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Atherosclerotic renal artery stenosis accounts for most cases of renovascular hypertension (RVH). Hypertensive patients with clinical features suggesting RVH should be submitted to further noninvasive evaluation including duplex Doppler ultrasonography, CT- or MR angiography. Invasive evaluation by contrast-enhanced angiography confirms the diagnosis of renal artery stenosis. However, neither diagnostic test reliably predicts the course of hypertension after revascularisation. The therapeutic approach in hypertensive patients with hemodynamically important renal artery stenosis includes medical or invasive therapy (renal percutaneous transluminal angioplasty, PTRA; renal arterial stent placement, PTRAS; surgical revascularisation). Randomized trials comparing invasive and conservative approaches demonstrated no differences in blood pressure control or renal function. Only patients with clear clinical indications should be submitted to interventional procedures as PTRA, PTRAS and surgical vascular intervention.

The number of patients with end-stage renal disease is constantly growing. If patients at risk are identified early enough, currently available therapeutic options allow a potent primary and secondary prevention of progressive renal failure. If the underlying disease can not be eliminated, the mainstay of the therapy are supportive measures such as antihypertensive and, in case of an underlying diabetes mellitus, antidiabetic therapy, dietary restrictions as well as avoidance of additional nephrotoxic agents. Furthermore, even a mild renal insufficiency has been identified as a potent cardiovascular risk factor. The second major goal of supportive therapy therefore is a reduction of the markedly increased cardiovascular morbidity of these patients. This can be achieved through treatment of various consequences of renal failure, such as hyperparathyroidism, renal anemia etc. Supportive therapy thus represents a highly complex and interdisciplinary treatment, which should prompt an early inclusion of a nephrologist into the therapeutic strategy.

The relative bioavailability of a new formulation of verapamil (CAS 52-53-9, Veramex 40) in comparison to a standard formulation was investigated in an open two-period cross-over study in 16 healthy volunteers under steady state conditions of 7 days duration each. For the estimation of verapamil a selective HPLC-method was used with fluorescence detection after direct injection and enrichment by column switching enabling a simultaneous separation and analysis of verapamil and N-norverapamil. The bioavailability was estimated using areas under the concentration-time curves (AUC), maximum serum concentrations (Cmax) and peak-trough fluctuation (PTF). Bioequivalence was tested calculating the 90% confidence intervals (ANOVAlog). The mean verapamil plasma profile after the test substance was up to 1.5 h slightly lower than the corresponding curve after the reference substance, thereafter slightly higher plasma levels up to 7 h were observed after the test substance. The individual plasma profiles had a similar variance, and hardly any difference was discernible between the two drugs. A similar behaviour was also seen for N-norverapamil. A mean relative bioavailability of 101% was observed after the test substance both for verapamil and N-norverapamil. The mean maximum plasma concentrations for verapamil and N-norverapamil were 50.0 and 49.7 ng/ml, respectively. After the standard formulation the corresponding values were 50.4 and 50.3 ng/ml. The mean PTF-values for verapamil and N-norverapamil were 178 and 76.6% after the test substance and 182 and 79.6% after the standard formulation, respectively. The 90% confidence intervals for AUC, Cmax and PTF for verapamil and N-norverapamil are completely within the accepted range of 80 to 125% for AUC, Cmax and PTF. Therefore bioequivalence between both formulations can be stated.

By means of a questionnaire and three personality tests, we investigated, whether there were any differences in the personality structure between patients who underwent an amniocentesis because of psychological indications, and a matched pair group of pregnant woman without amniocentesis. The results of the personality inventories showed no significant differences in the personality structure between both groups of pregnant women. In particular, they showed no difference with respect to the anxiety factor. As a result of our questionnaire we can state, that factors like education, the handicapped child in the environment, profession and the lack of commitment to bring up a handicapped child, influence the decision to undergo an amniocentesis.

A 23-year-old man survived a suicide attempt in which he had swallowed 1500 mg potassium cyanide. Initially there were cerebral seizure and marked lactacidosis. Six hours after hospital admission the cyanide blood level was 6 mg/l. The poisoning having at first not been recognized he at that time merely received supportive treatment to counteract the acidosis, as well as assisted ventilation with hyperventilation and hyperoxigenation. Afterwards, sodium thiosulphate was given additionally for 24 h at a dosage of 1 g per hour. The clinical course underlines the great importance of supportive measures in the treatment of cyanide poisoning. In the individual case the balance between risk and value of an intrinsically toxic antidote administration must be critically assessed.

Correlation between postthrombotic syndrome, ADP-induced aggregation and intracellular calcium concentration. This study presents a comparison of the ADP-induced platelet aggregation and free cytosolic platelet calcium concentration between patients with postthrombotic syndrome and healthy volunteers. The half maximal effective dose of the platelet aggregation induced by ADP was significantly decreased in postthrombotic syndrome (p less than 0.005). The mean values were 0.42 mumol/l in postthrombotic syndrome (n = 22) and 1.00 mumol/l in normal controls (n = 25). The free intracellular calcium concentration was slightly but significantly diminished in patients compared with healthy volunteers. In both groups there was seen a remarkable interindividual spread of platelet calcium concentrations. There was seen no significant correlation between cytosolic calcium concentration of platelets and the half maximal effective dose of ADP-induction. Therefore the considerable enhanced aggregability in postthrombotic syndrome cannot explained with altered cytosolic calcium content of platelets.

Following a placebo period of 2 weeks 39 patients with essential hypertension were given during 4 weeks a combination of 2 mg trichlormethiazide and 2 mg amiloride (Esmalorid). If the blood pressure was adequately reduced treatment was continued for a further 4 weeks; if not, a double dose was dispensed during the second 4-week period. Patients with a diastolic blood pressure under 90 mm Hg after 8 weeks when treated with a 1 mg dose, were subsequently treated with a 1 mg dose for a period of 3 months. After 8 weeks of treatment mean systolic blood pressure was reduced from 167 +/- 17 mm Hg to 151 +/- 19 mm Hg (sitting) and from 163 +/- 15 mm Hg to 148 +/- 18 mm Hg (standing), while mean diastolic blood pressure was decreased from 104 +/- 6 mm Hg to 93 +/- 8 mm Hg (sitting) and from 105 +/- 6 mm Hg to 94 +/- 8 mm Hg (standing). In 29 patients diastolic blood pressure had dropped to values under 95 mm Hg. Serum potassium remained constant during the treatment except for three patients with values outside the normal range (3.3, 3.4 and 5.2 mmol/l). The other serum electrolytes, glucose, creatinine, blood lipids, transaminases, hemogram, as well as body weight and heart rate remained unchanged. Two patients complained of side effects and did not complete the study. All other patients tolerated the treatment well.

In a multicenter randomized double-blind study, 284 patients with chronic purulent sinusitis were treated with an oral immunostimulant or placebo in addition to standard therapy (antibiotics, mucolytics, inhalants). Treatment lasted for three ten-day periods in three consecutive months. At the start and during the therapy as well as after six months, symptoms were assessed on the basis of a scoring system and the X-rays of the nasal sinuses evaluated. During the course of therapy and the follow-up period, improvement of the major symptoms headache, purulent nasal discharge, cough, and expectoration was statistically significant in the immunostimulant group as compared with the placebo group, objective evidence being provided by the X-ray examinations and the number of reinfections during the period of observation.