Daniele Bendayan, MD, Gershon Fink, MD, Dan Aravot, MD, Mordechai Ygla, MD, Issahar Bendov, MD, Leonard Bliden, MD, Nir Amiran, MD and Mordechai Kramer, MD
Background: Primary idiopathic pulmonary hypertension is a rapidly progressive disease with a median survival of less than 3 years. Recently its prognosis was shown to dramatically improve with the use of epoprostenol, an arachidonic acid metabolite produced by the vascular endothelium, which increases the cardiac output and decreases the pulmonary vascular resistance and pulmonary arterial pressure. This drug enhances the quality of life, increases survival and delays or eliminates the need for transplantation.
Objective: To review the experience of Israel hospitals with the use of epoprostenol.
Methods: The study group comprised 13 patients, 5 men and 8 women, with an age range of 3–53 years. All patients suffered from arterial pulmonary hypertension. Epoprostenol was administered through a central line in an increased dose during the first 3 months, after which the dose was adjusted according to the clinical syndrome and the hemodynamic parameters.
Results: After 3 months the mean dose was 10 ng/kg/min and the pulmonary artery pressure decreased from 7 to 38%. After one year, the PAP decreased at a slower rate. Two cases required transplantation, three patients died, and seven continued taking the drug (one of whom discontinued). Four episodes of septicemia were observed. Today 10 patients are alive and well and 7 continue to take epoprostenol.
Conclusion: We found that epoprostenol improves survival, quality of life and hemodynamic parameters, with minimum side effects.
Eyal Meltzer, MD and Shmuel Steinlauf, MD
Background: Lithium has been a part of the psychiatric pharmacopoeia for more than half a century. Its efficacy is marred by a narrow therapeutic index and significant toxicity.
Objectives: To increase physicians’ awareness of the various manifestations of lithium intoxication.
Methods: We reviewed the clinical data of cases of lithium poisoning occurring in a municipal hospital during a 10 year period.
Results: Eight patient records were located. The mortality rate was 12.5%. All patients were women and the mean age was 66.4 years. The most common symptoms were neurological. One illustrative case is described in detail with lithium serum levels showing the usual two-phase decline.
Conclusions: Lithium poisoning can present in many forms. Increased physician awareness and the early use of effective treatment, mainly hemodialysis, will prevent mortality and protracted morbidity associated with this condition.
Jacob Lavee, MD and Yoav Paz, MD
Lotan Shilo, MD, Susy Kovatz, MD, Ruth Hadari, MD, Eli Weiss, PhD and Louis Shenkman, MD