[Clinical symptoms and differential diagnosis of acute arterial vascular occlusion in the limbs]. / Klinische Symptomatik und Differentialdiagnose des akuten arteriellen Gefässverschlusses der Extremitäten

The acute arterial vascular occlusion is relatively rare, but without any exception it belongs to the medical emergency situations. The early diagnosing is decisive, since embolectomy is to be regarded as method of choice during the first 10 hours. After demonstration of the most frequent sources of embolism and their clinical manifestation symptomatology and most essential differential diagnoses of the acute arterial vascular occlusion are discussed. As consequence for practice must be demanded that at the least supposition on the presence of an acute arterial vascular occlusion the immediate hospitalisation is necessary.

[Comparative studies on the value of oscillography and venous occlusion plethysmography in the diagnosis of arterial occlusive diseases]. / Vergleichende Untersuchungen zur Aussagefähigkeit von Oszillographie und Venenverschlusspleplethysmographie bei der Diagnostik arterieller Verschlusskrankheiten.

Oscillography and plethysmography in phlebembraxis also occupy an important place in the screening of arterial obstructive diseases. The two methods give reliable results. In patients who have--as was established by oscillography and clinical examination--healthy vessels, as well as in patients with arterial obstructive disease in stage II a good correspondence with the findings of plethysmography in phlebembraxis could be proved, if all the three measuring sizes (first flow, peak flow and peak flow time) were taken into consideration. Hereby the normal values given partly deviate from those ones given in literature. They are guide values which in the individual case may fall below or transgressed also in patients with healthy vessels, whereby the peak flow time is to be regarded as the most reliable measuring size. On account of the slight expenditure of time the plethysmography in phlebembraxis is suitable as screening method, however it is not sufficient as the only method for the angiological prediagnostics. It is a valuable supplementation to the hitherto known unbloody examination methods.

[Frequent errors in ECG registration]. / Häufige Fehler bei der EKG-Registrierung

The correct ECG-registration is the basic prerequisite for a certain ECG-diagnostics. If certain mistakes in registration are not taken into consideration diagnostic errors attended with grave consequences are possible. The disturbances most frequently observed in practice (disturbances on the patient's part, errors in working, technical disturbances) are described and explained.

[Importance of ECG in the monitoring of patients with pacemakers]. / Die Bedeutung des Ekg bei der Uberwachung von Herzschrittmacherpatienten

As treatment method of choice in permanent bradycardic disturbances of cardiac rhythm the control of pacemaker patients increasingly obtained importance. The knowledge of the normal as well as the disturbed pacemaker ECG is one condition for the optimal care of pacemaker patients, since more and more practicing physicians are involved into this responsible activity. After description of the ECG in intact pacemaker function (including the possibilities of errors) the disturbances most frequently observed in practice (change of the pacemaker frequency, deficits of synchronisation and stimulation) are dealt with and explained.

[Routine diagnosis in patients with latent sinus node syndrome]. / Zur Routinediagnostik bei Patienten mit latentem Sinusknotensyndrom.

The establishment of latent disturbances of the sinus node function is with high security successful by the determination of the sinus node recovery time only after medicamentous provocation with propranolol/atropin and verapamil, since the sensitivity of the determination of the sinus node recovery time is to small in the up to now usual way and in normal findings it is not able to exclude a sinus node dysfunction. The course of the investigation could be optimized according to the fact that despite complete medicamentous provocation only one running through stimulation is necessary without an endangering of the patient being the results. By this means of 75 patients 32 patients (43%) could be identified as sinus node syndrome of different degree of severity. On the basis of the improved ability of statement the determination of the sinus node recovery time for the diagnostics in patients with unclear syncopes and inconspicuous findings of the ECG should be performed only after a combined medicamentous provocation.

[Problems of so-called functional ECG changes]. / Zur Problematik sog. funktioneller Ekg-Veränderungen.

It is reported on a 25-year-old African student with healthy heart in whom on account of an enlarged hepatologic diagnostics considerable changes of the ECG with repeated alteration between the ST-elevations and the T-negativations became manifest in the anterolateral BW-leads. In the otherwise inconspicuous findings functional changes of the ECG (early repolarization syndrome) with pronounced vegetative lability are concerned. The influence on the changes of the ECG by sympathicomimetics (isoproterenol test) may help to alleviate the diagnostics. In connection with diagnostic interventions the recognition and correct explanation of such ECG-findings is of decisive importance.

[Exercise ECG and serum enzymes in women using oral contraceptives]. / Belastungs-Ekg und Serumenzymverhalten bei Frauen nach Einnahme von Ovulationshemmer.

