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Bei 38 Patienten mit unbehandelter Sarkoidose und 33 Kontrollpersonen erfolgte die Bestimmung von Gesamtcalcium und ionisiertem Calcium im Serum und des Calcium/Kreatinin-Quotienten im 24 h- und Morgenurin. Bei allen hypercalciurischen Patienten wurde eine Abdomenleeraufnahme, bei Patienten mit Stein- oder Kolikanamnese ein i.v.-Urogramm angefertigt. Bei Analyse der aktuellen Serumcalciumbestimmungen fand sich bei 3 (7,9%) von 38 Patienten eine Hypercalcamie. Bei Mitbeurteilung von Serumcalciumbestimmungen in der vorausgegangenen Kontrollperiode zeigten allerdings 8 (33%) von 24 untersuchten Patienten zuweilen eine geringgradige klinisch nicht relevante Erhohung des Gesamtcalciums. Die ionisierte Calciumfraktion war bei 10 (27,8%) von 36 untersuchten Sarkoidosepatienten erhoht. Die mittlere Konzentration des ionisierten Serumcalciums lag bei den Sarkoidosepatienten signifikant hoher (p 0,15 im 24 h-Urin). Der Calcium/Kreatinin-Quotient war bei den Sarkoidosepatienten significant hoher (p

The effect of nifedipine (N) on the pharmacokinetics and pharmacodynamics of beta-acetyldigoxin (AD; n = 11) and digitoxin (DGT; n = 10) was studied in 21 patients with cardiac insufficiency stage II-III NYHA. Glycoside plasma concentration and renal excretion as well as electrocardiogram heart rate, atrioventricular transconduction time (PQ), duration of electrical systole corrected for heart rate (QTc), mean amplitude of T waves in leads V2 to V6 (TV2-6) and systolic time intervals total electromechanical systole index (QS21), left ventricular ejection time index (LVETI), pre-ejection period index (PEPI), PEP/LVET-ratio were recorded repeatedly before and during co-administrations of 40-60 mg/day N. Plasma AD concentrations were 0.64 +/- 0.22 ng/ml (mean +/- SD) before and 0.61 +/- 0.21 ng/ml during co-administration of N over 10-14 days, plasma DGT concentrations 13.9 +/- 4.1 ng/ml before and 13.7 +/- 4.5 ng/ml during co-administration of N over 4-6 weeks. Daily glycoside excretion was not affected by treatment with N. Heart rate and PQ-interval were not significantly changed during co-administration of N whereas T-wave flattening was intensified and QT-duration was lengthened. Concomitant treatment of AD and N led to an increase of PEPI and PEP/LVET compared to AD alone in ten patients whereas the systolic time intervals after concomitant treatment of DGT and N in most patients did not differ from those after DGT alone. From our findings we conclude that N had no clinically significant effect on pharmacokinetics and pharmacodynamics of AD or DGT.

In order to evaluate the prevalence of renal artery stenoses and the coincidence with hypertension, in this study 110 patients (24 women, 86 men, mean age 63.2±8.6 years) underwent retrograde aortography for reason of symptomatic arteriosclerosis obliterans of the lower limb arteries. In 18 (16.4%) patients renal artery stenoses by which the lumen was narrowed for more than 30% and in 2 (1.8%) patients occlusions of one renal artery were found, all of which seemed to be of arteriosclerotic origin. 12 (60%) patients with renal artery stenoses or occlusions showed arterial hypertension (RR 171±33/94±16 mmHg) inspite of adequate antihypertensive medication, 8 were normotensive even though renal artery stenoses were found angiographically. On the other hand 30 (33%) of the 90 patients without renal artery stenoses were hypertensive (RR 165±15/93±9 mmHg). These data support the observation that renal artery stenoses must not result in hypertension, but clearly indicate the higher prevalence of hypertension in patients with renal artery stenoses or occlusions. With regard to the low-risk procedure of percutaneous transluminal dilatation of renal arteries, it seems to be valuable for hypertensive patients to include renovasography into the angiographic evaluation of symptomatic lower limb arteriosclerosis.

In the present study 19 patients with rare forms of renal hypertension were investigated: 6 patients with renal artery aneurysm, 6 cases with unilateral hydronephrosis, 4 patients with unilateral simple renal cyst, 2 cases with coarctation of the abdominal aorta and associated renal artery stenosis and 1 patient with radiation nephritis.

