[Iloprost in the treatment of ischemic tissue lesions in diabetics. Results of a placebo-controlled multicenter study with a stable prostacyclin derivative]

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.

Accumulation characteristics of human colon carcinomas after monoclonal antibody ex vivo perfusion

Human colon carcinomas were operatively resected and the tumour-bearing segments interposed into an oxygenised ex vivo perfusion system. Pressure, flow, temperature, pH and metabolic parameters were controlled. Over a period of 45 min the 131I-labelled monoclonal antibody AUA1 was administered and its distribution in the tumour tissue analysed scintigraphically. The accumulated activity was determined in different tissues. The results showed that the AUA1 uptake increased with the degree of histological tumour differentiation. The main tumour:non-tumour ratio reached 0.8 in poorly, 4.1 in moderately and 5.9 in highly differentiated adenocarcinomas. Introducing the oxygenised erythrocyte-enriched perfusion media significantly increased the viability of the colon tissue. The ex vivo perfusion system will help to analyse factors determining monoclonal antibody accumulation in human colon carcinomas.

[Iloprost, a stable prostacyclin derivative, in stage 4 arterial occlusive disease. A placebo-controlled multicenter study]

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.

[Results and critical analysis of the treatment of obesity with the intragastric balloon]

In 54 patients with excessive obesity a silicone balloon was implanted endoscopically into the stomach. The overweight amounted to 76% (median) by Broca's formula. The therapeutical plan included balloon-implantation, dietary treatment, psychotherapeutical guidance, kineto-therapy and balloon-extraction. According to their therapeutical compliance there were three different groups of patients: G1 - maintenance of therapy; G2 - discontinuation of therapy; G3 - no additional therapy at all after balloon implantation. Up to the sixth week a weight reduction of 9.5-20.5 kg could be demonstrated in all groups. Only in the first group a further weight reduction by a mean of 20 kg after 20 weeks was noted. Patients in group 2 and 3 - in some the balloon was still implanted - had a renewed weight increase sometimes surmounting the original weight.

COMPLICATIONS

3 gastric respectively duodenal ulcers, one subileus. The long-term success can only be obtained by a multi-component therapy plan.

The influence of long-term application of isoproterenol on the results of temporary ischemia of the rat heart muscle

The results presented demonstrate that long-term application of small doses of isoproterenol produces an adaptive reaction in the heart muscle with increase of its tolerance of oxygen deficiency induced by temporary ischemia. After adapting animals in the described manner muscle necrosis appears delayed and to a smaller extent. Our results also emphasize the view that the definitive myocardial damage is determined by the secondary disturbances of microcirculation. Furthermore, our findings support the idea of a pharmacologically induced adaptation of the heart muscle resulting in an increased tolerance of ischemic injury.