In 45 women who in an average period of 5.6 years took oral contraceptives and who became evident in the transaminase screening a bicycle-ergometric load examination was carried out. At the same time before and after load estimations of enzymes (ALAT, ASAT, LDH, CK) were performed. Only in 4 women (8.9%) under load suspicious ECG-findings could be proved, which, however, could not be regarded as secure signs of ischaemia, but above all as falsely positive changes of the ECG in psychovegetative heart syndrome. The estimation of total enzyme activities did not achieve an additional gain of information.

[Does abdoman cause ileus?]. / Begünstigt Abdoman die Ileusentstehung?

On account of its favourable pharmacological properties Abdoman has proved in the treatment of patients with uncomplicated duodenal ulcer. On the basis of its pronounced motility inhibiting effect on the gastrointestinal canal it may be additionally used for the treatment of diarrhoea. It is reported on 5 patients in which under Abdoman therapy a paralytic ileus developed as severe complication, so that it must be warned of an uncontrolled prescription of abdoman concerning this indication. Abdoman should be used above all in juvenile patients, in which case particular attention must be paid to obstipation as most frequent side-effect.

[Evaluation of the clinical severity in occlusion of the superficial femoral artery]. / Zur Beurteilung des klinischen Schweregrades bei Berschlüssen der A. femoralis superficialis.

The judgment of the efficiency of the collateral circulation is of decisive importance for the estimation of the clinical degree of severity and thus also for the indication to angiosurgical measures. Since also angiographically only an indirect evidence concerning the collateral circulation can be given, the angiological findings of 18 patients with unilateral or bilateral occlusion of the superficial femoral artery (n = 25 lower extremities) were evaluated. On the basis of the measuring values received with the help of the phebembraxis plethysmography 3 degrees of severity may be differed which essentially correspond to clinical stage: 1. good collateral circulation (data in ml/100 ml tissue min: ff above 5 ml, pf above 15 ml, pf-time below 30 s 2. moderate collateral circulation: ff below 5 ml, pf below 15 ml, pf-time 30-60 s 3. bad collateral circulation: ff below 5 ml, pf below 10 ml, pf-time above 60 s. Of the measuring sizes (ff, pf, pf-time) the pf-time proved to be the most reliable parameter. On the basis of these results the phlebembraxis plethysmography is a valuble supplementation in the preoperative vascular diagnostics.

[Optimization of therapy using cardiac glycosides]. / Zur Optimierung der Therapie mit Herzglykosiden.

By the estimation of the serum glycoside concentration during the last years numerous new recognitions have been got, particularly concerning the pharmacokinetics of the heart glycosides, which increasingly will be reflected in the clinical practice. Apart from thoughts on pharmacokinetics the author adopts a definite attitude to glycoside tolerance, to the influence of age and bodyweight as well as to the importance of disturbances of the renal function. Moreover it is referred to new aspects in the dosage of heart glycosides, in which case the revision of the central therapy recommendations seems to be necessary.

[Response of the heart rate and blood pressure to exertion - criterion for the differential therapy of hypertension]. / Verhalten von Herzfrequenz und Blutdruck unter Belastung - ein Kriterium für die Differentialtherapie der Hypertonie?

In 37 patients with essential hypertension (WHO-stage I and II) ergometric examinations with submaximum stress were performed in sitting position for the judgement of the behaviour of heart rate and blood pressure (control group 20 clinically healthy persons). On account of the different behaviour of the heart rate the patients could be subdivided into 4 groups: A: normal heart rate in rest and under stress. B: heart rate increased only under stress. C: heart rate increased already in rest. Group D consisted of patients with hypertensive disturbance of the regulation (normal blood pressure immediately before ergometry). In 12 of the patients were also performed ergometric examinations under therapy: in group A the combined use of beta-receptor blocker and saluretic was necessary, in the groups B, C and D monotherapy with beta-receptor blocker was sufficient. The opinion is uttered that an abundant increase of blood pressure under stress in anamnestically known increased values of blood pressure in rest is also an indication to therapy as the appearance of very varying and on an average occasionally increased blood pressure values. In group A (normal regulation of frequency) by the beta-receptor blocker alone as a rule no sufficient effect is expected, the combination with a saluretic is necessary. In the other groups apart from the regulation of the blood pressure also the regulation of the heart rate is disturbed (among others reduction of the vagal inhibition of the heart, lack of training) and apart from the medicamentous therapy with beta-receptor blockers also a physical training is to be recommended. The different patterns of reaction which were to be proved by means of ergometry in patients with hypertension may in most cases be supposed already by the observation of the course and thus be included in the consideration concerning the differential therapy.

