Assessment of the nephrotoxic potential of ceftazidime and a ceftazidime/tobramycin combination in volunteers

Ten informed healthy volunteers with normal renal function received 2 X 3.0 g ceftazidime intravenously for three consecutive days. Four weeks later, ceftazidime was combined with 1 X 3 mg/kg body weight tobramycin, administered intramuscularly, for three consecutive days. The effect of the two treatments on parameters used to assess renal function was examined prior to administration, during administration for three days and for a follow-up period. Alanine-aminopeptidase (AAP) levels in 24 h urine samples were measured in addition to kidney function parameters. The urine from the volunteer who had shown the highest AAP levels in each series was examined by ultracentrifugation for the presence of membrane particles with AAP activity. Ceftazidime showed no effect on the proximal tubular membrane. No increased elimination of AAP could be demonstrated. The kidney function parameters remained unchanged. The combination of ceftazidime with tobramycin led to a cumulative increase in AAP activity which was not significantly different from the increase observed when the same dose of tobramycin is administered alone. No additive effects could be demonstrated. Ultracentrifugation showed no indication of an impairment of the membrane integrity when ceftazidime was administered alone or in combination with tobramycin.

[Clinical studies of intra-articular injections of Arteparon. Retrospective study following the treatment of 754 patients]

Glycosaminoglycan polysulfate (GAGPS = Arteparon) is used for the treatment of degenerative joint diseases; it inhibits enzymes that dissociate ground substance, e.g. hyaluronidase, beta-glucuronidase, and acid phosphatase. In turn, an improved synthesis of hyaluronate from the synovial lining cells to hyaluronic acid increases viscosity (Verbruggen and Veys 1977). From January 1975 to December 1979, in the Orthopedic Division of the Clinic "St. Elizabeth" in Saarlouis, West-Germany, we treated 754 patients with a total of approximately 8000 intra-articular injections of Arteparon. The problem with drugs influencing the metabolism of joint cartilage is that the results cannot - for obvious reasons - be as conspicuous as e.g. with corticoid injections, although the latter sometimes involve also marked side-effects. After several courses of therapy, on the other hand, the cartilage-protective effect of Arteparon becomes apparent, with an effect lasting for several months. The indications to include the patients into our study were: arthrosis and other cartilage disorders that had been diagnosed prior to onset of therapy by means of either X-ray, surgery, arthrography etc. Therapeutic results were measured by the parameters: subsidence of pain, recession of edema, improved joint motion, etc. Arteparon, applied intra-articularly, was well tolerated; local irritation, and swelling of the treated joints were reported in only 4.7% of the treated cases; the therapeutic overall result was good. Occasionally, a case of headache was observed, however, no case of joint infection was reported.

Insertion tendopathy in athletes. A light microscopic, histochemical and electron microscopic examination

Tendon tissue of eleven athletes suffering from insertion tendopathy and of two controls was examined. Part of the tissue was prepared for routine light microscopy, a part for enzyme histochemical staining of Nicotinamide-adenine-dinudeotide-diaphorase (NADP-diaphorase), lactate dehydrogenase (LDH), beta-glucuronidase and alkaline phosphatase. Small pieces of tissue were also prepared for electron microscopic examination. The removed tissue was edematous and mushy. The normally densely packed parallel or interwoven collagen bundles were loosened by edema, focal necrosis or hemorrhage. Infiltration of fatty tissue and granulation tissue was also present. The amount of acid mucopolysaccharides was markedly increased. The histochemical studies showed strong enzyme activity of NADP-diaphorase and LDH in normal tendon tissue as well as around areas of degeneration and in granulation tissue. beta-Glucuronidase and alkaline phosphatase was present, but in general with lesser activity than the above enzymes. The electron microscopic examination revealed marked degeneration of the fiber systems, focal necrosis, deposit of amorphous masses and mucopolysaccharides and focal mineralisation. The reparative zones showed proliferating capillaries, often with a collapsed lumen and prominent endothelial cells and basement membranes.

