Alexander Aviram

Long-Term Treatment of the Syndrome of Inappropriate Antidiuretic Hormone Secretion with Phenytoin

A 68-year-old patient with the syndrome of inappropriate antidiuretic hormone secretion secondary to basilary skull fracture was treated successfully with demeclocycline and phenytoin. Phenytoin, which was considered in the past only as a useful diagnostic tool, was given to the patient on a long-term basis. The drug reversed the patients symptoms and abnormal laboratory values to normal limits without adverse reactions during a treatment period of 8 months.

Cardiac Arrhythmia during Chronic Ambulatory Peritoneal Dialysis

Repeated bouts of ventricular tachycardia were triggered by the inflow of dialysate during acute peritoneal dialysis performed in a 79-year-old woman. Subsequent continuous Holter monitoring of 21 patients, many elderly and with cardiac disease, undergoing chronic ambulatory peritoneal dialysis (CAPD) revealed atrial and/or ventricular premature beats in 19 out of them. However, there were no differences in the type and frequency of the extrasystoles between the recordings performed on a day of dialysis or on a day on which dialysis was deliberately withheld. No new arrhythmias were seen in the 2 patients who were previously free of arrhythmias, in whom CAPD was undertaken. It seems that CAPD does not provoke or aggravate arrhythmias, even in elderly or cardiac patients.

Central pontine myelinolysis

SummaryA case of central pontine myelinolysis, the 19th so far published or communicated, is described in a Jewish woman of Yemenite extraction who had suffered for 12 years prior to her death from a mental condition diagnosed as chronic schizophrenia. Anatomo-pathologically the pontine lesion was similar to those described in previous cases, except that in this case there were “pools” of mucoid material present in it. The lesion developed in the absence of alcoholism and in association with a state of general dehydration and electrolyte imbalance in the patient.ZusammenfassungEin Fall von zentraler pontiner Myelinose — der 19. bisher veröffentlichte oder mitgeteilte — wird beschrieben: eine aus dem Yemen stammende Jüdin litt 12 Jahre vor ihrem Tod an einer Nervenkrankheit, die als chronische Schizophrenie diagnostiziert wurde. Anatomisch-pathologisch war die Brückenläsion ähnlich der in den früheren Fällen beschriebenen, mit der Ausnahme, daß Anhäufungen von mucoidem Material vorgefunden wurden. Die Läsion entwickelte sich bei dieser Patientin — ohne Alkoholmißbrauch — in Zusammenhang mit einem Zustand von generellem Flüssigkeitsverlust und Elektrolytgleichgewichtsstörung.

Diuretic and Natriuretic Response to a Salt Load in Hypertensive and Pre-Hypertensive Subjects

The diuretic and saluretic response to the intravenous infusion of a 5% salt solution (5 g of NaCl/m2 of body surface area) was examined in a group of normotensive subjects, in patients wit

Dialysis-Induced Eosinophilia

Blood eosinophils were counted by the counting-chamber method in 21 regular hemodialysis patients. Before dialysis, eosinophil counts were within the normal range in all patients (mean 98 cells/mm3, range 6-350). After the first 15 min of hemodialysis, with not reused coils or hollow-fiber dialysers, a significant drop in eosinophil counts was noted in all patients. The mean drop was 37.5% of the initial value (range 28-100%). At the end of the 5-hour dialysis, the eosinophil counts rose significantly in all patients but 1. The mean rise was 521% of the initial counts (range 22.3-1576%). Simultaneous neutrophil counts showed the already described drop at 15 min with a return to predialysis levels at 5 h. Predialysis IgE serum concentrations were lower than normal (mean 24.8, range 4.5-58 units/ml), and did not change at the end of the dialysis. It seems that pulmonary sequestration is responsible for both neutropenia and eosinopenia early in dialysis. The marked eosinophilia at 5 h may be the result of a release of eosinophilotactic substances induced by the dialysis procedure itself.

Increased Sensitivity of a Volume-Regulating Mechanism in the Pre-Hypertensive State Studies in Normotensive Women after Toxemia of Pregnancy

Normotensive women after toxemia of pregnancy reacted to the infusion of reconstituted human plasma with a water diuresis, whereas control subjects exhibited an antidiuretic response. The latter was probably due to the presence of antidiuretic material in the infused plasma, whereas the water diuresis, which has also been found in hypertensive subjects, can be explained as the manifestation of an increased sensitivity of a volume-regulating mechanism in the hypertensive as well as in the “pre-hypertensive” state.