816 MONOAMINE-OXIDASE INHIBITORS AND CAVIAR
tination. The titres of spermagglutinating antibodies in his serum and seminal plasma were 1/160 and 1/32, respectively in Kisbrick testing.2 The serum also had spermatotoxic activity (60% at the 1/5 dilution) as evaluated by the Hamerlinck modified technique.2 The patient took 2 mg dexamethasone acetate daily for three months and then decreasing doses for three months. Blood and sperm were sampled one month before therapy began, at the second and the fifth month of treatment, and two months after treatment ended.
SIR,-A 65-year-old woman had been taking ’Parstelin’ tablets (tranylcypromine 10 mg, trifluoperazine 1 mg), one three times daily for a depressive illness for 4 years with apparent therapeutic benefit. Her physical health was good and in 1976 her blood-pressure was 130/80 mm Hg. On Jan. 1, 1977, she took her third parstelin tablet of the day at 6.45 P.M. At 7.30 P.M. she had three or four heaped tablespoonsful of Iranian caviar. At 8.10 she had a "bursting" headache, nausea, and palpitations and felt very hot. One of us (P.I.) was called to see her and arrived at 8.15. He found the patient very distressed and anxious. She felt that her body was going to explode and that she was going to die. Her face was bright red. The upper chest was "goose pimpled" and she was sweating profusely. The conjunctive were suffused. Her pulse-rate was 84/min with frequent ectopic beats. Blood-pressure was 210/120 mm Hg. In the ambulance she improved, and by the time she reached hospital her blood-pressure was 120/50 mm Hg pulse 84/min, and there was no sweating, and the headache had nearly gone. She had fully recovered the next day and her blood-pressure was 130/80 mm Hg. A few years previously she had taken some soup with cheese in it and had had a similar but more severe and prolonged attack. Russian (not Iranian) caviar was obtained from a delicatessen in Oxford. Extracts were analysed by thin-layer chromatography, paper chromatography, and spectrophotofluorimetry. Tyramine was identified by all three methods, and the caviar analysed contained 0.68 mg/g. We calculated that the patient ate about 60 mg of tyramine, certainly enough to produce hypertension in a patient on M.A.o. inhibitors.’ Because of the flushing the caviar was also analysed for histamine, but none was identified. To the long list of foodstuffs!,2 containing amines which might produce hypertensive reactions in patients taking M.A.o. inhibitors should be added Iranian and Russian caviar. Wheatley,
EFFECT OF DEXAMETHASONE THERAPY ON
PATIENT’S
SPERM
P. ISAAC
Oxfordshire
M.R.C. Unit and University Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE
B. MITCHELL D. G. GRAHAME-SMITH
PERICARDIAL EFFUSIONS ASSOCIATED WITH MINOXIDIL
*
Mean values from 5 sperm examinations.
t 2 mg/day dexamethasone. :B: Decreasing doses of dexamethasone. The patient’s wife became pregnant during the fifth month of his treatment. At this time the titre of serum spermagglutinins was reduced and seminal plasma agglutinins and serum spermatotoxins had virtually disappeared (see figure). The sperm had normal morphological and behavioural features (see
table). In samples taken two months after treatment, serum spermatotoxic activity had reappeared but spermagglutinating antibodies remained in low titre. Sperm auto-agglutination was again observed morphologically despite the absence of agglutinating antibodies in the seminal plasma. Inserm U
23,
Hôpital Saint-Antoine, 75571 Paris Cédex 12, France
M. DE ALMEIDA
Laboratoire d’Histologie, Centre Hospitalier du Kremlin-Bicêtre, 94270 Le Kremlin, France
J. C. SOUFIR
SIR,-Dr Dargie and his colleagues (Sept. 10, p. 515) have demonstrated the efficacy of monoxidil in resistant hypertension. We have also been impressed with the value of this drug in refractory hypertension, but have had problems with pericardial effusions.3 Of 18 patients treated by us for refractory hypertension, 7 (39%) had pericardial effusions. Of these 7 patients, 4 had terminal renal failure and were on dialysis, 1 had moderate renal insufficiency, and 2 had normal renal function. All were symptom-free except for 1 patient whose hypotension during hsemodialysis may have reflected a degree of tamponade. Pericardial friction rubs were heard in only 4 but echocardiography was diagnostic in all 7. In the 2 patients with normal renal function, the pericardial effusion re? ’ved in 1 within 2 weeks of the drug being stopped while the other patier.t has remained symptom-free while continuing to receive minoxidil, and the effusion has persisted. Dr William B. Martin (personal communication) has reviewed the worldwide incidence of pericardial effusion in 1760 patients whose course on minoxidil therapy had been reported to Upjohn (Kalamazoo, Michigan) up to June, 1977. 53 cases of pericardial effusion were reported (3%). Fatal tamponade developed in 7 of 18 haemodialysis patients who had 1. 2
Massey Stewart, M. Adverse Drug Reaction Bull. 1976, 58, 200. Marley, E. in Drug Interactions (edited by D. G. Grahame-Smith); p. 171
3.
Marquez-Julio, A., From, plant Ass. (in the press).
London, 1977. 2. Rose, N. R., Hjort, T., Rümke, Immun. 1976, 23, 175.
Ph., Harper, M. J. K., Vyazov, O. Clin. exp.
