[Results of clinical trials with the cation exchange preparation campanyl in the therapy and metaphylaxis of calcium-containing urinary calculi (author's transl)]

The efficacy of the cation exchange preparation Campanyl (T1286) was tested in the treatment and metaphylaxis of calcium-containing urinary calculi. For this purpose, in vitro experiments, animal exeriments, orienting clinical studies in 79 patients, and a long term clinical trial in 42 patients over 12 months were undertaken; 22 of the latter patients are also still being treated with the cation exchange preparation, the observation period for 15 patients being 3 1/2 years and 2 1/2 years for 7 patients. As a result of these studies a lowering of the medium calcium excretion and a reduction of calculus discharge by more than half was achieved in the patients being treated with the cation exchanger, without restriction of calcium in the diet. There was not yet seen litholysis. Serious side effects or an influence on the serum electrolytes was not recorded with Campanyl (T1286).

[Effect of nutrition on composition of calculi in the animal experiment. III. Cation exchangers, anthraquinones, diphosphates, methylene blue]

Medicamenty and compounds used in the metaphylaxis of urinary calculi were tested on an animal model for objectifying the effect. Kation changers, anthrachinones, diphosphates, and methylene blue were used.

Treatment of hypercholesterolemia with Secholex. A long-term clinical trial and comparison with cholestyramine

The efficacy of an anion-exchange gel, Secholex, as a hypocholesterolemic agent was assessed in 46 patients in 4 different studies and the effects were compared with those of cholestyramine. All patients had severe Type II-a or II-b hyperlipoproteinemia. In short-term metabolic studies Secholex (15 g/day) and cholestyramine (16 g/day) decreased serum cholesterol levels and increased total fecal sterol output and serum methyl sterol concentration to a similar extent, but cholestyramine was more effective than Secholex in increasing fecal bile acid excretion. In crossover studies, the two drugs appeared to be equally effective in lowing serum cholesterol levels but the patients mostly preferred Secholex. Twenty patients were treated with Secholex over a two-year period. The average decrease in serum cholesterol levels from the mean pretreatment value of 406 mg/100 ml was 15% during the first year, and 13% during the second year. In 5 patients the serum cholesterol was permanently lowered by more than 20% (good responders), while in 7 patients the average reduction of serum cholesterol level during Secholex administration was less than 10% (non-responders). The serum triglyceride level was slightly decreased by Secholex in Type II-b patients but was unaltered in Type II-a patients. At the end of the treatment period, serum iron and vitamin B12 levels were normal but the serum folic acid concentration was reduced in eight of 20 patients. A dose--response study indicated that a similar cholesterol-lowering effect was obtained with daily doses of 9 and 15 g of Secholex. It is concluded that Secholex is a relatively safe drug which effectively reduces serum cholesterol levels in two-thirds of patients with severe hypercholesterolemia.

[Carbromal intoxication: influence of hemodialysis and hemoperfusion]

It has been demonstrated with an in vitro model that hemoperfusion through Amberlite XAD4 or coated charcoal containing cartridges eliminates carbromal and its ureid derivatives more efficiently than hemodialysis. The following clearancs were measured in vitro (blood flow: 200 ml/min): Coil dialyser (1 m2): 55-85 ml/min, charcoal hemoperfusion 100-125 ml/min, Amberlite XAD4 hemoperfusion: 200 ml/min. The data of one patient who had been hemoperfused after the ingestion of 35 g Carbromal with the Haemocol cartridge (SMith & Nephews) are depicted. Our results permit to draw the conclusion that hemoperfusion at this time is the most efficient means to eliminate Carbromal from intoxicated patients.

Changes in plasma lipoproteins in subjects treated with the bile acid-sequestering resin polidexide (Secholex)

The effects of a new anion-exchange resin, polidexide, 3-30 grams/day, on plasma lipids and lipoproteins have been studied in one normal subject and in three hyperlipidaemic patients. Plasma cholesterol concentrations were significantly reduced in all subjects over 80-120 days of therapy by amounts ranging from 14 to 20%. Plasma triglyceride concentrations increased in two patients with pre-existing hypertriglyceridaemia. Plasma apolipoprotein-B concentrations were reduced in all subjects. Cholesterol and apo-B concentrations in low density lipoproteins were reduced in all subjects, while triglyceride concentrations in very low density lipoproteins were increased in 3/4 subjects; Changes in high density lipoproteins were quite variable.

Role of hyperkalemia in the metabolic acidosis of isolated hypoaldosteronism

We studied the relative importance of hyperkalemia and mineralocorticoid deficiency in the metabolic acidosis of a patient with proved isolated hyporeninemic hypoaldosteronism and moderate kidney failure. The hyperkalemia and acidosis were severe in relation to the slight azotemia. Despite the systemic acidosis and urinary pH of 4.9, urinary ammonium excretion was distinctly blunted. Correction of the hyperkalemia by potassium-sodium exchange resin alone resolved the acidosis and restored the previously diminished urinary ammonium excretion to normal. Administration of mineralocorticoids only partially corrected the hyperkalemia and the acidosis. Hyperkalemia by itself, rather than hypoaldosteronism per se, caused the acidosis in this patient. Hyperkalemia apparently suppresses urinary ammonium excretion and thus interferes with urinary acidification.

