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Hypertonicity:Clinical entities,manifestations and treatment

作者： (美)罗杰·费希尔(Roger Fisher)，(美)丹尼尔·夏皮罗(Daniel shapiro)

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World Journal of Nephrology 2017年第1期6卷 1-13页

作者： Helbert Rondon-Berrios Christos Argyropoulos Todd S Ing Dominic S Raj Deepak Malhotra Emmanuel I Agaba Mark Rohrscheib Zeid J Khitan Glen H Murata Joseph I shapiro Antonios H Tzamaloukas Renal-Electrolyte Division Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA 15260United States Division of Nephrology Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87131United States Department of Medicine Strich School of MedicineLoyola University ChicagoMaywoodIL 60153United States Division of Nephrology Department of MedicineGeorge Washington UniversityWashingtonDC 20037United States Division of Nephrology Department of MedicineSchool of MedicineUniversity of ToledoToledoOH 43614-5809United States Division of Nephrology Department of MedicineJos University Teaching HospitalJosPlateau State 930001Nigeria Division of Nephrology Department of MedicineSchool of MedicineMarshall University Joan C.EdwardsHuntingtonWV 25701United States Informatics Section Medicine ServiceRaymond G.Murphy Veterans Affairs Medical CenterAlbuquerqueNM 78108United States Department of Medicine University of New Mexico School of MedicineAlbuquerqueNM 78108United States Marshall University Joan C.Edwards School of Medicine HuntingtonWV 25701United States Section of Nephrology Medicine Service(111C)Raymond G.Murphy Veterans Affairs Medical CenterAlbuquerqueNM 78108United States

Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and longterm neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and *** results from relative excess of body sodium over body water. Loss of water in excess of intake,gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of *** can be hypervolemic,euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and,if present,sodium deficit,and correction of the underlying pathophysiologic process that led to *** in hyperglycemia has two components,solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration,which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level.

关键词：渗血症高血糖治疗方法临床分析

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8岁儿童的肾脏腺瘤:病例报道和文献回顾

世界核心医学期刊文摘（儿科学分册） 2005年第11期1卷 60-61页

作者： Amodio J.B. shapiro E. Pinkney L. 王经纬 Department of Radiology New York University Medical Center NewYork NY10016United States

Metanephric adenoma (MA) is a renal tumor that is rarely found in children. We present a case of MA that was incidentally discovered in an 8-year-old child on computed tomography. We also review the literature regarding this lesion in the pediatric population. There are certain imaging features of MA that may suggest the diagnosis preoperatively. Metanephric adenoma is often hyperechoic on sonography, hyperdense on noncontrast computed tomography scans, and of low signal intensity on T1-and T2-weighted magnetic resonance images. Nephron sparring surgery has been performed in several cases. However, the distinction of MA from other metanephric lesions as well as from Wilms’tumor and papillary renal cell carcinoma may not be readily apparent at the time of surgery.

关键词：文献回顾乳头状细胞癌外科手术影像学儿童群体超声检查

川崎综合征首次超声心动图检查检测出的冠状动脉病变的发生率

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世界核心医学期刊文摘（儿科学分册） 2006年第12期2卷 16-17页

作者： Baer A.Z. Rubin L.G. shapiro C.A. 陈莉萍 Schneider Children's Hospital 269-01 76th AveNew Hyde ParkNY 11040United States Dr.

Objectives:To determine whether coronary artery lesions (ectasia and aneurysm) are commonly observed on the initiale chocardiogram of patients with acute Kawasaki syndrome,whether coronary artery ectasia and/or aneurysms occur more frequently in patients with incomplete Kawasaki syndrome than in those patients with complete findings,and whether earlier diagnosis and treatment of Kawasaki syndrome are associated with less frequent occurrence of coronary artery ectasia and/or aneurysm. Design:A retrospective medical record ***:A tertiary care pediatric hospital. Participants:One hundred patients treated for Kawasaki syndrome between July 1,1998,and June 30,2003,who were identified by a medical record search. Main Outcome Measure:Prevalence of coronary artery lesions (ectasia and aneurysm) on the initial and subsequent echocardiograms. Results:Forty-four percent of patients had a coronary artery lesion (31%with ectasia,13%with aneurysm) on the initial echocardiogram. Patients with incomplete Kawasaki syndrome were treated significantly later(median,10 days) and had a significantly higher occurrence of coronary artery aneurysms over the course of their illness(37%) than those with complete Kawasaki syndrome,who were treated at a median of 7 days (P< 0.001) and had a 12%aneurysm occurrence (P=0.009). Patients treated by day 7 of illness had a less frequent occurrence of aneurysm(6%) compared with those patients treated between days 8 and 10 of illness (27%) (P=0.03).Conclusions:Coronary artery lesions are frequently detected on the initial echocardiogram of children with Kawasaki *** future studies show ectasia to have a relatively high degree of specificity for Kawasaki syndrome,the initial echocardiography may be a useful adjunctive diagnostic test.

