Clinical investigation of the effects of pentoxifylline in patients with severe peripheral occlusive vascular disease.

Pentoxifylline was used in the treatment of 90 patients with atherosclerosis-induced chronic peripheral arterial occlusive disease and diabetic vascular disorders in the lower extremities (clinical Fontaine Stages III and IV) for whom surgical reconstructive treatment was not indicated and who had shown inadequate response to previous therapy. In 20 initially hospitalized patients, treatment was started with pentoxifylline intravenous infusions for 1 week (increased gradually from 500 mg to 1000 mg per day) and afterwards continued for a further 8 weeks by oral administration of the drug (400 mg 3-times daily). In 70 patients, oral treatment (400 mg 2 to 3-times daily) was carried out from the beginning for 3 to 6 months or longer. The majority (74%) of the patients showed good or very good results in respect of the clinical parameters. Pentoxifylline abolished or decreased rest pain and consumption of analgesic drugs, accelerated healing of leg ulcers, produced a statistically significant increase in mean pain-free walking distance (approximately 500%) and reduced concomitant symptoms. Definite improvement was achieved in 16 patients with initial intravenous treatment and in 62 patients on oral therapy alone. Haemodynamic measurements, as well as whole blood viscosity assessment using a middle and high shear rate viscosimeter, revealed only small and insignificant improvements. No essential changes could be found in the chemical blood parameters studied.

[Anamnesis and clinical examination--also today still principles of sensible diagnosis?]. / Anamnese und klinische Untersuchung--auch heute noch Grundlage einer vernünftigen Diagnostik?

The way to diagnosis goes over many parts, the end of which in each case means testing the obtained facts, critical overthinking and establishing the next steps up to the ascertainment of the real cause of the disease. At the beginning unchangedly stands the obtaining of the anamnesis of the patient and his disease by the physician himself who apart from the spoken word shall recognize, collect and classify plenty of observations at the patient with the help of as many senses as possible. This process is continued in the following physical examination of the patient with an immediate manual contact between the doctor's hand and the patient's skin. New findings are obtained, speculations will be approved or rejected. But finally in most cases the relationship between doctor and patient has become closer. A repeated critical consideration at the end of the physical examination with reasonable inclusion of the anamnestic data leads to the preliminary diagnosis. Only now the statements for further aimed diagnostic steps are done. Thus it is clearly to be stated that the fundaments of a reasonable diagnosis are the results of an integrated and critical synopsis of the objective and subjective findings at the patient by the doctor. History and physical examination are the unalterable condition before using technical possibilities.

[Glucagon, its discovery and description and the work of Max Bürger]. / Das Glukagon, seine Entdeckung und Darstellung und die Arbeiten Max Bürgers.

After intravenous injection of technical insulin (lower degree of purity) already in 1923 Murlin observed transient initial increases of blood sugar. He suggested that this would be caused by another hormone and he gave him the name of glucagon. Nearly from 1928 Bürger dealt with the synergistic effect of muscle work and intravenous application of insulin on the blood sugar. Here he also established the blood sugar increasing principle glucagon. Subsequently by animal experimental and clinical examinations he essentially contributed to the characterization of the substance itself and its mode of action. He always acknowledged the priority of Murlin. The statement of the A-cells of the pancreas as the place of the synthesis of glucagon, the clarification of its structure and its pure preparation caused the fact that nowadays comprehensive knowledge about the second pancreatic hormone is available.

[Therapy of diabetes mellitus today]. / Therapie des Diabetes mellitus heute

The therapy of diabetes mellitus is always connected with the observation of an adapted diet, the aim of which is the obtaining of the optimal weight. Still more intensive concentric educational measures for patients and persons endangered by diabetes are necessary, in which cases muscular action is of increasing importance. Sulfonylureas furthering the secretion of insulin are to be used only as far as necessary. Peripherally acting anti-diabetics, such as biguanides have an indication in diabetes mellitus which is exactly defined and to be observed. Also with regard to the combat against adiposity their influence on the lipometabolism needs further clarification. Metabolic and immunologic insulin resistance are complications of the insulin therapy. The extensive technical preparation of the human synthetic insulin may contribute to the improvement of the prognosis of diabetes. At present the introduction of artifical beta-cell-systems is a problem of the diminishing of the apparatuses. The genetic consultation for diabetics is important and in many cases possible.

