[Iloprost in the treatment of ischemic tissue lesions in diabetics. Results of a placebo-controlled multicenter study with a stable prostacyclin derivative]. / Iloprost in der Behandlung ischämischer Gewebsläsionen bei Diabetikern. Ergebnisse einer placebokontrollierten Multizenterstudie mit einem stabilen Prostazyklinderivat.

The efficacy of iloprost, a stable prostacyclin analog, was investigated in a placebo-controlled trial in 109 diabetics with ischemic lesions. 56 patients were randomly allocated to iloprost and 53 patients to placebo. Iloprost was intravenously applied for 6 hours daily on 28 consecutive days at an individually tolerated dose up to 2 ng/kg/min. The control group received identical solvent volumes. In addition all patients had an intensive basic, mainly local, therapy. At the end of the treatment in the iloprost group 31 of 50 patients (62%) showed partial (greater than 30%) or total healing of the lesion(s). In the placebo group this was the case in 12 of 51 patients (22.5%). The difference of 38.5% was statistically significant (p less than 0.05, chi 2-test, alpha = 0.05, beta = 0.1). The percentage of patients who were free of pain increased from 23% to 42% (+19%) in the iloprost group and from 38% to 48% (+10%) in the placebo group. After dose-titration iloprost was well tolerated. Flush, headache and abdominal complaints were the most frequent side effects. Heart rate and blood pressure were not influenced and the control of diabetes was not altered.

[Iloprost, a stable prostacyclin derivative, in stage 4 arterial occlusive disease. A placebo-controlled multicenter study]. / Iloprost, ein stabiles Prostacyclinderivat, bei arterieller Verschlusskrankheit im Stadium IV. Eine placebo-kontrollierte Multizenterstudie.

The effectiveness of iloprost, a prostacyclin derivative, was assessed in a placebo-controlled multicentre trial on 101 patients with chronic arterial disease, stage IV. All patients were on a basic local treatment, 53 randomly being assigned to the iloprost group, 48 to the placebo one. Both groups received identical saline infusions, one with the other without iloprost. Infusions were given on 28 consecutive days, iloprost being added at a dose of up to 2 ng/kg.min over six hours. At the end of the treatment period, 32 of 52 patients (61.5%) of the iloprost group and eight of the 47 in the placebo group (17%) had partial or complete healing of ulcers (P less than 0.05), the treatment effect persisting in both groups for a mean duration of at least one year. Iloprost was well tolerated, once individual dosages had been appropriately adjusted. Facial flushes, headache and nausea were the most common side effects. Heart rate and blood-pressure variations did not differ between the two groups.

[Transluminal catheter treatment in arteriovenous leg ulcers]. / Rekanalisierende Katheterbehandlung bei arterio-venösen Ulcera crurum.

Early diagnosis of possible atherosclerosis as a cause of ulcers in the lower leg is necessary for adequate therapy whether it is conservative, invasive, or operative. Percutaneous transluminal treatment of arteriosclerotic obstructions offer good and long-lasting results, particularly for the inoperable patient. Sometimes it is the prerequisite for the necessary venous treatment.

Local longtime lysis in combination with percutaneous transluminal angioplasty (TPA).

In order to produce an endogenous lysis in case of local longtime lysis Urokinase is infused directly into the occlusion in a maximum dosage of 40,000 U/h via an arterial catheter. Remaining stenoses are extended by means of a dilatation catheter. The so far obtained results concerning 72 patients with very long and/or very old arterial occlusions show a primary success-rate of 96% and a 2 years' patency rate of 85% for all patients with a primary success of treatment. Complications and side-effects are scarce with this method. Therefore it can be applied with patients for whom other recanalising catheter methods are not indicated and with whom vascular surgery is not possible. However, a lasting success of treatment is only to be expected on the basis of the precise planning and careful performance of a long-term after treatment.

Effect of intraoperative propranolol on serum creatine kinase MB release in patients having elective cardiac operations.

Intraoperative beta blockade has been evaluated as an adjunct to hypothermic cold blood potassium cardioplegia by quantitating serum creatine kinase MB release. Randomization of 80 patients having coronary artery bypass grafting and 18 patients having valve replacement with or without bypass grafting resulted in 46 of the former and seven of the latter receiving propranolol 0.05 mg/kg 4 to 5 minutes before aortic cross-clamping. Among patients having bypass grafting, infarct size (in gram-equivalents) was 7.9 +/- 0.7 gm-Eq for the propranolol group and 10.3 +/- 0.8 (p less than 0.05) for the control group. Ischemic times were 71.6 +/- 2.8 and 78.3 +/- 3/4 minutes (p = NS), respectively. In valve replacement, infarct size was 9.9 +/- 1.9 gm-Eq for those receiving propranolol and 12.6 +/- 2.0 (p = NS) for the control subjects; ischemic times were 99.4 +/- 12.5 and 80.5 +/- 5.7 minutes, respectively. When the two groups receiving propranolol were combined, infarct size was 8.2 +/- 0.6 gm-Eq versus 10.9 +/- 0.7 (p less than 0.01). When ischemic time was plotted against infarct size, analysis by linear regression revealed a significant correlation for patients receiving propranolol and having bypass grafting (p less than 0.01) and for all patients receiving propranolol (p less than 0.01). These data demonstrate a modest reduction of infarct size with intraoperative propranolol as an adjunct to our standard management of patients having aortic cross-clamping. Quantitation of creatine kinase MB release is the best clinically available method for assessing alterations in techniques of myocardial preservation.

[The influence of chronic pentroxifylline medication on ergometric and hemodynamic parameters in intermittent claudication (author's transl)]. / Behandlung von Patienten mit arterieller Verschlusskrankheit (Stadium II) mit Pentoxifyllin. Hämodynamische und ergometrische Befunde.

In an open clinical trial 14 patients with intermittent claudication caused by an obliteration of the femoral artery received 400 mg pentoxifylline 3 times daily over a period of 6 months. The walking distance, time to peak flow and calf ergometry showed a significant increase. Minor improvement of working hyperemia and peak flow could be found. The systolic pressure gradient over the obstruction didn't change. No patient complained about side effects.