HEXAMETHONIUM AND HYDRALAZINE HYDROCHLORIDE—For Treatment of Hypertension

Twenty-one patients have been treated for hypertension with oral doses of hexamethonium salts, Apresoline® or combinations of both. Three of 18 patients had good or excellent response to hexamethonium alone. Five of 13 treated with hexamethonium salts plus Apresoline had good or excellent results, as did 8 of 14 treated with Apresoline alone. The addition of very small doses of hexamethonium chloride to optimal doses of Apresoline improved the effect of the Apresoline in three patients. Postural hypotension and constipation due to hexamethonium were the most serious undesirable effects.     

Clinical Experience with Vincaleukoblastine Sulfate in the Treatment of 11 Patients with Hodgkin's Disease

Eleven patients with established Hodgkin''s disease were treated with vinblastine sulfate. Each patient received from 0.15 to 0.20 mg./kg. of body weight intravenously in 10 divided doses over a five-hour period as initial therapy. All had received one or more of the more established forms of treatment before being given vinblastine. The response to treatment with vinblastine was excellent in three patients, good in one, and poor in three; there was no response in four. The longest remission was 15 months. Two of the patients were father and son. The side effects of treatment in this series included alopecia, leukopenia, and septicemia.     

Chlorpromazine alone and with reserpine; use in the treatment of mental diseases

One hundred psychiatric patients were treated with chlorpromazine, alone or combined with reserpine. Fifty-six per cent of patients with chronic schizophrenic reactions showed moderate or pronounced improvement when treated with chlorpromazine alone. The results of treatment with the combined drugs were not so good as that. Indications are that treatment of patients with chronic schizophrenic reactions is more efficacious with these drugs than with other forms of somatic therapy. Complications of treatment were far greater with combined use of chlorpromazine and reserpine. For this reason, the combination appears to have limited usefulness. The Parkinson syndrome was the most frequent complication of large doses of these drugs. It appears to be a toxic reaction, requiring reduction in dosage. Jaundice appears to be neither a frequent nor a serious complication of treatment.     

CHLORPROMAZINE ALONE AND WITH RESERPINE—Use in the Treatment of Mental Diseases

One hundred psychiatric patients were treated with chlorpromazine, alone or combined with reserpine. Fifty-six per cent of patients with chronic schizophrenic reactions showed moderate or pronounced improvement when treated with chlorpromazine alone. The results of treatment with the combined drugs were not so good as that. Indications are that treatment of patients with chronic schizophrenic reactions is more efficacious with these drugs than with other forms of somatic therapy.Complications of treatment were far greater with combined use of chlorpromazine and reserpine. For this reason, the combination appears to have limited usefulness. The Parkinson syndrome was the most frequent complication of large doses of these drugs. It appears to be a toxic reaction, requiring reduction in dosage. Jaundice appears to be neither a frequent nor a serious complication of treatment.     

Metabolic Studies on Patients with Resistant Heart Failure Treated by Spironolactone

Metabolic balance studies were carried out on five patients with resistant heart failure treated with spironolactone and other diuretics. Spironolactone alone had little effect. When it was used in a daily dose of 400-600 mg. in combination with hydrochlorothiazide 100 mg. daily, the results were excellent in two patients. One of these was still free of failure after 12 months on combined therapy. In the other patient the serum potassium became elevated after a good diuresis, though on subsequent intermittent therapy with the drug the patient remained well for 12 months. In two other patients administration of spironolactone had to be discontinued because of elevation of the serum potassium before a good diuresis could take place. The fifth patient died.Spironolactone can be a useful adjunct to the therapy of resistant heart failure, but there appears to be a real danger of causing the serum potassium to rise to toxic levels in patients so treated.     

High voltage orbital radiotherapy and surgical orbital decompression in the management of Graves' ophthalmopathy

We report on 2 groups of patients with Graves' ophthalmopathy. A group of 21 patients was treated by high voltage (18 MV) orbital radiotherapy combined with mean doses of corticoids. The results were good or excellent in 12 patients (mean score 6.62 before and 4.0 after, soft tissues greater than proptosis greater than extraocular muscle involvement), without any complications from irradiation. Patients undergoing surgery initially presented less severe symptoms, even 7 patients treated after corticoid and/or radiotherapy failure. The results were satisfactory in all patients (mean score 5.1 before and 2.4 after, proptosis greater than soft tissues greater than extraocular muscle involvement). Both methods showed results within 3 months, and they can be combined.     