[Hyperlipoproteinemia in patients with arteriosclerotic occlusive diseases of the lower extremities]. / Hyperlipoproteinämien bei Patienten mit atherosklerotischen Verschlusskrankheiten der unteren Extremitäten.

After exclusion of a manifest diabetes mellitus occurrence and distribution of hyperlipoproteinaemias in 250 patients with atherosclerotic obstructive diseases of the lower extremities were examined. 54,8% of the patients showed increased serum lipid levels, in which cases most frequently hypercholesterolaemias (type IIa and IIb) could be proved. Patients with obstructions of the pelvic arteries had significantly more frequent hyperlipoproteinaemias than patients with more distal obstructions.

[Blood rheological changes and their clinical significance in chronic arterial obstructive disease]. / Hämorheologische Veränderungen und ihre klinische Bedeutung bei chronisch-arterieller Verschlusskrankheit.

New knowledge about the physiology and pathophysiology of the flowing properties of blood, particularly in the area of microcirculation, led to a better understanding of the pathogenesis of the arterial obstructive disease. When the vasomotor reserve is kept, the blood fluidity authoritatively determines the flow-time-volume depending on the conditions of flow. An increase of the blood and plasma viscosity as well as a decreased fluidity of erythrocytes and an increased aggregation of erythrocytes lead over an impairment to the nutritive capillary blood supply to hypoxic tissue damage. Physico-chemical changes of the milieu, such as lactacidosis and hyperosmolarity may additionally cause local rheological disturbances and contribute to a reduced perfusion. The improvement of the flowing properties of the blood takes at present place essentially by haemodilution and reduction of fibrinogen. The possibly most hopeful way to the reduction of blood viscosity consists in the immediate improvement of the fluidity of erythrocytes. Here up to now the xanthine derivative pentoxifylline showed good results in the clinical practice.

[Differences and similarities of Crohn disease and ulcerative colitis]. / Unterschiede und Gemeinsamkeiten von Colitis ulcerosa und Morbus Crohn.

Sometimes the demarcation of a colitis granulomatosa Crohn from an ulcerous colitis renders diagnostic difficulties. Also when certain communities of the two clinical pictures are recognizable, nevertheless the differences prevail. The judgment of the success of various forms of therapy and the further clarification of etiology and pathogenesis demand the differentiation in every case. Anamnesis, clinic, radiological findings, endoscopic and bioptical signs are building stones which in their totality render possible the findings of the diagnosis. Bioptical investigations in various stages of activity and after the beginning of the treatment are suited further to restrict the number of the non-classifiable colitides.

[Use of B-image sonography in abdominal vascular diagnosis]. / Die Anwendung der B-Bild-Sonographie in der Abdominalgefässdiagnostik.

The real-time-sonography as an evident non-invasive procedure is of high significance in the vascular diagnostics apart from the usual diagnostic approaches. Taking into consideration methodically conditioned limits the aneurysm of the aorta, the ectasia of the aorta, the elongation of the aorta, the early recognition of arteriosclerotic changes of the wall, the hypertension of the portal vein and the thrombosis of the inferior vena cava are the most important methods for the application of this method. In the aneurysm of the aorta sonography is authoritatively involved in the judgment of the indication for operation. Arteriosclerotic plaques are to be recognized from a size of 5 X 3 mm.

[Determination of isoenzymes of alkaline phosphatase and alpha-amylase in feces]. / Bestimmungen von Isoenzymen der alkalischen Phosphatase und alpha-Amylase im Stuhl.

Investigations for the proof of isoenzymes of the alkaline phosphatase and the alpha-amylase in stool were carried out. The measurements of the faecal enzyme activities were performed in 96 patients with intestinal diseases. The disc electrophoresis in the polyacrylamide gel served for the separation of isoenzymes. The separated enzyme bands of the extracts of stool were compared with those ones of serum duodenal juice and extracts of the mucous membrane of the duodenum, the jujunum, the ileum as well as of the colon. Hereby up to 4 very much anodically wandering bands were present, which might be subunits or fission products of the alkaline phosphatase. In the alpha-amylase up to 5 bands could be proved, which were compared with those ones of the serum, the duodenal juice and the urine. A coordination of these isoenzymes concerning their origin is not possible. The faecal activities of enzymes correlate with the weights of stool. In exocrine pancreatic insufficiency and ulcerous colitis increased faecal activities of enzymes are found, the genesis of which is discussed.

