Treatment of cutaneous lupus erythematosus with acitretin and hydroxychloroquine.

A randomized, double-blind, multicentre study was performed to compare the efficacy of acitretin (50 mg/day) with hydroxychloroquine (400 mg/day) in 28 and 30 patients, respectively, suffering from cutaneous lupus erythematosus (LE). The study was carried out over an 8-week period. Improvement of facial LE lesions after treatment with acitretin and hydroxychloroquine was assessed using several clinical parameters. In the acitretin group there was marked improvement or clearing of erythema in 10/24 patients (42%), of infiltration in 15/24 (63%) and of scaling/hyperkeratosis in 12/20 (60%). In the hydroxychloroquine group there was complete clearing or marked improvement of erythema in 17/25 patients (68%), of infiltration in 17/25 (68%) and of scaling/hyperkeratosis in 15/23 (65%). Overall improvement occurred in 13/28 patients (46%) treated with acitretin and in 15/30 patients (50%) with hydroxychloroquine. The incidence of side-effects was higher in the acitretin group, and necessitated discontinuation of treatment in four patients. The present results demonstrate that both acitretin and hydroxychloroquine provide effective treatment in approximately 50% of cases of cutaneous LE.

[Lovastatin efficacy and tolerance in primary hypercholesterolemia. The German Lovastatin Study Group]. / Wirksamkeit und Verträglichkeit von Lovastatin bei primärer Hypercholesterinämie. Die deutsche Lovastatin-Studiengruppe.

In the course of an open multicentre clinical trial 786 patients (512 men, 274 women; mean age 52.4 +/- 11 years) with primary hypercholesterolaemia (total cholesterol 328 +/- 72 mg/dl, triglycerides 174 +/- 87 mg/dl, LDL cholesterol 246 +/- 73 mg/dl, and HDL cholesterol 50 +/- 18 mg/dl) received 20-80 mg lovastatin daily for 12 weeks, after a four-week placebo period. On this regimen the concentration of total cholesterol fell by 27% to 238 +/- 52 mg/dl (P less than 0.001) of triglycerides by 13% to 140 +/- 69 mg/dl (P less than 0.001), that of LDL cholesterol by 36% to 157 +/- 53 mg/dl (P less than 0.001). But HDL cholesterol rose by an average of 12% to 54 +/- 17 mg/dl (P less than 0.001). Lovastatin was tolerated very well by 79% of patients, well by 19%, and poorly by 2%. Mild undesirable side effects of the drug (in particular meteorism, constipation, diarrhoea and nausea) were reported by fewer than 10% of patients. These data indicate that lovastatin is effective and well tolerated also when broadly applied in clinical practice.

Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis.

Compared with the antipsoriatic retinoid etretinate, the new aromatic retinoid acitretin represents an important advance due to its rapid elimination kinetics. Since in psoriasis vulgaris retinoids are used predominantly in combination regimens, we investigated the therapeutic efficacy of acitretin and UV-B compared with placebo and UV-B in a double-blind, randomized multicenter trial in 82 patients with severe psoriasis. They were treated with 35 mg of the study medication during the first 4 weeks of therapy and 25 mg thereafter, concomitantly with UV-B irradiation in increasing energy doses. Forty patients who underwent therapy with acitretin and UV-B and 38 patients who underwent therapy with placebo and UV-B were evaluated for efficacy. The target variables--psoriasis severity index and total UV-B dose--were reported at intervals of 2 weeks over a maximum period of 8 weeks. At the end of treatment, the psoriasis severity index decrease was 79% in the acitretin and UV-B group and 35% in the placebo and UV-B group. The response rate, defined as greater than or equal to a 75% decrease of the psoriasis severity index, was 60% for the combination treatment and only 24% for the control treatment. This treatment response was achieved with markedly lower cumulative UV-B energy. The median cumulative UV-B energy applied to reach 75% clinical improvement was 11.8 J/cm2 vs 6.9 J/cm2. Side effects showed a similar pattern in both groups. Our data show that the acitretin dramatically improves the results of UV-B treatment in patients with severe psoriasis. In addition, it markedly decreases the effective cumulative UV-B dose, thereby reducing the potential long-term hazards of UV irradiation. We conclude that the acitretin plus UV-B combination treatment represents a highly effective therapeutic regimen in severe psoriasis.

[The rate of injection of succinylcholine and onset of neuromuscular action, serum potassium or myoglobin levels. Studies in men during halothane anesthesia]. / Injektionsgeschwindigkeit von Succinylcholin und neuromuskulärer Wirkungseintritt, Serumkalium- bzw. -myoglobinkonzentration. Untersuchungen bei Männern in Halothannarkose.

Succinylcholine was injected at different speeds to 60 men in halothane anesthesia, to see whether the rate of injection influenced the effects. METHODS. Sixty men (ASA I and II, mean age 28.6 years) undergoing surgery without muscle trauma were studied. They were treated uniformly with respect to premedication, anesthesia, venipuncture (cubital), and concentration (1%) and dosage (1 mg/kg) of succinylcholine (SCh). The only difference lay in the speed of injection of the relaxant: 20 mg/s, 8 mg/s, 4 mg/s, 2 mg/s and 1 mg/s, 12 patients being randomly allocated to each. The injection rate was controlled by a preprogrammed microprocessor pump system (XD 5500, HC Ulrich, D-7900 Ulm, Donau). The neuromuscular transmission was monitored by the adductor pollicis twitch technique using indirect supramaximal stimulation (Accelograph, biometer, DK-5120 Odense). The recorded twitch response allowed determination of the total onset time (TOT) from the beginning of the injection to the maximal twitch depression, its components, latent and manifest onset times (LOT and MOT), and the twitch depression factor ki. Blood samples for measurement of potassium and myoglobin levels (RIA, sensitive to 5 ng/ml) were taken before and 5, 15, and 30 min after SCh administration. For determination of the course (difference between two values before and after SCh), the maximum level up to 30 min was recorded. RESULTS. The twitch depression amounted to 100% in 57 patients and to 93% or 98% in the remaining 3. Reducing the speed of injection led to significant prolongation of TOT and LOT (Table 3) and significant differences in the onset characteristic in regard to twitch depression factor ki (Table 4). No significant influence on the increase in potassium (Table 7) and myoglobin (Table 8) was observed. CONCLUSION. These findings give no cause to inject SCh more slowly than usual in healthy adults.