Carl F. Anderson

Membranoproliferative glomerulonephritis. A prospective clinical trial of platelet-inhibitor therapy

Forty patients with Type I membranoproliferative glomerulonephritis were treated for one year with dipyridamole, 225 mg per day, and aspirin, 975 mg per day, in a prospective, randomized, double-blind, placebo-controlled study. At the base line, the half-life of 51Cr-labeled platelets was reduced in 12 of 17 patients. The platelet half-life became longer and renal function stabilized in the treated group, as compared with the placebo group, suggesting a relation between platelet consumption and the glomerulopathy. The glomerular filtration rate, determined by iothalamate clearance, was better maintained in the treated group (average decrease, 1.3 ml per minute per 1.73 m2 of body-surface area per 12 months) than in the placebo group (average decrease, 19.6). Fewer patients in the treated group than in the placebo group had progression to end-stage renal disease (3 of 21 after 62 months as compared with 9 of 19 after 33 months). The data suggest that dipyridamole and aspirin slowed the deterioration of renal function and the development of end-stage renal disease.

Neurovascular Complications of Dialysis and Transplantation

Dialysis and transplantation are now standard treatments for end-stage renal failure. Often, neurologists are consulted regarding the neurological complications of these therapeutic procedures. In addition to previously reported complications, neurovascular disease is being recognized as a cause of mortality and morbidity in these patients. We report two cases of apparent thromboembolic stroke in young patients with renal failure — one treated by dialysis and the other by renal transplantation. The risk factors of both dialysis and transplant are identified and data from the American College of Surgeons/National Institutes of Health Transplant Registry are reviewed.

Limitations of nutritional assessment in predicting the outcome of colorectal operations

The value of preoperative nutritional assessment in predicting postoperative morbidity and mortality is controversial. To evaluate the predictive value of preoperative nutritional status, the courses of 100 consecutive patients undergoing colorectal operations were studied prospectively. Subnormal findings for triceps-skin-fold thickness (TSF) and percentage of ideal body weight were associated with a significantly higher complication rate, but occurred so infrequently in our patients that the routine use of these tests is not recommended. Subnormal values for commonly obtained nutritional variables may not justify delay of operation for nutritional repletion.

Post Mortem: Solving History's Great Medical Mysteries

We are fascinated by other peoples problems; we are fascinated by celebrity-and when celebrities have problems, the effect is synergistic, rather than additive. This is not merely the province of tabloids and daytime television-serious scholars crave their fix of morbid gossip too. Historical diagnosis has a long and juicy history, and in Post Mortem , Mackowiak revisits some of the most controversial diagnostic conundra from ancient times to the more recent past. In many cases we have only documentary accounts or artistic representations, and the reports of the times may be coloured by hearsay, political spin or mistaken superstition. Be that as it may, we like to feel in touch with our forebears, and maybe there is no better way to do it than to pick over their symptoms, real or imagined. This volume arises from a selection of cases from a series of historical Clinicopathological Conferences (CPCs; analogous to the Grand Rounds or clinical meetings that we in the UK know and love) held by the author in Baltimore, where he is a distinguished professor of Medicine. The first case on Mackowiaks cold analytic slab is Egypts heretic sun king Akhenaten, who ruled in the glorious heyday of the New Kingdom in the 14th century BCE. Abandoning the ways of his forefathers, Akhenaten launched a radical programme in which he overturned the cults of the traditional Egyptian gods, and promoted the monotheistic worship of his one true god, represented by the solar disc, the Aten. Even the traditional representational art of Egypt was redefined , and his depictions show him with elongated limbs, a pot belly, a serpentine neck, and other features previously unseen-and unthinkable-in the normally austere and idealised Egyptian artistic canon. There has been a lively debate over whether these were depictions of Akhenaten in his true likeness, or an affected artistic style encapsulating new Atenist ideas of other-worldly royal divinity. Taking the former approach, many scholars have proposed diagnoses that might account for this etiolated phenotype. By far the most plausible proposition in my opinion is the connective tissue disorder Marfan syndrome, although Mackowiak ditches this on relatively flimsy grounds in favour of Klinefelter syndrome. Akhenaten and his wife, the legendary beauty Nefertiti, had at least six children who were represented in a similar style to Akhenaten himself, which would seem to exclude Klinefelter at a stroke, as Klinefelter syndrome causes infertility (and it …