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The efficacy of iloprost, a stable prostacyclin analog, was investigated in a placebo-controlled trial in 109 diabetics with ischemic lesions. 56 patients were randomly allocated to iloprost and 53 patients to placebo. Iloprost was intravenously applied for 6 hours daily on 28 consecutive days at an individually tolerated dose up to 2 ng/kg/min. The control group received identical solvent volumes. In addition all patients had an intensive basic, mainly local, therapy. At the end of the treatment in the iloprost group 31 of 50 patients (62%) showed partial (greater than 30%) or total healing of the lesion(s). In the placebo group this was the case in 12 of 51 patients (22.5%). The difference of 38.5% was statistically significant (p less than 0.05, chi 2-test, alpha = 0.05, beta = 0.1). The percentage of patients who were free of pain increased from 23% to 42% (+19%) in the iloprost group and from 38% to 48% (+10%) in the placebo group. After dose-titration iloprost was well tolerated. Flush, headache and abdominal complaints were the most frequent side effects. Heart rate and blood pressure were not influenced and the control of diabetes was not altered.

In 15 patients (13 men, two women, mean age 63 [47-75] years) with peripheral arterial occlusive disease in stages IIB-IV (Fontaine) intravascular ultrasound findings were compared with the angiographic results before and after treatment. In 12 patients stenosis (n = 10) or occlusion (n = 2) of the iliac artery (n = 2) or the superficial femoral artery (n = 10) were treated by conventional balloon angioplasty; in three patients with occlusion of the superficial femoral artery excimer laser angioplasty was performed. There was good correlation between measurements of vessel diameter by the two techniques (r = 0.93, P less than 0.001). Ultrasound scanning provided additional informations regarding the thickness of the plaque, the density or firmness of the stenosis and the degree of calcification. The therapeutic outcome was quantified by measuring the gain in lumen diameter. The authors also assessed the morphological changes following angioplasty in the vicinity of the obstructing plaque. In the light of the ultrasound findings it was considered necessary to undertake further dilatation in four out of the 12 patients treated by balloon dilatation. The results indicate that intravascular ultrasound imaging is a valuable complement to angiography for monitoring of therapeutic results after vascular interventions.

Only 9 of more than 900 operated patients with ventricular septal defects suffered from this rare combination. The problems of the diagnosis are discussed. Only in one case this diagnosis was made praeoperatively, in 6 cases intraoperatively and in two cases only postoperatively. In the last two cases a reoperation was necessary. The surgical methods are described and the results of surgery are communicated.

The Doppler ultrasonic method can confirm the success of the operation in the early post-operative phase after reconstructive vascular operations as an essential non-invasive technique or clear a doubtful improvement of the blood flow. Thus an arteriography can be indicated in good time. On the basis of reconstructive cases the usefulness and the advantageous application of the Doppler ultrasonic flowmeter in the operating theater is demonstrated.

The effectiveness of iloprost, a prostacyclin derivative, was assessed in a placebo-controlled multicentre trial on 101 patients with chronic arterial disease, stage IV. All patients were on a basic local treatment, 53 randomly being assigned to the iloprost group, 48 to the placebo one. Both groups received identical saline infusions, one with the other without iloprost. Infusions were given on 28 consecutive days, iloprost being added at a dose of up to 2 ng/kg.min over six hours. At the end of the treatment period, 32 of 52 patients (61.5%) of the iloprost group and eight of the 47 in the placebo group (17%) had partial or complete healing of ulcers (P less than 0.05), the treatment effect persisting in both groups for a mean duration of at least one year. Iloprost was well tolerated, once individual dosages had been appropriately adjusted. Facial flushes, headache and nausea were the most common side effects. Heart rate and blood-pressure variations did not differ between the two groups.