmill exercise response.

Ten patients with stable angina pectoris secondary to atherosclerotic coronary artery disease received nifedipine (10 mg and 20 mg orally three times daily, each for 2 weeks) or placebo (for 2 weeks) in a single-blind manner during a 6 week period. One patient was excluded because nocturnal and resting angina developed while he was receiving placebo. The frequency of anginal attacks in the remaining nine patients decreased from 11.2 ± 2.2 (mean ± standard error of the mean) per patient per week during administration of placebo to 7.1 ± 1.6 during therapy with nifedipine at 10 mg and to 6.3 ±1.7 during administration of 20 mg of nifedipine (P < 0.05 for both doses of active drug versus placebo). Nitroglycerin consumption similarly decreased from 8.9 ± 2.3 tablets per patient per week (placebo) to 4.8 ± 1.4 tablets during administration of 10 mg of nifedipine and to 4.2 ± 1.2 during therapy with 20 mg of the drug (P < 0.05 for both doses of drug versus placebo). Duration of treadmill exercise increased from 368 ± 50 seconds (placebo) to 471 ± 72 seconds at the 10 mg dose of nifedipine and 522 ± 79 seconds at 20 mg (P < 0.05 for both doses versus placebo). Maximal S-T segment shift and product of heart rate × systolic blood pressure did not differ between the placebo period and that of active drug therapy. Treadmill exercise performed during subsequent double-blind, randomized crossover treatment with placebo and nifedipine revealed increased exercise duration after nifedipine therapy (524 ± 49 seconds) compared with that after placebo (462 ± 52 seconds) (P < 0.005) but, again, maximal S-T shift and the product of heart rate × systolic blood pressure did not differ. Side effects from nifedipine were minor and easily tolerable. The results seem to indicate that nifedipine prolongs exercise time by decreasing heart rate × systolic blood pressure product at a given work load, possibly in a manner similar to that of long-acting nitrate therapy.     

Quantitative variability in regional wall motion during serial left ventricular cineangiography: guidelines for assessing changes in segmental function with intervention studies

To assess the random variation in left ventricular (LV) volume and regional wall motion that occurs with quantitative analysis of LV cineangiography, 15 patients underwent 2 serial biplane LV cineangiograms in the 30 degrees right anterior oblique and 60 degrees left anterior oblique projections. Cineangiograms were separated by a waiting period of at least 15 minutes. Regional wall motion was quantitated with an area ejection fraction (EF) technique that divides the left ventricle into 8 areas. There were no significant changes in heart rate, mean arterial pressure or LV pressure or volume between the first and second angiograms. However, global EF increased from 0.57 +/- 0.11 to 0.58 +/- 0.10 (p = 0.055). Random variability in area EF was greatest in the septal and low posterolateral regions and least in the inferior and inferobasal regions of the left ventricle. Using linear regression analysis to obtain 95% confidence intervals, we determined the amount of absolute increase in area EF that must occur to be considered significant for each LV region. This amount varies from area to area and is as little as +/- 0.06 in the inferior region (area 4) and as high as +/- 0.16 in the septum (area 8). These data provide guidelines for the determination of the influence of interventions on regional wall motion in individual patients with cardiac disease, and indicate that statistically significant changes in regional wall motion are clinically important.     

Vascular anastomoses in growing vessels: the use of absorbable sutures

Primary end-to-end infrarenal aortic anastomoses were performed in 36 piglets using two synthetic absorbable suture materials: polydioxanone and coated polyglactin. Animals were killed at 1, 4, and 11 weeks and 6 months following operation. Each aorta was removed, burst-tested to 300 mm Hg, radiographed, and examined histologically. All anastomoses were patent, and no burst-test failures occurred. Stenosis occurred in 14 of 17 animals at 1 and 4 weeks, respectively. One of 5 animals exhibited stenosis at 11 weeks, and none of the 14 animals had stenosis 6 months postoperatively. Histological examination revealed fibrosis replacing areas of disrupted elastica at 6 months in both suture groups. This study suggests that absorbable suture material, in particular polydioxanone, because of its excellent handling characteristics and prolonged tensile strength retention, will be useful for the repair of vascular and cardiac anomalies where growth of the suture line is required.