Ventricular tachycardia "with reversal of points" and electrolyte disorders

Ventricular tachycardia "with reversal of points" is described and its occurrence in electrolyte disorders (hypokalemia, hypomagnesemia), particularly in combination with antiarrhythmic drugs, is discussed. This ventricular tachykardia occurs in cases of disturbed and prolonged repolarization and is typified by periodically changing amplitude in the ECG ("reversal of points"). From the therapeutic point of view acceleration of heart rate by use of either sympathicomimetic drugs or pacemaker has proved successful. This distinguishes the treatment from that of other ventricular arrhythmias.     

Special aspects of severe fetomaternal transfusion

Seventeen strains of Yersinia enterocolitica were isolated on examination of the caecal contents from 100 bacon pigs at slaughter. In another material consisting of 222 pigs with various diseases, the bacterium was found in 12 cases. Three out of 40 dogs were positive for the bacterium. Seven of the porcine and one of the canine strains belonged to serotype O 3, which is a human pathogen.     

Nephrology/hypertension/fluid and electrolyte disorders

The following annotated bibliography has been developed for the purpose of providing to primary care physicians a handy source of review articles and major studies in the field of nephrology, hypertension, and fluid and electrolyte disorders. Almost all of the articles are review articles of clinical topics that would be of interest to the practicing physician. JAOA will be publishing additional annotated bibliographies in various fields of internal medicine over the next several months. The second in this series will appear in a forthcoming issue of THE JOURNAL.     

Clinical aspects of acid-base disorders]

Acid-base disorders are frequently recognized in a wide variety of clinical settings such as severe systemic hospitalized patients. The principal object is to assessment of acid-base equilibrium and to obtain an appropriate guide to therapy. The approach is centered to a systemic analysis of blood gas evaluation. To establish this complex matter is followed. Is an acid-base disorder present? Is the disorder a simple or a mixed abnormality? What is the primary cause? These evaluations should be obtained by accurate history taking, physical examination, and routine laboratory tests. In addition, the supporting analysises such as anion gap (AG) calculation, urine AG assessment, urine chloride concentration and so on are also useful for correct diagnosis. In view of the complexty and difficult expression of acid-base disorders, it is desirable that clinicians must have full knowledges of systemic approach to the blood gas analysis and its evaluation.     

Clinical neuropsychological aspects of motor disorders in patients with post-CVA epilepsy

The study included 22 patients with poststroke epilepsy (group 1) and 30 patients with stroke without epilepsy (group 2). A bilateral decrease of the time of central conduction (TCC) through pyramidal path (both on the paretic and intact side) was revealed in group 1. This was not observed in patients of group 2 with similar gravity of motor disorders (p < 0.01). Tendency to TCC decrease was also observed in patients without epileptic disorders by day 5-6 after ischemic stroke. However, TCC values were increased in such patients by day 10-14. Low indices persisted for a long time in patients with poststroke. There was also an increase of delta index of facilitation (the difference between TCC in rest and in muscle effort). It was also found that motor disorders in the group of patients with poststroke epilepsy were characterised by higher muscular tone than in poststroke patients with the same degree of the paresis.     

Cultural and historical aspects of eating disorders

A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.     

Human papillomavirus infection in women. Special aspects of infectious diseases in women

These studies assess the quantity and morphology of the emitted aerosolized dose of irregularly shaped disodium cromoglycate particles in the fine particle fraction using in vitro methods. Disodium cromoglycate was treated with a homologous series of saturated fatty acids, between C8 and C18, in a range of concentrations. The products of these treatments were powders with a variety of particle size, shape, and aggregation characteristics. Samples of these powders were loaded in gelatin capsules, generated as aerosols from a Rotahaler and collected in a two-stage liquid impinger or eight-stage inertial impactor. Particles were examined directly by scanning electron microscopy and subsequently the images were analyzed to define morphology. The aerodynamic fine-particle fraction determined by the two-stage impinger increased approximately twofold with lauric acid treatment (0.0317 g/g, 6.7%) and threefold with stearic acid treatment (0.58 g/g; 9.7%) compared with disodium cromoglycate alone (0 g/g, 3.56%). The lauric acid formulation appeared to alter deposition primarily by changing particle morphology. Stearic acid altered particle shape to some extent and the increase in the fine-particle fraction appeared to be attributable to improved particle dispersion properties. The uncontrolled presence of irregular-shaped particles can introduce dosing errors due to effects on dispersion and aerodynamic behavior. Conversely, controlled particle morphology and size may be employed to optimize the dose delivered to the lungs particularly if particle-particle and particle-surface interactions can be minimized.     

Gastrointestinal and nutritional aspects of eating disorders

Anorexia nervosa (AN) and bulimia nervosa (BN) are potentially fatal eating disorders which primarily affect adolescent females. Differentiating eating disorders from primary gastrointestinal (GI) disease may be difficult. GI disorders are common in eating disorder patients, symptomatic complaints being seen in over half. Moreover, many GI diseases sometimes resemble eating disorders. Inflammatory bowel disease, acid peptic diseases, and intestinal motility disorders such as achalasia may mimic eating disorders. However, it is usually possible to distinguish these by applying the diagnostic criteria for eating disorders and by obtaining common biochemical tests. The primary features of AN are profound weight loss due to self starvation and body image distortion; BN is characterized by binge eating and self purging of ingested food by vomiting or laxative abuse. GI complications in eating disorders are common. Recurrent emesis in BN is associated with dental abnormalities, parotid enlargement, and electrolyte disturbances including metabolic alkalosis. Hyperamylasemia of salivary origin is regularly seen, but may lead do an erroneous diagnosis of pancreatitis. Despite the weight loss often seen in eating disorders, serum albumin, cholesterol, and carotene are usually normal. However, serum levels of trace metals such as zinc and copper often are depressed, and hypophosphatemia can occur during refeeding. Patients with eating disorders frequently have gastric emptying abnormalities, causing bloating, postprandial fullness, and vomiting. This usually improves with refeeding, but sometimes treatment with pro-motility agents such as metoclopromide is necessary. Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.