[Undesired drug effects after taking chlormezanone (Muscle Trancopal) with lethal results]. / Unerwünschte Arzneimittelwirkung nach Einnahme von Chlormezanon (Muskel Trancopal) mit letalem Ausgang.

HISTORY AND CLINICAL FINDINGS: A 34-year-old woman was admitted for treatment of toxic epidermolysis of the skin and mucosa. 16 days previously she had started to take chlormezanone (Muskel Trancopal) and some other medications for pain in the shoulder and neck. On admission she had a fever of 39 degrees C and, in addition to the epidermolysis, diffuse abdominal pain on pressure and blood-streaked stool. INVESTIGATIONS: Liver enzyme activities (GOT 979 U/I, GPT 1496 U/I, gamma GT 201 U/I) alkaline phosphatase 515 U/I), bilirubin (3.9 mg/dl) and pancreatic enzyme activities were raised. Sonography was nondiagnostic, computed tomography demonstrated only a small amount of ascites. TREATMENT AND COURSE: The epidermolytic lesions, cholestatic hepatitis and pancreatitis markedly regressed under aseptic wound treatment, antibiotics and parenteral nutrition. Persistent blood-streaked stools and bilateral pneumonia with progressive respiratory failure developed. Despite intensive medical care the patient died after 14 days from protracted sepsis with multi-organ failure. Autopsy additionally revealed adult respiratory distress syndrome and complete loss of colonic mucosa. CONCLUSION: The severe course of a toxic epidermal necrosis with fatal outcome is the first such case reported in Germany that very probably was caused by chlormezanone. 4 weeks after this case was reported to the German Doctors' Drug Commission, the manufacturers of the drug withdrew it from the market.

Comparison of threshold values between steroid and nonsteroid unipolar membrane leads.

The aim of this study was to evaluate whether steroid membrane leads can reduce pacing thresholds and thereby save energy as compared to nonsteroid membrane leads. The study was a random sample, double blind test consisting of 90 patients between 49-94 years of age admitted to seven hospitals in Europe for pacemaker implantation. The two leads compared in this study had contoured activated carbon tips covered with ion exchange membranes. The leads were identical except that 30 micrograms of dexamethasone was dissolved in the ion exchange membrane of one of the leads. Normal lead implant procedures were used. Follow-up procedures were conducted at 2 weeks and 1, 3, 6, and 12 months after lead implantation. The pulse generator was programmed to an amplitude of 2.5 or 5 V and a duration of 0.5 msec. The stimulation threshold was measured using the VARIO function. The threshold was measured a total of three times in order to determine the presence of microdislocations. At the 2- and 4-week follow-ups, the stimulation threshold was significantly lower for the steroid leads than for the membrane leads without steroid (0.54 +/- 0.19 vs 0.76 +/- 0.25 V, P = 0.0005; and 0.59 +/- 0.19 vs 0.74 +/- 0.26 V, P = 0.005), but after 3 months, the threshold values were almost the same for both leads.

The role of TXA2 in hypertension.

Blood pressure reduction induced by antihypertensive drugs with different mode of action approximated the pathological altered synthesis of TXB2 in spontaneously hypertensive rats to values of normotensive rats: in the kidney medulla by all drugs used, in the aorta only by the most efficient drugs (clonidine, dihydralazine) and in plasma and serum only in connection with a reduction in heart rate (clonidine, propranolol). The pathologically increased synthesis of 6-keto-PGF1 alpha was unchanged by drugs, therefore the ratio PGI2/TXA2 was directed towards the vasodilatory prostanoid. Unlike SHR in NTR an equieffective blood pressure reduction induced by the same drugs was without influence on TXB2 synthesis. From these results we can conclude, that the influence of antihypertensive drugs on TXB2 synthesis depends on the normotensive or hypertensive state of the animals and not on the drug per se. In hypertensive patients a blood pressure reduction by linseed oil was connected with a reduced TXB2 plasma level, too.

Postoperative fixation of the nose.

A method to maintain an operatively corrected nose in the desired form through the use of a transfixion plaster is described. This procedure has proved to be successful in giving a resilient fixation.

[Carcinoma of the breast. Reconstructive surgery]. / Mamma-Carcinoma. Rekonstruktive Chirurgie.

Every year in the German Federal Republic there are 15000 new cases of carcinoma of the breast in woman. In those cases in which metastases in the lymph nodes have not appeared, the rate of recovery is so high that a rehabilitation is worth careful consideration in each case. Methods of operation have been worked out over years of experimentation, with results that are now so good that not only breast-like forms, but genuine female breasts are created. With the reconstruction possibilities, the quality of the patients' survival time is improved.

Further progress in the axillary approach in augmentation mammaplasty: Prevention of incapsulation.

Over the last 21/2 years since we have been practicing moving the implant in a relatively large cavity, incapsulation has been reduced to a minimum. Only implants without patches and profile have been used. Since 1973 the axillary approach has been successfully applied in 727 cases of augmentation mammaplasty.

[Stimulation thresholds of implanted cardiac pacemakers (author's transl)]. / Reizschwellenverhalten nach Herzschrittmacherimplantation unter besonderer Berücksichtigung der Elektrodendisolkation

The Vario-pacemaker EM 169 makes it possible, without additional equipment, to determine stimulation thresholds after implantation. A study on 149 patients with implanted pacemakers demonstrated characteristic temporal changes in stimulation threshold: starting with a mean value of 0.57 +/- 0.18 V on implantation, a maximal value of 1.93 +/- 0.66 V to 2.00 +/- 0.58 V was reached between the eighth and fourteenth days. The threshold remained constant at this level for a time and then oscillated downwards from the third month onward to values of about 1.55 to 1.70 V. However, when the electrode was dislodged or dislocated, there was in most instances an increased threshold and, during the same test, variations in threshold values. In general, electrode dislocation could be diagnosed in time with the vario-principle, before failure of stimulation at maximal voltage of 5.2 V. In 17 of 140 cases of implantation (12%) the electrode position had to be revised: in 13 electrode dislodgement was diagnosed even before failure of stimulation at full voltage of 5.2 V. The reported results suggest that occurrence of an exit block is always due to electrode dislodgement. In addition, it is clear retrospectively that in most cases of dislocation primary fixation of the electrode in the trabeculations of the right ventricle had been unsatisfactory.