James A. Greene

Goodpasture's syndrome: A report of five cases and review of the literature

Abstract Five cases of Goodpastures syndrome are presented and fifty-one other cases recorded in the literature since 1964 are reviewed. Certain clinical features of this syndrome remain prominent such as hemoptysis, anemia, hematuria and pulmonary infiltrates appearing in a young man with rapid development of renal failure or pulmonary hemorrhage, together with pathologic findings confined to the lungs and kidneys. However, other aspects of this syndrome appear to have changed, such as an apparent increased incidence, later age of onset, less male predominance, a longer possible survival time and a greater chance of recovery. Whether these changes represent a new pattern of the syndrome or reflect the influence of case selection or therapy is not evident at this time.

Serum Erythropoietin After Renal Homotransplantation

Excerpt Considerable information concerning the hormonal control of erythropoiesis can be gained from long-term studies of patients who receive renal transplants. The purpose of our study was to in...

Effect of Drug Therapy of Hemorrhagic Hypotension on Kinetics of Peritoneal Dialysis in the Dog

Peritoneal dialysis is commonly used as an adjunct in the treatment of acute and chronic renal failure. It has been shown previously that if peritoneal dialysis is carried out during hemorrhagic hypot

Toxicity of intraperitoneal bisulfite

Studies were carried out in animals to investigate the toxicity of intraperitoneal bisulfite. The LD50 (dose lethal to 50 per cent of the animals) for a single intraperitoneal injection of NaHSO3 was calculated in the mouse, rat, rabbit, and dog. Studies indicated that the LD50 dose was increased by dilution of the bisulfite. When sodium bisulfite was infused at a rate of 80 mg. of NaHSO3 per kilogram per hour in the portal vein of dogs having bilateral ureteral ligations, bisulfite did not accumulate in the serum. Autoclaving dialysis fluid substantially reduced its bisulfite concentration. These studies suggest that NaHSO3 in amounts usually added to dialysis solutions is unlikely to cause toxicity in patients undergoing peritoneal dialysis.

Spontaneously Reversible Retinal Detachment Occurring During Renal Insufficiency

Excerpt Reversible retinal detachment occurring in association with renal insufficiency is an entity that has not been emphasized sufficiently. It is the purpose of this study to describe eight pat...

Effects of Diazoxide on Renal Function in the Dog.

Summary Renal clearance and stop flow studies were done in dogs before and after infusion of diazoxide directly into the left renal artery. In all animals the left kidney showed a prompt diuresis, natriuresis and increase in creatinine or inulin clearance when diazoxide was given. No inhibition of distal tubular sodium reabsorption following diazoxide administration was found using the stop flow technique. The natriuresis produced by infusing diazoxide directly into the renal artery is probably due to renal vasodilation and resulting changes in intrarenal hemo-dynamics.

Localization of the site of action of triamterene diuretic.

Summary The pteridine compound triamterene was studied in 11 dogs using the stop flow method. These data support the hypothesis that the site of action of triamterene is the distal tubule of the kidney and that triamterene produces its natriuretic effect by reducing Na reabsorption in this area. No evidence was obtained for a proximal renal tubular effect.

Absence of Response of Anemia of Myxedema to Liver Extract

The clinical manifestations of myxedema are enough like those of pernicious anemia to account for the fact that myxedema is more often mistaken for pernicious anemia than for any other disease. Myxedema may present a yellowish pallor, absence of weight loss, achlorhydria, anemia, color index about unity, parasthesias, difficulty in walking (not true postero-lateral sclerosis), increased serum bilirubin (indirect van den Bergh), leukopenia, urobilinogen in the urine, and remissions. Five cases have been reported in which myxedema and pernicious anemia co-existed in the same patient. 1 ,2 The possibility that there may be a decrease or absence of Castles factor in the gastric secretion of patients with myxedema led us to determine the response to liver extract therapy of patients with myxedema. Five patients not reported here were similarly studied during 1930 and 1931 by Doctors F. N. Cole and A. S. Fourt in this hospital. No response was obtained in any case but the exact figures are not available. The initial hemoglobin and erythrocyte levels were not low enough in some of the cases to permit of much increase in reticulocytes. In one case in which the initial hemoglobin value was 54% and the color index was unity, there was a reticulocyte response up to 5.2%, but this response lasted until the 24th day and did not correspond to the usual reticulocyte crisis. After 41 days of treatment the hemoglobin had not increased and the erythrocytes had increased but 500,000 per cu. mm. The patient received thyroid extract during the last days of this period. In the other patients there was neither a reticulocyte increase nor an increase in hemoglobin or erythrocytes.

Efficacy of Pellets of Posterior Hypophysis and of Pitressin in Oil in Diabetes Insipidus

The efficacy of the subcutaneous administration of dried posterior pituitary gland in diabetes insipidus has not been reported previously. Pellets of this material have been prepared and implanted subcutaneously into 4 cats with experimentally produced diabetes insipidus∗ and into 2 patients with diabetes insipidus. The results are shown in Table I. It is to be noted that mixing the material with tyrosine or impregnating the pellet with beeswax did not prolong the effect in the cats. An inflammatory reaction which occurred at the site of implantation of sterile pellets in the patients later required drainage. An attempt was made to prolong the action in man by impregnation of the pellets with lanolin or beeswax. The reaction which developed at the site of implantation was so severe that the pellets had to be removed before complete absorption occurred. The above results demonstrate that pellets of dried posterior pituitary gland implanted subcutaneously control the manifestations of diabetes insipidus, but that this method is not applicable for treatment in man. For this reason pitressin tannatef in oil was employed. This material was administered to 3 cats with experimentally produced diabetes insipidus and to 3 patients with the syndrome. In the cats 1.0 cc ameliorated the manifestations for 3 to 7 days and in man for 30 to 82 hours. There were no unpleasant or deleterious general or local reactions. The symptoms of the disease have been controlled in the 3 patients by the subcutaneous injection of 1.0 cc every 36 to 57 hours.

Principles and Practice of Geriatric Psychiatry

At long last, here is a penetrating text in the field of geriatric psychiatry! When assembling a fellowship program in my early geropsych days, 1980 or so, only a couple of books were available, namely, Busse and Pfeiffers Behavior and Adaptation in Late Life (1969) and Verwoerdts Clinical Geropsychiatry (1976). These books contained roughly 200 to 250 pages each. More recently, the American Association for Geriatric Psychiatry sponsored the publication of Comprehensive Review of Geriatric Psychiatry (1991), edited by Sadavoy, Lazarus, and Jarvik (770 pages). Principles and Practice of Geriatric Psychiatry contains more than 1000 pages and includes 148 chapters by 206 contributors, who are, in general, recognized world authorities. Roughly half are from North America, with the balance from Western Europe and Asia. This book is welcome and will probably be considered the gold standard in geriatric psychiatry. A textbook like this represents a massive undertaking. The editors and