[Prevention of acute stress hemorrhages of the upper gastrointestinal tract with pirenzepine and antacids. A controlled comparison between pirenzepine and cimetidine]

H2-antagonists, antacids and pirenzepine are effective drugs for prophylaxis of stress ulcer bleeding. Combined medication seems to be superior to single medication, but investigations of the effectiveness of a pirenzepine-antacid prophylaxis have not been carried out. We therefore evaluated the effect of this combination on gastric pH and on prevention of stress bleeding in ICU patients. In a prospective controlled randomized study 33 patients in each group received 50 mg. pirenzepine intravenously as a basic medication and alternatively 2000 mg. cimetidine i.v. or 2-hourly 10 ml. antacid. Gastric pH was determined three times per day. Stress bleeding was defined as bloody gastric juice, haematemesis or melaena. Two stress bleedings could be detected in each group. The pirenzepine-antacid combination proved to be superior to ensure a gastric pH of more than 3.5 than the pirenzepine-cimetidine group. After removal of the nasogastric tube the 2-hourly application of antacids proved to be impracticable.

[Preoperative phase of limited normovolemic hemodilution]

In 35 cases, the attempt is made to present hemodilution as an appropriate means of hepatitis prophylaxis and blood sparing in patients having to undergo selective orthopedic or oral surgery. Especially in hospitals which cannot afford the expensive methods of autotransfusion, this method which is easy to perform from the technical and practical point of view offers a possibility of markedly reducing the transfusion rate of whole blood. Taking into account possible contraindications, this method is to be considered in all patients undergoing selective surgery where the general condition of the patient is sufficient and a blood loss of 1000-1500 ml is not exceeded.

Single-drug and combined medication with cimetidine, antacids and pirenzepine in the prophylaxis of acute upper gastrointestinal bleeding

For an analysis of the risk factors for stress bleeding, 24 risk factors selected from 202 clinical parameters were analysed, and their values determined in 586 medical and surgical intensive-care patients treated for at least six days between 1975 and 1980, who received no prophylactic medication. In 420 patients who received a prophylactic treatment with 800 mg or 1200 mg cimetidine, 2-hourly 30 ml antacids or 30 mg pirenzepine individually or in combination, the total risk scores were determined as the sum of the risk factors. This risk score served as the unit for comparison of the prophylaxis groups. Combined medication with two or three drugs proved to be significantly superior to treatment with either of the medicaments given alone.

[Correction of amino acid imbalances as adjuvant therapy in septic peritonitis]

A prospective and randomized study was performed in 18 patients with septic peritonitis to investigate the behavior of free amino acids in serum before and during parenteral nutrition with 2 different amino acid solutions. One group received a so called "liver-solution" with 45% branched chain amino acids and reduced aromatic and sulphur-containing amino acids, the other group a conventional solution with 10,5% branched chain amino acids. Amino acid imbalances typically in sepsis--elevation of aromatic and sulphur-containing amino acids as well as alanine and proline, normal or decreased branched chain amino acids--could be observed only to some extend, because the influence of preceding operative trauma was overlapping. However, with conventional parenteral nutrition these imbalances then became clearly apparent. On the other hand, in patients treated with the special amino acid solution nearly complete normalization of amino acid levels took place. This effect was mainly due to the increased supplementation of branched chain amino acids positively influencing protein metabolism, and less produced by the changes in amino acid proportions supplied. Clinically these patients also had a clear improvement of consciousness status. The positive effect of such balanced solution on amino acid metabolism and mental situation of septic patients could be confirmed. Their use in septic peritonitis during necessary parenteral nutrition as an adjunctive treatment therefore seems to be efficient.

Die Korrektur von Aminosäurenimbalanzen als adjuvante Therapie bei septischer Peritonitis

In einer prospektiven und randomisierten Studie wurden bei 18 Patienten mit schwerer septischer Peritonitis die freien Aminosäuren im Serum vor und während einer parenteralen Ernährung mit 2 verschiedenen Aminosäurenlösungen untersucht. Eine Patienten-gruppe erhielt eine sogenannte Leberlösung mit 45%igem Anteil verzweigtkettiger Aminosäuren bei Reduktion der aromatischen und schwefelhaltigen Aminosäuren, die andere Patientengruppe eine konventionelle Lösung mit einem 10,5%igem Anteil von verzweigtkettigen Aminosäuren. Die typischen Aminosäurenimbalanzen bei Sepsis – Erhöhung der aromatischen und schwefelhaltigen Aminosäuren sowie von Alanin und Prolin, gleichzeitig normal bis erniedrigte verzweigtkettige Aminosäuren – waren bei den Patienten vor der parenteralen Ernährung nur bedingt zu beobachten, da sich der Einfluβ des vorhergehenden operativen Traumas überlagerte. Bei parenteraler Ernährung mit einer konventionellen Aminosäurenlösung traten im weiteren Verlauf diese Imbalanzen jedoch deutlich auf. Bei den Patienten, die mit der speziellen Aminosäurenlösung behandelt wurden, stellte sich hingegen eine weitgehende Normalisierung der Aminosäurenwerte ein. Dieser Effekt beruhte dabei weniger auf den veränderten Zufuhrraten als vielmehr auf einer günstigen Beeinflussung des Proteinstoffwechsels durch die vermehrt zugeführten verzweigtkettigen Aminosäuren. Klinisch zeigte sich bei diesen Patienten auch eine deutliche Besserung der Bewuβtseinslage. Der günstige Effekt derart bilanzierter Lösungen auf den Aminosäurenstoffwechsel und die mentale Situation septischer Patienten konnte somit bestätigt werden. Ihr Einsatz bei septischer Peritonitis im Rahmen der notwendigen parenteralen Ernährung als adjuvante Therapie erscheint daher sinnvoll.

