Thomas W. Sheehy

Acute pulmonary edema in falciparum malaria. A clinicopathological correlation.

Abstract Clinical and autopsy findings correlated in five patients with pulmonary edema due to acute falciparum malaria disclosed that the clinical illness was characterized by progressive deterioration, severe cerebral dysfunction, overt intravascular hemolysis and marked parasitemia. In all cases rapidly lethal pulmonary edema, unresponsive to vigorous therapy, occurred in the absence of detectable cardiac decompensation or fluid retention. This study suggests that abnormalities of the pulmonary microcirculation have a central role in the pathogenesis of pulmonary edema in malaria.

Complications of Falciparum Malaria and Their Treatment

Excerpt Infection withPlasmodium falciparummay result in such potentially lethal complications as acute renal failure, blackwater fever, cerebral malaria, and pulmonary involvement. These complicat...

Pathophysiology of Acute Falciparum Malaria* I. Correlation of Clinical and Biochemical Abnormalities

This prospective study of naturally acquired falciparum malaria in twenty-six American soldiers was performed in Vietnam. All subjects were nonimmune, receiving weekly chemoprophylaxis, and studied during their initial clinical episode of malaria. The sequential changes in clinical and laboratory abnormalities are defined and correlated. Clinical observations which warrant increased emphasis include the high incidence and long duration of orthostatic hypotension and splenomegaly. In addition to previously reported laboratory abnormalities, severely ill patients had hyponatremia, reversal of the urinary sodium to potassium ratio, increased urinary aldosterone excretion and urinary osmolality markedly exceeding that of serum during hyponatremia. There was a positive correlation between the clinical illness and laboratory abnormalities. A hypothesis in which a decrease in effective circulating blood volume plays a central role is presented.

Treatment of Chloroquine-resistant Plasmodium falciparum Infections in Vietnam

Excerpt Since Moore And Laniers (1) report of two patients with chloroquine-resistantPlasmodium falciparuminfections acquired in the Magdalena Valley of Columbia in 1961, a fear has existed among ...

Quinine, pyrimethamine, and sulphorthodimethoxine: clinical response, plasma levels, and urinary excretion during the initial attack of naturally acquired falciparum malaria.

Plasma concentrations and urinary excretion rates of antimalarial drugs were studied during acute illness in 15 patients with naturally acquired falciparum malaria despite chloroquine‐primaquine prophylaxis. The therapeutic regimen included single oral doses of sulphorthodimethoxine and pyrimethamine in combination with a 14 day course of quinine. The plasma half‐life of a 1 Gm. dose of sulphorthodimethoxine was 200 hours with levels exceeding 8 mg. per 100 ml. for 4 days. Plasma‐pyrimethamine concentrations remained relatively stable during the 14 day study. For both drugs a slow rate of urinary elimination accounts for sustained plasma levels following single doses. Doses of 650 mg. of quinine every 8 hours produced mean plasma levels in excess of 11 mg. per liter during the first 5 days. Thereafter the concentration gradually declined to levels observed in patients receiving quinine during relapse and experimental infections. Transient hepatic dysfunction during the acute phase of the illness may account for the initial elevation and subsequent decline during continued administration. In all patients the clinical illness was promptly controlled and no toxicity developed. There were no relapses. The advantages of single‐dose oral therapy, the promising clinical results, and low incidence of toxicity suggest that sulphorthodimethoxine may be an important antimalarial drug and that further clinical and pharmacological investigation is warranted.

Alimentary Lipemia and the Coagulability of Blood Analysis by Thrombelastography and Silicone Clotting Time

The effect of alimentary lipemia on the coagulation of blood has been studied by means of thrombelastography as a new approach to this problem. Our observations revealed no acceleration of blood coagulation during the phase of alimentary lipemia by this method, which is one of the few technics capable of demonstrating a state of hypercoagulability.

The Gastric Mucosa in Tropical Sprue

Summary Thirty Puerto Rican tropical sprue patients were evaluated for gastric function, and gastric mucosal abnormalities. 1.Twenty, or 67 per cent, of the patients demonstrated a gastric lesion. Six had simple gastritis and 14, or 47 per cent, had atrophic gastritis. 2.The gastric mucosal lesions correlated well with gastric acidity and uropepsin secretion, but we were unable to correlate B12 absorption because of the small bowel lesion. 3.Age, anemia, xylose absorption, serum carotene, vitamin A absorption, fecal fat excretion, jejunal lesions, and small bowel x-ray studies revealed no correlation with the type or severity of the gastric mucosal lesion. 4.Serial gastric biopsies over a 1-year period revealed no change in the lesion after complete hematologic and clinical remission of the tropical sprue. 5.The significance and possible etiologies of the gastritis in tropical sprue is discussed.

Tropical sprue and intussusception: An unusual association: Report of a case

SummaryA case is reported of a patient with intussusception complicating tropical sprue demonstrable over a period of months. There was clinical and laboratory evidence of malabsorption. The chronicity of tropical sprue and its delayed laboratory and histologic response to therapy was demonstrated.Such a case has not been previously reported.

Malaria in Servicemen from Vietnam

Excerpt Between January 1 and November 30, 1966, 390 cases of malaria were reported in the United States. Three hundred twelve of these infections were in military personnel and 92% of these indivi...

Carbohydrate studies in tropical sprue

The lactose tolerance test is useful for detecting malabsorption in tropical sprue. For this purpose it is superior to a number of other oral tolerance tests. The generalized disaccharidase deficiency found in tropical sprue appears to be a secondary phenomenon resulting from injury to the intestinal mucosa.SummaryThe lactose tolerance test is useful for detecting malabsorption in tropical sprue. For this purpose it is superior to a number of other oral tolerance tests. The generalized disaccharidase deficiency found in tropical sprue appears to be a secondary phenomenon resulting from injury to the intestinal mucosa.