Distal pancreatectomy in chronic pancreatitis.

BACKGROUND: The indications for a resective procedure in chronic pancreatitis are severe pain and local complications. The aim of this study, based on prospectively assessed data, was to evaluate distal pancreatectomy in patients suffering from chronic pancreatitis localized in the corpus and cauda of the pancreatic gland. METHODS: Seventy-four patients undergoing distal pancreatectomy were evaluated pre- and postoperatively (after a median observation period of 58 months) for pain, professional status, alcohol consumption, and endocrine function as measured by the glucose tolerance test preoperatively. RESULTS: The indication for operation was severe therapy-resistant pain in nearly all patients and an inflammatory tumor or pancreatic pseudocysts in over 50% of the patients. One fourth of the patients were operated in order to exclude malignancy. Ninety-five percent of the patients underwent distal pancreatectomy, only in 4 cases (5%) was a subtotal (Child) resective procedure performed. In 34% of patients undergoing distal pancreatectomy a splenectomy could be avoided. The early postoperative complications were few and mostly due to the severe comorbidity of the patients. During the median observation period of 58 months 14.7% of the patients died due to diseases not related to distal pancreatectomy. Six percent of the patients could not be reevaluated and were lost to follow-up. In the remaining 59 patients 88% had significantly less pain and 66% had an increase in median body weight of 8 kg. Fifty percent of the patients had full or partial professional rehabilitation, one fourth was unemployed and 24% had retired due to age. 51.7% had a normal endocrine function as assessed by the glucose tolerance test, 16.2 and 21.6% had a latent or manifest diabetes mellitus, respectively. In 74.5% of all patients the endocrine function did not worsen during the observation period. CONCLUSION: In comparison to conservative treatment distal pancreatectomy is a suitable therapeutic measure in patients with severe pain and local complications. It significantly improves the quality of life of patients without compromising endocrine function. Postoperative lethality is lower than in conservatively treated patients and is not related to distal pancreatectomy.

The value of nifedipine in the treatment of hypertension, coronary heart disease and myocardial infarction (post-infarction therapy).

Calcium antagonists are among the drugs most often prescribed in the treatment of cardiovascular diseases. Among the 2000 preparations most often prescribed in Germany in 1994, there were 48 calcium antagonists which presented a prescription rate of 1268 million defined daily doses. Calcium antagonists of the nifedipine type are by far the most often prescribed preparations of this group. They are targeted mainly against hypertension and coronary heart disease, with post-infarction angina pectoris also featuring among their indications. Recent publications have, in consideration of indications on possible risks associated with nifedipine medication, fanned discussions on the pros and cons of nifedipine medication and thus the value of calcium antagonists in treating hypertension and CHD as well as post-infarction patients. The purpose of this report is to analyze the current situation and to draw conclusions for the practical use of calcium antagonists.

Environmental impact of vehicular traffic in Nigeria: health aspects.

Blood lead levels were analysed and pulmonary function tests were performed on Nigerian traffic wardens, comprising sixty from Lagos (ages 24-52 years; 27 +/- 6), thirteen from the sparsely populated university town of Ile-Ife (ages 22-40 years; 27 +/- 8) and a control group of twenty-four subjects (age 19-55 years; 31 +/- 8). Perkin-Elmer Zeeman 3030/HGA 600 AAS was used for blood analysis. The mean lead level in Lagos wardens was 18.1 +/- 6.4 micrograms/dl, which was significantly higher than the level of 10.2 +/- 2.7 micrograms/dl in Ife wardens and 12.9 +/- 7.0 micrograms/dl obtained in the controls (P < 0.001). However, there was no significant difference between the levels of blood lead in Ife traffic wardens and normal controls. Significant differences (P < 0.0005) in spirometric measurements--peak flow rate (PEFR), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)--were observed between traffic wardens and control subjects. The noise levels measured along traffic roads exceeded the threshold for hearing damage.

Double-blind, randomized study of the anti-anginal and anti-ischaemic efficacy of fendiline and diltiazem in patients with coronary heart disease.

In a 6-week, randomized, double-blind trial, the drug effects of the calcium antagonists, fendiline (75 mg twice daily) and diltiazem (90 mg twice daily), as measured by subjective and objective parameters of coronary heart disease, were studied in 79 patients with stable angina pectoris. The statistical analysis included the data of 71 patients. The results of exercise-ECG tests showed that both medications were effective anti-ischaemic agents. Fendiline was found to be effective in reducing ST-segment depression at maximum comparable load (71 watts) as well as at the time of reaching the individual maximum tolerated load (discontinuation of exertion). Diltiazem, on the other hand, proved effective only at maximum comparable load (72 watts). There was no significant difference between the groups with regard to the reduction after 6 weeks. As regards work tolerance, the duration of exercise and time until appearance of a ST-segment depression of 0.1 mV, before and after treatment comparisons revealed significant changes only in the group receiving diltiazem and the differences between fendiline and diltiazem were statistically significant with regard to these three parameters. Reduction in the frequency of anginal attacks and the diminution of nitroglycerin consumption were comparable in both medication groups, and the changes from baseline were statistically significant. Assessment of the efficacy and tolerability of the medications by patients as well as by investigators revealed no statistically significant differences between the two groups. Blood pressure and heart rate were clearly lowered by diltiazem, whereas fendiline induced only a slight decrease in blood pressure. The results indicate that both medications are equally suited for the treatment of stable angina pectoris.

Automatic recognition of squirrel monkey vocalisations by means of a filterbank.

Up to now the problem of classifying squirrel monkey vocalizations has not been solved satisfactorily. The problems is now approached by a method, which consists of 2 phases. At first the monkey vocalizations are compared with the aid of physical criteria and classified by types. According to the classification of types, the membership of the individual vocalizations is tested.