[Drug side effects as the probable cause of death. Results of the Berne Comprehensive Hospital Drug Monitoring Program]

During the years 1974-1980, 19 of 17,285 inpatients of the divisions of internal medicine of two teaching hospitals showed a probable or definite adverse drug reaction (ADR) which was considered to be a major cause of death. In 7 patients the decisive ADR occurred during the hospital stay. The overall mortality from ADR is 0.040%. For each therapeutic group of drugs the following rate of drug-related death was calculated: for anticoagulants 0.047% (3/6378 inpatients), for cardiac glycosides 0.016% (1/6368), for analgesic/antirheumatic drugs 0.014% (1/7112) and for cytostatic drugs 0.38% (2/531). In 12 patients the ADR was already present on hospital admission.

Morphological changes in "dry eye syndrome"

The authors present the pathologic changes of the conjunctiva in "dry eye syndrome". They state that stratification of the epithelial cells and microplicae, change in the goblet cell population, and inflammation of the basal tissue cannot be regarded as characteristic symptoms.

[Diagnostic accuracy of pulmonary vessel blood flow assessed by roentgenography--a comparison with haemodynamic data (author's transl)]

The article reports on an examination of the diagnostic accuracy in assessing the pulmonary vessel blood flow via x-ray films of the thorax in 323 children by means of a comparison with the haemodynamic data of four examiners, on the basis of a Yes/No (True/False) decision. Overall accuracy in the total group of examined children--depending on the experience of the examiners--was 60 to 66%; in children below 2 years of age, it was 63-69%, and in children over 2 years old it was 59-65%. In a Left-Right Shunt smaller than 35%, accuracy was between 33 and 63%; if the Left-Right Shunt was greater than 57%, it was 81-97%. Diagnosis of reduced pulmonary blood flow proved more difficult than of an enhanced flow. Sensitivity of the examination method was 53-71%, whereas its specificity was 57-70%.

[Allergic alveolitis as a result of mold on the bedroom wall]

A 23-year-old woman patient became seriously ill with the typical signs and symptoms of allergic alveolitis and with deep hypoxemia during exercise. A broad spectrum of positive precipitating antibodies was found in the serum, mainly against Penicillium casei and Aureobasidium pullulans. Although she was intensively questioned on hobbies and on possible antigens at home and at work, it was only possible to trace an antigen source after a controlled antigen free period away from home in another environment and after a controlled reexposure experiment at home: it proved to be a patch of mould of 0.5 m2 on the bedroom wall. The filaments and the spores of the fungi of the mould were shown directly by microscope. Precipitating antibodies were also present against these fungi. After several antigen-free months (the patient moved into a dry and sunny new apartment) the threatening respiratory failure (severe hypoxemia during exercise) disappeared completely together with the clinical signs and symptoms. Thus, mould on bedroom walls may constitute a threat and should be considered in cases of allergic alveolitis of apparently unknown origin.

[Correlation between the placental surface and the maturity of the newborn]

Morphometrical method of determination of the surface of the vili of placenta is described. The average of the surface of placental vili in normal pregnancy appeared to be - 12,14 +/- 2,27 m2. This valued in toxaemia of pregnancy - 9,25 +/- 1,52 m2, and in cases of dismaturation 7,62 +/- 0,98 m2. It was established that the morphometrical method was sensitive and suitable for the study of the relationship between the surface of the placenta and intrauterine development of the foetus. This was evidenced by the fact that surface of the placenta of low weight newborns (10-25%) and that of the newborns with overweight (75%) had shown a significant difference. These findings are not in accordance with the data reported in the literature.

Study on cellular immune response after complicated cataract operations and in sympathetic ophthalmia

The authors studied the development of the cellular immune response following extracapsular, traumatic and uveitic cataract extractions as well as in cases of sympathetic ophthalmia. In order to detect the cellular sensibility the blast transformation method and the migration test with lens and iris antigen were applied.

[Cellular immunity in Sjögren's syndrom (author's transl)]

The authors made cellular immunological investigations with lacrymal and salivary gland antigens on 11 Sjögren's syndrome patients. The changes following the immuno-suppressive treatment were observed by the blasttransformation of the lymphocytes and by the inhibition of the leuckocyte migration.

[Psychological problems in obesity (author's transl)]

The MMPI was administered to 209 obese women and 72 obese men before onset of a weight reduction regime. Obese subjects differ in a variety of MMPI-standard-scales from the standard population as well as from a control group of healthy women: 1. Scales Hypochondriasis (Hs) and Hysteria (Hy) have significant higher values for the obese. This somatic impairment grows in the group of obese women with increasing age and obesity. In men, scale Hs corresponds to the degree of overweight but the youngest male age group (up to 19 years) has a Hs-peak as well as men above 35 years of age. 2. Higher than normal values for obese men and women in scales Depression (D) and Psychasthenia (Pt) in the obese point towards emotional upset. 3. Obesity does not decrease Hypomania (Ma) values for men or women; to the contrary: obese men felt more active than the standard population. With growing age women had a decrease in Ma-values.