Beta-blockers and nitrates in patients with peripheral arterial occlusive disease: long-term findings.

METHODS: The effect of 6 months' administration of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial occlusive disease (PAOD), double-blind and placebo-controlled, was investigated in 56 patients with chronic ischaemic heart disease and stage IIb PAOD, using as criteria the walking distance and the change in resistance index in the femoral artery. The placebo group consisted of 14 patients with chronic ischaemic heart disease and the same stage of PAOD. RESULTS: Patients on 50 mg/day atenolol showed a significant reduction in both pain-free and maximal walking range compared with the controls. In contrast, those taking 200 mg/day celiprolol and those on 80 mg/day isosorbide dinitrate demonstrated significant increases in pain-free and maximal, walking distance compared with the control group. The colour duplex sonographically measured Doppler flow through the femoral artery showed a significant decrease both in the patients taking celiprolol and in those on isosorbide dinitrate, while in those receiving atenolol the resistance index increased significantly. CONCLUSIONS: The study shows that the beta-adrenoceptor blocker celiprolol also possesses a nitrate-like vasodilatory property and can be used in patients with chronic ischaemic heart disease and impaired peripheral arterial blood flow.

Comparison of tissue plasminogen activator and urokinase in the local infiltration thrombolysis of peripheral arterial occlusions.

Recanalization of the vascular lumen by means of local fibrinolysis is of major importance in the treatment of peripheral arterial occlusive disease. While urokinase and streptokinase have been extensively used for local fibrinolysis, there have been few studies of infiltration thrombolysis with genetically engineered tissue plasminogen activator (rt-PA). The aim of the investigation reported here was to establish whether there is any difference between urokinase and rt-PA in the short- and long-term outcome of local fibrinolytic therapy. One-hundred twenty patients (70 men, 50 women) with acute or subacute femoral (n = 21), femoropopliteal (n = 33), popliteal (n = 13) or popliteocrural (n = 53) thrombotic occlusions were randomized to local lysis using urokinase or rt-PA, and 6 months later follow-up investigations took place. Recanalization of thrombotically occluded vessels, particularly in the lower leg, was found more frequently, and after treatment of shorter duration, with rt-PA. Large local haematomas occurred in 8% of cases in the urokinase group and 15% in the rt-PA group. No serious haemorrhages were encountered in either group. Six months after treatment, the rt-PA group showed lower rates of Fontaine stage III and IV disease and amputation than the urokinase group, with a higher number of patients in Fontaine stage IIb. This study shows that local lysis with rt-PA yields better results than urokinase, not only in the short term but also 6 months later.

[Are beta-blockers generally contraindicated in patients with peripheral arterial occlusive disease?]. / Sind Betablocker bei Patienten mit peripherer arterieller Verschlusskrankheit generell kontraindiziert?

Ninety patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease were investigated to determine the effect of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial blood flow. Walking distance and the resistance index in the femoral artery were measured before and after 3 months medication and compared with the findings in controls (30 patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease) who received placebo. Patients with peripheral arterial occlusive disease who were treated with atenolol 50 mg/day demonstrated significant decreases in both pain-free and maximal walking distance. In contrast, the walking distances in those given celiprolol 200 mg/day and those who received isosorbide dinitrate 80 mg/day did not differ from the distances in control subjects. The Doppler flow through the femoral artery, as measured by color duplex sonography, showed a significant decrease in resistance index, both in patients given celiprolol and in those given isosorbide dinitrate. In patients treated with atenolol the resistance index rose significantly. The results of this study confirm that the beta-adrenoceptor blocker celiprolol exerts a supplementary vasodilatory action resembling that of nitrates and hence can be used in patients with chronic ischemic heart disease and impaired peripheral arterial perfusion.

[Long-term results after caval filter implantation]. / Langzeitergebnisse nach Cava-Filter-Implantation.

In order to help clarify the long-term results of filter implantation and how best to manage the post-operative care, 92 patients with implanted filters were observed for up to 6 years. The follow-up examinations included detailed interrogation, a clinical investigation, plain abdominal radiography in two planes, contrast-enhanced computed tomography of the vena cava and colour-coded duplex sonography of the vena cava and the veins of the pelvic and legs. In the early phase of the study, two patients who received Günther filters in 1988 experienced dislocation of the filter after 3 months. In the later phase, 85% of those treated with oral anti-coagulants and compression showed patent pelvic veins in areas where, at the time of filter implantation, there had been thrombi with the potential to cause embolism. In 72 cases, the inferior v.cava proved to be patent in the area of the filter.

[Color-coded duplex ultrasound findings and transcranial color duplex ultrasound findings in patients with acute inner ear disorders--a preliminary observation]. / Farbkodierte Duplex-Sonographie-Befunde und transkraniell-farbduplexsonographische Befunde bei Patienten mit akuten Innenohrstörungen--eine vorläufige Beobactung.

A prospective investigation of 98 patients with acute loss of inner ear function showed that such patients display changes in the pulsatility of the basilar artery; however, the differences can be appreciated only by comparison with control sonograms during the course of the disease. Patients with sudden deafness or sudden loss of equilibrium generally showed unremarkable findings on duplex sonography of the cervical portions of vessels supplying the brain.

[Applications of transcranial Doppler ultrasound and color-coded intracranial duplex ultrasound in patients with stenoses of the extracranial brain arteries]. / Anwendung der transkraniellen Dopplersonographie und der farbkodierten intrakraniellen Duplexsonographie bei Patienten mit extrakraniellen Hirnarterienstenosen.

One hundred and fifty-eight patients (99 men and 59 women) aged 20 to 76 years, all with extracranial cerebral artery stenoses, were submitted to both transcranial Doppler sonography and color-coded intracranial duplex sonography in order to establish whether there were any differences between the two methods in their assessment of the degree of severity of stenosis of the internal carotid artery and the resulting flow rate in the middle cerebral arteries. The degree of stenosis in the carotids was investigated with color duplex sonography and angiographically. Il emerged that transcranial Doppler sonography permitted reliable conclusions as to the severity of the carotid stenosis only in the case of complete occlusion. In contrast, the systolic flow rate in the trunk of the middle cerebral artery as measured by means of color intracranial duplex sonography consistently decreased with increasing severity of the stenosis. In this group of patients, color duplex sonography had clear advantages over angiography in the assessment of stenoses of the extracranial vessels supplying the brain. In particular, early stages of arteriosclerosis were detected more readily.

Somatic sensory cortex of llama (Lama glama).

The somatic sensory cortex (SI and SII) was mapped in llamas using microelectrode mapping methods developed earlier in a study of SI of the slow loris. Projections to SI from the llama's prehensile browsing lips were differentially enlarged when compared to those reported for sheep. In llama, SII was reversed in its mediolatreal pattern from that reported for SII in most other mammals. Fissural landmarks reliably demarcated different projections within SI, between SI and SII and between SI or SII and other surrounding nonsensory areas. The use of microelectrode mapping methods in different mammals to determine gyral and fissural homologies is discussed.