[Angioneurotic edema of the head and neck in association with ACE inhibitors]. / Angioneurotische Odeme des Kopf-Hals-Bereiches unter der Therapie mit ACE-Hemmern: Katamnestische Studie 1988 bis 2001.

BACKGROUND: ACE-inhibitors are said to cause angioneurotic edema. In spite of the fact that patients with acute angioedema of the head and neck region are usually admitted to an ENT department, there is only limited information available in the otorhinolaryngological literature on the frequency, risk of recurrent episodes and clinical significance of ACE inhibitor related angioedema. MATERIAL AND METHODS: The medical histories of all patients admitted to our hospital due to acute angioneurotic edema during the period from 1 January 1988 to 31 December 2001 were reviewed. These were supplemented with the results of a standardized questionnaire filed out by the affected patients and of a non-affected control-group. RESULTS: During the observation period. 121 patients were treated for acute angioneurotic edema of the head and neck region. In 34 patients (=28.1%), edema was related to permanent treatment with ACE inhibitors. The overall frequency of angioedema and the percentage of ACE inhibitor related angioedema showed a continuous increase during the study period. There was a latency from the beginning of ACE inhibitor treatment until the first manifestation of angioedema of up to 13 years. In comparison with the group of edema patients without ACE inhibitor treatment, we found a threefold risk of recurrent edema in the ACE group. Women were affected by recurrent episodes more often than men. Until now, any individual assessment of the probable risk of developing an angioneurotic edema during ACE inhibitor treatment appears to be impossible.

[PTCA in the acute state of myocardial infarct: hospital course of 785 consecutive patients]. / PTCA im Stadium des akuten Myokardinfarktes: Hospitalverlauf von 785 konsekutiven Patienten.

Rapid reperfusion of the occluded coronary artery is essential for the reduction of mortality and complications of acute myocardial infarctions. Intravenous thrombolytic therapy using various thrombolytic substances has proven to be effective and easy to perform and has gained widespread acceptance for treatment of acute myocardial infarction. Because of several contraindications, as well as failure to achieve patency of the infarcted vessel in 25-30% of patients, severe bleeding complications, a time interval of 6 or more hours after suspected onset of myocardial infarction, and a high rate of recurrent ischemia, this treatment is currently limited to a small percentage of patients with acute myocardial infarction. Immediate percutaneous transluminal coronary angioplasty (PTCA) can be applied to nearly every patient presenting with acute myocardial infarction. Therefore, we offer immediate PTCA as the primary treatment to all of our patients presenting with acute myocardial infarction. Between January 1987 and December 1991, immediate PTCA was performed in 785 of 903 (87%) consecutive patients (aged 23-86 years, mean 61 +/- 10). 82% (640/785) of the patients were men. Anterior myocardial infarction was present in 372 patients (47%), inferior infarction in 413 patients (53%). 245 patients (31%) had 1-vessel disease, 221 patients (28%) two-vessel disease and 319 patients (41%) had three-vessel disease. 97 patients (12%) were in cardiogenic shock. In 675/785 patients (86%) the infarct related vessel was occluded (TIMI < or = 1). 86% of patients had a patent infarct related vessel (TIMI > or = 2) leaving the catheterization laboratory. The overall in-hospital mortality was 6.9% (54/785 patients), after exclusion of high-risk patients (age > 75 years, cardiogenic shock, PTCA under cardiopulmonary resuscitation) mortality decreased to 2.5%. Recurrent ischemia necessitated immediate repeat PTCA in 4.4% of the patients, in 8.1% of patients another elective PTCA was performed during hospitalization and 9.7% of patients were sent to surgery (4.0% on an emergency basis). 87% of all patients presenting with acute myocardial infarction could be treated successfully with immediate PTCA. With respect to the severely ill group of patients the primary success rate is high, the rate of reocclusion is low, and the overall mortality is extremely low. From our data, it is obvious that immediate PTCA compared to thrombolytic therapy is the superior treatment of myocardial infarction.