[Dipeptidyl peptidase IV of peripheral blood lymphocytes in patients with primary biliary cirrhosis]. / Untersuchungen der Dipeptidyl-Peptidase IV peripherer Blutlymphozyten bei Patienten mit primärer biliärer Zirrhose.

Investigations concerning changes of dipeptidyl-peptidase IV-positive (DP IV+) lymphocytes in the peripheral blood (PBL) were undertaken in 22 patients with primary biliary cirrhosis (PBC) under therapy with ursodeoxycholic acid (750 mg/day). We found that after 4-8 weeks of therapy the number of DP IV+ PBL was raised from an initially low, suppressed level of 5-12% to 18-33% corresponding to the range observed in healthy subjects. Concurrently liver function parameters of the patients were significantly improved. The identity of DP IV+ CD 26+ peripheral T-cells could be shown by the combination of cytochemical DP IV-staining with the indirect immuno-fluorescence of the lymphocyte marker CD 26. These results show that the UDCA-therapy in patients with PBC has a direct effect on the immune system and a positive influence on the immuno-regulative capacity.

[Dipeptidyl-peptidase IV of human lymphocytes in patients with primary biliary cirrhosis and UDCA therapy]. / Dipeptidyl-peptidase IV humaner Lymphozyten bei Patienten mit primärer biliärer Zirrhose unter UDCA-Therapie.

Investigations concerning changes of dipeptidyl-peptidase IV-positive (DP IV+) lymphocytes in the peripheral blood (PBL) were undertaken in 22 patients with primary biliary cirrhosis (PBC) under therapy with ursodeoxycholic acid (750 mg/day). We found that 4-8 weeks after therapy beginning the number of DP IV+ PBL was raised from a low initial suppressed level of 5-12% into a range of 18-33% corresponding to that of a healthy. Concurrently liver function parameters of the patients were improved significantly. The identity of DP IV+ and CDw26+ of peripheral T-cells could be shown by combination of the cytochemical DP IV-staining with the indirect immunofluorescence of the lymphocyte marker CDw26. These results show that the UDCA-therapy in patients with PBC has a direct effect on the immune system and a positive influence on the immuno-regulative capacity.

[Psychosocial changes following resuscitation]. / Psychosoziale Veränderungen nach Reanimation.

Of 68 patients successfully resuscitated within a period of 18 months 52 (38 men and 14 women; mean age 63 [32-90] years) were interviewed about their experience shortly after discharge. 37 reported to have been aware of the life-threatening nature of the acute episode; recurrent depressions were noted by 20; a positive change in attitude towards their life had resulted in 24 patients; 49 praised their doctors and nurses; 40 were appreciative of the medical technology used. All but one of the 52 patients would again choose to be resuscitated. After 12 months 38 patients were again interviewed (31 men and 7 women); 16 had died in the meantime. 21 of the 38 felt physically stronger than before, 25 were more cheerful and 34 were living more intensely. 36 of the 38 patients thought the interviews had been helpful and they would have liked more intensive psychiatric care even during their hospital stay.

[Differential therapy with calcium antagonists. Hemodynamic studies using nifedipine, verapamil and diltiazem]. / Differentialtherapie mit Calciumantagonisten. Hämodynamische Untersuchungen am Beispiel von Nifedipin, Verapamil und Diltiazem.

The haemodynamic effects of nifedipine, verapamil and diltiazem were measured and compared in an open randomized parallel investigation on 44 patients with coronary heart disease and compensated myocardial function. Each set of parameters was measured during a control phase and serially after a single dose (nifedipine in retard form, 20 mg; verapamil, 160 mg; diltiazem, 120 mg) over a period of 180 minutes at rest and after a standardized exercise. All three drugs produced a significant fall in systemic arterial pressure of 10-14% and of left-ventricular stroke work of 10-20% from the initial level. The main differences between the three drugs concerned heart rate and stroke volume. Nifedipine produced a significant rise in heart rate, while it fell by 8-10% below the control value after verapamil and diltiazem. On the other hand, verapamil caused a significant fall in stroke-volume index, while after nifedipine and diltiazem it remained unchanged. These results suggest differential therapeutic use of the various calcium antagonists.