G. L. A.,
Uldall,
P. R. Proc. Eur.
Dialysis Trans-
tination. The titres of spermagglutinating antibodies in his serum and seminal plasma were 1/160 and 1/32, respectively in Kisbrick testing.2 The serum also had spermatotoxic activity (60% at the 1/5 dilution) as evaluated by the Hamerlinck modified technique.2 The patient took 2 mg dexamethasone acetate daily for three months and then decreasing doses for three months. Blood and sperm were sampled one month before therapy began, at the second and the fifth month of treatment, and two months after treatment ended.
SIR,-A 65-year-old woman had been taking ’Parstelin’ tablets (tranylcypromine 10 mg, trifluoperazine 1 mg), one three times daily for a depressive illness for 4 years with apparent therapeutic benefit. Her physical health was good and in 1976 her blood-pressure was 130/80 mm Hg. On Jan. 1, 1977, she took her third parstelin tablet of the day at 6.45 P.M. At 7.30 P.M. she had three or four heaped tablespoonsful of Iranian caviar. At 8.10 she had a "bursting" headache, nausea, and palpitations and felt very hot. One of us (P.I.) was called to see her and arrived at 8.15. He found the patient very distressed and anxious. She felt that her body was going to explode and that she was going to die. Her face was bright red. The upper chest was "goose pimpled" and she was sweating profusely. The conjunctive were suffused. Her pulse-rate was 84/min with frequent ectopic beats. Blood-pressure was 210/120 mm Hg. In the ambulance she improved, and by the time she reached hospital her blood-pressure was 120/50 mm Hg pulse 84/min, and there was no sweating, and the headache had nearly gone. She had fully recovered the next day and her blood-pressure was 130/80 mm Hg. A few years previously she had taken some soup with cheese in it and had had a similar but more severe and prolonged attack. Russian (not Iranian) caviar was obtained from a delicatessen in Oxford. Extracts were analysed by thin-layer chromatography, paper chromatography, and spectrophotofluorimetry. Tyramine was identified by all three methods, and the caviar analysed contained 0.68 mg/g. We calculated that the patient ate about 60 mg of tyramine, certainly enough to produce hypertension in a patient on M.A.o. inhibitors.’ Because of the flushing the caviar was also analysed for histamine, but none was identified. To the long list of foodstuffs!,2 containing amines which might produce hypertensive reactions in patients taking M.A.o. inhibitors should be added Iranian and Russian caviar. Wheatley,
EFFECT OF DEXAMETHASONE THERAPY ON
PATIENT’S
SPERM
P. ISAAC
Oxfordshire
M.R.C. Unit and University Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE
B. MITCHELL D. G. GRAHAME-SMITH
PERICARDIAL EFFUSIONS ASSOCIATED WITH MINOXIDIL
*
Mean values from 5 sperm examinations.
t 2 mg/day dexamethasone. :B: Decreasing doses of dexamethasone. The patient’s wife became pregnant during the fifth month of his treatment. At this time the titre of serum spermagglutinins was reduced and seminal plasma agglutinins and serum spermatotoxins had virtually disappeared (see figure). The sperm had normal morphological and behavioural features (see
table). In samples taken two months after treatment, serum spermatotoxic activity had reappeared but spermagglutinating antibodies remained in low titre. Sperm auto-agglutination was again observed morphologically despite the absence of agglutinating antibodies in the seminal plasma. Inserm U
23,
Hôpital Saint-Antoine, 75571 Paris Cédex 12, France
M. DE ALMEIDA
Laboratoire d’Histologie, Centre Hospitalier du Kremlin-Bicêtre, 94270 Le Kremlin, France
J. C. SOUFIR
SIR,-Dr Dargie and his colleagues (Sept. 10, p. 515) have demonstrated the efficacy of monoxidil in resistant hypertension. We have also been impressed with the value of this drug in refractory hypertension, but have had problems with pericardial effusions.3 Of 18 patients treated by us for refractory hypertension, 7 (39%) had pericardial effusions. Of these 7 patients, 4 had terminal renal failure and were on dialysis, 1 had moderate renal insufficiency, and 2 had normal renal function. All were symptom-free except for 1 patient whose hypotension during hsemodialysis may have reflected a degree of tamponade. Pericardial friction rubs were heard in only 4 but echocardiography was diagnostic in all 7. In the 2 patients with normal renal function, the pericardial effusion re? ’ved in 1 within 2 weeks of the drug being stopped while the other patier.t has remained symptom-free while continuing to receive minoxidil, and the effusion has persisted. Dr William B. Martin (personal communication) has reviewed the worldwide incidence of pericardial effusion in 1760 patients whose course on minoxidil therapy had been reported to Upjohn (Kalamazoo, Michigan) up to June, 1977. 53 cases of pericardial effusion were reported (3%). Fatal tamponade developed in 7 of 18 haemodialysis patients who had 1. 2
Massey Stewart, M. Adverse Drug Reaction Bull. 1976, 58, 200. Marley, E. in Drug Interactions (edited by D. G. Grahame-Smith); p. 171
3.
Marquez-Julio, A., From, plant Ass. (in the press).
London, 1977. 2. Rose, N. R., Hjort, T., Rümke, Immun. 1976, 23, 175.
Ph., Harper, M. J. K., Vyazov, O. Clin. exp.
G. L. A.,
Uldall,
P. R. Proc. Eur.
Dialysis Trans-