[Investigation by borrowing-lending-phenomenon under conditions of intraarterial induced vasodilatation (author's transl)]. / Untersuchungen zum Borrowing-Lending-Phnomen unter den Bedingungen einer intraarteriell induzierten Vasodilation.

In fourty patients with peripheric atherosclerosis obliterans blood flow was measured by means of venous occlusion plethysmography during an intraarterial and an intravenous infusion of ATP. The intraarterial application showed a significantly higher increase of blood flow than the intravenous in the sick extremities. The "borrowing-lending-phenomenon" happened more seldom than after an intravenous load. This withdrawal of blood occurred most frequently in patients with proximal occlusions, when the infusion reached casually the arteria femoralis profunda only. The "borrowing-lending-phenomenon" can be measured by the poststenotic pressure and by the volume of blood flow in time. Then the patients complain about a begining or an increasing of an ischemic pain at rest.

[Studies on stress-conditioned secretion of somatotropin]. / Untersuchungen zur stressbedingten Wachstumshormonausschüttung

72 of 413 adults and 55 of 112 children with intact function of the hypophysis revealed secretions of the growth hormone already in the preparation time for a clinical test. These variations of the HGH basal levels must be regarded as conditioned on test. In the judgment of the function of the anterior lobe of the pituitary gland with the help of the dynamics of the HGH-secretion the changes in the pretest-period should be included in order to avoid false diagnoses. From the secretion of the growth hormone conditioned on stress hitherto no conclusions can be made to the following course of the HGH-secretion.

[Studies on the behavior of human growth hormone (HGH) level in the preparation period for the clinical test]. / Untersuchungen zum Verhalten von Wachstumshormonspiegeln (HGH) in der Vortestperiode

Behaviour of human growth hormone (HGH) during preparation for a clinical test. 172 adults and 63 children were examined for the behaviour of their HGH basic values during preparation for a clinical test. Even before the beginning of the stimulation itself 11% of the adults and 47,5% of the children showed a fluctuation of the HGH levels in the serum. Neglect of these HGH movements involves the risk of misinterpretation and thus of false diagnosis. It therefore appears to be essential, especially for judging stunted-growth forms in childhood, to make tests for "empty stomach" values for the purpose of HGH determination at least 30 minutes before and immediately at the beginning of the stimulation test. The behaviour of the basic values must be included in the assessment of the test.

[Preliminary studies on iodine administration during parenteral nutrition]. / Orientierende Untersuchungen zur Frage der Jodzufuhr bei parenteraler Ernährung.

Iodine deficiency is the main cause of endemic goiter. To estimate the iodine supply during parenteral nutrition, the iodine content of some important solutions used for infusions and routine parenteral nutrition has been assessed. It varied from 21 micrograms I/l to 68 micrograms I/l and is considered to be sufficient to supply the daily iodine requirement.

[Growth hormone secretion in growth retarded children and adolescents]. / Untersuchungen zur Wachstumshormonausschüttung minderwüchsiger Kinder und Jugendlicher.

In 119 children and adolescents with restricted growth whose secretion of growth hormone (hGH) was investigated in the insulin hypoglycaemia test, different hGH-secretion patterns were found. 52.1% of the investigated persons showed a prestimulatory stress-conditioned hGH-secretion. There were no relations to age or to sex. The hypoglycaemia-conditioned secretion of hormone following this spontaneous release has quantitatively no relation to the size of the decrease of blood sugar. However, it is also determined by the trend of secretion in the pretest-phase. Different modes of synthesis and release are the cause for this behaviour. High spontaneous hGH-levels decrease the hypoglycaemia effect of the intravenously applied insulin. In 33.9% of the cases the levels of the growth hormone are lower during the proper test phase or only as high as in the preparation time. Twelve times the poststimulatory values simulated a hyposomatotropism. The eventual importance of the secretion patterns remains up to now unclear for the longitudinal growth.