Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Long-term maintenance with noninvasive nocturnal mechanical ventilation

Fractional barrier function

dextran clearances

Electrostatic

Glomerular

polyanion

Medical history

stethoscopa

Physical diagnaets

Alveolar nocturnal Neuromuscular

hypoventllatlon

Kyphoscollosis disorders

Hepatic occupational

Tumor Louisville experience

angiosarcoma

The clinical course of 10 patients with hepatic angiosarcoma following industrial exposure to vinyl chloride was studied. Following prolonged exposure to vinyl chloride, the onset of this disease is insidious,and the clinical picture is that of nonspecific hepatic injury with mildly abnormal biochemical liver test results. Carcinoembryonic antigen and alpha fetoprotein are undetectable. Radionuclide and angiographic studies of the liver show characteristic but nondiagnostic abnormalities. A definite diagnosis-isusually made only by open liver biopsy. Treatment is unsatisfactory, but chemotherapy seems to prolong survival. Average survival from diagnosis is about 12 months. Overt liver failure usuallyoccurs only as a preterminal event and is the major cause of death in all of our patients.

Dannaher CL, Tamburro CH, Yam LT: Occupational carcinogenesis: the Louisville experience with vinyl chloride_associated hepatic angiosarcoma. Am J Med 1981; 70: 279-287.

Carclnogenesls,

Vinyl chloride

This study describes eight patients with alveolar hypoventilation syndromes who presented with carbon dioxide narcosis and coma. After reversal of severe hypercapnia, all patients were discharged and maintained at home for an average period of 10 years utilizing long-term “noninvasive” nocturnal mechanical ventilation. This form of treatment has allowed these patients to continue their previously productive lives. This study represents a long-term follow-up regarding this mode of treatment in patients with alveolar hypoventilation.

Garay SM, Turin0 GM, Goldring RM: Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Long-term maintenance with noninvasive nocturnal mechanical ventilation. Am J Med 1981; 70: 269-274.

ventilation,

Chronic hypercapnla Mechanical

Gontlnueo on page A41

The invention of the stethoscope by Rene Th&phile Hyacinthe Laennec occurred within an emerging French tradAlonof bedside empiricism that combined physical diagnosiswith autopsy correlation. On the occasion of the bicentennial of the birth of the discoverer of mediate auscultation, we celebrate the life and work of one of the founders of modern medicine.

Kligfield P: Laennec and the discovery of mediate auscultation. Am J Med 1981: 70: 275-278.

Auscultatlon

Laennec

To investigate the mechanism of proteinurla in minimal change nephropathy the renal handling of dextrans was studii in seven nephrotic patients with this disorder. Although the urinary excretion of albumin was greatly increased, the urinary excretion and fractional clearance of dsxtrans [Einstein-Stokes radius (ESB) range 20 to 48A], were depressed relative to nonproteinuric heatthy volunteers. This suggests that mean glomerular pore size or pore density was reduced. Uptake of colloidal iron by glomeruli obtained from these patients by needle biopsy was diminished, suggesting loss of giornerular polyanion. Since the fractional clearance of dextrana similar in size to albumin was depressed, not increased, it is proposed that lack of electrostatic interaction between the glomerular capillaries and polyanionic plasma albumin (ESR = 36s accounts for the selective albuminuria which characterizes minimal change nePhnJPathY.

Carrie BJ, Salyer WB, Myers BD: Minimal change nephropathy: an electrochemical disordar of the gtomeruiar membrane. Am J Mad 1981; 70: 262-268.

pore sire

Proteinuria

Glomerular