[Hemodialysis in patients with chronic schizophrenia (author's transl)]. / Hämodialyse bei chronisch schizophrenen Patienten.

In an open study three chronically schizophrenic patients with normal kidney function were treated by hemodialysis in an attempt to ameliorate their psychotic symptoms. Neuroleptic treatment was stopped at least four weeks prior to hemodialysis. The patients were dialysed once weekly for twelve (in one case eleven) weeks. Psychopathology was evaluated using the IMPS, BPRS and NOSIE. No patient showed any improvement during the course of dialysis, one patient showed a marked detrioration. These observations raise doubts about whether schizophrenic psychoses can be improved by means of hemodialysis as previously published by Wagemaker (1977).

Hemodialysis in schizophrenia. Results in three chronic cases.

Therapeutic trials with hemodialysis have been performed in three cases of chronic schizophrenia. The severely ill patients had been hospitalized for more than ten years and had not responded to different types of conventional somatic treatment. Psychopathology was evaluated by use of the IMPS, BPRS, and NOSIE scales. No improvement could be observed as a consequence of 12 (11 in one case) hemodialysis treatments. Rather, some deterioration occurred in two of the patients. This result is not in accord with the markedly positive findings of Wagemaker and Cade (1977). However, further studies appear necessary to render final conclusions.

[Effect of coronary flow reduction on the coronary flow distribution, the myocardial metabolism and left ventricular hemodynamics]. / Einfluss der Koronarflussdrosselung auf die Koronarflussverteilung, den Herzmuskelmetabolismus und die linksventrikuläre Hämodynamik

Myocardial blood flow, left ventricular performance, regional myocardial metabolites (ATP, CrP, lactate) and a-v differences of oxygen, lactate and pyruvate were determined in 6 open chest dogs with cannulated left coronary artery. A mean flow reduction from 92 to 43 ml/min/100 g heart weight resulted in marked heart failure accompanied by extensive flow reduction to the endocard with nearly 10 fold increase of lactate and a decrease of CrP content to 50% of control. In contrast, flow and metabolic parameters of the epicardial part changed only slightly. Furthermore, the DPTI/SPTI-ratio showed a good correlation with the subendocardial CrP content (r = 0.93, p less than 0.01).

Left ventricle contractile function in trained dogs with cardial hypertrophy.

Eight mongrel dogs exercised for 8 weeks by treadmill running at 20 per cent incline 20 to 25 minutes twice daily, 4-5 days/week. Another eight dogs which were kept in the cages for a similar period served as controls. The exercise program was effective in inducing myocardial hypertrophy since the ratio left ventricular weight/body weight was significantly (P less than 0.001) higher in the trained dogs (5.04 g/kg) than in the sedentary animals (3.83 g/kg). In morphine-chloralose anesthesia the dogs were studied by left heart catherization and cineangiography at spontaneous heart rate (run I), at paced heart rate (run II), at paced heart rate following cardiac autonomic nervous blockade by bilateral vagotomy and the administration of propranolol (run III) and during acute pressure loading with methoxzmine at constant heart rate (run IV). Intergroup comparison yielded no significant difference in any hemodynamic or volumetric parameter throughout the entire study. However, with intragroup comparisons between run III and run IV a less significant increase in left ventricular end-diastolic pressure (from 5 to 15 mm Hg; P less than 0.05) was observed in the trained animals than in the control dogs (from 6 to 25 mm Hg; P less than 0.001). Left ventricular end-diastolic volume increased significantly only in the control dogs during acute pressure loading. Mean aortic pressure and left ventricular peak dP/dt increased to a similar extent in both groups. Since in the trained dogs the left ventricle encroaches less on the Frank-Starling mechanism than in normal animals for overcoming an acute pressure burden it is concluded that the development of hypertrophy concomitant with chronic exercise represents an adaptive mechanism with evidence of beneficial consequences for the intrinsic contractile function of the myocardium.

The influence of hypertrophy on myocardial function.

In patients with hypertrophy from long-standing left ventricle pressure (PL) and volume overload (VL) as well as in a group of controls basal left ventricular contractility was assessed by peak measured isovolumic velocity of shortening (Vpm), mean velocity of circumferential fiber shortening (mean VCF) and mean normalized systolic ejection rate (MNSER). The angiographically determined left ventricular muscle mass was elevated to a similar extent in PL and VL. As compared to the control group both hypertrophy had decreased contractile indexes. No significant differences of contractility existed between the groups with PL and VL. Hence it appears that in chronic mechanical overloading the extent of hypertrophy is probably more important for the decrease of contractility than the nature of the stimulis to hypertrophy. In 15 patients with aortic stenosis left ventricular muscle mass and isovolumic and ejection phase contractile indexes were determined preoperatively and 13.5 months after successful valve replacement by a tilting disc prosthesis. Postoperatively there was a significant (P less than 0.001) decrease of muscle mass from 182 to 114 g/m2. Mean VCF increased from 1.07 to 1.52 circ/sec (P less than 0.01); MNSER from 1.92 to 2.59 enddiastolic volumes/sec (P less than 0.01); Vpm from 1.17 to 1.60 ML/sec (P less than 0.001) and total pressure Vmax from 1.61 to 2.09 ML/sec (P less than 0.01). In 9 of 13 patients an abnormal or pathologic response to handgrip at the preoperative study became normal postoperatively. It is concluded that in aortic stenosis removal of the chronic pressure burden leads to regression of left ventricular hypertrophy associated with an improvement of resting and exercise contractile function. Pressure-deprived contractile indexes; ejection phase contractile indexes; chronic pressure load; chronic volume load; aortic valve replacement; postoperative hemodynamics.