1/6. Pressure sore anemia: response to erythropoietin.anemia in patients with grade IV pressure sores is usually refractory to therapy with iron salts, and red cell transfusions are commonly required when reconstructive surgery is performed. The anemia is characterized by hypoferremia, reticulocytopenia, and normal-to-increased serum ferritin. Five patients with this anemia were treated with recombinant human erythropoietin (rHuEPO) in doses of 50 to 100 U/kg, given subcutaneously three times per week. The hemoglobin increased in every patient; the mean ( /- SD) value at the initiation of treatment was 8.8 /- 1.0 g/dL, and after a median of 4 weeks of therapy, it was 12.4 /- 1.6 g/dL (p less than .001). No adverse effects of treatment were observed. It is concluded that rHuEPO is a promising new agent for pressure sore anemia, but randomized, controlled clinical trials will be required to firmly establish its place in the management of patients with this type of anemia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/6. malnutrition in a compulsive runner: a case conference.A 28-yr-old, female marathon and "fitness" runner presented with leg swelling, fatigue, and loss of endurance. She was running an hour or more daily in addition to regular biking and swimming. She was an instructor in a fitness center. For 2 months prior to her leg swelling, she had increased fatigue and decreased exercise tolerance. She had been seen previously for a slow healing hamstring strain. She had not had a menstrual period for over 2 yr and had refused evaluation. She admitted to very low dietary intake, which she had always denied. She was worried about her body fat. She denied recent blood loss, diuretic or cathartic use, and induced vomiting. She appeared malnourished, pale, and older than her stated age. Her weight was 41.4 kg. Her blood pressure was 90/60, and her pulse was 100 per minute. She had pitting edema of the lower extremities to the knees. The diagnosis of anorexia nervosa was made and will be discussed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/6. Duodenal duplication presenting as relapsing pancreatitis in an adult.The first case of relapsing acute pancreatitis due to a tubular duodenal duplication is reported. The duplication is believed to have filled with secretions and intermittently impinged on and obstructed the pancreatic ductular system producing a clinical picture of relapsing acute pancreatitis. The increased pressure within the duplication also produced pressure necrosis of the mucosa lining the duplication with resultant hemorrhage and iron-deficiency anaemia. The diagnosis was made preoperatively with the aid of ERCP.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/6. iron deficiency and sickle cell anemia.In a patient with sickle cell anemia, iron deficiency was accompanied by hypochromic, microcytic RBCs, absence of bone marrow iron, and a low serum ferritin level. The mean corpuscular hemoglobin concentration (MCHC) was decreased (27.6 g/dL) and was associated with an extreme scarcity of sickled erythrocytes in blood smears. iron therapy resulted in reticulocytosis and an increase in sickled erythrocytes. in vitro studies demonstrated a decrease in sickling of erythrocytes as a function of oxygen saturation of the blood when the patient was iron deficient. The whole blood oxygen dissociation curve showed a substantial decrease in oxygen pressure necessary to produce 50% saturation of hemoglobin at pH 7.4 and 37 degrees C (P50), indicating an increased oxygen affinity. These data suggest that a reduction of the MCHC induced by iron deficiency may ameliorate sickling.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/6. Esophageal motility impairment in plummer-vinson syndrome. Correction by iron treatment.We report the case of a 41-year-old woman with plummer-vinson syndrome and an esophageal motility disorder. She complained of dysphagia and odynophagia and had cheilitis, glossitis, and hypochromic anemia. An esophageal motility study showed low amplitude of contraction and high intrabolus pressure in the esophageal body. After iron replacement, the patient was free from symptoms, and a new motility study showed increased amplitude of contraction and decreased intrabolus pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/6. Craniocephalic disproportion with increased intracranial pressure and brain herniation: a new clinical syndrome in anemic patients: report of two cases.OBJECTIVE AND IMPORTANCE: We describe a new clinical syndrome in two patients with chronic anemia. The major manifestation of the syndrome is herniation of the brain resulting in death caused by longstanding craniocephalic disproportion. The disproportion was caused by extreme thickening of the cranium because of erythroid hyperplasia. CLINICAL PRESENTATION: Two patients with known chronic anemia presented with chronic increase in intracranial pressure with acute deterioration resulting in brain herniation. INTERVENTION: Despite maximum medical therapy, both patients died as a result of uncontrollable increase in intracranial pressure. CONCLUSION: patients with chronic anemia presenting with progressive headaches should be monitored for this newly described clinical phenomenon.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |