A case of massive diphenhydramine abuse and withdrawal from use of the drug.
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Biomedical subjects
Publications and source records attributed to M Behar.
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This study describes biochemical comparison of proximal tubule antigens from the brush border membrane (BBM) of dog and rat kidney. The purpose was to determine if a difference in BBM composition could explain the inability to produce either active or passive Heymann Nephritis in the dog. Although the membrane composition as revealed by coomassie blue staining on 4 to 11 per cent polyacrylamide electrophoresis varied considerably between rats and dogs, polyclonal antibodies (rabbit anti-rat, rabbit anti-dog) against purified BBM from both species immunoprecipitated five identical polypeptides. Four bands were visualized between 70 kd and 170 kd; but the major polypeptide had an apparent molecular wt of approximately 460 kd. This high molecular wt constituent and three of the other peptides were bound specifically to lentil lectin column, confirming their glycoprotein nature. Only the 460 kd polypeptide was immunoprecipitated by monoclonal antibody against gp 330. Since both rat and dog BBM contain gp 330, believed to be the sole pathogenic antigen in Heymann Nephritis, we conclude that failure to produce active or passive Heymann Nephritis in the dog using the same protocol that is successful in rats cannot be attributed to differences in antigenic make-up of the brush border membrane.
We describe a congenitally afibrinogenemic young man who experienced massive spontaneous bleeding episodes at unusual sites, including the thigh muscles, lung and brain. Each of these life-threatening episodes raised theoretical and critical practical problems. A large local hematoma was responsible for an accelerated consumption of fibrinogen, which was relieved following evacuation. It is unusual for an afibrinogenemic patient to survive a number of potentially lethal bleeding episodes.
A 15 year old boy with chronic impetigo was admitted with severe acute oliguric renal failure requiring temporary dialytic treatment. Renal biopsy revealed typical diffuse and proliferative glomerulonephritis of the poststreptococcal type. Subsequently high temperature developed with flank pains at the biopsy site, concomitantly with deterioration of renal function. On exploration, a sterile perirenal hematoma was found and a wedge renal biopsy revealed crescentic rapidly progressive glomerulonephritis of the post infectious type. Deterioration to end stage renal failure occurred within a few months. Although universally accepted, biopsy proven evolution from diffuse proliferative and exudative glomerulonephritis to crescentic form of post streptococcal glomerulonephritis has been rarely reported.
A case of central nervous system depression which developed 7 hours after an intrathecal injection of 4 mg of morphine is described. The patient lapsed into coma with bradypnoea and "pin-point' pupils and there was no response to naloxone 0.4 mg. Treatment was continued for 3 hours. No postoperative analgesics were required for 126 hours. The problems associated with the use of intrathecal opiates are reviewed, delay in onset being the usual feature. Use of hyperbaric solutions of the narcotic and maintenance of a head-up posture may protect against respiratory depression.
A directive from the Food and Drug Administration indicates that the use of plasma protein fraction (PPF) is contraindicated during cardiopulmonary bypass because of possible hypotension. Bradykinin has been implicated as the cause of this hypotension. Bradykinin levels were measured by radioimmunoassay in PPF and in 5% albumin and were found to be consistently elevated in the former and occasionally in the latter. The addition of PPF to pump primes resulted in significantly elevated levels of bradykinin, which rapidly cleared, indicating that extrapulmonary sites of bradykinin inactivation were efficient. The potential hypotensive effect of PPF was observed by determining the change in mean perfusion pressure in two groups of patients: one group with a 3,000 ml crystalloid prime and the other with a prime of 2,000 ml of crystalloid and 1,000 ml of PPF. There was no significant difference in the perfusion pressure between the two groups at any point, and the hypotensive effects seen in both groups were readily treated, suggesting that the directive against the use of PPF during cardiopulmonary bypass may be unnecessarily restrictive.
Epidural injections of a 2 mg morphine were given to 10 patients with severe acute or chronic pain. All cases had considerable amelioration of pain, which commenced within 2-3 min, reached a peak in 10-15 min, and was effective for 6-24 h. It is suggested that the morphine reached the subarachnoid space and produced its effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior-horn cells of the spinal cord.
The incidence of death caused by cirrhosis of the liver has increased in Israel during the last 20 years as it has in other parts of the world; still the incidence is much lower than in most countries. Increasing alcoholism and higher rates of hepatitis probably play a role, however in many cases the cause of cirrhosis remains in the dark.
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Malnutrition is primarily due to poverty, a manifestation of social injustice with inadequate distribution of resources and services within and between countries. By limiting the capability of poor people to improve their economical and social status, malnutrition helps to perpetuate this situation. A change in developmental policies taking more into account the improvement of living conditions of the poor is needed to correct this social problem.
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