关键词：川崎综合征冠状动脉病超声心动图动脉瘤发生率检查检测冠状动脉扩张冠状动脉瘤病历调查完全

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激光脱毛后多毛症

世界核心医学期刊文摘（皮肤病学分册） 2005年第10期1卷 9-10页

作者： Alajlan a.shapiro J Rivers J.K H. Lui 罗素菊 Division of Dermatology University of British Columbia 835 W 10 Ave Vancouver BC V5Z 4E8 Canada Dr.

Objective:Hair removal using lasers or broadband intense pulsed light has become one of the most ubiquitous medical procedures. At our center a small proportion of patients have spontaneously reported what they believed to be increased hair growth at sites of previous laser epilation. We sought to retrospectively review the prevalence and features of this paradoxical effect. Methods:This was a single center, retrospective study that included all patients who underwent laser hair removal during a 4-year period with a long-pulsed alexandrite laser. All cases of laser-induced hypertrichosis were assessed clinically by history, examination, and laboratory tests, and confirmed by review of serial clinical photographs taken during the course of the laser treatments. The clinical features of patients with postlaser hypertrichosis were compared with 50 patients randomly selected from among all those who had undergone laser hair removal at our center (n=489). Results:Of 489 patients, 3 (0.6%, 95%confidence interval:0.01-1.9%) treated with the long-pulsed alexandrite laser (755 nm) reported increased hair after laser hair epilation. There was a trend for this adverse effect to occur in darker skin phototypes (IV) and with black hair as compared with the unaffected comparison group (n=50). However, the small number of cases (n=3) did not provide sufficient power to adequately test factors such as age, sex, treatment settings, and number of treatments statistically. Conclusion:Postlaser hair removal hypertrichosis is a real but rare occurrence in our experience.

关键词：激光脱毛多毛症皮肤类型紫翠玉脉冲光临床评估作用组单中心黑头发

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地震地球化学某些前兆机理的模拟实验研究

地震地质 1984年第1期 41-46页

作者：李桂如,蒋凤亮,J. Melvin,A. Rice,M. shapiro,T. Tombrello 国家地震局地质研究所国家地震局地质研究所美国加州理工学院美国加州理工学院美国加州理工学院美国加州理工学院加州州立大学佛伦敦分校加州州立大学佛伦敦分校

本文通过氡射气性能的压力实验,氡射气分配系数实验和岩石的溶滤实验等,对地下水氡及其它地震地球化学前兆机理进行了探讨。实验表明:氡射气的最高值发生在岩石严重破裂时;岩石射气性能高低与其本身的铀含量成正比;岩石在压力作用下射... 详细信息

本文通过氡射气性能的压力实验,氡射气分配系数实验和岩石的溶滤实验等,对地下水氡及其它地震地球化学前兆机理进行了探讨。实验表明:氡射气的最高值发生在岩石严重破裂时;岩石射气性能高低与其本身的铀含量成正比;岩石在压力作用下射出的氡气在水中的分配大于在气相中的分配;岩石在饱和CO2水中和压力作用下的溶滤程度要比在纯蒸馏水中和常压下大得多。因此,地震前地下水氡浓度和水中离子组分和气体组分会出现异常变化,而这种变化既与应力作用有关,又与地球内部水-气-岩系统在地震孕育过程中的物理化学作用有关。

关键词：模拟实验岩石地球化学异常化探异常地震前兆溶滤地震地球化学纯蒸馏水铀含量射气压溶前兆机理

液体绑带(2-辛基氰基丙烯酸酯)作为一种临时切口密闭剂用于透明角膜切口的白内障手术

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世界核心医学期刊文摘(眼科学分册) 2006年第4期 56-57页

作者： Meskin S.W. Ritterband D.C. shapiro D.E. 潘佳鸿 Dr.Ophthalmic Consultants PC New York Eye and Ear Infirmary 310 East 14th Street New York NY 10003 United States

