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RESUME Le syndrome de Churg et Strauss (SCS) est une affection caracterisee par une hypereosinophilie et une vascularite systemique compliquant un asthme preexistant. Vingt observations ont ete etudiees. L’asthme precedait le SCS de 8 ans en moyenne. L’eosinophilie sanguine, toujours superieure a 1 700/μL, depassait 5 000/μL dans 17 cas. Les manifestations cliniques etaient les suivantes : 20 alterations febriles de l’etat general, 13 neuropathies peripheriques, 15 lesions cutanees, 10 atteintes pericardiques ou myocardiques, 10 atteintes digestives, 9 atteintes myo-articulaires, 7 renales, toutes liees a la vascularite et 9 atteintes ORL. La radiographie thoracique montrait des anomalies pleuro-pulmonaires ou cardiaques dans 14 cas. Le diagnostic fut confirme histologiquement dans 15 cas. Aucune difference clinique, biologique ou evolutive entre le groupe des 15 malades a biopsie positive et celui des 5 malades a biopsie negative ne fut constatee. L’evolution, suivie pendant 8,4 ± 7,9 ans, se fit par poussees toujours annoncees par l’elevation de l’eosinophilie. Dix-huit malades furent traites avec succes par les corticoides et 9 recurent, en outre, du cyclophosphamide. La survie a 5 ans fut de 85 %. Cinq deces lies au SCS se sont produits, dont 2 faute d’un traitement adapte. Il faut insister sur l’urgence therapeutique du SCS dont le diagnostic, essentiellement clinique, peut se passer de confirmation anatomo-pathologique.

The β1- and β2-adrenoreceptor blockade by means of the systemic diffusion of three β-blocker eyedrops—timolol, carteolol, and betaxolol—was evaluated in a randomized, single-blind, three-way crossover study in 18 volunteers. The blockade was evaluated by analyzing the variations of the β1- and β2-blockade effects of isoproterenol before and after instillation of one drop in each eye. The β1-blockade effect was judged on the variation of heart rate, and the β2-blockade effect was judged on the change in peripheral blood flow measured by veno-occlusive plethysmography. Comparison of the blockade by these drops showed that carteolol and timolol totally inhibited the β1 and β2 effects of a dose of isoproterenol able to increase heart rate by 50% (placebo eyedrops were used as a control). Betaxolol differ significantly because it allowed the same effects with the same dose of isoproterenol. Intensity of the blockade was measured by comparison of the effective doses of isoproterenol. Carteolol and timolol were shown to be four times more inhibitory. Clinical Pharmacology and Therapeutics (1990) 47, 578–583; doi:10.1038/clpt.1990.78

Six obese subjects (mean ± s.d.: 145.1 ± 16.7% of ideal body weight) were randomly assigned to a single i.v. dose either of (±)-propranolol base (0.108 mg kg−1 of ideal body weight) or of (±)-sotalol base (1.06 mg kg−1 of ideal body weight). Each subject received the other drug 7 days later. Pharmacokinetic parameters were compared with those obtained previously in non-obese control subjects. In obese subjects, the pharmacokinetic data calculated for sotalol were comparable with those measured in controls (total body clearance = 9.4 ± 2.9 L h−1; volume of distribution during the terminal phase = 79.8 ± 19.8 L or 0.9 ± 0.2 L kg−1; terminal half-life = 6.2 ± 1.6 h). For propranolol, total clearance (44.3 ± 15.9 L h−1) and volume of distribution (230.5 ± 48.2 L or 2.7 ± 0.7 L kg−1) were significantly less than control values. The terminal half-life (3.9 ± 1.1 h), was not significantly increased. These results could be explained by altered tissue blood flow and a decreased metabolic capacity of the liver in obese subjects.

This study investigated the intensity of stress, anxiety and depression in a sample of 141 migraineurs compared with a control group of 109 non-migraine workers matched for age and sex. Stress was measured using the Perceived Stress Questionnaire, and anxiety and depression using the Hospital Anxiety and Depression Scale. Results indicated that stress and anxiety were higher in the migraine group than in the control group and above the clinical level. Depression scores remained low in both groups, under clinical relevance. Stress is a primordial factor in the triggering and perpetuation of migraine attacks. The high score of the items ‘morning fatigue’, ‘intrusive thoughts about work’, ‘feeling under pressure’, ‘impatience’, and ‘irritability’ of the stress questionnaire in the migraineurs is particularly significant in the intensive stress response. It seems necessary to manage stress to improve the daily life of migraineurs and to study the link between stress, anxiety and migraine.