[Long-term effect of a new delayed-action nitroglycerin compared to isosorbide dinitrate. Double-blind hemodynamic study]. / Langzeitwirkung eines neuen Depot-Nitroglycerins im Vergleich mit Isosorbiddinitrat. Hämodynamische Doppelblindstudie.

Nitroglycerin bound to cellulose (Nitroglin) was investigated in patients with coronary heart disease as to the oral long-term effects in a dosage of 10 mg (n = 10) and 20 mg (n = 10) in comparison with 40 mg sustained release isosorbide dinitrate (n = 10) and placebo (n = 10). Haemodynamics were evaluated in a randomised double blind protocol. All true medications showed comparable maximal effects on right heart atrial pressure, pulmonary artery and pulmonary capillary pressure taking place with certainty between the first and fourth hour. Differences were seen for the duration of action: 10 mg cellulose bound nitroglycerin showed a sustained action until the end of the sixth hour, 20 mg until the eighth hour. The 20 mg dosage was aequipotent to the action of 40 mg of sustained action isosorbide dinitrate. However, the high dosage of 20 mg cellulose bound nitroglycerin cannot be recommended universally as diminutions of cardiac output by 30-40% may occur. Cellulose bound nitroglycerin is an oral long-term nitrate with therapeutic relevance besides the sustained action isosorbide dinitrate.

[Guillain-Barré polyradiculitis in acute viral hepatitis type B--case report]. / Polyradikulitis Guillain-Barré bei akuter Virushepatitis Typ B--Fallbericht.

A polyneuritis of the Guillain-Barré type developed in a 29 year-old female patient during the icteric stage of viral hepatitis B. The main symptoms were diffuse paresthesias and increasing motor weakness of the limbs, ending up in paralysis of the legs. The analysis of the CSF (albumin raised, cell count normal) and electroneurographic findings were diagnostically reaffirming. The patient was given prednisolone. All symptoms disappeared within two months.

[Risks of treatment with beta-blocking agents in acute myocardial infarction (author's transl)]. / Risiken einer Behandlung mit Beta-Rezeptorenblockern. beim akuten Myokardinfarkt. Hämodynamische Untersuchungen bei 40 Patienten.

Haemodynamic investigations were performed in 40 patients with acute myocardial infarction before and after intravenous application of 6 mg propranolol. Cardiac index was significantly decreased caused by reduction of cardiac frequency and stroke volume. Pulmonary capillary pressure increased significantly. As a consequence pulmonary and peripheral vascular resistance increased. Arterial blood pressure remained largely unaffected. Propranolol showed a haemodynamically beneficial decrease of left ventricular stroke work without signs of negative cardiodepression at a cardiac index of more than 3.0 l/min . m2. At a cardiac index of less than 3.0 l/min . m2 a haemodynamically detrimental lowering of cardiac index to ranges of insufficiency of 2.0 l/min . m2 on average occurred. Thus cardiac index is an important factor for the decision of use of beta-blocking agents in acute myocardial infarction. Indiscriminate use of beta-blocking substances should not be accepted.

[The treatment of acute myocardial infarctions with beta-receptor-blockers. II. Hemodynamic effects of propranolol with and without combination therapy with nitroglycerin (author's transl)]. / Die Behandlung des akuten Myokardinfarktes mit Beta-Rezeptorenblocker - II. Hämodynamische Effekte von Propranolol mit und ohne Kombinationstherapie mit Nitroglyzerin.

In 20 infarct patients, whose age varies from 43 to 78 years (m 59.6), continuous hemodynamic measurements were made to determine the cardiovascular effects of propranolol without and during a simultaneous infusion treatment with nitroglycerin. In cases of compensated ventricular function and pulmonary wedged pressures of 15 mm Hg or less (N = 10), a mean intravenous propranolol dose of 6.1 +/- 1.3 mg led to a significant reduction of the LVSWI and a simultaneous increase of the PCP by 31% of the control value (P less than or equal to 0.005). A simultaneously performed infusion treatment with nitroglycerin at a mean dose of 3.0 +/- 1.6 mg/h resulted in totally cutting off the propranolol-induced PCP increase, whereas a decrease of the heart rate and the LVSWI due to a beta-receptor-blockade remained completely unchanged. In the case of pre-existing congestion insufficiency of the left ventricle (N = 10) and of a pulmonary wedged pressure of above 15 mm Hg, the administration of a mean dose of propranolol of 5.8 +/- 1.1 mg for protection of the myocardium resulted in a partly disquieting decrease of the volume of cardiac output (P less than or equal to 0.005) which was 28% of the control value for the CI an 12% for the SVI. Correspondingly the left ventricular stroke work decreased to 18%. Nitroglycerin has a reducing influence on these changes, but not down to the initial level. In cases of sufficient ventricular function, propranolol has a favorable influence on the myocardial O2-metabolism via its depressor effect on heart rate and contractility. By means of nitroglycerin, an increase of the pulmonary wedged pressure occurring under this condition can be inhibited. However, in the case of a pre-existing congestion insufficiency, propranolol can lead to a partly disquieting depression of the circulation, which, apart from the hemodynamic risks, makes a rather unfavorable influence on the myocardial O2-metabolism seem likely.

