Parietal Cell and Intrinsic Factor Antibodies in a Finnish Rural Population Sample

Parietal cell and intrinsic factor antibodies were studied in the sera of 156 inhabitants of Pornainen. Parietal cell antibodies were found in 8 per cent of the ‘random sample’, consisting of 135 subjects, and in 34 per cent of the ‘high risk group’ consisting of 29 subjects with decreased gastric secretion. Intrinsic factor antibodies were found in 3 cases in the ‘high risk group’. Two of these had manifest and one latent pernicious anaemia. It seemed that the determination of gastric antibodies may be of some value in screening for severe atrophic gastritis and pernicious anaemia.     

����������������Ƶ�ҩ���������

持续性肾脏替代治疗(CRRT)时药物剂量的调整由于影响因素众多而较为复杂。适宜的个性化剂量调整,对于保证患者有效治疗和减少药物毒副反应以及抗菌药物耐药产生均十分重要。文章介绍CRRT时影响药物清除的主要因素,以及药物剂量调整的基本原则。     

Evaluation of clinical tools and their diagnostic use in distal symmetric polyneuropathy

AimsTo compare the diagnostic usefulness of tuning fork, monofilament, biothesiometer and skin biopsies in peripheral neuropathy in individuals with varying glucose metabolism.MethodsNormoglycaemic, impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) individuals were recruited. Nerve conduction studies (NCS) and thermal threshold tests were performed. Vibrotactile sense was tested with a biothesiometer and a 128-Hz tuning fork. Touch/pressure perception was examined with a 10-g monofilament. Skin biopsies were performed and intraepidermal nerve fibres were quantified. Distal symmetric polyneuropathy (DSPN) was defined as neuropathy disability score ≥2 and abnormal NCS. Thermal threshold tests were used to define small nerve fibre neuropathy (sDSPN) in cases where NCS (large nerve fibres) were normal.ResultsThe prevalence of DSPN and sDSPN in the whole group (n = 119) was 18% and 23%, respectively. For the biothesiometer, a cut-off of ≥24.5 V had a sensitivity of 82% and specificity of 70% (AUC = 0.81, 95% CI 0.71–0.91) when evaluating DSPN. An intraepidermal nerve fibre density cut-off of ≤3.39 fibres/mm showed a sensitivity of 74% and specificity of 70% in the detection of sDSPN, whereas the sensitivity of the tuning fork and the biothesiometer were relatively low, 46% and 67%, respectively. When combining skin biopsies with the tuning fork, 10 more sDSPN cases were identified. Adding skin biopsy to the combination of the tuning fork and biothesiometer increased the sensitivity of finding sDSPN cases, but not DSPN, from 81% to 93%.ConclusionUsing a biothesiometer in clinical routine might be a sensitive method to detect large nerve fibre dysfunction in the lower extremity, whereas skin biopsies in combination with methods measuring vibrotactile sense could increase the diagnostic sensitivity of detecting peripheral neuropathy at an early stage.     

Renal Tubular Acidosis Secondary to Jejunoileal Bypass for Morbid Obesity

Renal handling of acid and base was studied in patients with persistent metabolic acidosis 3–9 years after jejunoileal bypass for morbid obesity. Excretion of acid was studied before and after intravenous infusion of NH₄Cl and excretion of bicarbonate after infusion of NaHCO₃. Bypass patients showed impaired capacity for acidification of urine. The lowest urinary pH was 5.53 ± 0.10 in 10 bypass patients and 4.76 ± 0.06 in 6 controls. The corresponding values for standard bicarbonate in plasma were 15.0 ± 0.3 mM and 15.8 ± 0.3 mM. Glomerular filtration rate was identical in the two groups. Fractional loss of bicarbonate in urine was higher in controls than in bypass patients. The renal impairment is classified as distal renal tubular acidosis.     

Gastric Biopsy in Peptic Ulcer: A Follow-up Study

Fundal biopsy was performed in 155 peptic ulcer patients (GU 65, DU 90) and antral in 43 (GU 17, DU 26) of the 155 patients. In GU fundal gastritis was found in 74 and antral in 94 % of the cases. In DU the percentages were 16 and 65 respectively. In a short-term follow-up of 30 patients (GU 15, DU 15) the state of the fundal macosa remained essentially unchanged in 19, became worse in 6, and possibly showed an improvement in 5. In a 1–6 year follow-up of 58 patients (GU 28, DU 30) the same type of mucosal structure was preserved in 40, worsening of the changes in 13, and some improvement in 5.     

Polymyositis: Essential Information for Primary Care Providers

Polymyositis is one of a rare group of skeletal muscle diseases known as idiopathic inflammatory myopathies. The etiology is not fully understood, and its clinical presentation is often vague yet similar to more common neuromuscular diseases, making diagnosis difficult. A number of different tests are available to assist providers in making an accurate diagnosis. Once a diagnosis is made, there are a number of various treatment modalities available. Nurse practitioners must be familiar with treatment protocols and follow-up. The focus of this article is on polymyositis; its presentation, signs, and symptoms; the process of accurate diagnosis; and common treatment strategies.