The effects of substance P and met5-enkephalin in dog ileum

Substance P initiated tonic contraction of dog ileum when administered in doses from 1 pg to 20 micrograms intraarterially (ED50 = 67 ng). Low doses acted to excite cholinergic postganglionic neurones since atropine or tetrodotoxin (TTX) increased the ED50 of substance P about 25-fold, while hexamethonium and local field stimulation had only a small effect to increase the ED50. Also atropine and tetrodotoxin effects were not additive. Higher doses apparently acted to stimulate smooth muscle directly, but no evidence was obtained that local field stimulation could release substance P to act on smooth muscle. Substance P tachyphylaxis prevented substance P actions on cholinergic nerves, but it did not affect responses to intraaterial acetylcholine or block distal inhibition from proximal distention or field stimulation. Met-enkephalin given intraarterially, was also excitatory in doses from 1 ng to 20 micrograms; the amplitude of tonic and phasic contractions produced was significantly decreased by TTX and atropine but was not diminished by hexamethonium or substance P tachyphylaxis. Partial tachyphylaxis to met-enkephalin was produced but was not diminished by hexamethonium or substance P tachyphylaxis. Partial tachyphylaxis to met-enkephalin was produced without affecting the ED50 for substance P. We conclude that substance P acts in small amounts on receptors in myenteric nerves to release acetylcholine by a mechanism, presumably involving postganglionic cholinergic nerves, while met-enkephalin also apparently may act at least in part through a similar TTX- and atropine-sensitive mechanism. These peptides also caused activation of other receptors, probably on smooth muscle by noncholinergic. TTX-insensitive mechanisms. Also the receptors for each peptide which are located on nerves were distinct and independent since tachyphylaxis could be produced to each without affecting the response to the other.     

Cryothalamectomy for Parkinson's Disease

In a review of 61 patients with Parkinson''s disease who were treated by cryothalamectomy, the technique of freezing a surgical target as compared with destroying it by alcohol or thermal heat was found effective and to a degree safer than other techniques. One patient died of unexpected cerebral hemorrhage. Of patients considered excellent candidates for the operation, 80 per cent had excellent and good results, while those considered good candidates showed 85 per cent excellent and good results. The results are more dependent on the selection of the patient as a candidate and the diffuseness of the pathophysiological circuits involved than on the technical factors of the cryogenic procedure.     

Rehabilitation of Paralytic Dysphonia

Vocal rehabilitation has been successful for patients with paralytic dysphonia. At the discretion of the laryngologist, vocal rehabilitation is used alone or in combination with intracordal injection. Except for post-surgical patients, a complete diagnostic evaluation is advisable before vocal therapy is undertaken. During vocal rehabilitation, pitch, volume, quality, breath support and the vocal image are realigned to afford an optimal and efficient voice.For the 18 patients completing vocal therapy, the results were excellent in 14 and good in four. Vocal therapy was completed within six months for 11 patients; seven were treated for periods ranging from six months to a year.     

Prolactinomas and resistance to dopamine agonists.

Among 288 patients with prolactinoma (aged 12-62 years; 242 women), 27 were diagnosed as resistant to bromocriptine as their plasma prolactin (PRL) levels remained elevated despite long-term (3 months or more) treatment at high doses (> or = 15 mg daily). These 18 women and 9 men, aged 29 +/- 9 years (mean +/- SD, range 13-50), followed-up for 8 +/- 4 years, had microadenomas (n = 6) or macroadenomas. They were treated by dopamine agonists alone (n = 6) or associated with surgical or radiation therapy. In 8 cases repetitive surgical treatments were necessary. Among the 24 patients who were treated with the nonergot dopamine agonist CV 205-502 after unsuccessful bromocriptine treatment, half of them (9 women, 3 men) resumed normal PRL levels on doses ranging from 0.15 to 0.45 mg/day. Despite daily doses of CV 205-502 from 0.3 to 0.525 mg, the remaining patients were not normalized by this drug which did not prevent tumor growth in 4 of them. Two patients died from invasive cerebral extensions of their tumor and a third had vertebral metastases with positive anti-PRL immunostaining. It is concluded that bromocriptine-resistant prolactinomas represent the most severe aspect of this disease and that a more powerful dopamine agonist like CV 205-502 is effective in only a fraction of these patients.     

