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Bright's disease

Bright's disease is a historical classification of kidney diseases that would be described in modern medicine as acute or chronic nephritis. The term is no longer used, as diseases are now classified according to their more fully-understood etiologies. more...

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It is typically denoted by the presence of albumin (blood plasma) in the urine, and frequently accompanied by edema (tissue particulate).

These associated symptoms in connection with kidney disease were first described in 1827 by noted English physician Dr. Richard Bright. Since that time, it has been established that the symptoms, instead of being, as was formerly supposed, the result of one form of disease of the kidneys, may be dependent on various morbid conditions of those organs. Thus, the term Bright's disease, which is retained in medical nomenclature in honor of Dr. Bright, must be understood as having a strictly historical application.

The symptoms are usually of a severe nature. Back pain, vomiting and fever commonly signal an attack. Edema, varying in degree from slight puffiness of the face to an accumulation of fluid sufficient to distend the whole body, and sometimes severely restrict breathing, is a very common ailment. The urine is reduced in quantity, is of dark, smoky or bloody color, and exhibits to chemical reaction the presence of a large amount of albumin, while, under the microscope, blood corpuscles and casts, as above mentioned, are found in abundance.

This state of acute inflammation may severely limit normal daily activities, and if left unchecked, may lead to one of the chronic forms of Bright's disease. In many cases though, the inflammation is reduced, marked by increased urine output and the gradual disappearance of its albumen and other abnormal by-products. A reduction in edema and a rapid recovery of strength usually follows.

Acute Bright's disease was treated with local depletion, warm baths, diuretics, and laxatives. There was no successful treatment for chronic Bright's disease, though dietary modifications were sometimes suggested.

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Response Rates Of Respiratory Symptoms To Surgical Treatment Of Coexistent Gastroesophageal Reflux Disease
From CHEST, 10/1/00 by Elizabeth A Miller

Elizabeth A Miller, MD(*); R A Bright, MD; S C Springmeyer, MD and D E Low, MD. Virginia Mason Medical Center, Seattle, WA.

PURPOSE: Many patients with gastroesophageal reflux disease (GERD) will have coexistent respiratory symptoms including recurrent infection, cough, asthma, hoarseness, and sore throat. It remains unclear what percentage of patients with respiratory symptoms will improve following surgical control of GERD.

METHODS: Over nine years (1991-99), 82 patients with GERD and respiratory symptoms underwent antireflux operations. All patients were reviewed in clinic and with subsequent telephone questionnaire (mean follow-up 38 months) to assess response of GERD and respiratory symptoms.

RESULTS: Preoperatively, all reported reflux symptoms refractory to conventional medical treatment and most (70%) had additional complications of GERD: aspiration (36%), Barrett's metaplasia (25%), and stricture (9%). Preoperative respiratory symptoms included cough (75%), hoarseness (42%), asthma (33%), recurrent infection (19%), and sore throat (3%). Respiratory symptoms required medical therapy in 75%, including 18% of patients who could not be weaned from steroids. Preoperative investigations included endoscopy, esophageal manometry, and 24-hour esophageal pH monitor. Mean 24-hour pH studies demonstrated abnormal levels of esophageal acid exposure in the total, supine, and upright positions. Most (94%) of the antirefiux operations were primary and performed as open procedures. Symptom responses following surgical treatment were: GERD (98%), recurrent infection (82%), hoarseness (72%), asthma (66%), cough (64%), and sore throat (33%). The need for GERD medications was eliminated in 85%. Respiratory medications were decreased or eliminated in 33% including 13 of 14 asthma patients who were able to discontinue steroids. QOL significantly improved postoperatively.

CONCLUSION: This series suggests that a significant percentage of patients with refractory respiratory problems and co-existing GERD will benefit from antireflux surgery.

CLINICAL IMPLICATIONS: Patients with GERD and refractory respiratory problems should be considered for antireflux surgery.

COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group

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