[Pancytopenia induced by triamterene: 4 cases].
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Biomedical subjects
Publications and source records attributed to C Buffet.
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The fifth case of a common bile duct carcinoid tumor is reported. The importance of endoscopic retrograde cholangiography on the one hand and specialized staining on the other for diagnosis is emphasized. The slow growing nature of these tumors favors extensive surgery whenever possible.
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In 23 patients previously operated on the stomach, the effect of pectin and wheat bran on the glucose tolerance test (G.T.T.) has been studied. If wheat bran had no significant effect on the glucose tolerance curve, pectin had a significant effect, lowering blood glucose value before the 90th minute (1,32 +/- 0,33 g/l as against 1,87 +/- 0,23 on the 30th minute) and elevating blood glucose value after the 90th minute of the G.T.T. (0.90 +/- 0,30 as against 0, 63 +/- 0,26 on the 120th minute). Therapeutic efficiency of pectin was confirmed in three patients who had symptoms of hypoglycaemia, which disappeared with the intake of 5 g of pectin before each meal.
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One case of primary linitis plastica of the rectum is presented, adding to the 20 previous cases reported in the literature, the diagnosis was made aften excluding the stomach as a primary source by per operative palpation and radiographic examination. Absence of blood in the stools and predominant symptomatology of diarrhea explains the delay of diagnosis in this patient with chorea. About 20% of all reported cases occur in association with ulcerative colitis. The prognosis is poor; the maximal survival reported is 2 1/2 years; the mean survival time is about 4 months.
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Drug-induced active hepatitis is rare. The three main drugs incriminated are oxyphenisatine, alphamethyldopa and isoniazid. Despite the histological appearance suggestive of chronic active hepatitis, such forms of hepatitis, and in particular those due to alphamethyldopa and isonizid, follow an acute rather than a chronic course. The course is usually rapidly favourable when the responsible drug is stopped, provided the histological lesions are not those of multilobar necrosis or cirrhosis.
The increase in volume of human erythrocytes during chronic alcoholic intoxication and its decrease after alcoholic deprivation was studied with a multichannel analyzer. When fractions of the population of red cells were separated by differential centrifugation the macrocytosis was found to be uniformly distributed. The presence of macrocytes was not related to changes of plasma osmolality or hyperhydration of red cells. A central origin was evoked, however, the role of the folic acid deficiency could not explain the macrocytosis, the mechanism of which remains to be elucidated.
In cirrhotic patients, the authors studied the modification of the pharmacokinetics of ampicillin in the plasma and in the ascitic fluid, as well as its concentration in the urine. The influence of the jaundice, the ascites and diuretics were studied. In cirrhosis, dilution and elimination of the antibiotic are modified, as is shown by the increase in T 1/2 alpha and T 1/2 beta. These anomalies seem to be due essentially to modifications in the distribution volume; the degree of hepatocellular insufficiency does not appear to be of importance. The ascites acts as an independent compartment, into which the antibiotic's passage in slight. The practical consequences are the following: less frequent injections, increasing of the fractionated doses, in situ injections of ampicillin in cases of infection of the ascitic liquid.
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Two women (aged 72 and 78 years) developed hepatitis due to clometacine. The main laboratory abnormalities were raised transaminases and blood eosinophil count. In one of these cases, in which the initial histological lesions had the appearance of aggressive chronic hepatitis, there was progression to cirrhosis despite the interruption of treatment. The mechanism of this hepatotoxicity is probably a hypersensitivity reaction.
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