Successful treatment of methimazole-induced severe aplastic anemia with recombinant human granulocyte colony-stimulating factor and high-dosage steroids.

The best-known adverse hematologic reaction of methimazole is agranulocytosis. Aplastic anemia is extremely rare. The prognosis within the entity of aplastic anemias is surprisingly good, despite the severe and prolonged course of the disease. The present article reports the case of a 74-yr-old female patient who exhibited aplastic anemia with severe clinical symptoms 8 weeks after the initiation of methimazole administration. The hemorrhagic symptoms were aggravated by a coumarin overdose. Supportive hemotherapy and antibiotic treatment were supplemented with recombinant human granulocyte colony-stimulating factor and high-dosage corticosteroids. The granulocyte count normalized on day 5 of treatment, the platelet count exceeded the critical value on day 11, and on day 25 the patient was discharged in remission.

[Six-year follow up on recently diagnosed NIDDM patients]. / Frissen felfedezett nem inzulindependens cukorbetegek (NIDDM) 6 éves követéses vizsgálata.

The six-year prospective data on 100 newly detected NIDDM patients aged 40-69 years were analysed. After careful and controlled dietetic training, the carbohydrate metabolism parameters (glycohaemoglobin, mean blood sugar level and glycosuria), the physical status, fundus picture and laboratory data (lipids and renal function) were examined yearly and the alterations of the treatment were registered. 24 patients dropped out during six years. 10 patients died. The carbohydrate status was also favourable and a moderate weight reduction was reached. After two years 59% of the patients proved well controlled. At the end of six years 41% of the patients were still well controlled merely by dietary means. The data were compared with those on 100 similarly detected new NIDDM patients whose education and control were provided by family physicians. There were non essential differences between the two groups in specific complications, BMI and lipids. The level of carbohydrate metabolism control was significantly better in the diabetic clinic-controlled patients; the proportion of sulfanylurea-treated patients was only 40.5% after six years compared with 73% among family physicians-controlled patients. The importance of a correct and controlled diet, good education and continuous control is emphasized.

Observations with captopril (Tensiomin) treatment in hypertensive patients (one-year period).

In the treatment of patients suffering from therapy-resistant hypertension the angiotensin converting enzyme inhibitor captopril seems to be one of the most promising drugs of the past decade. The authors examined and followed the effect of captopril (Tensiomin) for one year in 13 severe therapy-resistant hypertensive patients. The average arterial blood pressure of 12 patients suffering from essential hypertension and 1 patient with renal hypertension was, before the introduction of captopril therapy, 215/120 mmHg (SD +/- 23/18). At the end of the one-year examination period the average blood pressure was 186/111 mmHg (SD +/- 25/19). The acute effect of captopril was found to be very favourable, and the required blood pressure fall could be obtained during its long-term use even in cases of renal failure. Except for one case multiple combination therapy had to be applied in all patients for the moderation of blood pressure (in 5 cases 4, in 2 cases 5, in 1 case 6 drugs). The long-term use of the drug did not influence notably the serum potassium-carbamide-creatinine and SGOT values or the white blood cell count. On the basis of their results the authors emphasize that the therapeutic effectivity of captopril monotherapy is not sufficient in severe therapy-resistant hypertension cases, its adjuvant action may be expected in drug combinations. With daily doses lower than 200 mg demonstrable side-effects did not occur.