Antihypertensive and metabolic effects of ketanserin in diabetic patients with mild hypertension.

Ketanserin is a serotonin S2 receptor antagonist with antihypertensive activity. Its effects on blood pressure, glucose metabolism and serum lipids were assessed in 24 patients with diabetes mellitus and mild arterial hypertension in a double blind, placebo-controlled trial. Ketanserin in doses up to 80 mg daily caused a slight decrease of supine BP (from 159/97 +/- 19/11 to 153/90 +/- 20/9 mm Hg; NS/P less than 0.01) and upright BP (from 160/102 +/- 18/13 to 151/93 +/- 12/12 mm Hg; P less than 0.05/NS). However, these pressures did not differ significantly from the levels observed in the placebo group. Supine and upright heart rate, body weight, plasma sodium and potassium, serum creatinine, glucose, C-peptide, glycosylated haemoglobin, serum cholesterol and triglycerides, their lipoprotein fractions, apolipoprotein A1, A2 and B concentrations and the responses of serum glucose and insulin to a standard oral glucose loading test did not change. These findings indicate that the selective S2 receptor antagonist ketanserin did not unfavourably influence glucose and lipid metabolism in diabetic patients with arterial hypertension.

[Lumbosacral meningoradiculitis as a late manifestation of brucellosis (Brucella melitensis)]. / Lumbosakrale Meningoradikulitis als Spätmanifestation einer Brucellose (Brucella melitensis).

Neurologic complications can occur during the course of brucellosis. In a 25-year-old patient admitted July 3, 1984 because of loss of weight (10 kg) brucellosis (Brucella melitensis) was diagnosed on the basis of splenomegaly, positive agglutination and positive blood and bone marrow cultures. Therapy with cotrimazol was performed for eight weeks. On July 31, 1984 the patient was readmitted because of weakness in both legs. Neurologic examination revealed slight weakness of the hip extensors and a marked weakness of the knee flectors and foot extensors without loss of sensation. The cerebrospinal fluid had a protein concentration of 3.6 g/l and a white blood cell content of 410/3 (39% granulocytes and 57% lymphocytes). Radiologic examinations ruled out spondylodiscitis. Meningoradiculitis was diagnosed in view of the inflammatory changes in the cerebrospinal fluid. After therapy with prednisone, rifampicin and doxicycline the neurologic alterations improved markedly. The clinical features and prevalence of this neurologic complication as reported in the literature are discussed.

Body-sodium and blood volume in a patient with licorice-induced hypertension.

A 68-year-old man a nine-year history of licorice ingestion had moderate hypertension and low plasma potassium. Exchangeable sodium and blood volume were increased to 128 and 111%, respectively of the expected values; plasma renin and aldosterone levels were suppressed. Plasma norepinephrine concentration was distinctly elevated but the pressor response to infused norepinephrine was normal. After licorice withdrawal, blood pressure, plasma potassium and blood volume reverted to normal levels within three weeks, exchangeable sodium and plasma renin within four months. Exchangeable sodium in our patient with licorice-induced hypertension was increased to a comparable extent as in primary hyperaldosteronism. Moreover, blood pressure in relation to body sodium or plasma potassium did not differ between the exogenous or the endogenous types of mineralocorticoid excess. This observation does not support the possibility that in primary hyperaldosteronism excess aldosterone secretion per se could play an important pressor role independently from sodium retention.

[Digitalization without saturation dose using methyldigoxin. Experiences with 29 patients]. / Digitalisierung ohne Sättigungsdosis mit Methyldigoxin. Erfahrungen an 29 Patienten.

The indications and performance of oral digitalization without saturation dose are evaluated on the basis of clinical parameters and plasma digitalis levels. A group of patients with evident cardiac insufficiency received a daily maintenance dosage of digitalis (2 tablets of 0.1 mg methyldigoxin) from the outset. After 7, 15 and 30 days the plasma concentration of methyldigoxin was measured. Objective and subjective signs of cardiac insufficiency were noted. In 28 of 29 patients the therapeutic plasma level (0.8-2.0 ng/ml) was achieved with a mean plasma digitalis concentration of 1.47 +/- 0.4 ng/ml. A clinical improvement was observed in 18 patients. On the 15th and 30th day of treatment the mean plasma level of methyldigoxin showed no significant difference: X15 = 1.51 +/- 0.57 ng/ml and X30 = 1.40 +/- 0.46 ng/ml. The measured plasma values were not influenced by the patient's weight or age. In 6 patients with renal insufficiency a clear correlation between the plasma level of methyldigoxin and the creatinine level was observed. The evaluation of ECG signs showed only minimal alterations of conduction and repolarisation. On the basis of these results conclusions are drawn with regard to the clinical value and use of this therapy.

[Clinical experiences with the serum digitalis concentration. 1006 radioimmunological determinations]. / Klinische Erfahrungen mit der Serum-Digitaliskonzentration. 1006 radioimmunologische Bestimmungen.

Serum digitalis concentration was measured radioimmunologically on 1006 patients in the period from 1974-1976. The serum levels were correlated with the clinical signs of digitalis toxicity and the indications for determination of the serum digoxin concentration were established. Clinical signs of toxicity appear at a serum level of digoxin above 2.5 ng/ml. Therapeutic limits (range) are most influenced by individual factors. Serum digoxin determination is especially necessary in patients with renal failure and in undisciplined patients with erratic digitalis intake. It is a useful aid in controlling the course of digitalis intoxication, in "low dosage" digitalization and in the case of possible drug interactions.