Shlomo Dux

Spontaneous Bacterial Pleuritis in a Patient with Cirrhosis

Empyema of the left pleural cavity developed suddenly in a nonalcoholic cirrhotic patient. Cultures of the pleural fluid under anaerobic conditions grew Clostridium perfringens, an organism normally found in the enteric flora. The infection developed in an old pleural effusion. Since there was no evidence of trauma, necrotizing pneumonitis or subphrenic infection, spontaneous bacterial pleuritis is proposed.

Renin, aldosterone, and serum-converting enzyme activity during normal and hypertensive pregnancy.

Plasma renin activity, plasma aldosterone, and serum-converting enzyme activity were measured in 13 normotensive pregnant women in three sequential periods: 19-21, 29-31, and 38-40 weeks of gestation. The converting enzyme activity was also measured in a group of 6 women with hypertensive pregnancy and an age-matched control group of 35 normal nonpregnant women. Plasma renin activity and plasma aldosterone values were both significantly elevated in the three periods of pregnancy, but plasma aldosterone levels were relatively lower during the first two periods. This is suggested to be secondary to depressed aldosterone secretion by intravascular volume expansion. The serum-converting enzyme activity did not change during pregnancy, and the mean values (1.02 +/- 0.27 U) were lower than those found in the control group (1.23 +/- 0.26 U). Similar low values were found in the hypertensive pregnancy group (1.11 +/- 0.35 U). Therefore, we assume that the converting enzyme is not a limiting factor in the conversion of angiotensin nor does it contribute significantly to the pathogenesis of hypertensive pregnancy.

Recurrent Erythema nodosum, Arthritis and IgA Nephropathy

Erythema nodosum and IgA nephropathy are nosologic entities with an immunologic background. IgA nephropathy is a specific disease of the kidneys, while erythema nodosum may be associated with other illnesses. We report a unique case in which intermittent hematuria due to IgA nephropathy was superimposed on recurrent attacks of erythema nodosum and arthritis. A common pathophysiology is suggested.

Spontaneous Rupture of the Kidney in a Patient with Acute Autoimmune Disease

A percutaneous renal biopsy was performed on a 50-year-old female with rapidly progressive renal failure. The histologic specimen was characteristic of an immune complex disease, most likely systemic lupus erythematosus. Serologic tests were negative. 8 days after the biopsy, there was a spontaneous rupture of the kidney which necessitated nephrectomy. As no connection was found between the biopsy site and the rupture, it was concluded that the rupture was spontaneous in a patient with an immune complex disease.

Peritoneal adhesions produced by oral tetracycline.

medications. The first patient reported purchasing her medication in Mexico. Some medications purchased there have been reported to be adulterated withother substances/ While it is possiblethat this patients medication contained phenobarbital ratherthanbutalbital, this is unlikely due to the confirmation ofbutalbitalby thin-layer chromatography. Butalbitalmay cross-reactwith some Emit assays for phenobarbital determination,particularlyfollowing large ingestionssuch as those in acutepoisonings.

Labetalol in the Treatment of Essential Hypertension: A Single‐Blind Dose Ranging Study

The hypotensive efficacy of labetalol was evaluated in 29 patients with essential hypertension in a single‐blind dose ranging study. After a two‐week period of placebo treatment, labetalol was given in oral doses of 0.6 g/d, 0.8 g/d, and 0.8 g/d combined with 25–50 mg/d of hydrochlorothiazide. Each regimen lasted four weeks. The decrease in blood pressure was dose dependent: 90% of patients showed a significant reduction in diastolic blood pressure and 75% showed a significant reduction in systolic blood pressure. In 69% of the patients, side effects of the drug were noted, and in five patients (17%), treatment was discontinued because of the side effects. Seven patients received labetalol intravenously before the oral treatment. Their heart rate and blood pressure reductions were similar to those found in patients only taking the medication orally. We conclude that labetalol is an efficient and safe antihypertensive agent in both oral and intravenous administration. However, the high incidence of side effects makes labetalol a drug of second choice in uncomplicated hypertensive patients.

Hyperammonemia complicating mesenteric vein thrombosis.

Hyperammonemic coma developed in a 69-year-old woman with prolonged symptoms of abdominal pain, dysphagia, and fever. At laparotomy for an acute condition within the abdomen, mesenteric vein thrombosis was found and partial intestinal resection was performed. Following surgery, the patient regained consciousness and blood ammonia levels became normal. Hyperammonemia and coma complicating mesenteric vein thrombosis have not yet been described. Venous shunts are suggested as being responsible for this rare complication.