Alvin Dubin

Idiopathic, episodic inappropriate secretion of antidiuretic hormone

Abstract For five years, a fifty-one year old man has had recurrent episodes of confusion, hiccoughs, convulsions and profound hyponatremia. He has been well between attacks. During an observed episode, a balance study demonstrated the abnormal response to water loading typical of the syndrome of inappropriate secretion of antidiuretic hormone (ADH). Following administration of ACTH and 9α-fluorohydrocortisone a normal response to water occurred, suggesting that these drugs may be useful for therapy of this condition. In contrast to previously reported examples of the syndrome, the patient is without evidence of other disease. Inappropriate secretion of ADH thus may be primary, idiopathic, intermittent and compatible with good health in other respects.

Familial hypogammaglobulinemia, splenomegaly and leukopenia. With a review of the etiological factors of the hypogammaglobulinemias.

Abstract The death from disseminated histoplasmosis of a patient with hypogammaglobulinemia, increased susceptibility to infection, splenomegaly and leukopenia led to an investigation of his family. Three of his six living children, a thirteen year old boy and six year old fraternal twin girls, were found to have a similar syndrome without evidence of infection with histoplasmosis. The patients father had splenomegaly but no other features of this syndrome. The other members of the family had none of these abnormalities. In the involved members the level of gamma globulins and the degree of immunologic responsiveness, while depressed, were greater than usually observed in other forms of hypogammaglobulinemia. The evidence suggests that this apparently new clinical entity is an hereditary disturbance transmitted possibly by an autosomal dominant gene. The etiological features of the known forms of hypogammaglobulinemia are reviewed and commented upon.

Hypomagnesemic tetany due to excessive lactation

Abstract Tetany attributable to hypomagnesemia resulting from loss of the ion in milk is described in a twenty year old Negro girl with excessive lactation. The tetany occurred in the presence of normal serum calcium concentration (9.6 mg. per 100 ml.) and distinctly low serum magnesium concentration (0.4 mEq. per L.). Intravenous administration of 12.5 mEq. of magnesium resulted in retention of some 78 per cent of the administered dose, indicating a total body depletion of the ion.

Significance of serum aminograms in diagnosis and prognosis of liver diseases.

The diagnosis, prognosis, and treatment of various liver diseases are still frequently equivocal despite the various liver function tests and invasive procedures presently available to the clinician. The introduction of the Beckman Amino Acid Analyzer Model 119 Cl, greatly facilitated the determination of the individual amino acids in serum and cerebrospinal fluid, and the data thus obtained seem to help in the differentiation of some of the commoner types of liver disease. These data indicate that changes in the concentration of some of the aromatic amino acids (AAA) and branched chain amino acids (BCAA) are helpful in the diagnosis, evaluation of the severity of the hepatic morphologic changes, and prognosis of the type of liver disease. Moreover, the ratio between the AAA and the BCAA seems to be indicative of certain liver diseases. We describe the alterations in the amino acid patterns which may help in the diagnosis, prognosis, and treatment of patients with certain types of liver disease.

Significance of vitamin A alcohol and ester partitioning under normal and pathologic circumstances.

Summary Plasma vitamin A esters rise markedly after intake of vitamin A. They are elevated significantly in nephrosis and slightly and irregularly in conditions associated with hepatic impairment. The plasma vitamin A alcohol level does not change after the intake of vitamin A but is elevated in nephritis and sometimes in recovery from conditions associated with hypovitaminemia A. It is significantly decreased in malnutrition, infections, hepatic and wasting diseases, apparently due to reduced storage in and/or release from the liver. The vitamin A alcohol level, therefore, excels the total vitamin A level as index of hepatic vitamin A storage and vitamin A nutrition.

Diuretic action of benemid: Its effect upon the urinary excretion of sodium, chloride, potassium and water in edematous subjects

Abstract 1.1. In thirteen subjects with uncomplicated congestive heart failure benemid in dosage of 4 gm. daily produced a significant diuretic response. The mean increment of water excreted on the day of maximal response was 1,330 cc., of sodium 91 mEq. and of chloride 76 mEq./24 hours. A fourteenth subject with associated gout and renal disease showed a lesser but significant response. Diuresis occurred in most instances on either the first or second day of drug administration. 2.2. Water diuresis without enhancement of sodium or chloride excretion occurred in seven other subjects. Failure of diuresis to occur in the remaining five subjects was associated with the presence of hepatic disease, renal disease, hyponatremia and hyponatruria. 3.3. It is postulated that benemid-induced diuresis is the result of decreased tubular reabsorption of water, sodium and chloride.

Serum protein-bound carbohydrates and lipids in experimental tuberculosis.

Summary The previously demonstrated reduction of serum albumin and elevation of gamma globulin and mucoprotein in experimental guinea pig tuberculosis is associated with a slight elevation of total serum hexose which is to the greatest extent accounted for by a slight rise of the carbohydrate containing alpha globulin. No evidence was obtained that the carbohydrate content of this small increment differs from that of the normal alpha globulin. In contrast the marked rise of gamma globulin is associated with an only very small increase of gamma globulin associated carbohydrates. This suggests that the excess gamma globulin in experimental tuberculosis differs from the normal gamma globulin by a very low carbohydrate content and suggests a different nature and possibly a different origin of this increment. The serum protein-bound lipids are not altered in experimental tuberculosis.

SUCCESSFUL TREATMENT OF RECURRENT URIC ACID RENAL CALCULI WITH PROBENECID (BENEMID)

Excerpt Uric acid stones comprise 4 to 6%1, 2of all renal calculus disease. Treatment by surgical and dietary measures, by alkalinization of the urine and with salicylates has not been satisfactory...