Purpura and Neutropenia in Trimethadione Therapy

Abstract

flush and headache. Intramuscular injection of 1 cc. a day is sufficient in most cases to secure a response.Indeed;-we have given 1 mg. of histamine in 1 cc. of retarding menstruum in 22 cases that have not been reported in this series. Untoward effects were not observed. In-another group, we gave 2 mg. of histamine base in 1 cc. of retarding menstruum without noting any disagreeable effects. These cases will be reported at a later date. CONCLUSION 1. Histamine (as the diphosphate) in a retarding menstruum was used parenterally in 93 cases of peripheral vascular disease.2. Forty-one of 72 patients with intermittent claudication manifested definite improvement. After the patients had received a course of histamine in retarding menstruum complete cessation of pain was observed in 13. instances.3. A higher and more prolonged skin temperature of the lower extremities was observed in patients when results of treatment with histamine in retarding menstruum was compared with those of paravertebral block.4. Histamine in a retarding menstruum may decrease the length of time for demarcation and self amputation of mortifying extremities 5. In the period of two years, we saw 32 patients returning periodically for additional therapy. The effect of the course of histamine therapy ( about eighteen days),persists about three months.6. Attention is directed to the necessity of using a dry syringe and needle when injecting the mixture, because the effects of histamine occur too rapidly and are dissipated in a watery medium. Spielman, in 1944, was studying numerous chemicals for the purpose of devising a new analgesic. In so doing, he synthesized a drug, 3,5,5-trimethyloxazolidine-2,4-dione, which is now sold under the trade name of tridione.\s=r\ He found that besides having analgesic power it was also anticonvulsive. It was immediately used by many physicians for the treatment of epilepsy. Clinically, they observed that it was useful primarily for the petit mal type of epilepsy, and not for the grand mal type.Since 1944 there have been many reports about its usefulness in this syndrome.The purpose of this report is to present a case in which the drug was used, in which a serious complication developed, namely, agranulocytopenia, with exfoliative dermatitis and purpura. To date 3 such cases have been published. All 3 ended fatally, despite prompt and intensive therapy. The patient whose case I report survived.Mrs. R. K. is a 54 year old white woman, whose chief complaints were pain in her chest, a choking sensation followed by chills, and some peculiar "spells." She described these as follows : A spell occurs each morning. She has a prodromal symptom, namely, a strange sensation in lier stomach. She feels slightly nauseated and begins to choke. She feels as if she is unable to get air. Then she begins to shake. The shaking begins in the region of the jaw; then it involves the head, then the upper extremities, and finally the entire body. The spells last from one minute to two hours. The have occurred regularly over a period of two...