Purpose: To determine the feasibility and side effect profile of 2-octyl cyanoacrylate with parabens (Liquid Bandage) as an adjunct wound sealant and barrier against the inflow of ocular surface fluid after clear corneal cataract surgery. Design: Prospective interventional case series. Participants: Fifty-one eyes of 51 patients undergoing clear corneal cataract surgery. Methods: Fifty-one eyes of 51 patients who underwent cataract surgery by one surgeon (RSK) were enrolled. A 2.75-mm clear corneal, triplanar, temporal incision was used in each case, followed by routine phacoemulsification. At the conclusion of each case, the wound was dried with a cellulose sponge. A modified microsponge with 1 to 2 drops of 2-octyl cyanoacrylate with parabenswas then applied in a smooth layer to the wound. Allwoundswere rechecked for leakagewith a cellulose sponge applied at the wound lip. The following criteria were evaluated on the first 2 postoperative visits: (1) visual acuity; (2) patient complaints; (3) wound integrity; (4) presence of tissue adhesive; and (5) any adverse events, including abnormal increase in local tissue reaction to the adhesive. Main Outcome Measures: Side effect profile and clinical course of 2-octyl cyanoacrylate with parabens applied to clear corneal wounds. Results: All 51 eyes demonstrated intraoperative watertight wound closure after the application of 2-octyl cyanoacrylate with parabens. Forty-five eyes (88%) had tissue adhesive still completely covering the wound on postoperative day 1. Two eyes (4%) had tissue adhesive over portions of their wound, and 4 eyes (8%) had no adhesive noted on their wound. All wounds were watertight on all postoperative visits. Thirtyone of 51 patients (61%) complained of mild transient foreign body sensation on postoperative day 1. Twenty-six patients (51%) had trace diffuse bulbar conjunctival hyperemia. Five patients had trace focal conjunctival hyperemia adjacent to the wound. Nine patients (18%) had remnants of t

关键词：透明角膜切口苯甲酸酯安息香酸酯如银内障白内障氰基丙烯酸酯辛基手术绑带

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出生季节与成年后脑瘤患病危险性的研究

世界核心医学期刊文摘（神经病学分册） 2005年第1期1卷 34-35页

作者： Brenner A.V. Linet M.S. shapiro W.R. 陈云春 Radiation Epidemiology Branch National Cancer Institute NIH 6120 Executive Blvd. Bethesda MD 20892- 7238 United States Dr.

Background: Recent studies demonstrated an excess of winter births in children with brain tumors and in adults with various neurologic or psychiatric diseases relative to the general population. Objective: To investigate a possible association between month of birth and risk of brain tumors in adults using data from a large, hospital based case control study. Methods: Cases were patients with incident glioma (n=489) or meningioma (n=197) diagnosed at hospitals in Boston, MA, Phoenix, AZ, and Pittsburgh, PA. Controls (n=799) were patients hospitalized for a variety of nonmalignant conditions and frequency matched to cases by hospital, age, sex, race/ethnicity, and distance of residence from hospital. Odds ratios (ORs) were calculated using multivariate unconditional logistic regression allowing for cyclic variation in risk with month of birth. Results: A relationship between month of birth and risk of adult glioma and meningioma was found, best described by a 12 month periodic function with peaks in February and January and troughs inAugust and July. The association between month of birth and risk of glioma differed significantly by handedness, with left handed and ambidextrous subjects born during late fall through early spring being at particularly high risk of adult glioma as compared with those born at other times of the year. Conclusion: These findings suggest the importance of seasonally varying exposures during the pre or postnatal period in the development of brain tumors in adults.

关键词：胶质瘤脑膜瘤就诊医院成人患者回归法神经精神疾病波士顿市比值比右利手尼克斯

抗淋巴细胞抗体的预处理和他克莫司单一疗法在儿童肾移植中的应用

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世界核心医学期刊文摘（儿科学分册） 2006年第11期2卷 26-27页

作者： shapiro R. Ellis D. Tan H.P. T.E. Starzl 贺莉 TheThomas E. Starzl Transplantation Institute Departments of Surgery Pathology Children's Hospital of PittsburghPittsburgh PA United States Dr.

Objective: Heavy post-transplant immunosuppression may contribute to long-term immunosuppression dependence by subverting tolerogenic mechanisms; thus, we sought to determine if this undesirable consequence could be mitigated by pretransplant lymphoid depletion and minimalistic post-transplant monotherapy. Study design: Lymphoid depletion in 17 unselected pediatric recipients of live (n = 14) or deceased donor kidneys (n = 3) was accomplished with antithymocyte globulin(ATG) (n = 8) or alemtuzumab (n = 9). Tacrolimus was begun post-transplantation with subsequent lengthening of intervals between doses . Maintenance immunosuppression,morbidity, graft function, and patient/graft survival were collated. Results: Steroids were added temporarily to treat rejection in two patients (both ATG subgroup) or to treat hemolyticanemia in two others. After 16 to 31 months (mean 22),patient and graft survival was 100%and 94%, respectively. The only graft loss was in a nonweaned noncompliant recipient. In the other 16, serum creatinine was 0.85±0.35 mg/dL and creatinine clearance was 90.8±22.1mL/1.73m2. All 16 patients are on monotherapy (15 tacrolimus, one sirolimus), and 14 receive every other day or 3 times per week doses. There were no wound or other infections. Two patients developed insulin-dependent diabetes. Conclusion: The strategy of lymphoid depletion and minimum post-transplant immunosuppression appears safe and effective for pediatric kidney recipients.

关键词：抗淋巴细胞抗体免疫抑制移植物耐受机制类固醇治疗最小剂量溶血性贫血捐赠者移植术存活情