Signal-averaged P wave: predictor of atrial fibrillation.

Abnormalities of the P wave seen during sinus rhythm are associated with atrial fibrillation and other supraventricular arrhythmias. Intra-atrial conduction delays can be seen on the surface ECG as P wave prolongation, which is more visible with averaging techniques used in advanced recording devices. Averaging followed by amplification after proper filtering of the electrical signal should allow more precise measurements of duration and amplitude of the P wave. Data on reproducibility, filter settings, required number of beats, and precise definitions of onset and offset are dependent largely on the system used, which can be QRS or, preferably, P wave triggered. This explains conflicting data in the literature. It is clear that P wave duration is one of the best predictors of perioperative atrial fibrillation. For paroxysmal forms, the data are less convincing. Root mean square voltages of the P wave can be useful. Combining the P wave duration with other data often improves the diagnostic value of signal averaging. Standardization of the techniques appears to be necessary.

Neuroleptic malignant syndrome: observations on altered consciousness.

A young man with a previously untreated schizophrenia developed a neuroleptic malignant syndrome (NMS) on the second day of neuroleptic treatment. The dominant symptom was deep coma. The NMS occurred on the second day of neuroleptic therapy with rapidly progressing mental deterioration, temperature elevation, and extrapyramidal signs. After anticholinergics were injected the patient regained consciousness. This suggests that a cholinergic hyperactivity in the central nervous system (rather than hyperthermia) is responsible for the disturbance of consciousness in NMS. The experimental evidence that central cholinergic systems are stimulated by neuroleptics is discussed. It is concluded that anticholinergics might be helpful in treating coma during NMS.

[Five years experience with an influenza subunit vaccine (author's transl)]. / Fünf Jahre Erfahrung mit einem Influenza-Subunitimpfstoff.

After a short review on development, production, and assay of influenza vaccines the authors discuss the special properties of influenza virus subunit vaccine which contains the purified protective antigens of the influenza virus. The results of pre-clinical and clinical studies allow the conclusion that subunit vaccine is better tolerated than and at least as potent as conventional influenza vaccines. It therefore seems to be especially suited for annual re-vaccinations of persons at high risk.

[The Kleine-Levin-Critchley-syndrome. A contribution to the solution of differential diagnosis (author's transl)]. / Das Kleine-Levin-Critchley-Syndrom--Ein Beitrag zu seiner differentialdiagnostischen Klärung.

The typical symptoms of the so-called Kleine-Levin-Critchley-Syndrome are described according to our own observation of four selected patients (one woman, three men) on the background of the literature on the subject. In contrast to the first descriptions we characterise this syndrome by the Trias: periodic hypersomnia, vegetative disturbances (especially of food intake) and psychopathologic symptoms. Especially young men in their second decade of life suffer from this syndrome. As far as women are concerned the disease is found more seldom but the authors are sure that it exists. A spontaneous remission of the periodically proceeding disease often occurs in the third decade of life. In analogy to the respective literature a retardation of the EEG during the course of the disease going along with otherwise inconspicuous neurology was observed by the authors. Polygraphic-EEG studies are seldom. The cause of the syndrome is still open to question. Our observation show that a primarily disposition-linked and a secondarily acquisition-linked form can be assumed. Good effects are put down to amphetamines used for therapy. As far as differential diagnosis is concerned infections and abusus must be excluded.

[Immunisation against influenza with a new subunit vaccine tested on children at risk (author's transl)]. / Influenza-Schutzimpfung mit einem neuen Subunit-Impfstoff bei Risikokindern.

The efficacy and tolerance of Sandovac, a new subunit vaccine, was tested in 104 children and juveniles aged 2 1/4 to 17 years, at five children's clinics. Sandovac 1000 was given to 39 children, Sandovac 2000 to 65. The vaccine was well tolerated, no appreciable side effects--local or systemic--having been recorded. The efficacy of Sandovac was checked by determining the antibody titre against haemagglutinin and neuraminidase in 36 children before and 28 days after vaccination with SAndovac 1000. The conversion rate with haemagglutination-inhibiting antibody titres type A strain Victoria was 100% and type B strain Hong Kong 86%. The geometric mean values rose by a factor of 29 for type A and 7.4 for type B. For the neuraminidase-inhibiting antibodies the factors were 3.15 with type A and 5.83 with type B. Titre increases by a factor of at least 1.5 occurred in 75 and 84%, respectively of vaccinated children.

[Comparison of the effects of the anthracene derivative danitracen (WA335-BS) and amitriptyline in depressive patients (author's transl)]. / Wirkung des Anthracenderivats Danitracen (WA 335-BS) im Vergleich zu Amitriptylin bei depressiven Patienten

9,10-Dihydro-10-(1-methyl-4-piperidylidene)-9-anthrol (danitracen, WA 335) is a substance with a stronger peripheral and partly central antiserotonin and antihistamine effect than cyproheptadine. In 5 different hospitals, WA 335 (3 X 1 mg/die) was investigated versus amitriptyline (3 X 50 mg/die) in a double-blind study in 116 depressive patients of different nosology. In the end of the investigation period (20 days), under WA 335 treatment 67.7% and under ami-riptyline treatment 66.7% of the patients showed an improvement of 50% = decrease in the Hamilton depression score. However, a decrease of 50% in the selfrating scale (von Zerssen) was only shown by 57% of the patients under WA 335 administration and 51% under amitriptyline administration. There were no significant differences seen as regards course and side effects of the two drugs. Like amitriptyline, WA 335 shows sedative properties at the beginning of therapy.