Effect of BCG immunotherapy on the active-T and total T-RFC in patients with lung cancer

Summary This report describes a study of the active T-RFC, the total T-RFC, and the in vitro lymphocyte response to PHA stimulation in patients with inoperable, locally advanced, lung cancer before and monthly after either radiotherapy alone (RT) or RT-BCG (TICE strain). Pre-RT active and total T-RFC values were seen to be prognostic to patient survival. Immunoenhancement was demonstrated for RT-BCG patients who had significantly higher percentages of active T-RFC and greater PHA responses post-RT than patients treated by RT alone. These data suggest that the active T-RFC may reflect increased nonspecific immunity induced by BCG and be a good correlate to patient immunocompetence. The comparative relevance of the active and total T-RFC to patient clinical progress and survival are discussed.Abbreviations BCG= Bacillus Calmette-Guerin - RT= radiotherapy - T-lymphocyte= thymus-dependent lymphocyte - RFC= rosette-forming cell - PHA= phytohemagglutinin - SRBC= sheep red blood cells - PBL= peripheral blood lymphocyte Supported by the Medical Research Service of the Veterans AdministrationWe acknowledge the excellent technical assistance of Mrs. Barbara Kase and Mrs. Sue Brozio     

Severe euthyroid cardiac disease; technique for treatment with radioiodine

It is possible to safely lower the basal metabolism of patients suffering from severe cardiac disease by administering multiple small doses of radioiodine in order to achieve symptomatic relief. From the present study, multiple small doses of I(131) appeared to be as effective as single or multiple large doses of this material and complications such as thyroiditis, temporary thyrotoxicosis and bone marrow depression were almost always avoided. No damage to the parathyroid glands or the recurrent laryngeal nerve was observed. No radiation sickness developed after therapy.A scintigram of the thyroid gland was useful in determining the size, shape and function of the thyroid gland before and during radioiodine treatment and helped to determine the need for additional treatment. In order to prevent the distressing symptoms of the myxedema state, desiccated thyroid was administered when necessary. In the series of 278 euthyroid patients with severe cardiac disease who were treated with radioactive iodine, results were excellent in 35 per cent of cases and good in 44 per cent. In 21 per cent there was no improvement.     

INFORMATION

Forty-one patients with anxiety and tension or various conditions associated with neuroses were treated with hydroxyzine hydrochloride tablets. Of the 41 patients, eight had an excellent response, 14 a good response, 16 were improved and three responded poorly. The only side reaction in this series was temporary drowsiness which, in the majority of patients, ceased after therapy was steadily continued on the same dosage level.     

INFORMATION

Forty-one patients with anxiety and tension or various conditions associated with neuroses were treated with hydroxyzine hydrochloride tablets. Of the 41 patients, eight had an excellent response, 14 a good response, 16 were improved and three responded poorly. The only side reaction in this series was temporary drowsiness which, in the majority of patients, ceased after therapy was steadily continued on the same dosage level.     

SEVERE EUTHYROID CARDIAC DISEASE—Technique for Treatment with Radioiodine

It is possible to safely lower the basal metabolism of patients suffering from severe cardiac disease by administering multiple small doses of radioiodine in order to achieve symptomatic relief.From the present study, multiple small doses of I¹³¹ appeared to be as effective as single or multiple large doses of this material and complications such as thyroiditis, temporary thyrotoxicosis and bone marrow depression were almost always avoided. No damage to the parathyroid glands or the recurrent laryngeal nerve was observed. No radiation sickness developed after therapy.A scintigram of the thyroid gland was useful in determining the size, shape and function of the thyroid gland before and during radioiodine treatment and helped to determine the need for additional treatment. In order to prevent the distressing symptoms of the myxedema state, desiccated thyroid was administered when necessary.In the series of 278 euthyroid patients with severe cardiac disease who were treated with radioactive iodine, results were excellent in 35 per cent of cases and good in 44 per cent. In 21 per cent there was no improvement.     

Enhanced brain penetration of hexamethonium in complexes with derivatives of fullerene C<Subscript>60</Subscript>

The present report describes development of hexamethonium complexes based on fullerene C₆₀. Hexamethonium has a limited penetration into CNS and therefore can antagonize central effects of nicotine only when given at high doses. In the present studies conducted in laboratory rodents, intraperitoneal administration of hexamethonium-fullerene complexes blocked effects of nicotine (convulsions and locomotor stimulation). When compared to equimolar doses of hexamethonium, complexes of hexamethonium with derivatives of fullerene C₆₀ were 40 times more potent indicating an enhanced ability to interact with central nicotine receptors. Thus, fullerene C₆₀ derivatives should be explored further as potential carrier systems for polar drug delivery into CNS.     

