[Therapeutic efficacy and tolerance of a new drug, sodium diclofenac, in inflammatory and metabolic rheumatism]

A new antirheumatic, non-steroid drug, sodium diclofenac (Voltaren Geigy) has been experimented in 14 patients aged between 27 and 69 hospitalized at the IInd Medical Division of Enna Hospital. The patients were divided into three groups suffering from: rheumatoid arthritis, scapulohumeral periarthritis, uratic arthritis, and rheumatic carditis in active phase. In almost all treated cases, the drug proved to have good therapeutic effectiveness demonstrated by complete remission or attenuation of clinical symptomatology and by the return to normal or reduction in the various modified biohumoral indices; in all cases treated, good tolerance, absolute lack of side-effects and toxicity. Special attention has been paid to study of possible changes to gastric mucosa by means of careful evaluation of endoscopic and histological findings.

Nitroglycerin-induced improvement in exercise tolerance and hemodynamics in patients with chronic rheumatic heart valve disease

Nitroglycerin reduces elevated left ventricular filling and pulmonary arterial pressures in resting patients with rheumatic valve disease and reduces symptoms when given over long periods to patients with primary myocardial disease. To determine whether nitroglycerin may prove effective therapeutically in ambulatory patients with heart valve disease, its effects on hemodynamics and exercise capacity were studied in 11 severely symptomatic adults who were already receiving optimal treatment with digitalis and diuretic agents. Seven had predominant mitral valve disease, one had predominant aortic insufficiency and three had equally severe mitral and aortic valve disease. Maximal exercise capacity was assessed with graded treadmill exercise after placebo and after nitroglycerin (0.5 mg sublingually) administered in random sequence to each patient. Exercise capacity (exercise time to limiting fatigue or dyspnea) increased from a mean of 8.3 minutes after placebo to 9.8 minutes after nitroglycerin (P less than 0.005). Eight patients were studied hemodynamically during further intense treadmill exercise. Pulmonary arterial pressure was significantly lower (P less than 0.05) after nitroglycerin than after placebo (mean 44 versus 56 mm Hg), but cardiac output was greater after nitroglycerin (5.0 versus 4.6 liters/min, P less than 0.005). Thus, nitroglycerin appears to increase exericse tolerance and improve the hemodynamic response to exercise in patients with heart valve disease and may be valuable in the long-term pharmacologic therapy of such patients.

[Effect of rapid digitalization on the left-ventricular myocardial function according to the echocardiographic data]

The article deals with the data of echocardiographic examination of 61 patients (37 with rheumatic heart disease and 17 with atherosclerotic cardiosclerosis) subjected to rapid stage-by-stage digitalization by intravenous administration of various rapidly acting glycosides. In 10 patients with ischemic heart disease echocardiography was performed following a single strophanthin injection. Decrease in the volumes of the left ventricle and increase in the indices of central hemodynamics were noted as a result of rapid stage-by-stage saturation with strophanthin. The maximum inotropic effect of strophanthin does not coincide in time with the maximum chronotropic effect. The increase in the stroke volume noted in maximum deceleration of cardiac contractions is probably realized due to the Frank-Starling mechanism. Strophanthin increases the rate of myocardial contractions without changing the duration of the systole. The rate of diastolic relaxation grows, the phase of rapid filling becomes shorter and the phase of slow filling longer, which creates favourable conditions for the next contraction.

[Effect of treatment with cardiac glycosides and biologically active substances on the state of the lesser circulation according to the electrokymographic data]

Electrokymography was used to assess by pulmonary densograms and pulmonary artery pulse curves treatment-induced changes in cardiac contractility and lesser circulation in 455 patients with rheumatic heart disease and stage IIA, IIB, and III circulatory insufficiency. Treatment with cardiac glycosides in combination with metabolic preparations (ATP methionine, vitamin B12, inosine-F, and extract of the heart muscle) leads to a more conspicuous reduction in the symptoms of congestion in the lesser circulation than that encountered in treatment with cardiac glycosides alone. The reduction in these symptoms following treatment with ATP and heart-muscle extract may be explained not only by improved myocardial contractility but also by the direct vasodilating effect of adenyl compounds.

[Evaluation of the clinical effect of treatment with cardiac glycosides under conditions of ambulatory observation]

Thirty-four patients with rheumatic heart disease and 22 with atherosclerotic and post-infarction cardiosclerosis, signs of stage I-IIB circulatory insufficiency, and disorders of cardiac rhythm (auricular fibrillation) were kept under out-patient care for periods of 6 to 42 months. They all received cardiac glycosides per os in a maintenance dose determined in the clinic after intravenous digitalization. Clinical and echocardiographic examination of the patients was conducted every 4 to 6 months. Depending on the effect of long-term digitalization, all patients were divided into clinical groups in which the causes of the disturbed compensation were determined. The importance of regular doctor's control over proper intake of the maintenance dose of glycosides and its correction depending on each concrete clinical situation is stressed.

[Spiroergometric evaluation of the effectiveness of treatment of cardiac insufficiency with cardiac glycosides]

There were 29 patients with rheumatic heart disease and early stages of cardiac insufficiency under observation. Spiroergometry with the "Ergotest" device was conducted in dynamics to check whether the proper dose of the cardiac glycoside had been chosen. The results attest to the considerable improvement in the spiroergometric indices in patients with early stages of cardiac insufficiency who had been treated with digitalis. Spiroergometry yielded important additional criteria of the effectiveness of digitalization, particularly in individuals with normal or diminished rate of cardiac contractions.

[Clinico-experimental evaluation of therapeutic effectiveness of 1-dihydroxyphenylalanine in circulatory insufficiency]

The indices of central hemodynamics and myocardial contractility were studied by poly- and mechanocardiography in 25 patients with stage I-IIA circulatory insufficiency prior to and after treatment with 1-dioxyphenlalanine. The content of lactic and pyruvic acids in the blood and erythrocyte permeability to 32P were determined at the same time. The activity of the redox enzymes was studied in rats with experimentally induced circulatory insufficiency on the background of 1-DOPA medication. It was established that contractility of the heart and indices of central hemodynamics improved due to the effect of 1-DOPA. A decrease in the lactate concentration and an elevation of the pyruvate level in the blood of patients were noted. In animal experiments increased activity of cytochrome oxidase, succinic dehydrogenase, and alkaline and acid phosphatase in the myocardium was demonstrated.