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Changes in renal function in essential hypertension
I
Pneumonia Pulmonary clearance mechanisms
indlumlll chloride
Renal hemodynamics Water/sodium excretion
Plasma aidosterens
The occurrence of simultaneous tumors in different organs and the multicentric localization of the tumors in each OFthese organs are discussed on the basis of findings in a large kindred with Sipple’s syndrome.The invariable oca~~~enceof pheoc+romocytomachanges in accBssoIy adrenal tissue demonstrates the multicentricity of tumor development in Sipple’s syndrome. The aim of surgical treatment should be to remove all the pheochromocytoina tissue identified in the adrenal glands, the celiac plexus and side chain regions, thereby reducing the chance of recurrence of symptoms in these patients and the need for repeated surgical intervention. More extensive exploration of the chest, cervical regions, etc. was not considered justifiable. Medullary thyroid carcinoma is a dangerous tuner for which total thyroklectomy with extensive neck exploration is obligatory, preferably in an early stage. A short calcium test is described which is especially sensitive in this phase and useful for screening.
Lips CJM, Minder WH, Leo JR, Alleman A, Hackeng WHL: Evidence of multicentric origin of the multiple endocrine neoplasia syndrome type 2A (Sipple’s syndrome) in a large family in the Netherlands. Diagnostic and therapeutic implications. Am J Med 64: 569-578, 1976.
Sipple’s syndrome Pheochromocytoma Acessory adrenal glands Cortical nodules Hyperpiastlc medullary tissue
Multiple endocrine neopiasia 2A
Renal hemodynarnics. plasma renin activity (PRA) and aldosterone levels, and water and sodlurn excretion were studied in essential hypertension. Para-aminohippurate clearance (Cp& and PAH extraction ratio were normal or subnormal in those with benign hypertension and depressed in those with malignant hypertension.CpAHdkf not correlate inversely with blood pressue in benign hypertension. Later reexamination of untreated patients revealed a decrease in CPM, but no further increase in blood pressure. PRA was unrelated to renal hemcdynamics in benii hypertension. Water excretion correlated directly with blood pressure, and sodium excretion inversely with plasma aldosterone. There is no evidence for a primary renal disturbance in essential hypertension.
Reubi FC, Weidmann P, Hodler J, Cottier PT: Changes in renal function in essential hypertension. Am J Med 64: 556-563, 1976.
Essential hypertension Plasma renln activity
Continuedon page As3
A sensitive technic using indiumIi1 chloride was devised to investigate the occwence of phatyngeal aspiration. Twenty normal subjects and 10 patients with depressed consciousness were studied. Forty-five per cent of the normal subjects aspirated during deep sleep. Normal subjects who did not aspirate were noted to sleep poorly. Seventy per cent of the patients with depressed consciousness aspirated. Aspiration of pharyngeal secretions occurs frequently in patients with depressed sensorium and also in normal adults during deep sleep. Bacterial pneumoniamay result when aspirated bacteria are not effectively cleared. This may result when clearance mechanisms are impaired or when they are overwhelmed by large volumes of aspirated secretions.
Huxley EJ, Viroslav J, Gray WR, Pierce AK: Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 64: 564-568, 1976.
Pharyngeal aspiration Depressed consciousness
The heart was evaluated by echocardlography in 56 patients at risk for myocsrdial iron deposItion. Fifty-fourhad congenital anemia for which they required repeated transfusions,and two had primary hemochromatosis.The data, plotted according to one of three functionsof the body surface area, were compared to values obtained in 105 normal subjects whose age spanned a similar range. Left ventricular wall thickness, transverse dimension and mass, as well as left alrial transverse dimension,were increased in the majority of patients with chronic iron overload despite the infrequent occurrence of cardiac enlargement on routine chest films or electrocardiographic abnormality. Left ventricular ejection fraction was normal in all but four patients who died within a six month follow-up period suggesting that deterioration in systolic function indicates a poor prognosis. Echocardiography seems to provide a simple noninvasive means for assessing changes in cardiac structure and function that should prove useful in the serial evaluation of patients at risk for the development of myocardial iron deposition.
Henry WL. Nienhuis AW, Wiener M. Miller DR. Canale VC. Piomelli S: Echocardiographic abnormalities in patients with transfusion-dependent anemia and secondary myocardial iron deposition. Am J Med 64: 547-555, 1978.
