Persistent left superior vena cava as a cause for an unsuccessful ICD implant.

Transvenous ICD implantation has become a routine procedure at cardiologic centers. If such procedures fail because lead placement in the heart is impossible, anomalies of the venous vascular system should be considered. A persistent left-sided superior vena cava (LPSVC) with transition into the coronary sinus (CS) may be a cause of implantation difficulties. We describe the case of a 70-year-old patient, in whom non-invasive evidence of LPSVC was successfully gathered through contrast medium-supported transthoracic and transesophageal echocardiography and magnetic resonance imaging (MRI). System implantation from the right side was performed thereafter without problems.

[Acute and long-term effects of pimobendan (UD-CG 115) in NYHA II and III heart failure. Results of a randomized multicenter double-blind study]. / Akut- und Langzeiteffekte von Pimobendan (UD-CG 115) bei Herzinsuffizienz NYHA II und III. Ergebnisse einer randomisierten multizentrischen Doppelblindstudie.

The effects of pimobendan (UD-CG 115) on hemodynamics and exercise capacity after acute (single dose) and chronic (6 month) oral treatment, as well as acute treatment after 6 months were investigated in 67 patients with chronic heart failure of NYHA classes II or III, which had persisted in spite of treatment with diuretics and digitalis. They were treated with pimobendan (2.5 mg bid or 5 mg) or placebo in a randomized, double-blind multicenter trial. With a single administration before and after 6 months' treatment there was-compared to placebo-a significant fall in pulmonary capillary pressure (PCP) at rest (R) and during exercise (E) of 7% to 24%. Right atrial pressure (R) and pulmonary arterial pressure (PAP) (R, E) decreased after pimobendan on day 1; cardiac index (E) increased significantly. All other parameters were not influenced. After chronic therapy, PCP (E), PAP (E), LV stroke work index (E), and pulmonary resistance (R and E) values were significantly lowered by pimobendan when compared to day 1. Exercise duration was prolonged after 6 months by 83 s and 47 s after 5 and 10 mg/day, resp., compared to the placebo group (group difference not significant). Subjective wellbeing was improved in all three groups (no group difference). Clinical symptoms were not altered; six patients (two in each group) died suddenly. Another nine patients discontinued the trial prematurely because of poor efficacy or adverse events (no group difference). Overall, pimobendan was well-tolerated and had favorable effects on both acute and chronic hemodynamics and on exercise capacity. There was no evidence of any tolerance development.

[Arterial macrocirculation following ultraviolet irradiation of venous blood in patients with arterial occlusive disease]. / Untersuchungen zur arteriellen Makrozirkulation nach Ultraviolettbestrahlung venösen Blutes bei Patienten mit arterieller Verschlusskrankheit.

The influence on macrocirculatory parameters by ultraviolet irradiation of autologous venous blood was controlled in 5 patients. The ultraviolet irradiation did not show any positive effect on different sizes of blood supply. Therefore, as a conclusion the recommendation is given in every case at first to attempt the possibilities of a reconstruction of the arterial vascular system before the use of this therapy.

[Differential diagnosis of malaria]. / Ein Beitrag zur Differentialdiagnostik der Malaria.

Several basic principles of the diagnostics and therapy of malaria were repeated from own experience. On the basis of two casuistics the difficulties are shown which may be develop in positive proof of plasmodia, when the acute clinical picture is not caused by the malarial parasites, but represents an independent secondary disease.

[Humoral and cellular autoimmunity in genuine vitiligo studied by means of an antigen produced from melanoma cells]. / Untersuchungen zur humoralen und zellulären Autoimmunität bei genuiner Vitiligo unter Verwendung eines aus Melanomzellen gewonnenen Antigens.

Serum and lymphocytes of 11 vitiligo patients were examined for humoral antibodies and a specific sensibilization towards pigment cell protein by a melanom extract. Precipitating antibodies (Ouchterlony technique) and a specific sensibilization of vitiligo lymphocytes (lymphocyte transformation test) could not be identified by means of this antigen. The reason for the negative results obtained are discussed, with the antigen gained from malign degenerated cells being unsuitable with respect to the specific lymphocyte transformation test to identify a T-cell sensibilization of vitiligo patients towards melanocytes. It is probable that antigen changes due to the degeneration of melanocytes will render the antigen recognition more difficult because of lymphocytes sensibilized towards normal melanocytes and their components.

[Genuine vitiligo and its relevance for internal medicine]. / Uber die genuine Vitiligo und ihre Beziehunger zur Inneren Medizine.

After a short explanation of the epidemiology of the genuine vitiligo the pathogenesis of this disease is described above all from the point of view of immunology. The accumulated concomitant diseases, such as pernicious anaemia, diseases of the thyroid glands, diabetes mellitus and so on, are shown, also potential secondary diseases of the adrenal gland and the liver. Though the genesis of the vitiligo is very probable also of autoimmunological nature the causes of the common appearance are still fully unclear as in many other overlapping syndromes. The practical consequences from the hitherto got knowledge about vitiligo and its secondary diseases are discussed.

[Hepatological aspects of surgical interventions in the stomach]. / Hepatologische Aspekte operativer Eingriffe am Magen.

By means of quantitative-biochemical and histomorphological methods after vagotomies changes of the liver could be proved to a smaller extent than after resections of the stomach (Billroth II). Among the bionomic operation methods the supra-selective proximal vagotomy without pylorplastics is superior to other methods under the aspect of the change of the liver.

[Gastrectomy patients--a retrospective study]. / Magenoperierte Patienten--eine retrospektive Betrachtung.

Of 39 patients with resected stomach the endoscopic and radiological findings as well as the anamnestic and paraclinical data were analysed retrospectively and compared. In contrast to the patients with recidivation ulcer and stump gastritis the patients with a gastric stump carcinoma had an essentially higher average age and, in general, a considerably longer postoperative interval. The endoscopy, including biopsy, achieved a considerably greater diagnostic security in the various groups of disease than the X-ray examination. Symptoms, such as decrease of weight, gastric pains and vomiting, were most frequently found in patients with carcinoma.

[The effectivity of long-term treatment of porphyria cutanea tarda from a hepatological viewpoint]. / Untersuchungen zur Effektivität der Langzeitbehandlung der Porphyria cutanea tarda aus hepatologischer Sicht.

34 Patients with an ascertained porphyria cutanea tarda who underwent a long-term therapy a comprehensive internal and hepatological diagnosis was made. In these cases for the first time the estimation of the intrahepatic distribution of enzymes and its comparison with the serum enzymes were also performed. The liver histology allowed a division of our patients into three groups, in which cases the reactive hepatitides prevailed and a conspicuously large proportion of normal histological findings were present. The comparison of all data got with the literature made the conclusion possible that the phlebotomy therapy as well as the care in a special dispensary for years lead to very favourable results on liver and skin.

[Peptic ulcer and the liver]. / Peptisches Geschwür und Leber

The interorganic relations between liver and stomach are explained from the point of view of the primary diseases of each organ and the higher mechanism is also discussed. The at present well-known and partly hypothetic pathophysiological mechanisms are treated within the subject. On own combined histologo-biochemical examinations of the liver punctate is generally explained the too little regarded role of the peptic ulcer for the induction of so-called latent hepatopathies. In this respect in operations of the stomach the vagotomy as the method of choice serves the preference compared with resections of the stomach.