[Overturned left type - manifestation of impaired intraventricular stimulus conduction or position dependent?]. / Uberdrehter Linkstyp - Ausdruck einer intraventrikuären Erregungsleitungsstörung oder lagebedingt?

When an overturned left type is present special criteria render possible the diagnosis of the left-anterior fascicular block. Among 7,687 ECG in 698 cases (9.1%) an overturned left type was to be seen. In accidental random test of 300 ECG with overturned left type in 183 cases (61%) a left-anterior fascicular block, in 111 cases (37%) an overturned QRS-left position were found. In 6 cases (2%) a decision was not possible. The left-anterior fascicular block increasedly appears with growing age beyond the 50th year of life. Hypertension (67%), chronic ischaemic heart disease (46%) clearly prevail in patients with left-anterior fascicular block, on the other and non-cardiovascular diseases with 58% more frequently appeared in the group of patients with overturned QRS-left-position. In this group hypertension occurred only in 33%, chronic ischaemic heart disease only in 14%.

[Results of stationary management of patients with hypertension with reference to previous ambulatory care]. / Ergebnisse stationärer Behandlung von Patienten mit Hypertonie unter Berücksichtigung der ambulanten Vorbehandlung.

The case histories of 100 patients who were hospitalised in the Department of Internal Medicine of St. George's Hospital in the period from January 1975 to March 1976 are analysed mainly to study their treatment as outpatients (information of the patient, previous diagnoses and treatment, and diagnosis at the time of hospitalisation) and the results of their in-hospital treatment. Most of the patients were admitted to hospital at an advanced stage, usually when out-patient treatment had failed to produce results, but in 80% of the cases the result of in-hospital treatment was satisfactory or good. Besides improvement in drug combination and treatment of cardiac insufficiency, the most frequent complication, observation of general therapeutic principles under conditions of in-hospital treatment was found to be of special importance. Over and above this, we regard close cooperation of hospital and out-patient clinic as essential in the optimisation of the treatment of hypertension.

[Diagnostic problems of diabetic nephropathy in elderly patients with diabetes from a clinical point of view]. / Diagnostische Probleme der diabetischen Nephropathie bei Patienten mit Altersdiabetes aus klinischer Sicht.

The clinical findings of 28 diabetic females with suspicion of diabetic nephropathy were compared with the findings of 27 decreased female diabetics with ascertained diabetic glomerulosclerosis. In the two groups above all elderly female diabetics were concerned with an average duration of diabetes of more than 10 years. Of the parameters examined duration of diabetes and diabetic retinopathy still possessed the greatest diagnostic certainty. All the other symptoms (particularly proteinuria, hypertension) were only signs of reference. On account of the difficult differential diagnosis of the diabetic nephropathy an undiscriminating use of the notion should be avoided, above all then when a bioptical clarification is not possible.

[Incidence of toxic liver lesions due to Gravistat]. / Häufigkeit toxischer Leberschäden durch Gravistat.

In 200 women who on the average 5.6 years took ovosiston and/or non-ovlon, and in 40 women who during the last three months had not taken an oral contraceptive we determined the GOT, the GPT, and LP-X and the cholesterol in the serum before and after a three weeks intake of gravistat. After a three weeks intake of gravistat of the two groups ca. one fourth showed pathological transaminases. 30 women with pathological transaminases and/or positive LP-X were hepatologically investigated including liver biopsy after an on an average 7.3 weeks exposition of gravistat. In ca. one third of the cases histologically provable changes of the liver (toxic hepatosis, fatty liver, infectious hepatitis) and in ca. two thirds of the cases the picture of the metabolic activation were found. Morphologically no signs of an intrahepatic cholostasis could be proved, so that it does not seem to be the leading parameter of the toxic liver damage.

PIP: A study of the hepatic effects of Gravistat on 240 women is presented. 200 of the women had previously used either Ovosiston or Non-Ovlon continually for an average of 5.6 years, while the remaining 40 had used no hormonal contraceptives for the preceeding 3 months. After 3 weeks of Gravistat use, GOT, GPT, LP-X, and cholesterol levels were taken. 1/4 of the women in both groups showed pathological serum transaminase levels, and the cholesterol levels in both groups were within normal levels. 10 of the women who had previously used hormonal contraceptives, and none from the other group, showed a positive LP-X. A hepatological examination, including a liver biopsy, was performed on 30 of the women with pathological transaminase levels and/or positive LP-X. Pathological conditions (toxic hepatosis, infectious hepatitis, fatty liver) were found in 11 of those cases, while the rest showed metabolic activation. Intrahepatic cholestasis does not seem to be the major factor in the liver damage.

