Thallium-scan myocardial defects and echocardiographic abnormalities in patients with sarcoidosis without clinical cardiac dysfunction: An analysis of 44 patients

Sarcoidosis of the myocardium, an illness occurring predominantly in young adults, frequently becomes clinically apparent when the disease is far advanced. Since the thallium myocardial perfusion scan (TMPS) is known to be capable of detecting granulomas, it seemed to be promising as a noninvasive means of screening for this complication of sarcoidosis. We, therefore, examined 44 consecutive patients with sarcoidosis, none of whom had clinical evidence of heart disease, utilizing TMPS, echocardiography, electrocardiography, systolic time interval ratios (PEP:LVET) and 24-hour Holter monitoring. TMPS disclosed left ventricular defects in 14 patients (32 per cent) and abnormalities of the right ventricle in an additional four patients. Left ventricular abnormalities on the TMPS were associated with echocardiographic evidence of left ventricular dysfunction (widened mitral E point septal separation) but not with abnormalities on Holter monitoring or electrocardiograms. Systolic time interval ratios were insensitive but highly specific for the presence of abnormalities on the TMPS. We conclude that the TMPS frequently discloses abnormalities in sarcoidosis, which may be a reflection of its sensitivity in this setting.     

“脾肾安和”论治劳淋

劳淋为久病痼疾,病程缠绵反复、迁延难愈。膀胱湿热乃致病因素,脾肾亏虚为病理基础。脾肾亏虚为本,脾肾二脏的盛衰决定着本病转归。治以补脾益肾,无比山药丸加减。脾气得充,肾气得复,膀胱气化通利,水道通畅,纵有湿热之邪亦不足为患,可正胜邪去,疾病向愈。脾肾安和是治疗劳淋的关键。     

Renal studies in the hypothyroid rat

Whole kidney clearance studies were performed on 27 hypothyroid rats (H) and 25 euthyroid littermate rats (C). Absolute glomerular filtration rate (GFR) was less in hypothyroid rats (1.02 versus 1.39 ml/min), but when factored by body surface area (BSA) the two groups were comparable ($\text{GFR}\text{BSA}\text{= 2.26 versus 2.24 μl}\text{/min/sq/cm}$). Absolute and fractional (per GFR) sodium clearance was greater in the hypothyroid animals ($\text{C}{}_{\mathrm{Na}}\text{GFR:H}\text{= 0.36, C = 0.11, p < 0.001}$), but total electrolyte (Na⁺ + K⁺) excretion and clearance were comparable. End proximal tubular fluid (TF) micropuncture collections in 20 animals revealed no change in fractional reabsorption ($\text{TF}\text{P}$ inulin) in hypothyroid rats ($\text{TF}\text{P}$ insulin, 2.5 versus 2.7), but showed a decrease in single nephron GFR (Vo, 17 versus 36 nl/min) and absolute reabsorption (11 versus 20 nl/min). Hypothyroidism is associated with a decrease of sodium reabsorption at nephron sites distal to the convoluted proximal tubule. With ad libitum electrolyte and water intake most rats can maintain themselves in volume-sodium balance, but an occasional animal may display this distal leak syndrome in the extreme. One such rat had a urinary sodium concentration U_Na of 147 mEq/liter and a urinary flow rate of 56.0 μl/min (H = 3.33, C = 1.39). In addition, its hydropenic normal end proximal $\text{TF}\text{P}$ inulin mean of 2.7 confirmed the inability of the proximal nephron to compensate for this late leak. This rat's plasma sodium was 128 mEq/liter (H = 147, C = 148), dilutional hyponatremia. These renal problems are similar to those reported in man and suggest that the rat is an appropriate model for the study of human hypothyroidism.     

Platelet antibody in prolonged remission of childhood idiopathic thrombocytopenic purpura

Evaluations were performed in 20 patients with childhood idiopathic thrombocytopenic purpura (ITP) who remained in remission longer than 12 months. The mean duration of follow-up from diagnosis was 39 months (range 17 to 87 months). Eleven patients (four girls) in group 1 had an acute course of ITP, defined as platelet count greater than 150 X 10(9)/L within 6 months of diagnosis. Nine patients (five girls) in group 2 had a chronic course, defined as platelet count less than 150 X 10(9)/L for greater than or equal to 1 year or requiring splenectomy in an attempt to control hemorrhagic symptoms. Mean age at diagnosis and duration of follow-up were similar for both groups. Platelet count and serum (indirect) platelet-associated IgG (PAIgG) levels were normal in all 20 patients at follow-up. Both direct and indirect PAIgG levels were measured using a 125I-monoclonal anti-IgG antiglobulin assay. All had normal direct PAIgG levels, except for one patient in group 1 who had a borderline elevated value of 1209 molecules per platelet. These data suggest that the prevalence of elevated platelet antibodies is low during sustained remission without medication in patients with a history of childhood ITP. These data may be relevant for pregnant women with a history of childhood ITP, with regard to the risk of delivering an infant with thrombocytopenia secondary to transplacental passage of maternal platelet antibody.