24-hour blood pressure control after single daily doses of nivaldipine in patients with essential hypertension.

In an open monocentric phase II study, 20 inpatients with hypertension were treated with a single daily dose of nilvadipine for 3 weeks after a 1-week placebo washout phase. The initial dose in all patients was 8 mg/day p.o.; this was doubled to 16 mg once daily if an adequate blood pressure reduction was not achieved after 10 days on 8 mg. The objective of the study was to investigate the effect of this new calcium antagonist on the blood pressure in hypertensive patients. This was done by means of a 24-h blood pressure profile (with measurements at 0.5, 1, 2, 4, 8, 12, and 24 h after administration), and over the complete course of the treatment period (blood pressure measurements each day just before the medication was given). In addition, by determination of the nilvadipine plasma levels on the first, tenth, and last medication day, a possible concentration-efficacy relationship was to be ascertained between plasma concentration of nilvadipine and the observed blood pressure-lowering effect of the drug. Adequate blood pressure reductions were achieved with nilvadipine 8 mg once daily in 13 patients; 7 required a doubling of the dosage to 16 mg/day. Already on the first day of therapy, both the systolic and diastolic blood pressures were significantly reduced compared to those in the placebo phase (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Fascioliasis--a contribution to the differential diagnosis of focal liver processes]. / Fascioliasis--ein Beitrag zur Differentialdiagnose fokaler Leberprozesse.

The case of a 60 years old patient with a rare parasitosis, fascioliasis hepatica, is presented. The clinical, parasitologic, radiologic and histologic findings are discussed with reference to the literature. The diagnosis was established by examination of the faeces of the patient. The radiologic examinations document the extent of the organic involvement, in the presented case that of the liver. The finding of circumscribed hypodense liver lesions can be decisive for the further diagnostic proceedings only in the light of an appropriate history and typical laboratory findings.

Altered distribution of myosin isoenzymes in the cardiomyopathic Syrian hamster (BIO 8.262).

Myosin of the ventricular myocardium of the cardiomyopathic Syrian hamster and of control animals was analysed using non-dissociating pyrophosphate electrophoresis. Three different myosin isoenzymes exhibiting different Ca2+ activated ATPase activities were demonstrated in the ventricular myocardium of the Syrian hamster. As shown by peptide mapping, ventricular myosin isoenzymes differ in their heavy chain composition. In the cardiomyopathic hamster a shift to myosins of lower Ca2+-activated ATPase activities occurs in the stage of insufficiency (age 220 days), whereas no different isoenzyme pattern could be found at the age of 65 days compared to control animals. We conclude that this redistribution of myosin isoenzymes is the basis of reduced myosin ATPase activity in the ventricular myocardium of the cardiomyopathic Syrian hamster during the development of myocardial insufficiency.

Development of necrosis and its sequelae in the myocardium of polymyopathic hamsters (BIO 8262). An electron microscopic study.

Beginning about 30 days after birth, polymyopathic Syrian hamsters of the strain BIO 8262 develop calcifying myocardial necrosis. In the final stage the resorptive granulation tissue is followed by scars with multi-nucleated giant cells containing huge amorphous calcium plaques. The ultrastructural findings reveal the importance of myocardial mitochondria as starting points for calcification. The pattern of cell damage shows marked similarity to the changes observed in the myocardiocytes of magnesium-deficient rats. However, it is different from the alterations described in degenerating myocardiocytes of dehydrotachysterol-treated animals. Spicular electron-dense inclusions are the first and only kind of intramitochondrial calcification. Granular and annular-granular inclusions, as observed in ischaemic and infarcted canine myocardium, could not be detected, indicating that different pathogenetic mechanisms operate. The increased intracellular calcium level triggering myocardial necrosis is regarded as a secondary phenomenon, based on a genetic abnormality.

[The importance of early diagnosis of Wegener's granulomatosis: a typical problem case for the otolaryngologist (author's transl)]. / Bedeutung der Frühdiagnose der Wegenerschen Granulomatose. Ein typischer Problemfall des HNO-Arztes.

