Herbert L. Fred

Acute Pulmonary Edema of Altitude Clinical and Physiologic Observations

Three separate episodes of acute pulmonary edema are described that developed in two otherwise healthy individuals during heavy exertion at high altitudes. Detailed physical examination and laboratory studies failed to demonstrate pulmonary infection or cardiac disease. Data obtained by cardiac catheterization during one of these episodes revealed elevation of the pulmonary artery pressure and a normal left atrial pressure. This syndrome appears to be the consequence of pulmonary vascular obstruction distal to the capillary bed, presumably in the pulmonary veins. It is brought about by exposure of susceptible individuals to high altitudes, and is completely reversed by oxygen administration.

Hepatic portal venous gas: A review and report on six new cases

Abstract Six new cases of hepatic portal venous gas (HPVG) and forty-six previously reported cases are reviewed. Roentgenographically, gas in the intrahepatic ramifications of the portal vein characteristically appears as branching, tubular lucencies extending from the porta hepatis to the edge of the liver. Generally, patients with this sign are critically ill and have intestinal distention, often accompanied by abdominal pain, vomiting and diarrhea. In most instances HPVG probably results from gas-forming organisms which gain entry into the portal venous system via a disrupted intestinal mucosa. Over 90 per cent of those affected die. Treatment should be directed toward correcting the underlying disorder which usually is intestinal infarction in adults and enterocolitis in infants.

Occurrence of retinal pigmentation, ophthalmoplegia, ataxia, deafness and heart block: Report of a case, with findings at autopsy

Abstract A thirteen year old boy presented with facial weakness, ophthalmoplegia, retinal pigmentation, nerve deafness, mild ataxia and an elevated spinal fluid protein. Subsequently, there were disturbances in cardiac conduction with fatal outcome. Postmortem studies disclosed only minor changes in the extrinsic muscles of the eye and gave no clue as to the etiology of the cardiac conduction defect. No changes were demonstrated in the central nervous system or in the peripheral nerves. The length of illness and its progression suggest that in this case a familial disorder is represented which has clinical similarity to cases reported previously under the term, Refsums disease or heredopathia atactica polyneuritiformis.

Descriptive profiles of highly skilled women volleyball players.

Descriptive profiles were developed for 15 members of the United States Womens National Volleyball Training Team. Data were obtained from anthropometric, strength, physiologic, and motor performance domains. Within-group comparisons were made between the six women who were selected for the Pan-American Team and the nine who were not. The Pan-American selectees were taller and heavier and demonstrated greater motor ability than the non-selectees. Strength measurements did not indicate consistent differences between the two sub-groups. The non-selected players had a greater VO2max than those selected. Between-group comparisons on selected variables were made between the subject and other American women volleyball players. The training team subjects were taller and heavier than the comparative groups. The training team group demonstrated lower heart rate MAX (180 beats/min) than the other groups reported, and their VO2max (43.2 ml/kg/min) was within the range of the comparative groups.

A patient with Wegener's granulomatosis exhibiting unusual clinical and morphologic features

Abstract A patient with Wegeners granulomatosis is presented in whom several unusual manifestations were observed, including cerebral arteritis, an aneurysm of the left vertebral artery resulting from the arteritis, and three pulmonary cavities with unusually thin walls. The focal glomerular changes observed at necropsy showed regression in severity when compared to those seen in two renal biopsy specimens obtained during life. Renal function remained good, and death was attributed to the cerebral arteritis. The value of renal biopsy in establishing the diagnosis is emphasized. Corticosteroid therapy in doses sufficiently large to suppress completely the inflammatory elements of the disease is recommended.

Pheochromocytoma masquerading as overwhelming infection

Abstract A patient is described who had fever, hypotension, tachypnea, hyperpnea, tachycardia, sweating, flushed facies, and leukocytosis. Her hypotension responded to the replacement of fluid, but the other clinical abnormalities persisted, and were accompanied later by paralytic ileus, higher fever, and the development of a precordial systolic ejection murmur of progressively greater intensity. The clinical impression initially was gram-negative bacteremia, and, finally, bacterial endocarditis. Antemortem proof of infection, however, never was obtained. At necropsy, the only significant finding was an unsuspected pheochromocytoma containing epinephrine. Evidence is presented to support the contention that the tumor was responsible for the clinical features observed.

Clinical studyHepatic portal venous gas: A review and report on six new cases

Abstract Six new cases of hepatic portal venous gas (HPVG) and forty-six previously reported cases are reviewed. Roentgenographically, gas in the intrahepatic ramifications of the portal vein characteristically appears as branching, tubular lucencies extending from the porta hepatis to the edge of the liver. Generally, patients with this sign are critically ill and have intestinal distention, often accompanied by abdominal pain, vomiting and diarrhea. In most instances HPVG probably results from gas-forming organisms which gain entry into the portal venous system via a disrupted intestinal mucosa. Over 90 per cent of those affected die. Treatment should be directed toward correcting the underlying disorder which usually is intestinal infarction in adults and enterocolitis in infants.

Pulmonary arterial webs. A new angiographic sign of previous thromboembolism.

PULMONARY angiograms performed serially are useful in defining the natural history of pulmonary thromboemboli.1 We recently encountered a patient suspected of having acute pulmonary thromboembolism...

Grossly bloody urine of runners.

A study of 13 men with grossly bloody urine induced by running incriminated the urinary bladder neck or posterior urethra as the site of blood loss. Our evidence also showed that diet lacking in animal protein can play a causative role. The ailment seems to have no long-term sequelae and may not affect female runners. Although we recommend medical evaluation for any runner with gross hematuria, the extent of diagnostic work-up and any modification of the victims training problem program will depend on the circumstances in each case.

Sudden Loss of Consciousness, Dyspnea, and Hypoxemia in a Previously Healthy Young Man

A previously healthy 37-year-old man had a sudden syncopal episode that lasted an estimated 10 seconds. The patient’s wife, who witnessed the event, said that his eyes rolled back and that he urinated but had no tonic-clonic activity. On regaining consciousness, he complained of dizziness, shortness of breath, and sweating. An emergency medical service then brought him to the hospital. In the emergency department, the patient complained of shortness of breath but denied chest pain, cough, fever, headache, weakness, or previous neurological difficulty. He had no significant past medical history and had been well before losing consciousness. On physical examination, the patient was alert and oriented but anxious and dyspneic. His oral temperature was 99°F; pulse, 115 bpm and regular; blood pressure, 105/70 mm Hg; and respirations, 20 breaths per minute. Cranial nerve function and optic fundi were normal. Neck veins were not distended, and the precordium was quiet, with normal heart sounds and no murmurs. Lungs were clear to auscultation. Abdominal findings were unremarkable, and the extremities had full, equal pulses with no edema. The chest radiograph and ECG obtained at entry appear in Figs 1⇓ and 2⇓, respectively. Arterial blood gas analysis (room air) disclosed a pH of 7.46, a Paco2 of 30 mm Hg, a Pao2 of 52 mm Hg, and an O2 saturation of 89%. Results of the following laboratory studies were normal: complete blood count; urinalysis; serum creatinine, calcium, phosphorus, and electrolytes; blood sugar and urea nitrogen; and liver function tests. Figure 1. Chest radiograph showing prominent central pulmonary arteries with abrupt tapering of the lower lobe branches (especially the left), possible …