[Treatment of acute myocardial infarction with betareceptor blocking agents. I. Hemodynamic effects of Propranolol in combination with digitalis (author's transl)]. / Die Behandlund des akuten Myokardinfarktes mit Betarexeptorenblocker. I. Hämodynamische Effekte von Propranolol in Kombination mit Digitalis.

In the acute stage of transmural myocardial infarction, 22 patients ranging in age from 34 to 76 (mean 61.6) were given propranolol- because of its alleged myocardium-protecting properties - intravenously at a dosage of 0.03 to 0.1 mg/kg body weight under conditions of continuous hemodynamic control. Subsequently, the influence of digoxin, administered i. v. at a dosage of 0.01 my/kg body weight, on the negative-inotropic propranolol effects was examined. A hemodynamic comparison was made of the effects of propranolol before and after digitalis administration. In patients with compensated cardiac function (group 1, 16 patients), the propranolol-induced drop in the left ventricular stroke-work-index and rise in the left-ventricular filling pressure was completely compensated again by digitalis. The frequency-decreasing propranolol effect was nor influenced by digitalis. In patients with cardiac decompensation (group 2, 6 patients) digitalis only led to a renewed compensation of the left-ventricular stroke-work-index, the rise of the left-ventricular filling pressure remained unaffected. It follows from that, in cases of myocardial infarction without cardial decompensation, propranolol requires concomitant digitalisation. In cases of already existent myocardial insufficiency, propranolol can produce an unfavorable increase of the decompensation signs.

[Cardiac arrhythmias. Types and drug therapy (author's transl)]. / Herzrhythmusstörungen. Formen und medikamentöse Behandlung.

Arrhythmias are the expression of disordered stimulus formation or conduction. Focal genesis is due to an abnormal automatism in primary, secondary and tertiary impulse centers. Conduction blockade leads to bradycardial substitute rhythms which are determined by the site of the lesion. Bradycardial arrhythmias with a high degree of risk, with disturbed impulse automatism or with impaired hemodynamics require treatment with a pacemaker. Tachycardial and extrasystolic arrhythmias are treated today according to the differential therapeutic aspects. Treatment is also obligatory for premonitory arrhythmias and an identified Stokes-Adams disease. Ventricular fibrillations, high-grade ventricular bradycardia and asystole are cardiological emergencies.

[Long-term prognosis of cardiac pulmonary edema]. / Langzeitprognose des kardialen Lungenödems.

A retrospective determination of survival time over a total control phase of eight years was done in 53 patients who had been admitted to an internal intensive care unit in 1970 because of cardial pulmonary edema. The hospital survival rate amounted to 55%. 27% of the patients were still alive six months after discharge; after a year there were only 20%. Three of the 53 patients reached the 8th control year. The most unfavorable short- and long-term prognosis by far was evidenced by pulmonary edema resulting from an acute myocardial infarction with a hospital lethality of 80%; none of these patients survived longer than two years (n = 19). Irrespective of the nature of the basic disease, comparable rates were found for those types of pulmonary edema connected with a higher grade insufficiency of the right heart and corresponding increase of the central venous pressure over 20 cm water column (n = 13). In contrast, the pulmonary edema in consequence of a cor hypertonicum had a fairly good prognosis, because the 50% survival rate amounted to four years in this group (n = 21). All attempts to quantify the life prognosis in cases of pulmonary edema possess only speculative significance for the interests of the individual case. Nevertheless, they are indispensable for the correct choice of therapeutic procedure in medical borderline situations.