[Ergometric investigations with pressure measurements in the pulmonary arteria for judgment of the severity of the disease in patients suffering from left heart diseases (author's transl)]. / Ergometrische Untersuchungen mit Druckmessungen in der Arteria pulmonalis zur Beurteilung des Schweregrades bei Patienten mit Linksherzerkrankungen.

Pressure measurements in the pulmonary artery were performed on 34 patients by intracardiac floating catheter during rest and under ergometer load of 51 Watt (corresponding to an oxygen consumption of 750 ml/min). 15 of the patients were suffering from myocardial infarction 4--6 weeks after admission, 12 from chronic coronary heart disease respectively angina pectoris and 7 from affection of the aortic valve. The pressure during rest ranged within the norm. Under load the patients suffering from myocardial infarction and coronary heart disease showed two forms of reaction: 1. moderate ascent of pressure up to 40 torr systolic and 15--18 torr diastolic (mean pressure 25--28 torr). 2. distinct ascent of pressure up to 50--60 torr systolic and 25--30 torr diastolic (mean pressure 36--42 torr). Evidence of latent pulmonary hypertension was irrespective of classification as myocardial infarction with or without complications. That demands regarding of central hemodynamics for the further course of rehabilitation more than hitherto.

[Physical exertion and the course of hepatitis]. / Körperliche Belastung und Hepatitisverlauf.

Twenty-five patients with clinically and histologically verified acute hepatitis were subjected to a submaximal bicycle ergometer exercise during the first week after inpatient admission and afterwards subdivided into two groups. The first group maintained bedrest, and the other group trained for 30 minutes a day over six weeks at an exercise level amounting to 70% of the submaximal performance of the initial ergometry. Histological, clinical and laboratory results did not differ between the groups. It is concluded that immobilization for a short time only is indicated in acute hepatitis.

[Acute viral hepatitis and body loading--a self-excluding therapeutic principle?]. / Akute Virushepatitis und körperliche Belastung--ein sich ausschliessendes Therapieprinzip?

Of 27 patients with acute virus hepatitis 16 patients performed successfully a daily training programme during their stay in hospital. On the basis of both clinical and clinical chemical parameters in comparison to the control group of 10 patients who observed the conventional rest in bed the course of healing did not deteriorate. Also with regard to the late prognosis no higher rate of recidivation or chronification could be proved. Our examinations support the thesis that the demand of strong rest in bed is to be regarded as out of date in the treatment of acute virus hepatitis.

[Isovolemic hemodilution--an adjuvant treatment principle in patients with chronic cor pulmonale caused by chronic obstructive lung disease]. / Die isovolämische Hämodilution--ein adjuvantes Behandlungsprinzip bei Patienten mit Cor pulmonale chronicum infolge chronisch obstruktiver Lungenkrankheit.

On the basis of 10 patients with chronic cor pulmonale due to chronic obstructive lung disease and secondary polyglobulia in a clinical and experimental study could be made evident that by limited isovolaemic haemodilution (haematocrit value of 0.58 +/- 0.03 reduced to 0.36 +/- 0.01) are to be expected a decrease of the total pulmonary-arterial resistance, a reduction of the mean pulmonary arterial pressure, an increase of the partial O2-pressure as well as an increase of the heart index. Analogically to this as a consequence of the improved rheologic conditions a clear involution of the clinical signs of a heart insufficiency developed. Complications were not observed. The technique of the limited haemodilution should find a broader use in the medical practice, taking into consideration the isovolaemia as adjuvant treatment principle for patients with the indication mentioned.

[Toxic hepatoses due to Gravistat]. / Toxische Hepatose durch Gravistat.

With the help of 5 cases with toxic hepatosis by administration of Gravistat the problems concerning ovulation inhibitor and toxic hepatosis were explained. The clinical, paraclinical and histological findings may be pronounced differently. Anamnestically in prescribing ovulation inhibitors particularly a jaundice during pregnancy or a pronounced pruritus in the 3rd trimester of the pregnancy must be taken into consideration. Toxic liver damage may appear not only when the ovulation inhibitor is given the first time, but also after changing it. For this reasons idiopathic jaundice during pregnancy and condition after toxic hepatosis by ovulation inhibitor in every case must be regarded as contraindications for the application of oral contraceptives. In order to establish subclinical courses a control of transaminases in the first three cycles of using the remedies is to be demanded.