Safety and efficacy of procainamide infusions.

Thirty-four patients who were resistant to conventional doses of lidocaine received procainamide intravenously according to a pharmacokinetically designed two infusion technique. A mean peak serum concentration of 7.1 mg/liter was achieved with an average loading dose of 989 mg administered over 1 hour. A mean steady state serum concentration of procainamide of 6.5 mg/liter was achieved with a mean dose of 64.4 mg/kg body weight for the first 24 hours of treatment. Dose, renal impairment, the degree of congestive heart failure and acetylator status influenced the steady state serum concentration of procainamide. Dangerous ventricular arrhythmias were abolished in 74% of the patients at a steady state level of 6.9 +/- 3.7 mg/liter (mean +/- standard deviation). Nonresponders to procainamide had a mean steady state serum concentration of procainamide of 4.2 +/- 2.1 mg/liter (P less than 0.05). Systolic and diastolic blood pressures decreased moderately (10 and 8%, respectively), and heart rate decreased 11%. The infusion was interrupted in one patient because of hypotension. The duration of electrocardiographic conduction intervals was increased slightly in some patients. It is concluded that procainamide administered by this two infusion method is effective and well tolerated by most patients.

[Isoelectrofocusing on polyacrilamide gel in the study of gamma-globulin changes during neurological illnesses (author's transl)]. / L'uso dell' isoelettrofocusing nello studio delle proteine liquorali, sua applicazione nella diagnosi delle malattie del sistema nervoso.

Isoelectrofocusing on polyacrilamide gel in the analysis of cerebrospinal fluid proteins is particularly suitable for investigations of gamma-globuline changes in the course of various neurological conditions. This technique makes it possible to recognise three patterns besides the normal one. The first is characterized by a diffuse increase in gamma-globulines with a great number of high density fractions showing uniform distribution in the alkaline pH area. It was observed in a case of Guillain-Barrè syndrome and in two cases of intramedullary tumours. It seems to be due to an alteration in the permeability of the blood-brain barrier. The second pattern shows a diffuse increase in the number of fractions and appears uneven owing to a certain amount of higher density bands which stand out clearly. This was observed in one case of tubercolous meningo-encephalytis, in one case of chickenpox encephalytis and one case of cryptococcal meningitis in a patient affected by lymphogranuloma. This pattern is probably due to an alteration of blood-brain as well as of immunological systems. The third pattern presents a clear fractionation of gamma-globulins gathered in a certain number of highly coloured bands, mainly in the most alkaline area of gel. This was observed in all the ten cases of multiple sclerosis and in the only case of subacute sclerosing panencephalitis. This may be attributed to the intrathecal production of oligoclonal gamma-globulines (Ig.G.).