Long-acting contraceptive agents: testosterone esters of unsaturated acids

The synthesis of 13 new esters of testosterone is described, with the esterifying acids bearing acetylenic, olefinic, or polyunsaturated functions in the chain, for evaluation as long-acting androgens.

Displacement of warfarin from human serum proteins by halothane anaesthesia

The in vitro effects of the halothane metabolite, trifluoroacetic acid, on the binding of warfarin to human serum proteins have been investigated. An increase in the percentage of free warfarin following incubation with different concentrations of trifluoroacetic acid (1 and 4 mmol/l) was observed. In addition, protein binding of warfarin was studied in serum from patients undergoing halothane anaesthesia (1-2.5%; 2.5 h). After 24 h from the end of the halothane anaesthesia, an increase in the percentage of free warfarin was also detected (0.92 +/- 0.06% at 24 h vs 0.60 +/- 0.02% before halothane administration; P less than 0.005). We conclude that halothane anaesthesia may temporarily potentiate the pharmacological effect of warfarin in the postoperative period following anaesthetic procedures.

Pseudohyperaldosteronism due to application of an antihemorrhoid cream

Three cases of pseudohyperaldosteronism produced by the application of an antihemorrhoid cream containing 9 alpha-fluoroprednisolone are reported. All three presented edema, hypokalemia and metabolic alkalosis. Two of the patients also exhibited slight arterial hypertension. This iatrogenic possibility must be ruled out in cases of hypermineralocorticoidism, thus avoiding unnecessary and costly examinations.

Effect of sodium valproate on midazolam distribution

The displacement of midazolam, a new water-soluble, short acting benzodiazepine, from its plasma binding sites by sodium valproate, has been studied in man. An increase of its free fraction (ranging from 2.71 to 5.35%) in plasma from epileptic patients receiving sodium valproate was observed. A similar situation was created in rabbits by pretreatment with sodium valproate (600 mg kg-1 day-1) and posterior hypnosis with midazolam. Due to the interaction, sodium valproate-pretreated rabbits showed an increase in midazolam brain levels (130.91 micrograms g-1 in cortex vs 84.55 micrograms g-1 in control animals). Therefore, it seems likely that displacement of midazolam by sodium valproate in epileptic patients could lead to an increase of the midazolam response.

[Aicardi syndrome]

The association in young girls of flexion spasms of early beginning, partial or total agenesis of the corpus callosum, severe chororetinopathy and frequent skeletal anomalies is known as the Aicardi syndrome. On occasion of two observations a review of the literature is made.

[Ventricular rigidity in mitral stenosis measured by an echocardiographic and hemodynamic method]

Ten patients with mitral stenosis underwent right and left heart catheterization. In order to assess the diastolic properties of these ventricles an hemodynamic-echocardiografic techniques was employed. Left ventricular pressure and an echocardiogram of the body of the left ventricle were simultaneously registered. Ventricular volume was determined using the minor axis (T) of the left ventricle measured form the echogram and assuming the long axis (L) from the L to T relationship observed in the left cineventriculography. Using a microcromputer, a smoothed volume-time curve was obtained, together with its first derivative and a pressure-volume loop. The exponential portion of the diastolic loop was used to obtain a felt ventricular stiffness index at zero volume. End diastolic volume and ejection fraction were normals. Left ventricular filling was impaired but ventricular stiffness was found in the normal range. It is concluded that the proposed method permits the simultaneous obtention of pressure volume data. The processing of complex data can be achieved with a pocket microcomputer. There is no evidence of a left ventricular compliance defect in mitral stenosis.