Lyle A. Baker

Gross hematuria in sickle cell trait and sickle cell hemoglobin-C disease.

Summary 1.The occurrence of gross hematuria in five cases of sickle cell trait and three cases of sickle cell hemoglobin-C disease is reported. The investigation of these patients included electrophoretic and fetal hemoglobin studies. 2.Some of the previous cases of sickle cell trait reported with symptoms of crisis and/or hematuria might well have been sickle cell hemoglobin-C disease. The literature is reviewed in this connection. 3.The finding of hematuria with sickle cell trait in a significant number of patients is believed to indicate a significant relationship. 4.The singular susceptibility of the kidney to stress associated with sickle cell trait is offered as a possible etiologic mechanism for the vascular defects causing hematuria.

THE MUCOCUTANEOUS LESIONS OF REITER'S SYNDROME

Excerpt In recent years we have observed a number of patients with Reiters syndrome. Although the triad of urethritis, conjunctivitis and arthritis is now rather well known, the high incidence of ...

Intestinal absorption of iodine 131-labeled triolein and oleic acid in normal subjects and in steatorrhea.

Summary 1.The absorption of triolein and oleic acid may be adequately quantitated in the normal using I 131 -labeled preparations. 2.The absorption of triolein and oleic acid in digestive and absorptive defects with steatorrhea would appear characteristic enough to differentiate these defects from the normal and from each other.

Pepticulcer in laennec’s cirrhosis

In an investigation of 417 cases of Laennec’s cirrhosis, peptic ulcer was found in 13.9 per cent. Of these patients with peptic ulcer 28 per cent, or 16, were admitted because of hemorrhage from the ulcer. Some of the factors leading to this increased incidence of peptic ulcer in patients with Laennec’s cirrhosis are discussed.

BILATERAL RENAL VEIN THROMBOSIS AND THE NEPHROTIC SYNDROME

Excerpt Gradual thrombotic occlusion of the renal veins may be manifested by the nephrotic syndrome.1-9The entity is characterized by anasarca, proteinuria, hypoproteinemia and hyperlipemia in a pa...

Cardiac rupture associated with metastases to the heart from cardinoma of the duodenum

Abstract Metastases to the heart from a primary carcinoma in the duodenum weakened the myocardium and precipitated cardiac rupture in a patient with rheumatic heart disease. The case is without parallel in the literature, as far as we can ascertain.

Adrenocorticotropin and cortisone in the treatment of severe Reiter's syndrome.

Excerpt Reiters syndrome, a condition of undetermined etiology, is manifested by urethritis, conjunctivitis and arthritis, and in its moderate and severe forms follows a characteristic course over...

Blood volume in congestive heart failure as determined with iodinated human serum albumin

Abstract 1.1. Blood volume was determined in thirty-two cases of congestive heart failure. Repeat determination was made in twenty-five of the patients after treatment leading to compensation. Human serum albumin labeled with I 131 was used in making these studies. 2.2. Blood volume was elevated above normal in those cases studied. Total packed red cell volume was more markedly elevated than plasma volume. 3.3. In response to therapy the plasma component was more labile and decreased more rapidly than the cellular component. Hematocrit increased with therapy. 4.4. During recovery from congestive heart failure the rate of apparent destruction of erythrocytes exceeded, in some instances, the expected calculated rate of destruction.

Temporal arteritis occurring in a Negro.

Abstract A case of temporal arteritis is presented. This is the first case reported in a member of the Negro race. The clinical course is characteristic with persistent low-grade fever, inflammation of the temporal arteries, and relief of pain by severance. The artery not severed apparently gave rise to persistent mild symptoms, with recurrence finally disappearing on section. The patient had a weakly positive serology on two occasions. He had an old history of syphilis. Definite arteriosclerotic changes are present in the patient including coronary insufficiency and funduscopic changes. The course was benign with complete subsidence of symptoms referable to temporal arteritis, but persistence of symptoms of moderate myocardial insufficiency and coronary artery disease, suggesting involvement of multiple arteries. The pathological picture of the arteries in this patient demonstrated round-cell infiltration of all layers with thickening, particularly of the intima and media. No eosinophilic or polymorphonuclear leucocytes were present. Scattered giant cells were detected.

Clinical analysis of the S wave pattern electrocardiogram: An investigation including extensive unipolar lead studies☆

Abstract A study of otherwise normal electrocardiograms of fifty-two patients showing S waves in all standard limb leads was carried out, using precordial leads, six unipolar limb leads, and right upper quadrant and left upper scapular unipolar leads. The S waves in the standard limb leads were 25 per cent or more than the R deflection in the same lead. The clinical diagnoses in fifty-two patients were heart disease in twelve, hypertension alone in one, pulmonary disease alone in eleven, and hypertension and pulmonary disease together in two cases, while in twenty-six patients there was no disease present which would influence the electrocardiogram. The only positive correlation which was noted from inspection of the standard limb leads was that when the S-wave deflections were of considerable magnitude in all leads there was a high incidence of pulmonary disease. Unipolar lead studies were made in an attempt to establish criteria for differentiating patients with disease from those without disease and for correlating the electrocardiographic findings with the clinical findings. The multiple unipolar precordial leads offered no assistance in this respect. By grouping the various patterns noted in the unipolar limb leads, it was found that the pattern designated as Type 1 was associated with a very high incidence of cardiovascular or pulmonary disease. The remaining types did not contribute any further information. The unipolar leads from the right upper quadrant and left upper scapular areas were of no more than slight value in determining the presence of hypertrophy of either ventricle. It is probable that the fundamental factor in determining the presence of S waves in the standard limb leads is the position of the heart. A tendency toward a vertical position with the apex displaced posteriorly is the most common cause. A heart in a transverse position with marked counterclockwise rotation on its long axis rarely will give rise to such a pattern. Cardiac or pulmonary disease is active in producing the pattern only insofar as it may contribute to such cardiac positions. In one-half of the patients studied, this electrocardiographic pattern was a normal characteristic of the individual. It is concluded from this study that such extensive unipolar lead investigations are impractical as a routine clinical procedure because of the relatively little clinical value that they yield. Tracings meeting the criteria used in this paper are obtained in approximately 2 per cent of all electrocardiograms taken on adults.