[Effectiveness of pravastatin and bezafibrate in primary hypercholesterolemia]. / Wirksamkeit von Pravastatin und Bezafibrat bei primärer Hypercholesterinämie.

The efficacy and safety of pravastatin and bezafibrate (in retard form) were compared in a randomised double-blind trial comprising 96 patients (48 men, 48 women; mean age 52.5 [20-68] years) with primary hypercholesterolaemia types IIa and IIb. After four weeks' treatment 6 out of 38 patients (400 mg/d bezafibrate) and 27 out of 58 patients (20 mg/d pravastatin) reached a LDL cholesterol level of 190 mg/dl or less. In the other 31 patients of the pravastatin group the dose was raised to 40 mg/d. During the twelve-week course of pravastatin total cholesterol concentration fell from a mean of 364 +/- 75 mg/dl (initial value) to 281 +/- 61 mg/dl (P less than 0.01), while LDL-cholesterol fell from 288 +/- 81 mg/dl to 206 +/- 64 mg/dl (P less than 0.01) and triglyceride concentration from 168 +/- 83 mg/dl to 148 +/- 80 mg/dl (P less than 0.05). During the twelve-week course of treatment with 400 mg bezafibrate total cholesterol concentration fell from a mean of 363 +/- 91 mg/dl to 325 +/- 73 mg/dl (P less than 0.01), LDL-cholesterol level fell from 284 +/- 88 mg/dl to 242 +/- 70 mg/dl (P less than 0.01) and the triglyceride concentration from 173 +/- 91 mg/dl to 121 +/- 83 mg/dl (P less than 0.01). HDL cholesterol concentration rose by 9% in the bezafibrate group and by 8.4% in the pravastatin group (P less than 0.05). Except in the case of HDL-cholesterol, the falls were significantly different in the two treatment groups: pravastatin was superior to bezafibrate in terms of the reductions in both total and LDL-cholesterol (P less than 0.01 for each). However, bezafibrate produced a greater fall in serum triglycerides (P less than 0.05). No serious side effects were associated with either drug.

[Acute and long-term effect of captopril in severe chronic heart failure]. / Akut- und Langzeiteffekt von Captopril bei schwerer chronischer Herzinsuffizienz.

In nine patients with severe, treatment-resistant heart failure (stages IV in the NYHA classification) the acute and long-term effect of captopril were studied. In the acute experiment, peripheral resistance fell by 27% after administration of 25 mg captopril, cardiac index rose by 25%, arterial pressure, pulmonary arterial pressure and mean right atrial pressure fell by a similar amount. This haemodynamic improvement increased slightly in the course of longterm treatment (cardiac index +30%, peripheral resistance -30%, mean pulmonary arterial pressure -42%). The fall in heart rate by 15% and 25%, respectively, was an expression of haemodynamic improvement and reduction in angiotensin II. The fall in peripheral vascular resistance coincided with a 50% reduction in angiotensin II concentration. Over the longer term, 2-42 weeks, the renin system stimulation regressed with the improvement in haemodynamics. Four of the nine patients in stage IV improved to stage II, while the remaining five patients improved from IV to III.

[Acute polyneuritis in non-A, non-B hepatitis]. / Akute Polyneuritis bei Hepatitis-nonA-nonB.

Neurologic involvement may occur in the course of acute viral hepatitis; acute polyneuritis is an extremely infrequent manifestation. Hepatic failure, leading to death on the 10th day of disease, became manifest in a 26-year-old man on the 6th day of postinfectious polyneuritis Guillain-Barré-Strohl requiring ventilation. Clinical aspects, additional diagnostic assessment and post mortem findings supported diagnosis of nonA-non-B hepatitis. A causal connection between both disease entities appears likely.

[Hemodynamics in ventricular and atrioventricular sequential stimulation in patients with bradycardia arrhythmias. Is differentiated stimulation meaningful?]. / Hämodynamik bei ventrikulärer und atrioventrikulärer sequentieller Stimulation bei Patienten mit bradykarden Rhythmusstörungen. Is eine differenzierte Stimulation sinnvoll?

In order to assess the effects of on-time atrial contraction on haemodynamics, the appropriate investigations were done in 16 patients with bradycardic arrhythmias before and two weeks after implantation of a pacemaker. Eight patients received a ventricular stimulating pacemaker (group A) and eight a sequentially stimulating atrioventricular pacemaker (group B). Haemodynamic data of both groups were identical before implantation of the pacemaker. After implantation the cardiac index in group A rose only slightly, whereas group B demonstrated a significant increase (P less than 0.001). Stroke volume decreased by 36% in group A, whereas the mean did not change in group B compared to baseline data. Both arteriolar pulmonary resistance and peripheral vascular resistance decreased more in group B, both parameters were significantly lower after pacemaker implantation than in group A. Thus patients with ventricular pacemaker stimulation benefit less haemodynamically than patients with atrioventricular sequential stimulation.

Influence of ipratropiumbromide on heart rate and hemodynamics in patients with sinus bradycardia.

In 13 patients with sinus bradycardia, heart rate and hemodynamics were recorded before and 3, 30, 60, and 120 minutes following intravenous administration of 0.5 mg ipratropiumbromide (Itrop by C. H. Boehringer Sohn, Ingelheim, West Germany). Heart rate already started to rise during the injection of ipratropiumbromide. It increased by an average of 78% three minutes following the administration as compared to pretreatment control values. Mean heart rate still was markedly increased by an average of 26% at 120 min following the injection of the drug. This effect of ipratropiumbromide on heart rate was accompanied by an increase in cardiac index while stroke volume decreased due to a decrease in ejection fraction and diastolic filling time.

