Plural, Not Pleural
Total Page：16
File Type：pdf, Size：1020Kb
hepatomegaly, and jaundice. This cal advice.) His serum creatinine level tension today is far from perfect, the diagnosis was confirmed by a liver is 1.3 mg/dl. He has made a satisfac- Veterans Administration' study has biopsy specimen and hepatic venogra- tory recovery each time. clearly demonstrated the reduction in phy.3 Following an intensive education morbidity and mortality in male Sickle cell anemia has been re¬ program, his compliance and attend- patients with diastolic hypertension ported as causing Budd-Chiari syn¬ ance at the clinic has been satisfac- greater than 115 mm Hg. None of the drome." Our patient had only 38% tory for the past six months. His 18 agents listed here have been shown hemoglobin S on hemoglobin electro- blood pressure was 160/100 mm Hg to be effective antihypertensive phoresis and manifested no anemia. when taking 80 mg daily of furo- agents. The potential also exists for Further, no evidence of sickling was semide (Lasix), 120 mg daily of consumption of harmful amounts of seen in the biopsy tissue. Therefore, propranolol hydrochloride (Inderal), minerals and vitamins (eg, potassium, sickling did not appear to play a role and 20 mg daily of prazosin hydro- calcium, vitamin D, vitamin A). The in our patient. Further hématologie chloride (Minipress). safe level of consumption for many of evaluation, including measurement of Despite our advice that his medica¬ these substances is not known. antithrombin III levels, was within tion was extremely important to him, We are concerned that this form of normal limits. he went to a health food store and advice affords great potential for We propose that the development was told that these medications were harm and that many patients may of the Budd-Chiari syndrome in our "potentially harmful to his body." He not realize this fact. One must ques¬ patient was the result of extrinsic was advised by the proprietor of the tion the motives of the persons selling compression on hepatic veins by store that he should cease the and advising use of these prepara¬ inflammation and edema from sar- prescribed medications and com¬ tions. At the very least, it is an irre¬ coid granulomas, leading to narrow¬ mence a program of megavitamins sponsible act to meddle with the ing of venous channels, venous stasis, that would "act to lower his blood therapy of patients. and subsequent thrombosis. No other pressure by opening up the circula¬ Walter M. Kirkendall, MD apparent cause for vein occlu¬ tion." two weeks of this Jeremy J. Hammond, MD hepatic Following The University of Texas sion was demonstrable by history, regimen he attended our clinic with a Health Science Center laboratory studies, or anatomic find¬ blood pressure of 230/140 mm Hg. Houston ings at laparotomy. The findings in The tablets that he was taking, the 1. Effects of treatment on morbidity in hypertension: Results in patients with diastolic blood aver- our indicate that the Budd- and the bottle pressures patient dosages, prices per aging 115 through 129 mm Hg, Veterans Administration Chiari syndrome can complicate sar- (where available) were as follows: Cooperative Study Group on Antihypertensive Agents. coid involvement of the liver. This calcium pangamate, 50 mg, three JAMA 202:1028-1034, 1967. diagnosis should be considered in tablets daily ($4.59); manganese, 15 patients with sarcoidosis who mani¬ mg, three tablets daily ($3.99); mag¬ fest ascites, increased hepatomegaly, nesium oxide, 250 mg, four tablets and deteriorating liver function. daily ($2.49); a vitamin preparation Michael R. Natalino, MD (vitamin A, D, and B complex), one Richert E. GOYETTE, MD tablet daily ($5.99); dessicated liver, Loren C. Owensby, MD four tablets Ronald N. Rubin, MD daily ($4.99); lecithin, Plural, Not Pleural.\p=m-\ In the April 3 Brooke Army Medical Center 1,200 mg, three tablets daily ($3.99); Fort Sam Houston, Tex amino acid chelate, three tablets daily issue of The Journal (239:1401\x=req-\ 1. Rudeki C, Ishak KG, Zimmerman HJ: Chronic B 1402, 1978), line 6 of paragraph 2 in J Med 59:373\x=req-\ ($4.49); lipotropic vitamin complex, intrahepatic cholestasis sarcoidosis, Am three tablets the COMMENTARY "Hyperventilation. 387, 1975. daily ($7.99); panto- The Vapors. Effort Syndrome. Neur- 2. Siltzbach LE, James DG, Neville E, et al: Course thenic acid, one tablet daily ($8.99); and prognosis of sarcoidosis around the world. Am J Med asthenia.: Anxiety by Any Other 57:847-852, 1974. potassium (75 mg) and kelp, three Name Is Just as Disturbing" should 3. Clan D, Freston J, Kreel L, et al: Clinical diagnosis tablets daily ($1.79); megavitamin B6 of the Budd-Chiari syndrome. Am J Med 43:544-554, 100 three tablets have referred to the plural of the 1967. (B„, mg), daily (no term "vapors," not the pleural of 4. Hirsh HL, Manchester B: Chiari's syndrome. N price); magnesium (280 mg) and Engl J Med 235:507-511, 1946. calcium (750 mg), four tablets daily the term. ($1.99); vitamin A (10,000 units) and D three tablets Hemochromatosis.\p=m-\ In the May 12 of (4,000 units), daily (no Danger Megavitamin Therapy price); vitamin E (100 units), three issue of The Journal (239:1999\x=req-\ To the Editor.\p=m-\A48-year-old black tablets daily ($6.95); a casein hydrol- 2000, 1978), several errors were made in the ORIGINAL CONTRIBUTION man has been observed in our hyper- ysate preparation, three tablets daily "Preclinical a tension clinic for three years. He has ($8.95); garlic and parsley, nine Hemochromatosis in severe essential hypertension (blood tablets daily ($6.25); brewers yeast, Population on a High-Iron-Forti- fied Diet." In the the pressures up to 260/150 mm Hg 7.5 grains, four tablets daily ($2.99); Table, heading without treatment) that has been and a vitamin preparation (1,000 mg above the bracket over columns 6 and should "DF*-Induced present for at least five years. Treat- of vitamin C with B complex), four 7 read ment has been difficult because of the tablets daily ($7.49). Iron Excretion/kg Body Weight/24 hr." The second footnote patient's poor compliance with medi- The patient was therefore taking 18 (dagger) cation and the severity of his hyper- different types of tablets with a total should read "Samples taken during acute febrile tension. In 1972 he suffered a stroke daily intake of 61 tablets. The quoted disease." On page 2000, with right-sided hemiplegia; in 1976, prices total $83.92, with two bottles column 2, the first sentence in the third should read as an anterior myocardial infarction; unpriced. The majority of the bottles paragraph follows: "The four men with iron and in 1977, a second stroke with contained 100 tablets; therefore, to right-sided signs. (Each of these cata- follow this regimen for one year overload have recently been phle- strophic events occurred when he would cost in excess of $1,000. botomized to iron deficiency." stopped his medication against medi- Although the treatment of hyper- Downloaded From: https://jamanetwork.com/ on 10/02/2021.