Delayed respiratory failure during the treatment of myxedema coma

Three male patients (aged 41, 71 and 65 years) with untreated severe hypothyroidism of long duration were in a state of coma. This had been preceded by respiratory symptoms accompanied by hypoxemia and hypercapnea. There were also various chest radiographic findings. All the patients were treated with mechanical ventilatory assistance, circulatory support and i. v. administration of high doses of l-triiodo-thyronine (T3) during the early period of treatment. None of the patients showed any serious cardiac ill-effects immediately or a few days following the intravenous administration of T3. In spite of the stabilisation of vital signs and improvement in arterial oxygenation, the patients remained in a comatous or semicomatous state for the first few days. During the second week, the condition of their lungs deteriorated and prolonged respiratory failure ensued with fever, rales, excessive bronchial secretion, homogeneous densities in the chest radiograms and persistent hypoxemia even though mechanical ventilatory treatment was continued. The implications of this delayed respiratory failure during the treatment of myxedema coma are discussed.     

Age and the course of nephrotoxic nephritis in rats]

In experiments on two groups of mongrel rats (4 weeks old and 4 months old) with induced nephrotoxic nephritis it was revealed that in comparison with adult rats the course of nephritis in ratlings was characterized by lesser proteinuria, selective in nature, by lesser reducticn of endogenous creatinine clearance and diuresis. The acido- and ammo-niogenesis decreased in ratlings and adult rats to the same extent. Morphological changes in the kidneys of ratlings were less pronounced than in adult animals, and were mostly localized in the convoluted tubules. The level of DNA-synthetic activity of the epithelial nuclei of the glomeruli prevailed over this index of the convoluted tubules epithelium. The weight index of the kidneys increased less in ratlings with nephritis than in adult rats. beta-lipoproteinemia in ratlings increased 8 times. Normalization of the urine and blood indices occurred more rapidly in ratlings than in adult rats.     

The effect of losing the twin and losing the partner on mortality.

Several studies have explored the impact of marital bereavement on mortality, while increasing emphasis has recently been placed on genetic factors influencing longevity - in this paper, we study the impact of losing the spouse and losing the co-twin, for twins aged 50 to 70. We use data from the Danish Twin Registry and the Population Register of Denmark for the period 1968 through 1999. Firstly, we use survival analysis to study mortality after the death of the spouse or the co-twin. We find that the risk of dying is highest in the first year after the death of the spouse, as well as in the second year after the death of the co-twin. We then use event history analysis techniques to show that there is a strong impact of the event 'losing the co-twin' even after controlling for age, sex and zygosity and that this effect is significantly higher in the second year of bereavement. The effect is similar for men and women, and it is higher for monozygotic twins. The latter confirms the influence of genetic factors on survival, while the mortality trajectory with a peak in the second year after the death of the co-twin is consistent with the existence of a twin bereavement effect.     

A Web-based course of lectures in respiratory physiology

A complete course of respiratory physiology suitable for first-year medical and graduate students has been placed on the Web for our own students and for other educational institutions. There are several reasons for doing this. The first is that the modern-day student uses a variety of options for acquiring knowledge. These include attending lectures, reading texts, iPod downloads, and surfing the internet. This Web-based course is another option that may be preferable for some students. A second reason is that it is becoming increasingly difficult for some medical schools to find faculty members who are willing and able to teach the principles of respiratory physiology. This is a potentially serious problem because a sound knowledge of respiratory physiology will always be necessary for the intelligent practice of medicine. Schools with limited faculty may find it useful to use these Web-based lectures followed by a discussion session with students. Another reason is that some schools have moved away from systematic lectures to case-based discussions, with the possibility that students will not be exposed to some of the principles of respiratory physiology. The hope is that this comprehensive course of lectures will help students to assimilate this important material as the medical school curriculum continues to expand at a rapid rate.