[Status of phytotherapeutic drugs in treatment of benign prostatic hyperplasia]. / Stellenwert von Phytotherapeutika bei der Behandlung der benignen Prostatahyperplasie (BPH).

Phytotherapeutic preparations are still commonly used for the treatment of symptomatic benign prostate hyperplasia (BPH) in Germany; in recent years there has even been an increase in their use, so that sales now amount to more than DM 220 millions per year. The preparations most frequently used are extracts of Hypoxis rooperi, the roots of the stinging nettle, the fruits of the saw palmetto, pumpkin seeds and rye pollen. The suggested mechanisms of action have not been documented by scientific observation. This applies especially to the blocking effect on 5 alpha-reductase postulated with the doses used. Moreover, a critical analysis of the data available suggests that the effects of phytotherapy are no better than those of placebo treatment. Further studies are urgently needed, to compare the effects of phytotherapy with those of chemically defined drugs (alpha 1-receptor antagonists, 5 alpha-reductase blocker) that seem to have a beneficial influence on the pathomechanism underlying symptomatic BPH.

[Does budgeting modify quality and efficiency of ambulatory drug therapy? Use of indicators exemplified by the prescribing behavior of established physicians of a North German region with predetermined quality deficits before introduction of the Health Structural Law]. / Beeinflusst eine Budgetierung Qualität und Wirtschaftlichkeit der ambulanten Arzneimitteltherapie? Anwendung von Indikatoren am Beispiel des Verorrdnungsverhaitens niedergelassener Arzte einer norddeutschen Region mit festgestellten Qualitätsdefiziten vor der Einführung des GSG.

Application of indicators exemplified by the prescribing conduct of physicians in a specific region of northern Germany showing deficits before implementation of the new GSG (Health Structure Law). The prescriptions of physicians in a specific region of northern Germany were examined to see whether the quality of drug therapy in this region, which showed deficits before the implementation of the GSG, had been influenced by this law. After encoding the prescription data the 100 most often prescribed drugs were identified as physician-related the resulting costs determined and arranged in order of precedence ("medicine charts"). The indicators were defined as to which "medicine-chart" drug they related, to facilitate a qualitative analysis of the prescriptions. The indicators were: Drugs, whose therapeutic advantage is not proven Drugs based on obsolete therapeutic concepts Drugs with lower-priced and/or therapeutic equal alternatives Standard-Therapeutics.

[Conservative, non-hormonal treatment of benign prostatic hyperplasia]. / Konservative, nicht-hormonelle Behandlung der benignen Prostatahyperplasie.

The indications for and efficacy of non-hormonal drugs in the treatment of benign prostatic hyperplasia (BPH) are the subject of some controversy. However, a critical evaluation of the available literature shows that no clinically relevant reduction of prostatic size has been reached with any drug tested so far. It is suggested that alpha-adrenergic blockers exert a beneficial effect by reducing the "dynamic" component associated with prostatic obstruction. The application of objective criteria has not shown cholesterol-lowering and phytotherapeutic drugs to have any significant and clinically relevant advantage over placebos. The evaluation of drug therapy in BPH patients is complicated by the fact that the obstructive signs are masked by irritative symptoms ("prostatism", "unstable bladder"), the causes of which are also unknown. A causal drug therapy should have an impact on biochemically and/or biologically confirmed changes that are responsible for the development of BPH. Als long as the cause of BPH remains unknown, drugs cannot fulfil these requirements. The efficacy of drug therapy in patients with BPH can only, therefore, be evaluated in double blind controlled studies including modern urodynamic investigations. However, these standards should also be applied to the decision as to whether operative treatment is indicated and to evaluation of the results.

[Recent aspects of antirheumatic therapy in the elderly]. / Neuere Aspekte antirheumatischer Therapie bei älteren Patienten.

Consequences have to be derived in respect to the antirheumatic treatment from recent withdrawals of several non-steroidal anti-inflammatory drugs (NSAID). This especially applies for elderly patients with reduced renal function. The dosage has to be carefully adjusted to the individual problems of the patient. No attempts should be made to achieve a completely pain-free state by use of highest dosages: the lower the dose maintaining the patient's mobility, the safer the therapy. NSAID with long elimination half-life time carry a special risk of adverse effects for the elderly due to accumulation. Reduced renal function of the elderly may also result in hypertension and heart failure. Combination of NSAID with glucocorticoids may enhance the antiinflammatory effect, but also causes an increase of adverse effects. Therefore, the combined use appears to be justified only in special situations of severe inflammatory activity no sufficiently controlled by NSAID in which the glucocorticoids are used in the lowest effective dose applied according to the circadian rhythm. The duration of treatment is to be limited, since the adverse effects of glucocorticoids increase with time.

Adverse drug reactions to first- and second-generation antidepressants: a critical evaluation of drug surveillance data.

We reviewed data on adverse drug reactions (ADRs) to first- and second-generation antidepressants, recorded by two different drug surveillance systems. The rate of ADRs that led to discontinuation of the drug in the individual case, assessed within a multi-centered hospital-based drug monitoring system (AMUP), was significantly higher in case of exposure to tricyclics (7.4%) than with the second-generation drugs (3.1%). On the basis of voluntary reports to the Medicines Commission of the German Medical Profession (AMK), profiles of ADRs to the drugs under survey were constructed and compared with data compiled by the WHO. The types of ADRs varied more between second-generation drugs than between tricyclics. Special attention was paid to rare but serious ADRs (e.g. seizures during treatment with maprotiline, and blood dyscrasias attributed to mianserin).

Effects of PGI2 and PGI analogues on cAMP levels in cultured endothelial and smooth muscle cells derived from bovine arteries.

PGI2 increased cAMP levels in cultured endothelial cells derived from bovine aortas in the presence of isobutylmethylxanthine (IBMX). Stable PGI analogues were more effective, while PGE1 was without effect. In cultured smooth muscle cells from bovine aortas, PGI2, pGE1 and the stable PGI analogues dose-dependently increased cAMP levels in the absence and presence of IBMX. The data confirm the stimulatory effect of PGI2 on cAMP content in bovine coronary artery rings and suggest that the effect is mainly due to the stimulatory action of PGI2 on cAMP in smooth muscle cells.

Effects of dipyridamole in vivo on ATP and cAMP content in platelets and arterial walls and on atherosclerotic plaque formation.

In rabbits receiving an atherogenic diet for 2 months, the ATP content of platelet rich plasma (PRP) and arterial tissue was significantly elevated as compared to normal rabbits. This increase in ATP levels of platelets from atherosclerotic rabbits was paralleled by higher basal as well as PGI2-induced cAMP levels. In arterial tissues, an increase was only obtained in PGI2-stimulated cAMP content. Treatment with dipyridamole (DPD) for 4 weeks resulted in a reduction of the ATP content in platelets and arterial tissue from atherosclerotic rabbits to values seen in normal animals. Again, the reduction of ATP content was reflected in a decrease of basal as well as PGI2-induced cAMP levels in platelets, whereas in arterial tissue a decrease was only obtained in PGI2-induced cAMP content. At the same time, DPD treatment enhanced atherosclerotic plaque formation in the aortic wall. The enhanced atherosclerotic plaque formation seen in DPD treated atherosclerotic rabbits may be linked to the inhibition of adenosine uptake, resulting in a decrease of the adenine nucleotide pools of arterial wa-l cells. The decrease also caused a reduction in PGI2-induced cAMP content. This effect may be linked to altered proliferative activity, since in many cell types, stimulation of cAMP levels results in reduced proliferation rates.