Showing papers by "Rambam Health Care Campus published in 1984"

Jaundice, the circulation and the kidney

Abstract: (Fig. 1) Cholemia per se (i.e. independent of parenchymal liver damage) causes a profound disturbance of systemic hemodynamics. This includes decrease in total peripheral vascular resistance, and possible impairment of left ventricular performance. These, in turn, lead to a decrease in effective blood volume, a tendency to hemorrhagic shock and prerenal failure. Early in the course of cholemia , the natriuretic effects of bile salts in the circulation may aggravate the hypovolemia. In marked contrast to the decrease in total peripheral vascular resistance, the regional vascular beds of the kidney and the brain constrict during cholemia . The combined effect of cholemia may thus lead to redistribution of cardiac output away from the kidney and the brain. When parenchymal liver damage complicates obstructive jaundice, the tendency to arterial hypotension is aggravated. The overall interrelationship between jaundice and circulatory homeostasis is depicted in figure 1.

Transient osteoporosis of hip joint with liver cirrhosis.

Abstract: We describe the association between transient osteoporosis of the hip (TOH) and liver cirrhosis in a female patient. The clinical course, radiographic and scintigraphic features were similar to cases of TOH described previously. The pathogenesis of this syndrome is unknown and we suggest there may be a relationship between the hemodynamic changes common in cirrhotic patients and in pregnant women and the development of TOH.

Night blindness and liver cirrhosis as late complications of jejunoileal bypass surgery for morbid obesity

Abstract: A patient underwent end-to-side jejunoileostomy for morbid obesity, and 3 years later an end-to-end jejunoileostomy with ileotransversostomy was performed. Nine years later she presented with night blindness, severe diarrhea and mild jaundice and was found to have malabsorption with vitamin A and K deficiencies as well as asymptomatic liver cirrhosis. Her shunt was removed, and a gastric partition was performed. The night blindness and abnormal prothrombin time were corrected by the administration of vitamins A and K. This case demonstrates that complications may appear many years after jejunoileal bypass surgery, and therefore, the patients should remain under strict medical supervision indefinitely.

Renal tubular handling of potassium in patients with medullary sponge kidney. A model of renal papillectomy in humans.

Abstract: • Renal tubular function, with special emphasis on potas[ill]ium excretion, was studied in three patients with medullary [ill]ponge kidney (MSK). Urinary acidification and concentration [ill]bilities were impaired, while glomerular filtration rates re[ill]ained normal. After short-term intravenous (IV) potassium [ill]hloride loading, maximal excretion of potassium was lower in [ill]e patients with MSK than in the normal controls. The ka[ill]uretic response to IV sodium sulfate and acetazolamide [ill]fusion was maintained. The capacity of the kidney to sustain [ill]otassium balance under conditions of either long-term potas[ill]at loading or depletion was preserved. We have concluded [ill]at the medullary and papillary segments of the human [ill]ollecting duct, have an important role in the handling of short-[ill]rm Potassium loading. The integrity of these segments, [ill]owever, ever, is not essential for adaptation to prolonged potas[ill]ium surfeit or dietary depletion. ( Arch Intern Med 1984;144:2201-2204)

Function of peripheral blood and bone-marrow monocytes in preleukemic patients: normal phagocytosis and intracellular killing of Candida albicans.

Abstract: Studies were performed to evaluate the function of peripheral blood and bone marrow monocytes from 15 patients with preleukemia and 16 healthy controls. The patients were grouped according to the criteria of the FAB collaborative group. No abnormality in phagocytosis and killing of Candida albicans by peripheral blood and bone marrow monocytes was found in patients compared to normal controls. Normal opsonization by autologous serum was found. No differences were found in this respect between the three groups of patients.