Vasodilators as first-line therapy for congestive heart failure: a comparative hemodynamic study of hydralazine, digoxin, and their combination.

Although digitalis and vasodilators both enhance cardiac performance in patients with congestive heart failure, their relative efficacy is unknown. Accordingly, the acute hemodynamic effects of intravenous hydralazine (0.15 mg/kg), digoxin (1.0 mg), and the hydralazine-digoxin combination were evaluated in 14 normotensive heart failure patients at sitting rest, nine of whom were also studied during submaximal upright bicycle exercise. Hemodynamic responses at rest and exercise were similar. Cardiac output and stroke volume rose with both agents, the increase in cardiac output with hydralazine exceeding that with digoxin at rest. Left and right ventricular filling pressures declined equally. Systemic arterial mean pressure and total systemic vascular resistance fell with hydralazine, while, with digoxin, systemic arterial mean pressure increased and total systemic vascular resistance was unchanged. The hydralazine-digoxin combination produced increases in cardiac output and stroke volume that were greater than with either drug alone, and that equalled the sum of the drugs' individual effects; reductions in ventricular filling pressures were similar to the single-drug interventions. Thus, hydralazine is at least as effective as digoxin in improving cardiac function over the short term. Vasodilators may constitute an acceptable alternative to digitalis as initial therapy for congestive heart failure, except where a reduction in systemic arterial pressure is potentially deleterious. Use of combined treatment produces greater increases in cardiac output than with either drug alone, but requires risking the toxicities of two agents.

The effect of medial amygdalotomy and anterior hippocampotomy on behavior and seizures in epileptic patients.

In 70 patients with epilepsy and severe behavioural disturbances with EEG changes in the temporal regions, we performed EEG investigations of deep temporal structures, temporal cortex and scalp, using Talairach's stereotactic apparatus. Taking into account the recorded changes we performed 115 stereotactic lesions on the medial amygdala (both unilaterally and bilaterally) and on the anterior hippocampus (cornu Ammonis). The results in epileptic processes were: total recovery in 11.4%, evident clinical improvement in 74.3% and no improvement in 14.3%. Similar results were obtained in behavioural disturbances. Bilateral amygdalotomy and unilateral hippocampotomy in selected cases may produce recovery or amelioration and make possible return to normal social life for epileptic patients with severe behavioural changes.

[Comparison of the changes in bioelectric activity recorded simultaneously from the amygdaloid body and the hippocampus and from the cranial surface during the stereoelectroencephalographic examination in epilepsy]. / Porównanie zmian czynnosci bioelektrycznej rejestrowanej jednoczesnie z ciala migdalowatego i hipokampa oraz z powierzchni czaszki podczas badan stereoelektroencefalograficznych w padaczce.

The authors analysed 95 SEEG records in epileptics with prevalent temporal-lobe changes comparing the bioelectric activity of the brain recorded simultaneously in the amygdala, hippocampus, temporal cortex and cranial surface during these investigations and relating them to EEG records obtained before the operation. In these records pathological elements typical of epilepsy were found occurring in different variants synchronously or asynchronously in leads at three above mentioned levels. In the findings reported attention is called to occurrence of seizure discharges in the amygdala and hippocampus which had no equivalent in cortical or cranial bioactivity records. In the light of these SEEG observations and a survey of the literature the authors stress the diagnostic importance of SEEG investigations in epilepsy.