[Psychogenic polydipsia: pronounced cerebral edema after exaggerated consumption of boiled water]. / Psykogen polydipsi: Udtalt cerebralt ødem efter overdreven indtagelse af kogt vand.

A case of psychogenic polydipsia is presented. A 40 year old female was brought to the emergency room after a sudden seizure at home. The patient had spontaneous eye opening, was making incomprehensible sounds and had abnormal and agitated flexion of the limbs. Severe cerebral edema was seen on the computed tomogram. The patient was found to have hypotonic polyuria and hyponatremia. Two months previously, the patient had stopped taking bromazepam (a benzodiazepine) and on the advice of a neighbour had taken plenty of water to avoid withdrawal symptoms. The diagnosis and therapy are discussed.

Carotid artery disease and low cerebral perfusion pressure: symptomatology, operative risk and outcome.

Direct internal carotid artery blood pressure measurements in patients undergoing carotid endarterectomy identified 49 patients, among 239 consecutive cases (21%), who had a reduction in perfusion pressure of 20% or more. The clinical history, objective findings and angiographic data were compared with those of a control group of a further 49 patients selected from the remaining patients operated on over the same period. The two groups were compared for short- and long-term outcome of surgery. We were unable to delineate a symptomatic neurological profile that identified patients with low perfusion pressures. Surgery in patients with low perfusion pressures seemed to be associated with an increased complication rate (12% versus 4%), although this was not statistically significant. Definite postoperative improvements in persisting neurological deficits were observed only in one patient. Long-term results were equal in the two groups with an annual stroke risk of 3%.

Effect of electrode temperature on orthostatic changes in forefoot transcutaneous oxygen tension (tc-PO2).

The influence of increasing the temperature of the transcutaneous oxygen tension (tc-PO2) electrode from 37 to 45 degrees C on the orthostatic changes in tc-PO2 was studied in six normal subjects. The tc-PO2 electrode was mounted on the forefoot. The blood pressure of the forefoot was changed by elevating and lowering the forefoot in relation to heart level. At all electrode temperatures tc-PO2 decreased about 35% when the forefoot was elevated. At electrode temperatures between 41 and 45 degrees C tc-PO2 increased about 20% when the electrode was lowered below heart level. This indicates a passive vascular bed in the heated tissue under the electrode. However, at 37 degrees C tc-PO2 decreased about 40% when the forefoot was lowered. This indicates that the local vasoconstrictor response to increased venous transmural pressure is preserved when the tissue under the electrode is heated to 37 degrees C only. The study suggest that tc-PO2 monitoring at 37 degrees C may be used for continuous, non-invasive monitoring of the local vasoconstrictor response, and thus of arteriolar contractility and intact sympathetic innervation.

Kinetics of cefuroxime in the groin wound after vascular prosthetic implantation.

The kinetics of cefuroxime in serum and wound fluid were investigated in the period after vascular prosthetic implantation. Cefuroxime was administered as intravenous bolus injections in doses of 0.75 gm (five patients) or 1.5 gm (five patients). The concentration of cefuroxime in wound fluid increased after the injection and reached a maximal level corresponding to serum concentration levels with 1.5 hours. The subsequent elimination of cefuroxime from the wound fluid closely paralleled the elimination from the serum. The wound fluid concentrations were found to be greater than the minimum inhibitory concentration for Staphylococcus aureus and Escherichia coli in 8 and 5 hours, respectively, after injection of 0.75 gm of cefuroxime, and in 11 and 7 hours, respectively, after injection of 1.5 gm of cefuroxime.