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SEPTICÆMIA AND PULMONARY EMBOLISM COMPLICATING MAINTENANCE HÆMODIALYSIS
1129
Although the serum-magnesium level in depressed patients is not a useful measurement, further studies of magnesium metabolism in depression are indicated. We should like to thank Dr. R. E. Kelly, Dr. R. Ross Russell, and Dr. H. E. Webb, of the Department of Neurology, and Dr. W. Sargant and Dr. J. Pollitt, of the Department of Psychological Medicine, for allowing us to study patients under their care.
Departments of Neurology, Psychological Medicine, and Chemical Pathology, St. Thomas’ Hospital,
L. HERZBERG A. M. BOLD.
London S.E.1.
SHARING AUTHORITY
SIR, Your editorial commending the management changes in Sydney Hospital (April 29, p. 941) highlightsa
problem which bedevils the National Health Service Traditional accounting practices provide no incentive tc save money, because what is saved in one department cannot be spent by another. Any saving benefits the Treasury rather than the local hospital. Until the accountancy system is changed the lessons o: the Sydney experiment may benefit the National Healtl Service administratively but thev St. Helen’s Hospital,
Hastings, Sussex.
cannot
do
RO
financiallv.
P. F. PLUMLEY R. E. IRVINE.
Fig. 2-Complete resolution of pulmonary infiltrates after 2 months.
inserted
at a new arterial site, and the external shunt was reestablished, using the original venous cannula. 3 days after the shunt revision we observed a wound infection with septic fever. Staphylococcus aureus was found in the wound, but repeated blood-cultures were negative. We started antibiotic therapy with penicillin 4 million units three times a day, oxacillin 0-5 g. twice a day, and gentamicin 40 mg. daily. The shunt was removed, and
arteriovenous fistula was created on the other side. A week later the patient developed left-sided pleuritic chest pain with fever and dyspncea. A chest X-ray showed multiple infiltrates in both lungs (fig. 1). 10 days after starting the antibiotic therapy, the fever had subsided and the leucocyte-count was normal again. 2 months later the chest X-ray showed complete resolution of these infiltrates (fig. 2). No further episodes of pulmonary embolism have been observed in the subsequent 11 months. an
SEPTICÆMIA AND PULMONARY EMBOLISM COMPLICATING MAINTENANCE HÆMODIALYSIS or internal shunt infections in patient SIR,-External undergoing maintenance hxmodialysis may cause septi camlia or pulmonary embolism. These complications hav
1st Medical Clinic of the University of Vienna.
P. SCHMIDT J. ZAZGORNIK H. KOPSA R. KOTZAUREK.
REGIONAL SODIUM-PUMP ACTIVITY AND EPILEPSY
Fig. 1-Chest X-ray showing multiple infiltrates in both lungs. been described in 3 cases by Goodwin et al.1 and in 7 cases by Levi et al. We report here a further case of this severe complication with complete recovery of the patient. A 46-year-old man with terminal renal failure has been undergoing chronic hsemodialysis since June, 1970. 10 months after beginning maintenance hsemodialysis a spontaneous subcutaneous hasmatoma developed at the arterial site of the arteriovenous shunt, necessitating surgical exploration. A new cannula was 1.
is greatly increased after seizure induction by intraConcopper, and zinc. versely, chronic administration to rats of the anticonvulsant drug, diphenylhydantoin, results in a decrease of sodium content in various brain regions. rat
ventricularly injected ouabain,
Goodwin,
N. J., Castronuovo, J. H., Friedman, E. A. Ann. intern. 1969, 71, 29. Levi, J., Robson, M., Rosenfeld, J. Lancet, 1970, ii, 288. Med.
2.
SIR,-Dr. Viukari (April 1, p. 749) proposed a relationship between Na-K-A.T.P.ase activity and epilepsy. Evidence from our laboratory may support this hypothesis. We have shown1 that ouabain (a specific inhibitor of Na-KA.T.P.ase) injected intraventricularly in rats is potent in eliciting clonic-tonic seizures. Such seizures are also elicited by divalent cations (copper and zinc) that inhibit Na-KA.T.P.ase in vitro. The intraventricular injection of ouabain, copper, and zinc results in vivo in a greatly decreased activity of the transport enzyme, Na-K-A.T.P.ase, particularly in certain rat-brain regions-the hippocampus and hypothalamus.1 Our current investigations indicate that along with the decrease in hippocampal and hypothalamic transport-enzyme activity, there is also an increase in total sodium content and in the Na/K ratio in rat hippocampus and hypothalamus during the ouabain-induced seizures. Copper and zinc, which strongly inhibit the transport enzyme in vitro and in vivo, also increase brain regional sodium content and the Na/K ratio. We have also found that the content of potassium in cerebrospinal fluid of the
1.