Although the etiology and pathogenesis of Wegener's granulomatosis is still obscure, the pathological process is assumed to belong to the group of immunologic diseases. Destructive lesions commonly appear in the midface, particularly in the nose, and are seen microscopically as necrotizing vasculitis. We report a 19 year old woman with undetected disease who was finally diagnosed by repeated biopsies through collaboration between an otolaryngologist and a pathologist. This emphasizes the importance of an early diagnosis for therapeutic reasons since cooperation with an internist prevented the patient from developing gross mid-facial lesions. Treatment involved corticosteroids, immune suppression, and temporary low-dose heparin. During a seven-year period of follow-up, limited tissue changes occurred. Wegener's granulomatosis without treatment will proceed to death, while early recognition and proper treatment can induce long-lasting remissions. Thus, it becomes necessary for head and neck clinicians to become familiar with symptoms of the initial stage of the disease since they must help to secure a proper diagnosis (particularly through biopsies when indicated).

[Therapy of orthostatic dysregulation. Comparative studies on anti-hypotensive sympathomimetics with a tilt-table test]. / Zur therapie der orthostatischen Dysregulation. Vergleichende Untersuchungen antihypotensiv wirksamer Sympathikomimetika im Kipptisch-Versuch.

In 7 patients suffering from orthostatic hypotension the early behaviour of arterial mean blood pressure was studied in the tilting table experiment under influence of etilefrine, norfenefrine, gepefrine (D-(+)-1-(3-hydroxyphenyl)-2-aminopropan-(2R, 3R)-hydrogentartrat) and of its I-isomere. Significant improvement of early orthostatic disregulation of the arterial pressure could be only observed under gepefrine. Amelioration seems to be induced by sensitization of the pressoreceptors.

The cardiomyopathy of the Syrian hamster (strain BIO 8262)--hypertrophic or dystrophic?

Chemical as well as cytophotometric studies were carried out on myocardium of cardiomyopathic hamsters of strain BIO 8262 and of healthy control hamsters of strain CLAC. Our interest was to find out whether the cardiomyopathic hamsters suffer from hypertrophic cardiomyopathy or not. The heart muscle mass was only slightly increased in the older cardiomyopathic hamsters when compared with the controls. This increase was accompanied by an elevated content of total DNS, RNS and protein. Furthermore, the number of hyperdiploid heart muscle cells was slightly increased in the older diseased animals. However, all these changes were of minor degree. Thus, a distinct hypertrophying process in the myocardium of the cardiomyopathic hamsters can be excluded. On the other hand, the connective tissue components (polysaccharides and collagen) were distinctly increased in the hearts of older cardiomyopathic hamsters. This is in accordance with morphological investigations, in which replacement of necrotic myocardium by fibrosis could be detected.

Electrocardiographic changes in cardiomyopathic Syrian hamsters (strain BIO 8262).

Under ether anesthesia electrocardiograms were derived from Syrian hamsters (strain BIO 8262) suffering from cardiomyopathy and muscular dystrophy. In addition, ventricular weights and body weight were determined. Young hamsters -- not yet showing morphological signs of the cardiomyopathy with the exception of possible left ventricular hypertrophy -- demonstrated only a longer ventricular activation time than normal hamsters. With the onset of cardiac necrotization left axis deviation in frontal plane projection and right bundle branch blocks are developing in the cardiomyopathic hamsters followed by first degree atrioventricular conduction defects. During the late stage of the cardiomyopathy left bundle branch blocks are additionally arising, while left ventricular hypertrophy is disappearing. Since no overt heart failure is occurring in this strain of cardiomyopathic hamsters, gradual development of high degree conduction defects is assumed to terminate their lives. The electrocardiographic pattern of the hamster cardiomyopathy fits partly into that of human primary as well as secondary cardiomyopathy. Nevertheless, it seems to form an entity of its own, as arrhythmias, higher degree atrioventricular conduction disturbances, typical signs of ventricular or septal hypertrophy, abnormal P and Q waves, ST segment and T wave changes are lacking.