SOME EFFECTS OF THE AMINOGLYCOSIDE ANTIBIOTIC AMIKACIN ON NEUROMUSCULAR AND AUTONOMIC TRANSMISSION

The effects of the new aminoglycoside antibiotic amikacin onneurohumoral transmission were tested in the anaesthetized cat,and in mouse, rat and chick isolated nerve-muscle preparations.Amikacin had blocking actions on both autonomic and neuromusculartransmission. The autonomic effects were caused mainly by ganglionblockade and were reversed by calcium. The amikacin-inducedneuromuscular blockade resulted from a decreased release ofacetylcholine and a reduced postjunctional sensitivity. Intracellularrecording from end-plates in the rat diaphragm demonstratedthat amikacin had magnesium-like effects on acetylcholine release.The blockade was reversed completely by calcium, 4-aminopyridineand 3, 4-diaminopyridine and partially by neostigmine. The neuromusculareffects of amikacin in vivo were augmented greatly after pretreatmentwith tubocurarine. It is concluded that care should be exercisedif amikacin is administered during surgery in conjunction withtubocurarine.     

SYSTEMIC CONRTICOSTEROIDS AND FOLIC ACID ANATONISTS IN THE TREATMENT OF GENRALIZED PUSTULAR PSOBLASIS EVALUATION AND PROGNOSIS BASED ON THE STUDY OF 104 CASES

SUMMARY.— Treatment with systemically administered corticosteroids and folio acid antagonists was evaluated in 104 patients with generalized pustular psoriasis.
Seventy-three were given steroids; the remainder were not. Seventeen patients died. There were more deaths and fewer lasting remissions in the steroid-treated group. Although steroids can control the pustular phase, the incidence and severity ot side effects seriously reduced their long-term value. Steroid treated patients tended to suffer increasingly severe generalized pustular relapses often precipitated by attempted withdrawal of the steroid. Satisfactory control with minimal or no side effects was achieved in only 12 out of 73 patients.
Forty-seven patients received folic acid antagonists, predominantly methotrexate. In 37 the pustules were cleared by the drug at some stage. Response to methotrexate was less satisfactory in patients previously treated with steroids, but it was of particular value in covering steroid withdrawal in patients whose disease had become refractory to the latter or in whom serious steroid side effects had developed.
There were 8 deaths among the methotrexate treated patients, 3 of which were directly attributable to the drug. In 16 other patients treatment had to be discontinued because of side effects. Methotrexate w as responsible mainly for the minor short-term complications and steroids for the more serious long-term ones.
The outlook for spontaneous and long-lasting remission was much greater in younger patients and in those with a previous history of long-standing ordinary psoriasis.