[Long-term prognosis of conservative or surgical treatment of peripheral arterial occlusive disease--critical evaluation]. / Langzeitprognose nach konservativer oder operativer Behandlung der peripheren arteriellen Verschlusskrankheit--kritisch betrachtet.

The spectrum of therapeutic measures for PAOD (peripheral arterial occlusive disease) has increased substantially. A combination of therapeutic measures is therefore applied more frequently. It makes sense to evaluate the patients individually. This is increasingly recommended. Some therapeutic guidelines are shown. It has to be stressed that there are no more clear-cut borders between conservative and operative measures. It is a fact, that the treatment of PAOD improves the quality of life and the morbidity.

[The significance of "coronary risk" for life insurance]. / Die Bedeutung des "Koronaren Risikos" für die Lebensversicherung.

In many countries heart and circulatory diseases are still the commonest cause of death (over 50%). This is particularly important for the life insurer because heart and circulatory diseases, including coronary heart disease, represent a relatively important risk in life insurance and that is often difficult to insure against. With the help of some diagrams (from the literature), an attempt is made, firstly to demonstrate the epidemiological relationships between "risk factors" and coronary heart disease, and, secondly, to show the relationship between the extent and localisation of arteriosclerosis in the coronary vessels and its influence on mortality, which is decisive for the life insurer. In the last three decades, new and more favourable factors for the insurability of coronary heart disease have come into existence. This circumstance is being and has been increasingly taken into account in risk assessment for life insurance. To the degree that the significance of the coronary heart disease risk for the life insurer has decreased, the acceptance of coronary risks has increased. There are three factors, above all, that determine the insurability of coronary heart disease: a) the age of the insuree; b) the presence of "cardiac risk factors"; c) the state of the coronary vessels of the insuree (existence of corresponding clinical findings).

Primary pulmonary hypertension: follow-up of patients with and without anorectic drug intake.

Long-term follow-up of 75 patients with pulmonary hypertension developing their symptoms prior to 1970 was performed. Anorectic drug intake, survival, repeated haemodynamic measurements and past and present symptoms were evaluated. The higher incidence of pulmonary hypertension at that time was strongly related to anorectic drug intake. No difference in the long-term survival was found in patients with and without anorectic drug intake. None of the patients showed normalization of the pulmonary pressure and the changes were unpredictable from the values found at the initial measurements. Long-term survival is possible even in patients with very high pulmonary arterial pressure. Improvement of the haemodynamic indicators was more frequent in patients with anorectic drug intake. In approximately 30% of the patients with anorectic drug intake a decrease in symptoms was observed while in none of the other patients was such a decrease found. It therefore seems that at least some of the patients with pulmonary hypertension and a history of anorectic drug intake adapt themselves better than those without anorectic drug intake.

[Emergency treatment with a temporary balloon-floated pacemaker electrode (author's transl)]. / Notfalltherapie mit der temporären Schrittmacher-Ballonelektrode.

The "blind" insertion of a balloon-tipped pacemaker electrode is a suitable method when emergency pacing at the bedside is needed. The disadvantage of placement of the electrode without fluoroscopic control is counter-balanced by the saving of time and the lesser stress and risk involved for the patient, who is not required to be moved to a fluoroscopic room.

[Parenteral nutrition in hepatic coma (author's transl)]. / Parenterale Ernährung bei Coma hepaticum

A special program of parenteral nutrition was established in 16 patients with genuine hepatic coma and in 24 patients with portal encephalopathy; this program involves stepwise addition of various nutritional components. On the day of admission water and electrolyte balance is normalized, on the following morning infusions with 40% glucose solutions are started, and the patient is adapted to glucose as the source of calories within the next 48 hours. After this period total parenteral nutrition is instituted comprising all essential ingredients of nutrition. Application of amino acids was especially adjusted to the situation of hepatic coma taking into account not only the typical derangements of metabolism in hepatic coma, but the essential complications of this disease as well. Serial determinations of plasma amino acids were done in order to assess the program of nutrition. Before the beginning of parenteral nutrition plasma levels of amino acids were altered in a manner typical for liver failure; these alterations could be normalized almost completely by total parenteral nutrition.

[Haemodynamic changes in acute myocardial infarction following high doses of furosemide (author's transl)]. / Anderungen der Hämodynamik beim akuten infarkt nach hohen Dosen Furosemid

Haemodynamic measurements were carried out after administration of furosemide to 10 patients suffering from acute myocardial infarction and congestive heart failure. It was observed that a transient deterioration in cardiac function (decreased cardiac output, increased enddiastolic pulmonary arterial pressure and increased pulmonary and systemic resistance) occured in the pre-diuretic stage in these failing hearts. After the onset of diuresis the haemodynamic parameters showed a reversal of the previous trends (increased cardiac output, decreased enddiastolic pulmonary arterial pressure and pulmonary resistance). The consistently lower enddiastolic pulmonary arterial pressure in the diuretic phase as compared with the pre-diuretic value ensured an improvement in cardiac haemodynamics. An attempt was made to interpret the haemodynamic results in the light of the Frank-Starling's curve.

