[Dose-effect relation of N-prajmalium bitartrate with control of plasma levels]. / Dosis-Wirkungs-Beziehung von N-Prajmaliumbitartrat unter Plasmaspiegelkontrolle.

15 patients with ventricular ectopic beats classified to at least Lown class III with more than 100 ventricular ectopic beats in one hour were treated with N-prajmalium bitartrate (NPAB) in increasing dosages. The first dosage of 4 X 5 mg/d has been increased by 5 mg in three steps of three days to a level of 4 X 20 mg/d. A resting ECG, the systolic time intervals and a 24 h ECG were registered before treatment and after every dose. The median PQ time increased from 170 msec to 200 msec, the increase becoming significant (p less than 0.05) with a dose of 4 X 5 mg/d NPAB and above. Frequency, QRS and the frequency-corrected QT time did not change significantly. At a dose of 4 X 10 mg/d NPAB the increase of the quotient pre-ejection period to ejection time PEP/LVET became significant, increasing continuously from 0.35 to 0.48. Six of the 15 patients showed a significant reduction of ventricular ectopic beats, couplets and salvoes. In two patients the antiarrhythmic effect was significant at 4 X 5 mg/d. With an increasing dose from 4 X 10 mg/d each responder showed a significant reduction of ventricular ectopy. The lowest effective plasma concentrations ranged from 15 to 213 ng/ml with a median value of 58 ng/ml and an upper quartile of 94 ng/ml. There was no significant difference in plasma concentrations between responders and non-responders.

[Preoperative stress. Study of the mental behavior and parameters of physiological stress in non-premedicated patients during the preoperative period]. / Der präoperative Stress. Untersuchung zum Verhalten psychischer und physiologischer Stressparameter nichtprämedizierter Patienten in der präoperativen Phase.

In 29 male patients undergoing arterial bypass operations of the lower limb, psychological and physiological stress parameters were investigated. They received no premedication. We found an increase of heart rate (HR), arterial blood pressure (BP), plasma cortisol (Cort), free fatty acids (FFA), ventricular ectopic beats (VEB) and supra-ventricular ectopic beats (SVEB) (registered with a 24 hour ECG). The physiological dynamics were different, depending on the results of the psychological tests (MMQ and ESB): Repressor had higher HR and increased significantly more than sensitizer. Depressive patients had higher Cort levels the day before surgery compared to hopeful ones, but remained at these levels, whereas hopeful patients had a significant increase of Cort immediately before operation. They had also higher BP's and HR's. Patients with sthenic affections increased significantly more with FFA levels than asthenic ones. Anxious and asthenic patients had significantly more VEB than non anxious and sthenic ones. These results can well be interpreted in terms of dynamic psychophysiological stress reactions. We propose the use of psychological and physiological stress parameters for investigations of methods for the reduction of preoperative stress.

[Early mobilization after myocardial infarction. Hemodynamic and metabolic studies]. / Frühmobilisation nach Herzinfarkt. Hämodynamische und metabolische Untersuchugen

In a controlled study two groups of patients with acute myocardial infarction were compared. One group consisted of 75 patients who were early mobilized; a control group of 38 patients was treated conservatively. Although the early mobilized patients showed a slightly increased stress on the hemodynamics these findings had no clinical significance: the complication rate in this group was not higher than in the conservatively treated patients. The main advantage of early mobilization however as compared to conservative treatment seems to be the prognostically and psychologically favourable effect especially with respect to rehabilitation.