[Manifestation and prevention of adverse drug reactions (ADR) in the pharmacotherapy of cardiovascular diseases]. / Manifestation und Präventionsmöglichkeiten unerwünschter Arzneimittelwirkungen (UAW) in der Pharmakotherapie von Herz-Kreislauf-Erkrankungen.

OBJECTIVES: Cardiovascular drugs are the most often prescribed drug class in Germany. The objective of this study is to analyze the adverse drug reaction (ADR) profiles of these drugs and to identify some targets for prevention of ADR. METHOD: Since 1997 specially trained medical staff members of five Pharmacovigilance Centers in Germany prospectively screened all hospital admissions at the departments of internal medicine of five large teaching hospitals. ADR leading to hospital admission were registered and reported. Especially ADR caused by cardiovascular drugs and all factors, which could have been important for their occurrence were analyzed. RESULTS: 559 of 2270 (24.6%) registered ADR cases were related to cardiovascular drugs. The drugs most frequently related to ADR were angiotensin inhibitors (17.9%), digitalis (17.3%), calcium channel blockers (13.9%), beta blockers (12.8%), and diuretics (12.2%). The most often observed ADR were arrhythmias (27.1%), syncopes and blood pressure dysregulations (25.1%), gastrointestinal symptoms (12.4%), and metabolic disorders (10.2%). 72% of patients were older than 65 years. Older patients were on a significantly higher number of drugs (6.2 +/- 2.4 vs 5.5 +/- 3.2; p < 0.001) than the younger ones. Furthermore, they were hospitalized significantly longer (13.2 +/- 9.9 vs 15.3 +/- 9.3 days; p < 0.01). Eleven patients (2%) died because of ADR due to cardiovascular drugs. CONCLUSIONS: Cardiovascular drugs are frequently used. They are prescribed mainly to older patients. Often observed ADR can be prevented effectively by considering their indication, by a clear definition of the therapeutic target, by a dose adjustment to the individual clinical parameters of the patient and by regular control investigations. The large number of drug-induced rhythm disorders--in particular bradycardia--show that extraordinary attention should be paid to rhythm-affecting drugs. The detailed instruction of the patient about therapeutic aims, risks and a concrete guideline for the therapy/drug handling is generally necessary.

[Rhabdomyolysis as a rare complication of theophylline poisoning]. / Rhabdomyolyse als seltene Komplikation einer Theophyllinintoxikation.

CASE REPORT: A case of a 73-year-old male with theophylline overdose complicated by rhabdomyolysis is reported. After uncontrolled self-medication with an unknown number of theophylline slow release 350 mg tablets and furosemide 40 mg tablets he was admitted with unspecific clinical signs like tachyarrhythmia, vomiting and restlessness. Maximum theophylline concentration was 66.5 mg/l, other abnormal laboratory findings included hypokalemia (2.8 mmol/l) and hyponatremia (123 mmol/l). The maximum creatinkinase level was measured after admission (32.29 mumol/s/l) accompanied by a serum myoglobin level of 3,789 micrograms/l. Immediate treatment with oral activated charcoal and continuous veno-venous hemodialysis (CVVH) was instituted, together with intravenous potassium and sodium chloride substitution, forced diuresis and continuous administration of intravenous metoprolol. The theophylline, creatinkinase and myoglobin levels decreased rapidly and there was no second rise in theophylline found. The patient survived without sequelae. CONCLUSION: Rhabdomyolysis is a rare complication of theophylline intoxication. In literature only a small number of cases are reported. Our results illustrate the necessity of a purposeful and fast management to successfully prevent renal failure or death. Some pathogenetic mechanisms of theophylline-induced rhabdomyolysis, epidemiologic data, risk factors and therapeutical principles will be demonstrated by a detailed literature survey.

[Influence of etiology and morphology of traumatic vascular injuries on outcome, risk of amputation and mortality]. / Einfluss von Atiologie und Morphologie von traumatischen Gefässverletzungen auf Outcome, Amputationsrisiko und Letalität.

In a retrospective trial 159 vascular injuries in 149 patients were registered between 1987-1996. Extremity vessels were injured in 76% of the cases. The same incidence was observed in blunt and penetrating mechanisms. Blunt vascular injuries were associated with an higher rate of live threatening organ damage, longer times of ischaemia (6.5 versus 3.0 h) and an higher mortality (9.7 versus 20.3%) than penetrating injuries. We have found an increased mortality rate in all cases with concomitant trauma of CNS, chest, abdomen or bones. The overall amputation rate in all peripheral vascular injuries has been 22.6%. The functional outcome has been reduced by nerve lesions, amputation and the sequelae of fractures.