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2733. Interstitial lung diseases of unknown cause. Disorders characterized by chronic inflammation of the lower respiratory tract (first of two parts).
作者: R G Crystal.;P B Bitterman.;S I Rennard.;A J Hance.;B A Keogh.
来源: N Engl J Med. 1984年310卷3期154-66页 2734. Current concepts. Serum osmolality. Uses and limitations.
The serum osmolality measurement has a clearly circumscribed use in clinical medicine. Comparison of the measured osmolality with the osmolality calculated from the concentrations of the major solutes in serum gives information about large deviations in the serum water content. In addition, comparison of the measured and calculated values of osmolality provides rapid screening information about the presence of foreign low-molecular-weight solutes in the blood. Taken at face value, the test cannot be used to determine whether abnormalities in tonicity homeostasis are present. A simple and direct way to assess whether tonicity is normal is to calculate the effective osmolality from the concentrations of sodium and glucose in serum. With rare exceptions, this calculation provides the information needed to make decisions about therapy.
2739. Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus.
New knowledge of the relationship between the varicella-zoster virus and its host suggests a heretofore unappreciated dynamic pattern. Molecular finger-printing has demonstrated a degree of heterogeneity between different strains of virus. It is probable that exogenous reinfection with different strains and endogenous reactivation are commonplace events, although usually asymptomatic. The lability of the endogenous interaction inversely parallels the responsiveness of the cell-mediated immune system--a major factor in viral containment by the human host. Thus, the therapeutic use of immunosuppressive or cytotoxic substances increases the morbidity and mortality associated with varicella-zoster. Promising new approaches to the prevention and treatment of the virus should alter the balance in favor of the host.
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