[Myocarditis and cardiomyopathy: underestimated complications resulting from clozapine therapy]. / Myocarditis en cardiomyopathie; ernstige complicaties van clozapinetherapie.

BACKGROUND: Treatment with clozapine can affect the heart, leading to serious complications such as myocarditis and cardiomyopathy. When in their early stages both illnesses are difficult to diagnose; this can have serious consequences. Recent analyses of clozapine data suggest that particularly myocarditis is possibly more common than has been assumed hitherto. AIM: To determine the frequency of these complications and to find out what diagnostic tests are available and whether it is necessary or possible to adjust current guidelines on these complications. METHOD: The relevant literature was consulted via PubMed, Embase Psychiatry and Psycinfo on the basis of the keywords 'clozapine' and 'myocarditis', 'cardiomyopathy' and 'heart failure'. RESULTS: Studies showed that the incidence of myocarditis varied from 0.015 to 1.3%. Cardiomyopathy was the subject of fewer studies, one study reported an incidence of 0.022%. More than 50% of the cases of myocarditis developed during the first few weeks of treatment, the average time being about 15 days. For an early diagnosis it is important to monitor the patient's symptoms carefully, especially during the first four weeks following the start of medication. Monitoring should include laboratory tests and electrocardiography. Echocardiography and MRI can be useful additions to the diagnostic process. CONCLUSIONS: Early diagnosis of myocarditis is important because it is a serious condition. Timely recognition of subclinical myocarditis could possibly prevent later complications such as cardiomyopathy. Clinical guidelines are proposed on the basis of the literature.

[(Incidence of gallstone disease in autopsy material and outpatients from West Germany) ]. / Die Häufigkeit der Cholelithiasis im autoptischen Material und ambulanten Krankengut aus Deutschland.

The incidence of cholelithiasis and rate of cholecystectomy has been studied in three differently selected groups: first, in 3842 autopsies during the years 1969-1977, second, in 6564 patients who underwent to x-ray examination during 1970-1974 for various reasons; third in 163 patients aged over 50 years referred for reasons other than abdominal discomfort. The incidence of dyspeptic symptoms was registered in the patients of the last group. The rate of cholelithiasis and cholecystectomy in the first group corresponds well to that in the second group. In men and women over 60 years, who had been referred to the outpatients clinic for reasons not related to abdominal pain, the rate of cholelithiasis was 33% and 42% respectively. This finding corresponds to that of the first and second group. There was no difference in the incidence of dyspeptic symptoms among the patients of the last group with and without cholelithiasis. The results suggests that in the old patients the incidence of silent gallstones increases, but that the rate of cholecystectomy did not.

Morphological findings of different areas of gastric mucosa in patients with achlorhydria, extreme hypochlorhydria, normochlorhydria and their relationship to serum gastrin levels: evidence for two different types of gastritis.

The morphological changes of gastric mucosa taken from different areas has been studied in patients of approximately the same age with achlorhydria, extreme hypochlorhydria and normochlorhydria. The serum gastrin level and parietal cell antibodies were determined in the achlorhydric parietal cell antibodies were determined in the achlorhydric patients. In the latter the diffuse gastritis was localized in the corpus-fundic area, while the changes in the antral region were few and occurred mostly in the superficial zone. In normochlorhydric patients however, the diffuse gastritis was localized in the antral region, with only few changes at the corpus-fundic area. In patients with extreme hypochlorhydira either the fundic or the antral region was involved. Besides the diffuse gastritis intestinal metaplasia, pseudopyloric metaplasia, and atrophy of mucosa were also observed, although much less commonly. The increase of gastrin level could not be related to a definite morphological pattern in the gastric mucosa. It can be assumed that each of the two types of gastritis has a different natural history; the antral site of gastrititis cannot be transformed into the fundic site, nor can the fundic site be transformed into the antral site.