Effect of tumor promoter 12-O-tetradecanoyl-phorbol 13-acetate on induction of sister-chromatid exchanges in Chinese hamster V79 cells treated with mutagens

The effect of a tumor promoter, 12-O-tetradecanoyl-phorbol 13-acetate (TPA) alone and in combination with mitomycin C (MMC) or cyclophosphamide (CPP) on the induction of sister-chromatid exchanges (SCE) in Chinese hamster V79 cells was investigated. TPA alone at various doses and durations caused no increase of SCE frequency. MMC either at the dose of 0.03 or 0.003 μg/ml alone or in combination with TPA (2 μg/ml) all caused a significant increase of SCE frequencies. There was no difference in SCE frequencies between the cultures treated with MMC alone at 0.03 μg/ml and those treated with MMC plus TPA. However, cultures treated with MMC at 0.003 μg/ml plus TPA had significantly and consistently higher SCE frequencies than those treated with MMC alone at all durations. Treatment of CPP at 1 μg/ml activated by S9 mix caused significant increase of SCE frequencies. Surprisingly, the cultures treated with CPP, S9 mix plus TPA (2 μg/ml) caused a drastic reduction of SCE frequencies as compared to those treated with CPP and S9 mix only at all durations. These results indicate that TPA alone had no effect on SCE in V79 cells. TPA enhanced the SCE induction in V79 cells treated with MMC at a low dose, i.e. 0.003 μg/ml, but it inhibited SCE induction in cultures treated with the indirect mutagen CPP. Thus, TPA has no direct effect on genetic materials but it may indirectly alter the effects of a mutagen.     

Evaluation of the users value of salts against apple scab and powdery mildew for the integrated fruit production

As new fungicides are mainly unisite action fungicides, the problem of fungicide resistance development is becoming more important every year. Combining chemical fungicides, which is the best anti-resistance strategy, is not always possible or recommended in the case when the number of available chemical fungicides are limited or a reduction in fungicide use is asked for. Therefore the use of salts as an anti-resistance strategy was looked upon. The salts evaluated were K(HCO3), KH2PO3, KHPO4 and K2SiO3. When using these salts as an anti-resistance strategy the efficacy obtained when spraying the compounds alone was often to low to be used in rotation with chemical fungicides. Only with K(HCO3)2 a good efficacy can be observed in some years. The variation in efficacy with K(HCO3)2 observed is higher for powdery mildew. Chitosan was also included in the trials against powdery mildew, however chitosan had no effect on the infestation.     

Treatment of spasmodic torticollis by dorsal column stimulation.

A new method is described to treat spasmodic torticollis with the implantation of a dorsal column stimulator at the C1--2 level or with transcutaneous stimulation. 22 patients were evaluated. 3 had sufficient relief to be treated with transcutaneous stimulation only. An additional 6 patients had surgically implanted dorsal column stimulators. It was empirically determined that a frequency of 800--1,100 Hz gave the best relief from torticollis. 1 patient had an excellent result; 3 have had good results; 1 had a fair result, and 1 had a poor result. An additional patient with dystonia musculorum deformans was considerably improved by the use of dorsal column stimulation.     

Myasthenia Gravis: Comparative Evaluation of Medical and Surgical Treatment

Sixty-eight patients with myasthenia gravis were evaluated and compared to determine the results of medical and surgical treatment; eight patients with thymoma were evaluated separately. In the group of 30 non-thymoma patients treated medically 50% of patients derived moderate to good improvement over a mean follow-up period of 11 years. Ten per cent of patients in this group died from myasthenia.In the group of 30 non-thymoma patients treated by thymectomy, 83% achieved good to excellent improvement. There was no surgical or myasthenic mortality over a mean follow-up period of nine years.The results of treatment in the eight thymoma patients were decidedly inferior and there was no significant difference between the medically and surgically treated patients. Fifty per cent showed only moderate improvement during a mean follow-up of five years and 50%, after initial improvement, deteriorated later and died from myasthenia between three and four years after thymectomy.Two additional patients had thymoma without myasthenia. Neither of them had developed myasthenia, two years following thymectomy in one case and after 25 years in the other, despite recurrence of the tumour with extensive invasiveness in the very long-standing case.