[Treatment of diabetics with metformin]. / Lechenie na diabetno bolni s metformin.

After a brief survey of the mechanism of biquanides treatment and their indications and contraindications with the peroral treatment of diabetes mellitus, the adverse effects of that treatment are stressed upon, manifested mainly in lactacidosis. The latter is indicated to be most frequently found during the treatment with tenformin, rarely -- with buformin and most rarely and in a lighter form -- with metformin. That uneven effect of biquanide preparations is associated with a certain difference in their pharmacodynamics and pharmacokinetics. On the other hand -- those adverse effects result most frequently from unproper treatment carried outnot observing the indications and particularly the contraindications and surpassing the therapeutic doses. Very good results are reported, that were obtained by the authors, in the treatment with metform of 70 diabetic patients with insulin-independent type of diabetes and body overweight, that failed to respond to the treatment with a reducing diet or a diet and sulfurea preparations and resistant to insulin. Indications for that treatment are presented as well as the necessity of strict observation of the contraindications for its administration.

[Clinical picture and prognosis of insulinoma]. / Osobenosti v klinichnata kartina i prognozata na insulinoma

A case of insulinoma is reported, with initial malignant degeneration, diagnosed and operated 16 years ago. Six years later hypoglycemic attacks appeared again and lymph metastasis from malignant degenerated insulinoma were found near to the pancreas. After a period of eight years, in good health state, a third surgical operation was performed because of repeated hypoglycemic attacks and a new metastasis from the insulinoma was found in the pancreas tail. The patient has no hypoglycemic phenomena 18 months after the last operation. Besides that long-period of progress of the malignant degenerated insulinoma, not observed so far, certain peculiarities of the carbohydrate metabolism of the patient are stressed upon, as well as the necessity of early diagnosis and timely surgical treatment of insulinoma.

[Characteristics of the clinical picture and prognosis of insulinoma]. / Osobenosti v klinichnata kartina i prognozata na insulinoma

A case with insulinoma is reported, with initial malignant degeneration, diagnosed and operated 16 years ago. Six years later hypoglycemic attaks appeared again and lymph metastasis in good health a third surgical operation was performed because of repeated hypoglycemic attacks and a new metastasis from the insulinoma was found in the pancreas tail. The patients has no hypoglycemic phemonena 18 months after the last operation. Besides the long period of progress of the malignant degenerated insulinoma, not observed so far, certain peculiarities of the carbohydrate metabolism of that patient are stressed upon as well as the necessity of early diagnosis and timely surgical treatment of insulinoma.

[Treatment of orthostatic hypotension with dihydrated ergotamine derivatives]. / Lechenie na ortostatichnata khipotoniia s dikhidrirani ergotaminovi proizvodni

After a brief review on the orthostatic disturbances in the regulation of blood circulation the author stresses upon the treatment of the orthostatic hypotonia with dihydrated ergotamine derivatives (Dihydergot retard). A favourable effect was obtained in 59 patients (84.3%) out of the treated 45 patients with secondary orthostatic hypotonia and 25 patients with primary hypotonia. The treatment of orthostatic hypotonia with dihydrated ergotamine derivatives was emphazised to be pathogenetically grounded, because tones the venous system (system of low pressure) and eliminates the developed contraregulatory sympathicotonia. Its combination with low doses of sympathominetics improves even more the effect.

[The incidence and clinical characteristics of the postinfarct syndrome (Dressler's syndrome)]. / Vurkhu chestotata i klinichnata kharakteristika na postinfarktiniia sindrom (sindroma na Dressler)

After a brief review of the post infarction syndrome, the authors report the results from the examinations of 257 patients with myocardial infarctions and post infarction states, treated at the Therapeutic clinic for the last 10 years. They found post infarction syndrome in 12 patients--4,8 per cent. Six of the patients--2,4 per cent--were with a complete clinical picture and six patients--2,4%--were with a frustrate form. In two of the patients, the syndrome developed as early as the first week and in the rest--10--between the first and the eighth week post infarction onset. The most frequent, almost compulsory symptoms of the syndrome were: febrility, leukocytosis, accelerated erythrocyte sedimentation, followed by chest pains, pericarditis, pleuritis and pneumonia. tnine of the patients were established to have anterior or anterolateral infarction and only three were with infarction of the posterior wall. With respect to the infarction severity, preceding the syndrome--two patients were with a light infarction form; four with moderately severe and six--with severe. The authors stress upon the particular importance of the combination of the syndrome with heart aneurysm post myocardial infarction, observed in two of the patients. At the end they accentuate on the diagnostic difficulties, caused by the syndrome.

[Hormonal treatment of arterial hypotension]. / Vurkhu khormonalnoto lechenie na arterialnata khipotoniia

After a brief review on the incidence rate and classification of arterial hypotonia--the author discusses the treatment of primary (essential) hypotonia. The unpleasant side effects in the treatment with sympathicomimetic remedies (vasopressive amines) are stressed upon as well as the favourable effect of certain hormonal preparations: mineral corticoids, anabolic steroids and Docabolin--the combined preparation from those two groups of remedies. The author reports the results from the treatment of 45 patients with primary hypotonia with that combined preparation. The subjective complaints were very favourably affected as well as the decreased arterial pressure in 42 of them. Side effects during the treatment were not observed with the exception of a slight palpebral edema in one female patient. The author recommends the combined hormonal treatment of primary hypotonia, especially in cases proceeding with asthenia.