Donaldson, J., St-Pierre, T., Minnich, J., Barbeau, A. Can. J. Biochem. 1971, 49, 1217.
Although the serum-magnesium level in depressed patients is not a useful measurement, further studies of magnesium metabolism in depression are indicated. We should like to thank Dr. R. E. Kelly, Dr. R. Ross Russell, and Dr. H. E. Webb, of the Department of Neurology, and Dr. W. Sargant and Dr. J. Pollitt, of the Department of Psychological Medicine, for allowing us to study patients under their care.
Departments of Neurology, Psychological Medicine, and Chemical Pathology, St. Thomas’ Hospital,
L. HERZBERG A. M. BOLD.
London S.E.1.
SHARING AUTHORITY
SIR, Your editorial commending the management changes in Sydney Hospital (April 29, p. 941) highlightsa
problem which bedevils the National Health Service Traditional accounting practices provide no incentive tc save money, because what is saved in one department cannot be spent by another. Any saving benefits the Treasury rather than the local hospital. Until the accountancy system is changed the lessons o: the Sydney experiment may benefit the National Healtl Service administratively but thev St. Helen’s Hospital,
Hastings, Sussex.
cannot
do
RO
financiallv.
P. F. PLUMLEY R. E. IRVINE.
Fig. 2-Complete resolution of pulmonary infiltrates after 2 months.
inserted
at a new arterial site, and the external shunt was reestablished, using the original venous cannula. 3 days after the shunt revision we observed a wound infection with septic fever. Staphylococcus aureus was found in the wound, but repeated blood-cultures were negative. We started antibiotic therapy with penicillin 4 million units three times a day, oxacillin 0-5 g. twice a day, and gentamicin 40 mg. daily. The shunt was removed, and
arteriovenous fistula was created on the other side. A week later the patient developed left-sided pleuritic chest pain with fever and dyspncea. A chest X-ray showed multiple infiltrates in both lungs (fig. 1). 10 days after starting the antibiotic therapy, the fever had subsided and the leucocyte-count was normal again. 2 months later the chest X-ray showed complete resolution of these infiltrates (fig. 2). No further episodes of pulmonary embolism have been observed in the subsequent 11 months. an
SEPTICÆMIA AND PULMONARY EMBOLISM COMPLICATING MAINTENANCE HÆMODIALYSIS or internal shunt infections in patient SIR,-External undergoing maintenance hxmodialysis may cause septi camlia or pulmonary embolism. These complications hav
1st Medical Clinic of the University of Vienna.
P. SCHMIDT J. ZAZGORNIK H. KOPSA R. KOTZAUREK.
REGIONAL SODIUM-PUMP ACTIVITY AND EPILEPSY
Fig. 1-Chest X-ray showing multiple infiltrates in both lungs. been described in 3 cases by Goodwin et al.1 and in 7 cases by Levi et al. We report here a further case of this severe complication with complete recovery of the patient. A 46-year-old man with terminal renal failure has been undergoing chronic hsemodialysis since June, 1970. 10 months after beginning maintenance hsemodialysis a spontaneous subcutaneous hasmatoma developed at the arterial site of the arteriovenous shunt, necessitating surgical exploration. A new cannula was 1.
is greatly increased after seizure induction by intraConcopper, and zinc. versely, chronic administration to rats of the anticonvulsant drug, diphenylhydantoin, results in a decrease of sodium content in various brain regions. rat
ventricularly injected ouabain,
Goodwin,
N. J., Castronuovo, J. H., Friedman, E. A. Ann. intern. 1969, 71, 29. Levi, J., Robson, M., Rosenfeld, J. Lancet, 1970, ii, 288. Med.
2.
SIR,-Dr. Viukari (April 1, p. 749) proposed a relationship between Na-K-A.T.P.ase activity and epilepsy. Evidence from our laboratory may support this hypothesis. We have shown1 that ouabain (a specific inhibitor of Na-KA.T.P.ase) injected intraventricularly in rats is potent in eliciting clonic-tonic seizures. Such seizures are also elicited by divalent cations (copper and zinc) that inhibit Na-KA.T.P.ase in vitro. The intraventricular injection of ouabain, copper, and zinc results in vivo in a greatly decreased activity of the transport enzyme, Na-K-A.T.P.ase, particularly in certain rat-brain regions-the hippocampus and hypothalamus.1 Our current investigations indicate that along with the decrease in hippocampal and hypothalamic transport-enzyme activity, there is also an increase in total sodium content and in the Na/K ratio in rat hippocampus and hypothalamus during the ouabain-induced seizures. Copper and zinc, which strongly inhibit the transport enzyme in vitro and in vivo, also increase brain regional sodium content and the Na/K ratio. We have also found that the content of potassium in cerebrospinal fluid of the
1.
Donaldson, J., St-Pierre, T., Minnich, J., Barbeau, A. Can. J. Biochem. 1971, 49, 1217.