Ethchlorvynol (Placidyl) Intoxication and Its Treatment by Hemodialysis

Twenty hours after ingesting 15-25 g. of ethchlorvynol, a 37-year-old woman was admitted comatose and in shock. The blood level of ethchlorvynol was 21.6 mg. % (method of Wallace). Supportive measures were instituted and hemodialysis, carried out for 10 hours, removed 5.49 g. of the drug. The post-dialysis blood level was 9.05 mg. % and the rate of dialysance was 50.5 ml./min. Only 0.6 g. of the substance was recovered from the urine over the same period.Although dialysis removed significant amounts of the drug and sustained life, the patient remained comatose for five days before withdrawal symptoms and seizures developed.     

Treatment of Hypertension with Hydrochlorothiazide and Spironolactone

A comparison was made of the antihypertensive effect of a daily dose of 150 mg. of hydrochlorothiazide (HCT) with one of 150 mg. of spironolactone (SL) in 48 patients with essential hypertension.The blood pressure values after six weeks of therapy with HCT were not significantly different from those after SL. Treatment of 25 of these patients with the two agents combined did not reduce the blood pressure further. Blood urea nitrogen concentrations increased with both HCT and SL treatment.With combined treatment there was a further increase in blood urea nitrogen concentration and a decrease in serum sodium concentrations without weight loss beyond that achieved with either HCT or SL alone.     

MRI study of regional variations of pharyngeal wall compliance in cats

Upper airway compliance indicates the potentialof the airway to collapse and is relevant to the pathogenesis ofobstructive sleep apnea. We hypothesized that compliance would varyover the rostral-to-caudal extent of the pharyngeal airway. In aparalyzed isolated upper airway preparation in cats, we controlledstatic upper airway pressure during magnetic resonance imaging (MRI, 0.391-mm resolution). We measured cross-sectional area andanteroposterior and lateral dimensions from three-dimensionalreconstructed MRIs in axial slices orthogonal to the airway centerline.High-retropalatal (HRP), midretropalatal (MRP), and hypopharyngeal(HYP) regions were defined. Regional compliance was significantlyincreased from rostral to caudal regions as follows: HRP < MRP < HYP (P < 0.0001), and compliancedifferences among regions were directly related to collapsibility. Thusour findings in the isolated upper airway of the cat support thehypothesis that regional differences in pharyngeal compliance exist andsuggest that baseline regional variations in compliance andcollapsibility may be an important factor in the pathogenesis andtreatment of obstructive sleep apnea.