[Double blind test with a protective ointment (Ivosin) on the hands of cement workers]

56 builder's labourers manipulating lime cement applied a protective cream on their hands and 57 used a placebo in a double blind test of two months' duration. The labourers, the doctors who surveyed the condition of their hands, and the statistician who analyzed the results knew only that one cream had a blue label, and the other a green one. Before and after the test, the presence or the absence of certain symptoms on the hands were objectively examined, while the subjective opinion of the labourers was registered at the end of the test. As usual in tests of that kind, the great majority of the labourers (more than 75%) were satisfied, 62% of them acknowledged an improvement. That percentage justified a comparative double-blind study that revealed a much higher quota (86% of the test persons) of satisfaction among the labourers treated with Ivosin than in the placebo group (66%). That difference was statistically significant. On the other hand, no objective difference could be revealed between the two groups. It was impossible to discover among the symptoms studied, any objective cause of that subjective difference.

[Diagnosis and treatment of disorders of the potassium balance with special reference to infusion therapy]

Following a short review of the physiological regulation of body potassium diagnostic procedures to detect disturbances in potassium balance are cited. The limited value of serum potassium concentration is emphasized. Possible caused of potassium deficiency and prophylactic measures to prevent negative potassium balance are summarized including oral and parenteral potassium administration. A synopsis of the causes of hyperkalemia is followed by a description of therapeutical measures. Chronic hyperkalemia may be treated by oral or rectal administration of ion-exchange resins, while acute lifethreatening hyperkalemia is corrected by infusion of isotonic saline, glucose and insulin, and calcium gluconate as well as by correction of metabolic acidosis with sodium bicarbonate. In patients with intact renal function these measures will generally result in rapid correction of increased serum potassium levels.

Effect of sodium cellulose phosphate therapy on crystallization of calcium oxalate in urine

Effects of oral sodium cellulose phosphate therapy (5 g three times a day with meals for 4 days) on renal excretion of oxalate and on the crystallization of calcium oxalate in urine were examined in six patients with absorptive hypercalciuria on a constant metabolic dietary regimen. During treatment, urinary oxalate increased by 9-50 mg/day. However, urinary calcium decreased by 138-225 mg/day (50%-70%). Thus, the state of saturation of urine with respect to calcium oxalate decreased or did not change significantly. There was no consistent or significant change in the formation product ratio (limit of metastability) or in the crystal growth of calcium oxalate in urine.

Potassium. The intracellular cation

Normally the concentration of potassium in the extracellular space is maintained within relatively narrow bounds; in disease, these boundaries may be exceeded. Hyperkalemia and sometimes hypokalemia must be considered medical emergencies, to be treated promptly, effectively, and appropriately.

Treatment of pruritus in cholestasis of pregnancy with a new anion exchange resin (Secholex)

Anion exchange resins form a non-absorbable complex with bile acids in the intestine, thus removing bile acids from the enterohepatic circulation and facilitating bile acid excretion in the faeces. A new bile acid sequestrant (PDX chloride, Secholex) was evaluated for the relief of pruritus in cholestasis of pregnancy (CP) in 31 women. CP was verified by the presence of the abnormal lipoprotein X in serum and the clinical series was divided into two degrees of severity, pruritus gravidarum (PG) and hepatosis of pregnancy (HP) based on liver function tests. Eleven of 31 women discontinued treatment because of gastro-intestinal side effects. Of the 20 women continuing the study for more than one week, all with a milder form of cholestasis, PG (n=8), experienced relief of pruritus, while some relief was obtained in 75% of the women with HP. After up to 4 weeks administration of Secholex, no obvious interference with fat absorption was evident judging from the serum lecithin content of linoleic and arachidonic acids. A reduction in serum folic acid might indicate an interaction in folic acid absorption. An expected reduction in serum cholesterol levels which are characteristically increased in CP, was not achieved by the administration of Secholex.

Effect of treatment with a bile-sequestering agent (Secholex) on intestinal absorption, duodenal bile acids, and plasma lipids

Four female and five male patients (mean age 26 years) with hyperlipoproteinaemia type II A were treated with an anion exchange gel (Secholex) 9 g/day for 3 months and 15 g/day for 9 months. After these 12 months clofibrate 1.5 g/day was added to the therapy in 6 patients, whereas 2 patients continued with the resin alone for another 6 months, and one was withdrawn from the trial because of pregnancy. During the first year plasma cholesterol decreased averagely 18% from a mean pretreatment value of 461 mg/100 ml. Dosis of 9 g/day seemed to be as efficient as 15 g/day. When clofibrate was added, a further decrease of plasma cholesterol by 6% was observed, and the levels of triglycerides were reduced. Significantly increased concentrations of bile acids and a rise in the glycine/taurine ratio in duodenal aspirate were caused by the resin. On combined treatment the concentration of bile acids decreased to the pretreatment values, whereas the glycine/taurine ratio remained unchanged. During the trial slight transient changes in serum folic acid, fasting insulin, calcium, alkaline phosphatases, and vitamin B 12-absorption occurred. No changes in serum vitamin A, vitamin-K-dependent clotting factors, serum gastrin, gastric acid output, the absorption of glucose and iron, and faecal excretion of fat were observed. Serum insulin 30 and 60 minutes after an oral glucose loading decreased in the patients on combined treatment, whereas the insulin response remained normal in patients taking Secholex alone. Liver function tests and creatinine were unchanged during the trial. Apart from transient abdominal discomfort in two patients, no side-effects were discovered. The patients found the gel palatable.