Preliminary clinical experience with imipramine HCl in the treatment of sleep apnea syndrome.

In the last 2 years we have systematically treated 31 sleep apnea patients with 25-50 mg imipramine HCl given 30 min before bedtime. Imipramine treatment was attempted for nonoverweight patients with negative ear, nose and throat (ENT) findings and for patients who had not responded to weight reduction or ENT surgery (in all patients the apneas were not considered life threatening). Thirteen of the 31 (41.9%) patients, of whom 9 had central apnea, reported subjective improvement in diurnal and nocturnal symptoms within 10-15 days from the initiation of treatment. Sleep laboratory recordings conducted 1-5 months after the beginning of treatment revealed a significant decrease in the total number of apneas from 242 +/- 156 to 142.8 +/- 120.1 (p less than 0.01) in these patients. We concluded that treatment with imipramine may benefit selected sleep apnea patients particularly of the central type.

Lithium-induced nephrogenic diabetes insipidus: studies of tubular function and pathogenesis.

We describe a patient with lithium-induced nephrogenic diabetes insipidus in whom detailed investigations of distal tubular function were performed. Clearance of free water during water diuresis was found to be augmented. This suggests proximal suppression of sodium reabsorption by lithium. Reabsorption of free water during high solute clearance was impaired. Acidification of the urine following ammonium chloride loading was abnormal, and this was corrected by sodium sulfate infusion. The cellular mechanism of lithium was investigated by means of indomethacin, an inhibitor of prostaglandin synthesis. Indomethacin caused a partial reversal of the nephrogenic diabetes insipidus, suggesting that the primary cellular action of lithium may be to inhibit the formation of cyclic AMP in the collecting duct cell, although a direct action of indomethacin in increasing solutes in the renal medulla could not be ruled out. It is possible that the lithium-induced polyuria is partially due to an enhancement by lithium of renal prostaglandin action.

Candida albicans abscess of lung.

Candida albicans lung abscess is a rare entity. We present a case in a patient who suffered from Hodgkin's disease and was receiving immunosuppressive therapy. The patient responded to treatment with 5-fluorocytosine.

New observations in the clinical spectrum of the Budd-Chiari Syndrome.

Some observations on the natural history, surgical management and metabolic phenomena in B.C.S. are presented. In one patient side to side portocaval shunt brought dramatic improvement with asymptomatic followup of 5 years. The patient died of causes unrelated to B.C.S. At postmortem the shunt was patent and normal liver architecture was preserved. The second patient presented with a fulminant course culminating in acute hepatorenal syndrome. There was marked hypofibrinogenemia and extreme elevation of SGOT. Emergency portocaval shunt was followed by marked improvement in liver status. The patient died of respiratory complications on the 8th postoperative day. The third patient is one year on conservative treatment only and well. In this patient excessive renal tubular reabsorption of sodium at a distal site was documented. This may explain the generalised edema formation in patients with B.C.S. even without inferior vena cava obstruction. This is apparently the first reported instance of renal tubular function studied in B.C.S.