Severe tubulo-interstitial disease in a renal allograft due to cytomegalovirus infection

A 34 year old female developed impaired function of her renal allograft 21 months post-transplant. This was associated with lethargy, pyrexia, tenosynovitis, pancytopenia and a colonic ulcer. Severe tubulo-interstitial changes with intranuclear inclusion bodies and intracytoplasmic herpes type viral particles were seen on renal biopsy. There was no evidence of rejection. Cytomegalovirus was cultured from the urine and there was a rise in CMV antibody titer. These findings suggested the renal impairment was due to a direct cytopathic effect of the CMV. Despite treatment with transfer factor and adenine arabinoside, there was progressive loss of graft function.     

The suspicious contraction stress test

From a clinical service using the contraction stress test as an evaluator of fetal well-being, a 37-month review of the significance of the suspicious contraction stress test was performed. There were no antepartum losses in a group of 107 patients whose initial test was suspicious. Following each testing a number of patients delivered spontaneously or were delivered for other reasons. Results in 5 of 67 patients at the second testing changed from a suspicious to a positive test, 36 became negative, and 26 remained suspicious. There were no further conversions to a positive test after the second testing. There is a strong correlation between the loss of fetal heart reactivity and the repeated suspicious contraction stress test. The chief value of the suspicious test is as a marker in the high-risk pregnancy appraisal for consideration of additional fetal and maternal evaluation and possible clinical management alteration.     

Selenium and the immune response: 1. Modulation of alloreactive human lymphocyte functions in vitro

A role for the dietary trace mineral element selenium in the reduction of cancer incidence has been documented in numerous epidemiological and experimental studies. The precise mechanism of this antitumor effect is not well understood, but published data suggest that both inhibition of tumor cell growth and enhancement of host immunity are likely to be involved. In this study we report that selenium at physiologic concentrations can inhibit human lymphocyte proliferation in response to irradiated tumor cells in mixed lymphocyte/tumor cell cultures (MLTC). In addition, we demonstrate that the various lymphocyte functional activities generated in these cultures exhibit different levels of sensitivity to the effects of selenium. The generation of suppressor-cell activity in MLTC was strongly inhibited by the presence of physiologic levels of selenium, while the development of cytotoxic T-lymphocyte activity in identical cultures was not affected by selenium. Production of interleukin-2 in these cultures showed an intermediate sensitivity to the effects of selenium. Thus, selenium appears to be capable of selectively regulating the generation of functional lymphocyte subsets in vitro. Such selective regulation could explain the published effects of selenium on immunity and would be consistent with a role for immunity in the observed reduction of cancer incidence associated with elevated selenium intake.     

Atenolol, methyldopa, and chlorthalidone in moderate hypertension.

Combined treatment with low doses of different drugs is widely used for moderate hypertension. The effects of atenolol and methyldopa at two dose levels and in combination at the lower doses were studied in patients with moderate hypertension on continuous treatment with moderate hypertension on continuous treatment with chlorthalidone. The mean reduction in standing blood pressures obtained with atenolol 150 and 300 mg/day was about 27/17 mm Hg and with methyldopa 750 and 1500 mg/day about 28/14 mm Hg. Combined treatment with atenolol 150 mg/day and methyldopa 750 mg/day for four weeks resulted in a reduction of 38/25 mm Hg. No difference was observed between the two doses of methyldopa. The lower dose of atenolol was better than the lower dose of methyldopa in reducing lying and standing diastolic blood pressures. These findings show that in patients on continuous treatment with chlorthalidone the addition of atenolol alone or methyldopa alone or of atenolol and methyldopa in combination is effective in the treatment of moderate hypertension.     

Withdrawal of long-term therapy with atenolol in hypertensive patients.

1 The offset of effects on blood pressure and heart rate after cessation of long-term therapy (19 +/- 3.6 months) with atenolol (200 mg once/daily) was studied in six hypertensive patients. 2 Withdrawal of atenolol resulted in a gradual return of lying, standing and post-exercise systolic and diastolic blood pressure levels and heart rate towards the baseline value. The offset of effect greatly exceeded the time for elimination of atenolol. 3 No significant differences in the pharmacokinetic profile of atenolol were evident between the values obtained following chronic dosing and an acute single-dose study. 4 The lack of clinical evidence of increased cardiac adrenergic sensitivity or rebound hypertension following withdrawal of atenolol contrasts with reports of a withdrawal syndrome following cessation of therapy with propranolol. Nevertheless until the mechanism of the propranolol-withdrawal syndrome is better understood caution is required when stopped therapy with atenolol in patients with severe coronary artery disease.     

Viloxazine and amitriptyline in endogenous depression

In a double-blind clinical trial carried out on 20 outpatients with the diagnosis of endogenous depression, amitriptyline (75–225 mg) was found to be somewhat faster in its therapeutic effects on depression than viloxazine (150–450 mg), whereas viloxazine was somewhat faster in its therapeutic effect on anxiety. Cardiovascular adverse effects were only encountered with amitriptyline, whereas gastrointestinal side effects were present with viloxazine.