[Heart rate behaviour and hemodynamics after oral therapy with ipratropium bromide in patients with sinus bradycardia (author's transl)]. / Frequenzverhalten und Hämodynamik nach oraler Therapie mit Ipratropiumbromid bei Patienten mit Sinusbradykardie.

Haemodynamic parameters were measured in 11 patients with sinus bradycardia before and 2.5, 4, 6 and 10 h following p.o. administration of 10 mg 8-isopropyl-3 alpha-DL-tropoyloxy-1 alpha H, 5 alpha H-tropanium hydroxide (ipratropium-bromide, Sch 1000). 2.5 h after Sch 1000 there was a significant rise in heart rate (p less than 0.001) which was still significantly elevated above control values 10 h following ipratropiumbromide ingestion (57.5 +/- 13.2 beats/min; p less than 0.001). Cardiac index was increased following ipratropiumbromide treatment and this was accompanied by a decrease in stroke volume.

[Clonidine in the management of hypertensive crisis (author's transl)]. / Clonidin bei hypertensiver Krise. Hämodynamische Befunde und ihre Beeinflussung.

Haemodynamic data were obtained by means of Swan-Ganz balloon catheters in eight patients during hypertensive crisis. After obtaining control values, 150 microgram clonidine in 10 ml isotonic sodium chloride was administered intravenously over ten minutes. During the hypertensive crisis there was a moderate rise in pulmonary artery and right ventricular pressures, in addition to a rise in systemic arterial pressure. In addition there was a lower than normal cardiac index, averaging 2.2 l/min.m2, a reduced stroke volume of 49.3 ml, a markedly elevated peripheral vascular resistance of 3584 dyn.s.cm-5, and an elevated cardiac work index of 5.08 kg.m/min.m2. After clonidine administration there was a significant fall in systolic, diastolic and mean femoral artery pressures (P less than 0.005), without any significant fall in pulmonary artery and right ventricular pressures. At the same time there was a further fall in cardiac index to an average of 1.85 l/min.m3, largely due to a reduced heart rate. Stroke volume fell slightly in only two patients. Peripheral vascular resistance did not fall significantly, while cardiac work index was significantly below the control value as late as four hours after clonidine administration.

[Concomitant infarction of the right ventricle in patients with acute transmural myocardial infarction (author's transl)]. / Mitbeteiligung des rechten Ventrikels beim akuten Myokardinfarkt.

In 56 patients with acute transmural myocardial infarction hemodynamic parameters were studied. 21 patients proved to suffer from anterior infarction and 35 patients an inferior infarction. By clinical as well as by hemodynamic findings 10 patients out of the group of the 35 patients with inferior infarction were suspect of having a concomitant infarction of the right ventricle. As it is known from literature and documented by the present results this is not a rarity. Failure of the right ventricle is the main cause of death in these patients.

[Treatment of rhythm disorders of ventricular origin with KO 1173 (Mexiletin) (author's transl)]. / Behandlung von Rhythmusstörungen ventrikulären Ursprungs mit KO 1173 (Mexiletin).

In 52 patients, KO 1173 (Mexiletin) administered intravenously and/or orally has been used for the treatment of rhythm disorders of ventricular origin. The disturbances of rhythm studied included ventricular extrasystoles, ventricular tachycardia and by DC-cardioversion abolished ventricular fibrillation. By intravenously administered KO 1173, 31 of the 32 patients had a more than 75% reduction of their ventricular extrasystoles or complete abolition of the arrhythmia. In 5 patients with ventricular tachycardia, rhythm disorder was terminated by administration of a total dose of 125 to 250 mg. When used prophylactically in patients with ventricular fibrillation terminated by electrical means, KO 1173 was successful in 10 of the 11 patients. Oral administration was carried out in a total of 32 patients. In 26 of the 32 patients optimum dosage for maximum beneficial effect appeared to be 200 mg 3 times daily. 6 patients responded unsatisfactory to KO 1173. The intravenous administration of KO 1173 induced side-effects, primarily manifested by central nervous system disturbances, which we have partly attributed to the dosage and the time of injection. No noteworthy side-effects have been reported at the oral administration. In 1 patient complaining of gastric irritation KO 1173 was withdrawn.

[Dopamine in patients with cardiogenic shock (author's transl)]. / Dopamin beim kardiogenen Schock.

The effect of dopamine was tested in 20 patients with cardiogenic shock. 14 patients suffered from acute myocardial infarction, 6 patients from severe heart failure. In the beginning the dosis of dopamine was 200 to 300 microgram/min. 4 patients with an acute myocardial infarction died in shock. The remaining 10 patients survived the first shock symptomes. All patients with heart failure survived the cardiogenic shock. Hemodynamic studies showed a sigificant increase of the arterial mean pressure and a decrease of the diastolic arterial pulmonary pressure. During dopamine a statistically not significant increase of cardiac index and stroke volume was observed.

[Fundamentals of parenteral feeding in internal diseases]. / Grundlagen der parenteralen Ernährung bei inneren Erkrankungen

A review of parenteral infusion therapy in internal medicine is given. The principles of total parenteral nutrition with fatty acids, ethanol, glucose, non-glucose-carbohydrates (fructose, sorbitol, xylitol) and amino acids are discussed. Problems such as indication and contraindication, metabolism and utilization of the applied substances as well as adverse effects are dealt with. The practice of infusion therapy and its form of application are shown on the basis of the author's own experience. Finally a scheme for total parenteral nutrition is presented.

[Mendelson's syndrome (author's transl)]. / Das Mendelson-Syndrom

It is reported on 10 patients with the features of Mendelson's syndrome; 4 patients died. Diagnosis, therapy, course and prognosis of this severe complication following aspiration of gastric hydrochloric acid are discussed.