[C1-esterase inhibitor in ACE inhibitor-induced severe angioedema of the tongue]. / C1-Esterase-Inhibitor bei ACE-Hemmer-induziertem schwerem Angioödem der Zunge.

Angio-oedema are often massive but temporary swellings of the soft tissue of the face or the throat, which can also affect other regions of the human body (e.g. the skin or internal organs). An oedema of the face and throat represents a life-threatening situation. Apart from the clinical condition of the patient and detailed knowledge of the medical history (incl. medical applications), the treatment should depend on the different pathogenesis. In this reported case, we describe the severe clinical development of an angio-oedema under a long-term treatment with an ACE-inhibitor, which in the end was only successfully treated with the application of a C1 inhibitor concentrate.

[Decreasing mortality in acute pancreatitis with sodium selenite. Clinical results of 4 years antioxidant therapy]. / Letalitätssenkung der akuten Pankreatitis mit Natriumselenit. Klinische Resultate einer vierjährigen Antioxidanzientherapie.

UNLABELLED: Results obtained from pancreatitis research prove the genesis if free radicals in acute pancreatitis. Xenobiotics, ethanol as well as biliary diseases will induce a deficiency in antioxidants. In antioxidative treatment sodium selenite as a water soluble redox substance represented an alternative. In the middle of the year 1990 the therapy regime was introduced in Rostock, a short time later in Dresden too. The diagnosis was made by CT enhanced by a contrast medium as well as by clinical and paraclinical parameters. CT was repeated after a week. Up to May 31, 1994 there were 245 patients treated in Rostock and 85 patients in Dresden (n = 330). Immediately after making the diagnosis 200 micrograms were given as a bolus, 800 micrograms in the following 24 hours. From the second day on 500 micrograms of selenite were administered daily. In addition, infusions of carbohydrates, electrolytes (no calcium), fluid and analgetics were given. Lavation of the intestine was made three times daily. With a well-timed selenium therapy the rates of letality, complications and operation dropped drastically. In spite of a constant number of patients no patient has died in Rostock since 1993, in Dresden 8 of 85 patients came ad exitum. Complications occurred if the therapy began too late (if patients were administered too late) and in biliary forms. CONCLUSION: An improvement in the prognosis of acute pancreatitis can be achieved if antioxidative selenium therapy with sodium selenite is introduced in time. In rare cases total necroses and complications in organs only occurred in those patients who were admitted to this therapy too late.

[Acute abdomen--anesthesiologic and intensive care management]. / Akutes Abdomen--anästhesiologisches und intensivmedizinisches Vorgehen.

The expression "acute abdomen" is a provisional destination of a complex of various abdominal diseases which require quick diagnostic as well as urgent surgical therapy. A close interdisciplinary cooperation during the whole perioperative period is of high importance for the prognosis of this potentially life-threatening syndrome. The anesthetist must have profound knowledge on causes and clinical signs of this disease, on diagnostic measures and on therapeutic principles. Anaesthesiological problems arise from the discrepancy between an urgent operation on one hand and the necessity of an improvement of the preoperative status of the patient on the other. Furthermore, these patients have high risks of aspiration due to disturbed motility of the gastrointestinal tract. Intensive therapy of these patients is characterized by the peculiarity that a primarily local abdominal disease is frequently followed by severe extraperitoneal general reactions and multiple organ failure, respectively.

[Anti-oxidative therapy of pancreatitis--an 18-month interim evaluation]. / Antioxidative Therapie der Pankreatitis--eine 18monatige Zwischenbilanz.

99 patients affected with acute pancreatitis of different genesis were treated in hospital (necrotizing n = 38, mild form n = 61) from May 1990 to November 1991. Nearly 80% of these illnesses were ethanol-induced, 12% were of biliary origin. 90 patients were submitted to an adjuvant antioxidant therapy with selenium and D-alpha-tocopherol (necrotizing form n = 29, mild form n = 61). The average lethality rate of 34% (1982-1989) fell to 1.1% (1 female patient with biliarily induced pancreatitis). No lethal courses were observed in alcohol-induced, idiopathic, post-traumatic, and post-operative forms. Clinical courses proceeded more easily under adjuvant antioxidant therapy, surgical treatment was not necessary. A treatment at reasonable costs can be made in all general internal wards.

[Acute pancreatitis--a free radical disease. Decrease in fatality with sodium selenite (Na2SeO3) therapy]. / Akute Pankreatitis--eine "Free Radical Disease". Letalitätssenkung durch Natriumselenit (Na2SeO3)-Therapie.

Malonic dialdehyde as an indirect marker of the lipid peroxidation was found increased in the acute pancreatitis compared with persons of the same age and sex. Its concentrations inversely correlated to those of the serum calcium during the course of the disease and additionally they proved to be indicator of the prognosis. Postulating that the acute pancreatitis must be a "free radical disease", in a randomized clinical study the adjuvant therapy of the acute necrotizing pancreatitis (n = 8) with sodium selenite was carried out in a daily dose of 500 micrograms. The lethality of the control group was 89% (8 out of altogether 9 patients), no patient died in the therapy group. By the selenium therapy within 24 hours a normalization of the serum calcium and a decrease of the increased MDA-values could be achieved. It was concluded that by selenium increased activities of the phospholipid-hydroperoxide-glutathione peroxidase were induced, by means of which a peroxidation protection of membrane fatty acids, an inhibition of the activity of phospholipase A2 and an interruption of the arachidonic acid cascade must have been reached.

[Report of experiences with fibrinolytic therapy of deep venous thrombosis of the legs]. / Erfahrungsbericht über die fibrinolytische Therapie bei tiefen Beinvenenthrombosen.

It is reported on the fibrinolytic therapy of thrombosis of the deep veins of the legs, the pelvis and the arms. This treatment was analysed in 18 patients who were treated between 1983 and 1986. The possible causes of the development of thrombosis, such as ovulation inhibiting drugs and the postoperative state, are mentioned. Fibrinolysis was performed with streptokinase (awelysin) and urokinase (ukidan). In 11 patients streptokinase infusions therapy in ultra-high doses was carried out. Within 6 hours and 30 minutes the patients got 9.500,000 units of streptokinase. The complications of the streptokinase treatment are discussed. According to the age of the phlebothrombosis and the control phlebography 2 groups of patients were formed. In the first group including thromboses lasting for 1-6 days, 7 patients showed a complete recanalisation. In the second group including thromboses lasting for 1-3 weeks, only 4 patients developed complete recanalisation. The remaining patients had only a partial recanalisation. The post-lysis effect is stressed. Streptokinase therapy with ultra-high doses has become the standard procedure of fibrinolysis treatment in our hospital.