[The effect of "standardized forced diuresis" (SFD) on serum and urinary electrolytes(author's transl)]. / "Standardisierte forcierte Diurese" (SFD); Elektrolytverhalten im Serum und Harn

The effect of standardized forced diuresis (SFD) on the serum and urinary electrolyte levels was investigated in 10 cases of severe self-poisoning with hypnotic drugs. Diuresis was initiated by furosemide and maintained at an hourly urinary ouput of 2 litres. Fluid and electrolyte substitution was carried out with a standardized electrolyte solution. Initiation and termination of the SFD was performed abruptly. The mean values of sodium, potassium, chloride and phosphorus in the urine varied widely at the beginning of the SFD, while the calcium and magnesium values varied only slightly. During SFD, urinary stabilization occured at a particular ionogram, in correlation to the electrolyte concentrations in the infusion fluid and with only minimal individual variation. Owing to this satisfactory correlation, none of the patients developed signs of electrolyte disturbances, so that no correction of the infusion constitution was necessary. The abrupt termination of the SFD prevented electrolyte disturbances in the recovery phase.

[Angiotensin - a possible cause of acute renal failure (author's transl)]. / Angiotensin - mögliche Ursache eines akuten Niervenversagens

The hypertensive action of angiotensin is purely brought about by peripheral vasoconstriction and may, thus, lead to reduced perfusion of vital organs, especially the kidneys. The dangers of angiotensin in triggering off acute renal failure are illustrated by a case report in which this drug was administered to a comatose patient with hypovolaemic hypotension following barbiturate self-poisoning.

[Severe intoxication with leponex (author's transl)]. / Schwere Leponex-Vergftung und ihre Intensivbehandlung

The clinical picture and the therapeutic management of a severe case of self-poisoning with Leponex (clozapin) are presented. In particular, the grave complications, their possible aetiology and the value of the administration of cortisone are discussed. Forced diuresis or haemodialysis are ineffective measures on account of the low serum concentrations of Leponex.

[Clinical results with dopamine in acute renal failure (author's transl)]. / Erfahrungen mit Dopamin beim akuten Nierenversagen

Dopamine possesses specific pharmacological actions which distinguish it from the other catecholamines. Apart from its positive inotropic effect, dopamine exerts a favourable influence on renal function with an increase in renal blood flow and alterations in intrarenal haemodynamics. The use of dopamine in the early stages of acute oliguric failure is recommended on the basis of the good therapeutic response achieved in a series of cases.

[Septic shock with disseminated intravascular coagulation and adrenal failure (author's transl)]. / Septischer Schock mit Verbrauchskoagulopathie und Nebennierenausfall

The case is reported of a 15 year-old patient admitted in a state of severe shock with disseminated intravascular coagulation, complicated by unilateral adrenal failure as demonstrated scintigraphically by the absence of I131-labelled cholesterol uptake. Problems arising in the differential diagnosis and therapeutic management are discussed.

[Partial parenteral nutrition in acute myocardial infarction (author's transl)]. / Partielle parenterale Ernährung (PPE) beim akuten Herzinfarkt

The influence of partial parenteral nutrition (PPN) was compared with the effect of a calorie-free solution in 2 groups of patients (n = 10) with acute myocardial infarction. Both groups received the same daily diet of 800 to 1000 Cal. The control group was given, in addition, a calorie-free electrolyte solution and the PPN group was given a nutritious solution consisting of 1000 Cal carbohydrate and 26.5 g 1-amino acids daily by means of a subclavian catheter. The exact monitoring of the water balance indicated that patients with acute myocardial infarction can safely be given parenteral nutrition. Neither haemodynamic nor metabolic complications occurred in the group with PPN due to the small infusion volume and the continuous administration of the infusion volume and the continuous administration of the infusion. The control group was in negative nitrogen, potassium and phosphorus balance in comparison with the PPN group. This demonstrates that a hypocaloric diet is insufficient in the acute phase of myocardial infarction and causes catabolism, which can be prevented by PPN. Stimulation of healing of the myocardial infarct can be expected through the improvement of protein metabolism by PPN.

[The Moschcowitz syndrome--a rare cause of coma of unknown aetiology (author's transl)]. / Moscheowitz-Syndrom--Seltene Ursache eines ungelklärten Koma

A case of the Moschcowitz syndrome, a rare cause of sudden coma, is presented and its clinical features and chemopathological findings described. The histological changes as well as the pathophysiological mechanisms and therapy of this syndrome are discussed.

[Fatal self-poisoning with the tetracyclic antidepressive drug, ludiomil (author's transl)]. / Tödliche Vergiftung mit dem "tetrazyklischen" Antidepressivum Ludiomil

The clinical and analytical data are presented of a case of severe Ludiomil self-poisoning (assumed total ingested dose: 3000 mg). Ludiomil resembles the tricyclic antidepressive drugs in regard to its toxic effects. Two essential observations made in Ludiomil poisoning are: 1) the limited therapeutic possibilities due to delayed elimination and 2) the severe degree of respiratory distress.

[Acute pancreatitis with shock and acute renal failure (author's transl)]. / Akute Pankreatitis mit Schock und Nierenversagen

Acute pancreatitis is discussed from the viewpoint of a medical intensive care unit, with particular reference to the early and late complications. The measures which must be promptly implemented in order to successfully combat the grave early complications of shock and acute renal failure are stressed. Continuous monitoring ensures that prompt surgical management is undertaken in cases of late complications-abscess formation, sequestration and sepsis. A review of the characteristic clinical and laboratory data of patients with acute pancreatitis treated in our unit is presented in table I.