Altered water metabolism in tuberculosis: role of vasopressin
Article Abstract:
Active tuberculosis has been associated with decreased levels of sodium and chloride in the blood. A syndrome of inappropriate antidiuretic hormone (SIADH) secretion may be caused by tuberculosis. Some researchers have reported that tuberculosis patients with low blood sodium levels (hyponatremia) do not dilute urine normally after drinking excessive amounts of water; other researchers have observed a normal dilution process. This study examined the nature of the diluting defect in these patients, and evaluated vasopressin response to changes in plasma osmolality (pressure exerted by the blood on its surrounding semi-permeable membrane or vessel wall.) Twenty-eight hyponatremic tuberculosis patients were evaluated, and blood and urine chemistry tests were performed; 22 patients were given excess water. Volume status was determined by urine sodium concentration, blood and urea nitrogen, and plasma renin. All patients showed a decrease in urine osmolality after drinking excess amounts of water. Water excretion was totally normal in seven of the 22 patients. Vasopressin circulating in the blood was measured in ll of the 22 patients given excess water, as well as in the six who were not. Vasopressin levels declined in the patients given excess water. The hyponatremia disappeared following antituberculous treatment. It is concluded that vasopressin is found in these hyponatremic patients and responds to changes in osmolality. Hyponatremia in tuberculosis patients is usually not severe, and normally follows the course of the tuberculosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Pericarditis: an unusual manifestation of giant cell arteritis
Article Abstract:
Giant cell arteritis (GCA) is a condition in which arteries in the head and body become inflamed. Although GCA can affect the heart, pericarditis (inflammation of the membranes surrounding the heart and great vessels) associated with this disease is rare. The case report is presented of a 68-year-old woman in whom GCA-associated pericarditis developed without other signs of GCA. The patient had become weaker, lost weight, and noted reduced appetite during the year preceding her diagnosis. A dry cough and difficulty breathing upon exertion had developed during the preceding few months. Headaches, visual disturbances, or abnormalities of the temporal arteries were not present. Tests revealed the presence of a lung infiltrate and material in the pericardium (the membranous sac containing the heart and great vessels). A biopsy of the temporal artery revealed GCA, and methylprednisolone (a steroid) was administered, leading to rapid disappearance of all symptoms. GCA is a systemic disorder in which blood vessels throughout the body become inflamed. Only 11 cases of pericarditis associated with GCA have been reported. These studies are briefly summarized. In 7 of 10 cases, classical symptoms of GCA were present, but symptoms involving arteries of the head (of which the temporal artery is one) were not present in half the cases. Pericarditis should be added to the list of abnormalities that can be associated with GCA. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Pleuritis as a manifestation of reactivation tuberculosis
Article Abstract:
Pleuritis, or pleurisy, is inflammation of the pleura, the lining between the lungs and chest wall. Tuberculosis (TB) remains one of the most widespread infections in the world, and is frequently manifested as tuberculous pleuritis. Classically, pleuritis was considered a late manifestation of the primary disease process, occurring without co-existing tubercular lung infection. However, recent findings suggest that tuberculous pleuritis may be a manifestation of reactivation (recurrent) TB. The frequency and characteristics of reactivation and classic tuberculous pleuritis were studied in 59 patients with TB who did not have AIDS (which can alter the pattern of TB infection). Patients with reactivation TB constituted 46 percent of the group; this may reflect the declining prevalence of active TB infection in the US. Half of the patients with reactivation TB had TB organisms in the sputum, so that biopsy of lung fluid was not necessary. Reactivation disease was associated with a more chronic disease process, including symptoms of productive cough and weight loss. Other findings, such as poor reactivity to skin tests and low levels of granulomata (growths containing granular white blood cells), suggest that the immune response in reactivation TB is less effective. Continuing research into the different manifestations of tuberculosis is desirable. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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