Medical edema protection--clinical benefit in patients with chronic deep vein incompetence. A placebo controlled double blind study.

In a randomized placebo controlled parallel double blind study on 40 patients suffering from venous edema in chronic deep vein incompetence, the edema-reducing effect of horse chestnut seed extract vs. placebo, being the main test variable, was demonstrated by hydroplethysmography to be statistically significant. In addition, measurements of leg volume under aggravated conditions (edema provocation) were conducted, which yielded the same results. Additional measurements of leg circumference tendentially confirm the demonstrated clinical efficacy of verum, as is true for phlebody-namometric measurements (pressure at rest, minimum pressure, replenishment time) as well. By measuring the leg volume before and after edema provocation, it could be shown that the clinical benefit for the patient is present in all everyday situations (in movement as well as on sitting or standing). Treatment with an edema protective agent of the horse chestnut seed extract type is thus a useful adjunct to compression therapy. The tested preparation were well tolerated.

Status of patients seven years after completion of the hypertension detection and follow-up program in Evans County, Georgia.

The Evans County, Georgia, cohort of the Hypertension Detection and Follow-up Program (HDFP) was reexamined seven years after termination of the trial in 1979. Of the 510 survivors, 91 percent of the black and 91 percent of the white hypertensive subjects were evaluated by blood pressure (BP) levels, electrocardiograms (ECG), height-weight measurements, and questionnaire. The HDFP had treated a randomly selected half of the patients in an intensive stepped care (SC) program and the other half was referred to usual care (RC). At the beginning of the five-year trial, diastolic blood pressure (DBP) levels were higher in blacks in both SC and RC. At the completion of the trial in 1979, black women had mean DBP levels comparable to whites in both SC and RC, but black men displayed higher levels. During the five years of the trial there were no cases of left ventricular hypertrophy (LVH) in SC in either race. In RC the incidence of LVH was slightly higher in blacks than in whites. During the seven-year post-trial period, the incidence of LVH in blacks rose to 13 percent, more than double that of whites. Medication compliance was reduced in black men during this time, most likely because of removal of the supporting elements of HDFP (frequent medical contacts, free medication).In both races, hypertensive subjects underwent weight changes during the seven years of the post-trial period. Weight loss of 15 lb was associated with normotension. Weight gain of 9 to 10 lb over seven years was associated with hypertensive BP levels.The supportive or detrimental effect of weight loss or weight gain on BP levels was thus reconfirmed in this biracial cohort.

[Therapeutic use of lowering blood pressure, especially in mild hypertension. Results of a hypertension detection and treatment program]. / Therapeutischer Nutzen der Blutdrucksenkung, besonders bei milder Hypertonie. Ergebnisse aus dem Hypertonie-Fahndungs- und Behandlungsprogramm (HDFP).

The results of the Hypertension Detection and Follow-up Program (HDFP), one of the largest hypertension intervention trials will be reported. 5,485 hypertensives received systematic antihypertensive drug therapy (stepped care) and 5,455 were referred to community medical therapy (referred care) with less intensive treatment. In contrast to other hypertension intervention studies, HDFP did not have any exclusion criteria. The results of the HDFP confirmed that intensive antihypertensive therapy can significantly lower the five-year mortality from all causes of all hypertensive patients. This is also true for the range of mild hypertension (diastolic blood pressure (DBP) 90-104 mm Hg): reduction in all cause mortality by 20.3%. A reduction of the average DBP in this mild range to 83.4 mm Hg was achieved, which is much lower than 90 mm Hg, usually recommended. The reduction of mortality included a decrease of the stroke and myocardial infarction rate, which reached nearly 50% among mild hypertensives of the stepped care group in comparison to the referred care group. Incidences of nonfatal stroke, myocardial infarction, angina pectoris und left ventricular hypertrophy could also be lowered. The best results were achieved if therapy was started early, before end-organ-damage was present. On the other hand, antihypertensive therapy was of benefit in patients with end-organ-damage and in the elderly. The noncardiovascular mortality was also reduced, which was due to improvement of cardiac reserve under antihypertensive therapy. The side effects of drug treatment have been within the known range and did not negate the therapeutic benefit.

[Peripheral venous tolerance of a hyperosmolar basic solution]. / Zur Frage der peripheren Venenverträglichkeit einer hyperosmolaren Basislösung.

A controlled open clinical trial was carried out to compare the peripheral venous tolerance of patients receiving a hyperosmolar basic nutrition solution (3% amino acids, carbohydrates and electrolytes, 806 mosm/l) with that of patients receiving an isoosmolar electrolyte solution (299 mosm/l). 13 patients received the basic solution, 11 the electrolyte solution. The study was terminated after 4 days. For comparison the infusion time and local venous irritation of each patient were recorded. In both the infusion time and local irritation a slight trend in favour of the electrolyte solution was found, which, however, did not reach statistical significance. We conclude, that under normal clinical circumstances a hyperosmolar basic nutrition solution does not cause a higher rate of peripheral venous irritations compared with an isoosmolar electrolyte solution and should be administered to patients with an expected infusion time of not longer than 4 days.

[Indications for surgery of carotid artery stenosis with contralateral carotid occlusion]. / Zur Frage der Operationsindikation bei Carotisstenose mit kontralateralem Carotisverschluss.

