Portal Hypertension and Gross Splenomegaly in Uganda

Abstract

PEMPIDINE FOR HYPERTENSION BETISH 15 micturition difficulty, and impotence in 2 each; and ileus in 1. Constipation and abdominal distension usually responded to vegetable laxatives taken at night.In only one case was constipation serious enough to lead to a true paralytic ileus, and this cleared com- pletely after the drug was stopped.The infrequency of complaints of dryness of the mouth is notable in our series.This fact might be related to the local staple diet of steamed unripe banana (" matoke "), which has a soft porridge-like consistency.Matoke is likely to act as a demulcent in a dry mouth.The action of pempidine resembles that produced by mecamylamine on neuro- muscular transmission, in that both drugs potentiate the effect of tubocurarine (Corne and Edge, 1958).Clinically, curare-like side-effects of muscular weakness, increased fatigability, and aching in the limbs were reported by 10 patients on continuous treatment.These side-effects do not appear to have occurred in other treatment series (Botha, 1959; Mathisen, 1959).In no case were the side-effects unduly severe.It is uncertain whether the additional fact of tropical heat has a part to play in the production of the curare-like effects recorded in this series.Blurred vision occurred in eight instances and, of the two who complained most bitterly, only one was literate and benefited from the use of glasses.Effect of Chlorothiazides on the Fall in Blood-pressure due to Pempidine.-Aswith all other ganglion-blocking drugs (Smirk, 1959), the hypotensive action of pempi- dine was increased by the addition of 0.5 g. of chloro- thiazide or 50 mg. of hydroflumethiazide, twice daily, together with 1.5 g. of potassium chloride.This regime was particularly effective in patients with heart failure.Comparison of Mecamylamine and Pempidine.-Ifthe effects of different ganglion-blocking drugs are to be compared accurately, it is necessary to make the comparison in the same patient at about the same time after the commencement of therapy.As we were unable to achieve such a comparison and as the sideeffects of ganglion-blocking drugs are inclined to vary in the course of several months, an attempt to compare the effects of mecamylamine and pempidine was abandoned.The general impression gained was that there was no constant ratio between the effective dose of mecamylamine and pempidine in controlling blood- pressure.Little difference was noted in the incidence of side-effects in any one patient on each drug; the intensity and duration of side-effects were, however, distinctly less with pempidine.Summary Forty-three African patients with severe hypertension were treated with pempidine.Thirty-seven received treatment for from 4 weeks to 16 months-I of them for 12 months or more.A complex regime proved successful under simple conditions.Pempidine was shown to be an effective oral ganglionblocking drug in most patients.In general, the advantages over mecamylamine were that continuous administration produced mild or moderate side-effects.Continuous therapy with pempidine did not lead to significant drug tolerance.We are indebted to Mr. E.