[The effects of captopril and metoprolol on blood pressure and side effects in patients with mild to moderate hypertension]. / Effekten af captopril og metoprolol på blodtryk og forekomst af bivirkninger hos patienter med mild til moderat hypertension.

A material of 76 patients from general practice treated with diuretics for mild to moderate hypertension were randomized to supplementary treatment with captopril (39 patients) and metoprolol (37 patients), respectively, on account of diastolic blood pressure greater than or equal to 95 mmHg. Satisfactory regulation of the blood pressure (diastolic blood pressure less than or equal to 90 mmHg) and acceptable wellbeing was obtained in 29 patients in the captopril group and in 23 patients in the metoprolol group. Six patients in the captopril group were excluded on account of absence of effect on the blood pressure and four dropped out on account of side effects. In the metoprolol group, nine patients were excluded on account of absence of effect on the blood pressure and five on account of side effects. This difference was not significant. In the captopril group, 14 side effects were registered in eight patients while 23 side effects were observed in 15 patients in the metoprolol group. This difference was not statistically significant, p greater than 0.05 (risk for type 2 error = 60%). It is concluded that captopril + a diuretic is just as effective a form of treatment of slight to moderate hypertension as metoprolol + a diuretic and that treatment with captopril + a diuretic is associated with so few side effects that it may be considered as an alternative first choice of treatment in cases of slight to moderate hypertension.

Dementia and central nervous system involvement in chronic lymphocytic leukaemia.

2 patients with early-stage chronic lymphocytic leukaemia had involvement of the central nervous system causing dementia as the predominant clinical symptom. None of the patients had focal neurological abnormalities. One patient was successfully treated first with irradiation therapy to the central nervous system, and later with intrathecal administration of methotrexate. The other patient died with massive leukaemic infiltration of the central nervous system before effective treatment had been given. Although significant involvement of the central nervous system is rare in chronic lymphocytic leukaemia and usually does not occur until late in the disease, these cases show that clinically important infiltration may happen very early. The clinical picture of dementia has not been described in chronic lymphocytic leukaemia.

Antiglobulin-tests for detection of auto-immunohaemolytic anaemia during long-term treatment with ibuprofen.

Auto-immunohaemolytic anaemia is a very unusual complication during long-term treatment with ibuprofen. In order to detect the haemolytic antibodies involved, serum and erythrocytes from 87 patients were investigated after continuous treatment with an average daily dose of 1337 mg ibuprofen for some 6-47 months. Eight patients showed a weak or medium-positive antiglobulin test result with polyspecific anti-human serum. With monospecific anti-human serum, complement C3c and/or C3d were detected on the surface of 8 patients' erythrocytes, but none had biochemical parameters indicating haemolysis. None of the 87 patients had IgG, IgM or IgA on their erythrocytes. The findings neither indicated haemolysis present nor early stages in any of the four types of drug-induced auto-immunohaemolytic anaemia. The frequency of a positive antinuclear factor test (ANF) among patients treated with ibuprofen did not differ from that of healthy subjects in the same age group. The type of haemolysis associated with ibuprofen is discussed, but available data do not permit any definite classification. It is concluded that ibuprofen is a safe drug which rarely causes haemolysis and does not seem to cause induction of ANF.

Administration o gentamicin to obese patients.

The relation beteen a single bolus dose of gentamicin and the subsequent concentration in serum was studied in 17 obese patients with 82.7% excess weight and in 10 normal-weight patients. The apparent volume of distribution (AVD) for gentamicin in the two groups was calculated. In the obese group the AVD (17.7%) was found to be significantly lower than in the normal-weight group (23.2%). The AVD for the adipose tissue and the lean body mass was calculated to be 10.3% and 31.0%, respectively. The uptake of gentamicin in adipose tissue was found to be 43.7% of the uptake in the total body mass of normal-weight patients. A formula which indicates an adjudged body weight is recommended when the proper dose of gentamicin for obese patients is calculated. The formula is recommended only in cases of severe obesity.

Thyroid replacement therapy in Down's syndrome with hypothyroidism.

Three elderly subjects with Down's syndrome and biochemical evidence of hypothyroidism were investigated before and after four months of thyroid replacement treatment. The patients' appearance was demonstrated by photographs and the biochemical thyroid values and the intellectual performance were assessed. The appearance before treatment varied from a florid myxoedematous appearance to a state without features indicating myxoedema. Thyroid replacement therapy was given in usual dose and the biochemical response was similar to that seen in normal subjects. The intellectual performance improved little or not at all. The characteristic discomfort usually associated with hypothyroidism was very pronounced in one case and disappeared totally during treatment. It is concluded that the diagnosis of hypothyroidism in elderly subjects with Down's syndrome can be very difficult when based on appearance and history alone and biochemical thyroid tests are often necessary. The patients should be treated with replacement therapy just as other patients suffering from hypothyroidism.

Sarcoidosis of the stomach. A case report.

A case of sarcoidosis of the stomach in a 76-year-old woman is described. Fiberoptic gastroscopy and roengenograms presented the appearance of an infiltrating carcinoma. It was possible to follow the spontaneous behaviour or roentgenograms during a period of 4 years. A preceding, spontaneously remitted lesion of the lungs is described, and the lack of parallelism between the two lesions is discussed. The case is seen in the light of other cases described in the literature, and the difficulties concerning the differential diagnosis are discussed.

Iodine-induced hypothyroidism and its effect on the severity of asthma.

Among 1107 patients with asthma or chronic asthmatic bronchitis and 96 with hypothyroidism we found 12 patients with both diseases. Seven of these patients had hypothyroidism induced by iodine-containing expectorants. Five of 209 patients with hyperthyroidism had coexistent asthmatic lung disease, but none of these five had been taking iodine. The severity of asthma is considered in relation to changes in thyroid function following withdrawal of iodine. Three patients had an exacerbation of their asthma, while another three had no change in their asthma when the iodine treatment was discontinued and the euthyroid state subsequently restored. All six patients had a marked improvement of their general wellbeing when the euthyroid state was re-established. It is concluded that treatment with iodine-containing expectorants causing hypothyroidism is unwise and should be withdrawn even when the patients praise the beneficial effect of iodine on the asthma per se.

Thyroid function tests in adults with Down's syndrome.

Thyroid status was studied in 24 patients above the age of 40 years with Down's syndrome. Three patients had thyroid function tests indicating hypothyroidism. Eight patients had thyroid autoantibodies in serum and 8 patients had a higher than normal level of thyroid stimulating hormone in serum. None of the patients had figures indicating thyrotoxicosis. None of the patients showed any of the clinical signs usually seen in patients with hypothyroidism. It is concluded that biochemical tests indicating hypothyroidism are much more often seen in patients with Down's syndrome than in normal subjects and that thyroid status should be assessed in old patients with this disease.