In a retrospective study the course of 69 patients of the Surgery Department of the University of Heidelberg (66 men, 3 women, mean age 60 years) with carotid artery stenosis with contralateral carotid occlusion has been reported. 10% of the patients with carotid artery stenosis had a contralateral occlusion. Corresponding to the side of occlusion most patients had a preoperative neurological stage IV (55%, 19% stage II, 26% stage I) and corresponding to the side of stenosis most patients had a stage I (57%, 28% stage II, 4% stage III, 12% stage IV). In addition to the stenosis the occlusion had been operated on in 7 patients, in 5 of them the revascularisation was not possible. In 88% the arteriotomy could be closed using a venous patch and in 97% a intraluminal shunt was used. All operations were done under general anesthesia. The early lethality rate was 10%, in one patient a postoperative neurological deficit occurred. The late mortality rate was 21%, in 5% a new neurological deficit could be found (n = 57, mean follow-up: 3.0 years). In relation to the preoperative neurological stage corresponding to the side of stenosis the highest mortality rate was found in patients with stage IV. In a separate analysis of two periods (1962-1978 and 1979-1981) it can be demonstrated that the high early mortality rate is nearly entirely found in the first period with a low operative frequency. In the second period 1979-1981, 33 carotid endarterectomies in patients with contralateral occlusion were operated with a mortality rate of 3%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gunshot injuries in peacetime and their therapy]. / Schussverletzungen im Frieden und deren Therapie.

Between 1976 and 1982 46 patients with gunshot injuries (43 m., 3 f.) were seen at the University of Heidelberg Department of Surgery. Frequent causes of injury in 42 adults (40 m., 2 f.) and 4 children (3 m., 1 f.) were suicide attempts (19) and carelessness in the handling of shotguns (11). Criminal offence was related to nine injuries; no retrospective classification of the event causing the injury was possible in further seven cases. Affected in descending order of frequency were brain and lung (10 each), soft tissue of thigh (9), intraabdominal organs (5), heart (4), liver and bone (3 each), blood vessels (2) and facial skull, penis, buttock, neck and mediastinum (1 each). Six patients suffered from combined injuries, in three cases a combined abdomino-thoracic injury was seen. Whilst suicidal injuries of the skull are related to poor prognosis, other peacetime gunshot wounds are less problematic when compared to military gunshot wounds due to the lower speed of the projectiles. Therapeutic procedures follow the general rules of open treatment of injuries including prophylaxis against tetanus and botulism as well as systemic antibiotic therapy. In general abdominal and abdomino-thoracic gunshot wounds as well as vascular injuries require immediate surgical procedure. In isolated thoracic injuries a conservative approach may be justified depending on the situation. The same rule applies to fractures caused by gunshots.

[Peripheral arterial vasoocclusive disease: no absolute contraindication to beta receptor blockers (author's transl)]. / Periphere arterielle Verschlusskrankheit: keine absolute Kontraindikation von Beta-Rezeptorenblockern.

An initial dosis of 40 mg followed by 40 mg propranolol (Dociton) t.i.d. for 4 weeks was administered to 16 hypertensive patients with manifest arterial vasoocclusive disease of the pelvic and thigh type (stage II according to Fontaine). Blood pressure decreased 90 minutes after the first oral administration from 174/106 to 155/93 mm Hg. Cardiac frequency was lowered significantly from 75 to 66/min. Occlusion plethysmography and Doppler pressure estimation were not changed significantly either in the acute nor in long-term assessment. The painfree walking distance remained constant 90 minutes after propranolol initially (baseline value 230 m, after 90 minutes 220 m). It rose to 330 m after two weeks and to 350 m after four weeks. Use of beta receptor blocker in arterial vasoocclusive disease is thus not contraindicated, at least as far as stage II is concerned.

[The effects of nicotine on the circulation and metabolism after cigarette smoking with reference to the plasma levels of nicotine and COHb (author's transl)]. / Nikotinwirkungen nach Zigarettenrauchen auf Kreislauf und Stoffwechsel unter Berücksichtigung der Plasmanikotin- und CO-Hb-Spiegel.

The effects after smoking cigarettes with different nicotine content (1.5 mg and 0.08 mg nicotine/cigarette) were investigated in 6 healthy habitual smokers. Carboxyhemoglobin (COHb) and plasma nicotine levels were determined at the same time as circulatory parameters, heart rate and blood pressure together with metabolic parameters like blood sugar, lactate, free fatty acids and plasma dopamine-beta-hydroxylase (DBH) and plasma cortisol. With the exception of COHb the parameters investigated were shown to be dependent on the nicotine levels. For blood pressure, heart rate and lactate the peaks appeared simultaneously with the maximum nicotine levels, whereas for DBH, cortisol, blood sugar and the free fatty acids there was a delayed reaction in comparison with the nicotine levels. The parameters investigated are not affected by COHb with levels up to 5.6 +/- 0.5%. These results show that after cigarette smoking, nicotine causes considerable changes in the circulation and metabolism.

The influence of increased dietary linoleate on essential hypertension in man.

A pilot study testing the hypothesis of a blood pressure lowering effect of polyunsaturated fatty acids was conducted in Evans County, Georgia. A moderate increase of dietary linoleic acid significantly decreased diastolic blood pressure in eight borderline hypertensives who were otherwise healthy, within four weeks. The change was not due to a reduced sodium content of the diet. A significant increase in creatinine excretion and clearance was noted, indicating an improvement in kidney function which might explain the blood pressure lowering effect of the fat-modified diet.