In three patients with diabetes and hyporeninemic hypoaldosteronism changes in renin activity, plasma aldosterone and cortisol were examined under various conditions: orthostasis and intravenous furosemide, infusion of synthetic beta1-24 ACTH on two consecutive days and diurnal variations in basal hormone fluctuations. Each patient showed unmeasurably low renin activity unresponsive to orthostasis and intravenous furosemide while plasma aldosterone was below normal range. Under ACTH-infusion only marked increases in aldosterone were observed in one patient whereas cortisol responded normally in all diabetics tested. Analysis of diurnal night day fluctuations (20.00-8.00) in plasma aldosterone and cortisol revealed a close and statistically significant relationship between both hormones in each of the three patients (p less then 0.05-less than 0.001). Variations in plasma aldosterone thus were mediated through changes in endogenous pituitary ACTH. Compared with normal controls however, diurnal aldosterone curves were set at a lower level. Our results demonstrate that a reduced sensitivity of the adrenal gland to ACTH is not responsible for the observed subnormal plasma aldosterone levels in these patients. Therefore, the lack of circulating angiotensin II seems to be the causative reason of hypoaldosteronism. The exact mechanism of undetectable renin activity in these patients remains unknown.

The effect of diltiazem (D) on the pharmacokinetics and pharmacodynamics of β-acetyldigoxin (AD;n=12) and digitoxin (DGT;n=10) was studied in 22 patients with cardiac insufficiency stages II–III by the New York Heart Association. Glycoside plasma concentration and renal excretion as well as electrocardiogram [heart rate, atrioventricular transconduction time (PQ), duration of electrical systole corrected for heart rate (QTc), mean amplitude of T-waves in leads V2 to V6 $$(T_{V_{2 - 6} } )]$$ and systole time intervals [total electromechanical systole index (QS21), left ventricular ejection time index (LVETI), pre-ejection period index (PEPI), PEP/LVET ratio] were recorded repeatedly before and during co-administration of 180 mg/day D. In eight patients digoxin plasma levels increased continuously during additional D administration. After reaching a new steady state at 0.93±0.35 ng/ml digoxin concentrations were at an average 43% higher than before D administration (0.65±0.27 ng/ml) with a simultaneous increase in renal glycoside excretion. The other four patients showed neither changes in digoxin concentrations in plasma nor in renal glycoside excretion. Only half the patients treated with DGT and D revealed an increase in DGT plasma levels of 21.4%. Daily renal glycoside excretion was not altered by D administration. In accordance to the increasing AD plasma concentration, PQ-interval was prolonged and T-wave flattening was intensified, whereas the systolic time intervals after concomitant treatment of AD and D did not differ from those after AD alone. In contrast, the lesser increase of DGT plasma concentration seems not to be cardiac active as shown by the different electrocardiogram parameters and systolic time intervals. From our findings we conclude that AD plasma concentration should be controlled in patients receiving a combined therapy of AD and D until the new steady-state concentrations are obtained, and the AD dose reduced if there is evidence of toxicity. On the other hand, such measurement seems unnecessary during combination of DGT and D.

In the present study the effect of surgery on blood pressure was investigated in 35 patients with renovascular hypertension: 17 patients with fibromuscular hyperplasia (FMD) and 18 with atherosclerosis (ASS) of the renal artery. Patients with FMD were younger (31,8 years), showed a shorter duration of hypertension (1.8 years) and were prevalently female (82%), whereas patients with ASS were markedly older (48.2 years), showed a longer duration of hypertension (2.6 years) and were most often male (78%). In both groups of patients the intravenous urogram was positive in a comparable high percentage (FMD=64%, ASS=61%). Following surgical intervention 47%(n=8) of the 17 patients with FMD were cured, 47% (n=8) were improved and only 6% (n=1) showed insufficient reduction of blood pressure values. In ASS the respective values were 28, 55 and 17%. Consequently a good effect of surgery (cured and improved) was observed in 88.5% of all patients. Patients with ASS who failed to respond to surgery (n=3) showed a remarkable long duration of hypertension (7.0 plus or minus 1.4 years). Plasma renin activity (PRA) was determined preoperatively in both renal veins in all 35 patients. From these values the PRA-ratio (PRA affected/unaffected side) was calculated. In 27 patients PRA determinations were repeated following (15 and 30 min) intravenous injection of 40 mg furosemide. PRA-ratios of larger than or equal to 1.5 were considered to be significant. In 31 patients with unilateral renovascular hypertension PRA-ratios were correlated to the postoperative blood pressure reduction. No significant differences in mean PRA-ratios were observed between cured and improved patients. Furthermore, for the total group of 31 patients no significant correlations were obtained between PRA-ratios and postoperative blood pressure reduction. Our results do not support the widespread opinion that PRA determinations in both renal veins are useful to predict the effect of surgery in patients with unilateral renovascular disease. Therefore, from our experience this method should not be recommended as obligatory in the diagnostic work-up of renovascular hypertension.