[Acute effects of low carbon monoxide concentrations on blood rheology, platelet fuction, and the arterial wall in the minipig (author's transl)]

While investigating the initial effects of low carbon monoxide concentrations on haemorheology and the arterial wall, minipigs were exposed to CO-air mixtures with 160, 185, and 420ppm CO. The daily exposure time was 4h. Exposure to 160 and 185 ppm CO led to a significant increase of platelet aggregation. Four hundred twenty parts per million CO caused an increase in haematocrit, blood and plasma viscosity, and in platelet aggregation. When examined by light microscopy, there were no changes in the arterial wall, whereas scanning electron-microscopic examinations revealed adhesions of shape-changed platelets on the arterial endothelium in some cases already after a single 4-h exposure to 160 or 185 ppm CO. After 4 x 4-h exposures to 420ppm CO there were mixed microthrombi on the arterial endothelium. According to preliminary transmission electron-microscopic studies these adhesions of platelets and also adhesions of mononuclear elements can always be related to foci of degeneration in the endothelial cells. These examinations showed that low concentrations of carbon monoxide can cause both haemorheological and morphological changes in the arterial wall. The further development of these changes under chronic CO exposure and a possible significance of the environmental hygiene beyond cigarette smoking has to be clarified by long-term experiments.

Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images

In the present report a score system is introduced with the aim of analysing routine angiographic images. The system consists of a vectorial score, which codes the pattern of occlusions, stenoses and plaques, and of an additive score describing the severity of the lesions visualised. The technique is suitable for computerised data analysis.

[Eighteen years' experience of thrombolytic therapy with streptokinase (author's transl)]

18 years clinical experience with thrombolytic therapy has shown that venous and arterial thrombotic occlusions which persist not only for a few days but also for weeks and 2 to 4 months can be dissolved in about 60-70% of the cases by intravenous infusion of streptokinase. Although this treatment is one of the great break-throughs of internal medicine in this century it is not yet in general use. The reason for this is that the risk of a deleterious bleeding is difficult to assess. This and also the numerous contraindications can be diminished by direct infiltration of an intravasal clot with a relatively small amount of streptokinase through a catheter.

[Changes in the relation between therapist and group in the phases of intended dynamic group psychotherapy]

The progress of a group under intended dynamic direction was recorded over a period of 65 hours on the basis of interaction frequencies and directions as well as interaction contents and styles. It could be demonstrated that by means of this relatively simple or global approach an adequate and sufficiently sensitive picture of the therapist/patient activities and their phase-specific change could be reflected. On the basis of an example of a cohesive group, the change in significance of the therapist postulated in our conception and the interaction process between group, therapist and patient could be confirmed. The data obtained for the individual hours have been condensed for a demonstration of the phase-typical course.

[Low dose thrombolytic treatment for revascularisation in arterial occlusion (author's transl)]

Acute and subacute arterial occlusions of between 4.5 and 29 cm long could be dissolved in 11 patients by infiltration of small amounts (4000 to 110 000 U) of streptokinase or urokinase directly into the thrombus using a catheter. Use of a Grüntzig catheter enabled dilatation of possible stenoses during the same session. In 3 femoro-popliteal obliterations where lysis and catheter dilatation did not lead to sufficiently patent lumina occlusion recurred. In 3 patients with wide-ranging obliteration of the femoral, popliteal and almost all the arteries of the calf almost complete revascularisation could be achieved. Only transient slight side effects of lysis and coagulation disturbances were observed systemically. For prophylaxis of reobliteration platelet aggregation inhibitors are given for pre- and long-term aftercare.

How often does peptic ulcer produce "typical" ulcer symptoms?

Subjective symptoms of 876 hospitalized patients who underwent upper fiber-panendoscopy were evaluated in a prospective study. Ulcer-like symptoms were defined as pain-like discomfort with a regular food-related rhythm. These symptoms indicate ulcer disease with high specificity (96%) but low sensitivity (28%). In particular old patients with second disease rarely have ulcer-like symptoms. In spite of their high specificity, however, ulcer-like symptoms are not proof of active ulceration. Patients with scars but no ulcers may also have ulcer-like symptoms.