The case was tried to a jury between February 6 and June 13, 1980. After completion of MCI's case in chief, the district court directed a verdict in favor of AT & T on seven of the twenty-two alleged acts of misconduct.^[5]The remaining fifteen

1093

*1093chargesall based on section 2 of the Sherman Actwere submitted to the jury. A special verdict form required the jury to make a separate finding of liability as to each of the fifteen charges, but permitted the jury to award damages in a single lump sum, without apportioning MCI's claimed financial losses among AT & T's various lawful and unlawful acts. The jury found in favor of MCI on ten of the fifteen charges submitted, and awarded damages of $600 milliona sum equal to two thirds the total damage figure claimed in MCI's aggregated lost profits study.^[6]The district court trebled this damage award, as required by section 4 of the Clayton Act, resulting in a judgment of $1.8 billion, exclusive of costs and attorneys' fees.

Question 1

1. Why do conditions that cause retention of sodium, such as cardiac

failure, result in low serum sodium?

2. What is meant by 'free water'?

Question 2

Why is there a difference in the pattern of oedema in nephrotic syndrome

and cardiac oedema? How is it related to the interstitial spaces and all

that? I am confused.

Question 3

Why is there a difference in the clinical presentation of oedema due to

renal failure and oedema due to cardiac failure, and how is this related

to the loose nature of the interstitial tissue in the periorbital area? The

answer given was that it is because, in cardiac failure, there is orthopnoea

and the most dependent portion in this case is the legs, which is why the

oedema occurs there. You also mentioned that in renal failure there is no

orthopnoea and the patient doesn't have to sit up, hence the difference.

This does not seem to take into account right ventricular heart failure

(RVF), where there is no question of orthopnoea. Pedal oedema is found in

right ventricular failure. Is the answer not that, in congestive heart failure

(CHF) there is pump failure (and the heart cannot pump blood against

gravity) hence oedema in the dependent areas, whereas in renal failure

there is no pump failure and the heart does not lose its capacity to pump

blood against gravity. The oedema in this case develops in those tissues

that have a loose interstitium, one such site being the periorbital area of the

face. This is the reason for the difference in clinical presentation.

Question 4

What treatment is recommended for recurrent attacks of generalized

swelling, with angio-oedema, in a middle-aged female patient?

Question 5

Is an osmotic diuresis, due to hyperglycaemia for instance, a cause of

both hyponatraemia and hypernatraemia. Please explain how this can be

the case.

Question 6

What is the mechanism of 2-agonists (albuterol) in correcting

hyperkalaemia in emergency? How does it cause a shift of potassium?

Question 7

Why do we give sodium lactate along with sodium bicarbonate in

acidotic patients? How does sodium lactate then act?

Question 8

How does hypochloraemia alone cause a metabolic alkalosis?

Question 9

I have read the part concerning acid-base imbalances and I would like to

ask about two things:

1. Why is there a higher concentration of anions (18) on measuring the

anion gap while there is a high concentration of immeasurable anions?

I would have expected a higher concentration of cations because most

of them are measurable.

2. Could you explain to me in more details how NaCO3 loss or HCl

retention could lead to normal anion gap acidosis?

Question 10

What is the exact formula for calculating the serum anion gapc12