Maintenance of metabolic alkalosis despite saline administration in the presence of ascites

The administration of more than 15 L of saline over 10 days did not correct the metabolic alkalosis (plasma total CO2 35 mEq/L) of a patient with ascites secondary to ovarian carcinoma. Weight gain was more than 6 kg and urine chloride concentration remained less than 15 mEq/L. The tubular avidity for chloride and sodium which maintains metabolic alkalosis persisted in the face of saline administration, perhaps because of "ineffective" volume expansion.

Accuracy of imaging modalities in staging the local extent of prostate cancer

In this study, none of the evaluated clinical staging methods was found to predict reliably the presence or absence of extracapsular growth of histologically proved carcinoma of the prostate. In this respect, digital rectal examination, transrectal ultrasound, CT, and MR imaging cannot contribute to treatment decisions in localized prostate cancer. Further studies are under way to determine the value of 7.5-MHz scanners in transrectal ultrasound and high-resolution surface coils in MR imaging.

Amyloidosis. An unusual complication of Gaucher's disease

Gaucher's disease has been associated with plasma cell dyscrasias. A patient had Gaucher's disease, nephrotic syndrome, and systemic amyloidosis. Plasmacytosis in the bone marrow, the presence of light chains in the urine and renal glomeruli, and the finding of low circulating immunoglobulin levels suggest that the amyloid in this patient is related to a plasma cell dyscrasia.

Congestive heart failure with hypernatremia

A patient presented with hypernatremia (plasma sodium level equals 171 mEq/L), marked congestive heart failure, and fluid retention. A high-salt intake and an inappropriate lack of thirst in this patient with poor cardiac function resulted in hypernatremia accompanied by edema. Hypertonic salt intake may have been due, in part, to zinc deficiency.

Thermal therapies in interventional MR imaging. Laser

Laser ablation of cerebral tumors is an alternative to surgical excision and radiosurgery; however, more clinical testing is necessary. Various MR parameters can be used during laser ablation to detect structural as well as temperature changes in near real-time for diagnostic and therapeutic applications. Unfortunately, MR-guided ablation does not solve the problem of defining a precise target in high-grade tumors of the central nervous system.