Bei einem ausgepragten Spruefall wird auf rontgenologischem Wege die Frage der Herkunft der grosen Flussigkeitsmengen im Darm geklart. Es handelt sich nicht um eine entzundliche aktive Sekretion in das Darmlumen hinein, sondern um eine Stagnation im Darm bei einer verminderten Resorption. Die herabgesetzte Wasseraufnahme ist die Ursache fur den starken Wassergehalt der Stuhle und fur die Austrockungserscheinungen am Patienten.

1. Fur Serumkreatinin, -Harnstoff, anorganisches Phosphat und — nach Literaturangaben — auch fur Harnsaure werden im Autoanalyzer gleiche Werte wie mit bewahrten manuellen Nachweisverfahren erhalten.

Nachdem einleitend uber einige allgemeine Fragen der Rontgendiagnostik der Coronarsklerose gesprochen wird, wird das Bewegungsbild der verkalkten Herzkranzschlagader geschildert. Es werden pulsatorische Lageanderungen wie auch pulsatorische Weiteanderungen beobachtet. An wenig sklerosierten Gefasabschnitten last sich durch Zeitvergleich feststellen, das die Dehnung des Gefases am Ende der Ventrikelsystole stattfindet.

Bei einer Patientin wurde eine aseptische Meningitis angenommen. Auf Ratten ubertragener Urin erzeugte Temperaturen, wahrend Blut- und Liquorubertragungen ohne Einflus waren. Der von den fiebernden Tieren ubertragene Urin erzeugte in der 2. Tierpassage wieder Fieber, in der 3. Tierpassage kaum noch Temperaturen. Es wird angenommen, das ein nicht genauer definiertes Virus, das im Urin ausgeschieden wird, eine der Ursachen der unter dem Begriff der aseptischen Meningitis zusammengefasten Erkrankungen ist. Eine Trennung dieses Virus von dem Virus bei Poliomyelitis wie auch bei Schweinehirtenerkrankung ist unter Berucksichtigung der Empfangnisfahigkeit der Versuchstiere und des Fieberverlaufes moglich.

An Hand von Rontgenaufnahmen wird die Erkennung der Coronarsklerose im Rontgenbild besprochen. Es wird eine spezielle Durchleuchtungs- und Auf-nahmetechnik fur die Darstellung der Kranzarterienverkalkung angegeben. Die Differentialdiagnose der Kranzarterienverkalkung im Rontgenbild wird dargelegt.

Bioavailability of acetylated derivatives of digoxin tablets have been studied in healthy subjects after a single oral and intravenous dose as well as during maintenance therapy. alpha-acetyldigoxin shows a lower bioavailability than beta-acetyldigoxin even if the alpha-acetylated derivative is incorporated in a matrix of aerosil (SiO2). Moreover, beta-acetyldigoxin can be transferred to alpha-acetyldigoxin in alkaline solutions. This isomerisation leads to a decrease of the bioavailability of such fixed preparations which contain beta-acetyldigoxin and the hygroscopic salts of potassium-magnesium-aspartate. A prevention of the isomerisation is attained by isolating beta-acetyldigoxin from potassium-magnesium-aspartate. The bioavailability of a such new formulation is comparable to that of beta-acetyldigoxin alone. The experiments show the bioavailability of acetylated derivatives of digoxin to be influenced by the physico-chemical properties of a drug and its preparation.

The effect of diltiazem (D) on the pharmacokinetics and pharmacodynamics of beta-acetyldigoxin (AD; n = 12) and digitoxin (DGT; n = 10) was studied in 22 patients with cardiac insufficiency stages II-III by the New York Heart Association. Glycoside plasma concentration and renal excretion as well as electrocardiogram [heart rate, atrioventricular transconduction time (PQ), duration of electrical systole corrected for heart rate (QTc), mean amplitude of T-waves in leads V2 to V6 (TV2-6)] and systole time intervals [total electromechanical systole index (QS21), left ventricular ejection time index (LVETI), pre-ejection period index (PEPI), PEP/LVET ratio] were recorded repeatedly before and during co-administration of 180 mg/day D. In eight patients digoxin plasma levels increased continuously during additional D administration. After reaching a new steady state at 0.93 +/- 0.35 ng/ml digoxin concentrations were at an average 43% higher than before D administration (0.65 +/- 0.27 ng/ml) with a simultaneous increase in renal glycoside excretion. The other four patients showed neither changes in digoxin concentrations in plasma nor in renal glycoside excretion. Only half the patients treated with DGT and D revealed an increase in DGT plasma levels of 21.4%. Daily renal glycoside excretion was not altered by D administration. In accordance to the increasing AD plasma concentration, PQ-interval was prolonged and T-wave flattening was intensified, whereas the systolic time intervals after concomitant treatment of AD and D did not differ from those after AD alone.(ABSTRACT TRUNCATED AT 250 WORDS)