Transfusion-dependent anemla Echocardiography Myocardial iron deposition Cardlac structure and function
Pneumonia Pulmonary clearance mechanisms
indlumlll chloride
Renal hemodynamics Water/sodium excretion
Plasma aidosterens
The occurrence of simultaneous tumors in different organs and the multicentric localization of the tumors in each OFthese organs are discussed on the basis of findings in a large kindred with Sipple’s syndrome.The invariable oca~~~enceof pheoc+romocytomachanges in accBssoIy adrenal tissue demonstrates the multicentricity of tumor development in Sipple’s syndrome. The aim of surgical treatment should be to remove all the pheochromocytoina tissue identified in the adrenal glands, the celiac plexus and side chain regions, thereby reducing the chance of recurrence of symptoms in these patients and the need for repeated surgical intervention. More extensive exploration of the chest, cervical regions, etc. was not considered justifiable. Medullary thyroid carcinoma is a dangerous tuner for which total thyroklectomy with extensive neck exploration is obligatory, preferably in an early stage. A short calcium test is described which is especially sensitive in this phase and useful for screening.
Lips CJM, Minder WH, Leo JR, Alleman A, Hackeng WHL: Evidence of multicentric origin of the multiple endocrine neoplasia syndrome type 2A (Sipple’s syndrome) in a large family in the Netherlands. Diagnostic and therapeutic implications. Am J Med 64: 569-578, 1976.
Sipple’s syndrome Pheochromocytoma Acessory adrenal glands Cortical nodules Hyperpiastlc medullary tissue
Multiple endocrine neopiasia 2A
Renal hemodynarnics. plasma renin activity (PRA) and aldosterone levels, and water and sodlurn excretion were studied in essential hypertension. Para-aminohippurate clearance (Cp& and PAH extraction ratio were normal or subnormal in those with benign hypertension and depressed in those with malignant hypertension.CpAHdkf not correlate inversely with blood pressue in benign hypertension. Later reexamination of untreated patients revealed a decrease in CPM, but no further increase in blood pressure. PRA was unrelated to renal hemcdynamics in benii hypertension. Water excretion correlated directly with blood pressure, and sodium excretion inversely with plasma aldosterone. There is no evidence for a primary renal disturbance in essential hypertension.
Reubi FC, Weidmann P, Hodler J, Cottier PT: Changes in renal function in essential hypertension. Am J Med 64: 556-563, 1976.
Essential hypertension Plasma renln activity
Continuedon page As3
A sensitive technic using indiumIi1 chloride was devised to investigate the occwence of phatyngeal aspiration. Twenty normal subjects and 10 patients with depressed consciousness were studied. Forty-five per cent of the normal subjects aspirated during deep sleep. Normal subjects who did not aspirate were noted to sleep poorly. Seventy per cent of the patients with depressed consciousness aspirated. Aspiration of pharyngeal secretions occurs frequently in patients with depressed sensorium and also in normal adults during deep sleep. Bacterial pneumoniamay result when aspirated bacteria are not effectively cleared. This may result when clearance mechanisms are impaired or when they are overwhelmed by large volumes of aspirated secretions.
Huxley EJ, Viroslav J, Gray WR, Pierce AK: Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 64: 564-568, 1976.
Pharyngeal aspiration Depressed consciousness
The heart was evaluated by echocardlography in 56 patients at risk for myocsrdial iron deposItion. Fifty-fourhad congenital anemia for which they required repeated transfusions,and two had primary hemochromatosis.The data, plotted according to one of three functionsof the body surface area, were compared to values obtained in 105 normal subjects whose age spanned a similar range. Left ventricular wall thickness, transverse dimension and mass, as well as left alrial transverse dimension,were increased in the majority of patients with chronic iron overload despite the infrequent occurrence of cardiac enlargement on routine chest films or electrocardiographic abnormality. Left ventricular ejection fraction was normal in all but four patients who died within a six month follow-up period suggesting that deterioration in systolic function indicates a poor prognosis. Echocardiography seems to provide a simple noninvasive means for assessing changes in cardiac structure and function that should prove useful in the serial evaluation of patients at risk for the development of myocardial iron deposition.
Henry WL. Nienhuis AW, Wiener M. Miller DR. Canale VC. Piomelli S: Echocardiographic abnormalities in patients with transfusion-dependent anemia and secondary myocardial iron deposition. Am J Med 64: 547-555, 1978.
Transfusion-dependent anemla Echocardiography Myocardial iron deposition Cardlac structure and function