The effect of hyperthyroidism on the short-term memory variability of blood pressure and heart rate was evaluated in 12 untreated hyperthyroid patients during thyrotoxicosis and after a 6 1/2 month treatment designed to achieve a stable euthyroid state. Beat-by-beat finger blood pressure was measured with a Finapres device. The pulse interval, from which pulse rate was derived, was obtained from the blood pressure signal. Due to the significant change in heart rhythm associated with thyrotoxicosis, both pulse interval (taken as a surrogate of heart period) and pulse rate (taken as a surrogate of heart rate) were computed. Power spectral analysis showed a reduction in the overall heart period variability in the supine position in the hyperthyroid compared to the euthyroid state. This effect was observed in the low-frequency (0.005-0.068 Hz), mid-frequency (0.068-0.127 Hz) and high-frequency (respiratory) domains as well, with a significant reduction of the modulus of these bands of 31%, 35% and 47%, respectively. The heart rate spectral modulus also exhibited a reduction of the high-frequency component (31%) in the supine position in the hyperthyroid subjects. These changes in heart rhythmicity corroborate a vagal deficit in hyperthyroidism. In addition, blood pressure spectral power exhibited a significant deficit in the orthostatism-induced mid-frequency systolic blood pressure rise in the hyperthyroid state (64%) compared with the euthyroid state. This observation may reflect a reduced vascular sympathetic activation with standing. The resulting vasodilatation could well contribute to normalize blood pressure in thyrotoxicosis in which cardiac output is increased.

All eye drops raise problems of local tolerance, but with variable frequencies. They can induce pain on instillation, allergic reactions, delayed healing, punctate keratitis, disturbances of lacrimal secretion, disturbances of accommodation (especially the parasympathomimetics) and local pigmentation after prolonged use. Corticosteroids are associated with 2 major risks: chronic glaucoma and cataract, initially reversible if treatment is stopped. There is still a major risk of corneal herpes with corticosteroids. It is important to be aware of these local problems as they are responsible for poor patient compliance. The systemic effects essentially concern the agonists and antagonists of the autonomic nervous system. beta-Blocker eye drops can cause bronchospasm, heart failure, syncope and psychiatric disorders, especially at high doses and with nonselective beta-blockers. These consequences are usually related to failure to comply with the prescribing precautions. alpha-Adrenergic agonists, which exert dose-dependent effects, can induce hypertensive crises or angina attacks. Apart from patients at risk (children under the age of 30 months and the elderly), parasympathomimetics cause few systemic adverse effects; anticholinesterases, which have curare-like properties, are contraindicated for 6 weeks before general anesthesia. In the very young and the very old, atropinic eye drops carry a risk of cardiovascular collapse and neuropsychiatric disturbances. Problems may also occur with other classes of drugs such as anti-infectives, antispectics, anti-inflammatories and contact lens products. Nevertheless, it is clear that this form of treatment is generally very well tolerated in relation to the volume of eye drops prescribed by ophthalmologists each day.

Every year over 25 million non-immune people visit areas of the world where the prevalence of malaria is high. Although Plasmodium falciparum is resistant to the combination of chloroquine and proguanil, this type of prophylaxis is still common. To date, few adverse side effects and hardly any drug interactions have been described with these drugs. We report a case of interaction between thyroxine sodium and chloroquine and proguanil. A 52 year old white woman, who had no history of medical illness except for hypothyroidism, which was …

B antagonists eye drops are most effective for the treatment of chronic open angle glaucoma. By this way of administration they have a very good systemic bioavailability. Bronchial, and cardiovascular effects of three of these topicals: timolol, carteolol and metipranolol have been evaluated in three parallel groups of asthmatic patients. The three topics induce bronchoconstriction without significant difference between them, and lower heart rate (sometimes very intensely) whatever the B antagonist studied. From these data, it is recommended to practitioners to follow carefully the rules of administration of B blockers, even in eye drops.

Systemic mastocytosis is an uncommon disorder due to multiorgan infiltration by mast cells. The authors report the case of a man whose mastocytosis was revealed in an unusual way by hepatomegaly and portal hypertension of the sinusoidal type. This case was also characterized by the absence of urticaria pigmentosa, the presence of seborrheic warts in which mast cell infiltration was noted and the absence of digestive symptoms. The peculiarities of this case are compared to the published data.

Five clinical cases of interaction between benzodiazepines on one hand and erythromycin, troleandomycin, josamycin and cimetidine on the other hand have been analyzed. These interactions resulted in severe disorders of behaviour, amnesia (including amnesia-automatism syndrome in one case), disturbances of consciousness and withdrawal syndrome. These disorders were consecutive to inhibition of the hepatic cytochrome P-450 system. Practical means of avoiding this risk consists in limiting such drug combinations, reducing benzodiazepine dosage and, if a combined treatment is necessary, using by preference either benzodiazepines degraded by conjugation instead of oxidation, or macrolides, or anti-H2 compounds with reduced inhibitory effect on microsomes.