Secondary hypertension due to concomitant aldosterone-producing adenoma and parathyroid adenoma.

There is a growing body of evidence supporting a bidirectional relationship between parathyroid hormone (PTH) and aldosterone (Aldo). We report a case of secondary hypertension due to concomitant Aldo-producing adenoma (APA) and parathyroid adenoma (PA) requiring both unilateral adrenalectomy and parathyroidectomy.

Calciphylaxis in the current era: emerging 'ironic' features?

Background: Calcific uraemic arteriolopathy (CUA), previously known as calciphylaxis, is a condition of microvascular calcification and thrombosis with resultant tissue necrosis. Due to the rarity of this disease, our understanding of its pathogenesis remains speculative. Iron has emerged as a potential pathogenic contributor to the development of CUA, but investigation into this link is lacking.

Perforation of the jejunum secondary to AIDS-related gastrointestinal Kaposi's sarcoma.

Intestinal perforation in human immunodeficiency virus-positive patients due solely to Kaposi's sarcoma (KS) has rarely been described. A homosexual man with acquired immunodeficiency syndrome-related KS who presented with an acute abdomen is presented. He was found to have a jejunal perforation through a small KS lesion.

Analysis of nutritional intake in a cohort of homosexual men.

The objective of this study was to examine differences in the nutritional intake of seronegative (SN) and seropositive (SP) AIDS-free subjects within a cohort of gay men. The nutritional intake of 145 SN and 139 SP subjects between October 1991 and September 1992 was evaluated using a self-administered 24-h dietary recall questionnaire. The calorie and nutrient content of all food items eaten in a day was coded using the Canadian Nutrient File database.

Acute pancreatitis presenting with visual disturbance.

Retinopathy is a rarely recognized complication of acute pancreatitis. We review the literature on this condition and report a case in which the manifestations of retinopathy dominated the clinical picture, initially diverting attention away from the presence of pancreatic disease.

Clinical skills of medical residents: a review of physical examination.

Students are introduced to techniques of physical examination at medical school. However, their skills are deficient at the time of graduation, and with the increasing shift of clinical teaching away from the bedside and into the conference room it is expected that these skills will weaken in succeeding generations of physicians. A practical and satisfactory method of addressing this problem during internship and residency training has not been forthcoming because of the lack of a regular forum for the teaching of clinical skills in busy tertiary referral hospitals and the shortage of teachers with the necessary skills and commitment to teaching a large number of house staff.

Cardiac dysfunction associated with the acquired immunodeficiency syndrome (AIDS).

Five patients with acquired immune deficiency syndrome (AIDS) developed clinical evidence of mild to severe cardiac dysfunction confirmed by nuclear angiography and echocardiography. In 4 patients who were studied postmortem there was no evidence of myocarditis, valvular, or ischemic heart disease. Cardiac involvement in patients with AIDS may include pericardial and myocardial involvement by opportunistic pathogens or Kaposi's sarcoma, subclinical myocardial dysfunction, or an as-yet unexplained cardiomyopathy.

Dietary supplementation and respiratory muscle performance in patients with COPD.

We studied the effects of oral nutritional supplementation on respiratory muscle (RM) performance in 25 ambulatory patients with severe chronic obstructive pulmonary disease (COPD). There was a relationship between body weight and anthropometric parameters of nutritional status (triceps skinfold thickness [r = 0.67; p less than 0.

Malnutrition and the heart.

Earlier concepts that the heart is spared in malnutrition have been shown to be incorrect. Inadequate intake of protein and energy results in proportional loss of skeletal and myocardial muscle. As myocardial mass decreases, so does the ability to generate cardiac output; however, various compensatory factors come into play.

Central venous catheter malposition presenting as chest pain.

Erroneous positioning of central venous catheters in small tributaries of large central veins is a rare occurrence. We describe three such unusual incidents involving cannulation of the left internal mammary vein. Malposition was suspected when infusion of hypertonic parenteral nutrition led to persistent precordial pain.

Portal and pulmonary hypertension with microangiopathic hemolytic anemia.

Marked pulmonary hypertension developed in a 40-year-old man with known cirrhosis and a previous portosystemic shunt. Terminally, he also showed signs of microangiopathic hemolytic anemia. At postmortem examination, he had severe plexiform dilatation lesions in the pulmonary vasculature, with deposition of fibrin in the vasculature channels.

Long-term parenteral nutrition with arteriovenous fistula.

Sixteen arteriovenous fistulas were created for parenteral nutrition. The complications included stenosis at the site of needling or at the site of vascular anastomosis. Two infections occurred from the surgical creation of a fistula.