Revista de medicina interna, neurologe, psihiatrie, neurochirurgie, dermato-venerologie. Medicina interna最新文献

A 3 years' study was performed on a group of 32 patients with systemic scleroderma. 23 of them had digestive manifestations involving the whole digestive tract. The diagnosis was based on the clinical, radiological, echographic, endoscopic and anatomopathological examinations. In the prolonged forms of the disease, successive associations appeared in various segments of the digestive tract, the esophageal one being always the first. In all cases, the digestive manifestations followed the cutaneous involvement and were constantly correlated to Raynaud's syndrome presence. Digestive manifestations did not influence the prognosis of the substrate disease.

The paper reports and assesses the most topical data having led to delimiting the asymptomatic myocardial ischemia as the most precocious form of manifestation of ischemic cardiopathy. The role of asymptomatic myocardial ischemia involvement in angina pectoris, myocardial infarction and serious arrhythmias leading to sudden cardiac death are also underlined from the viewpoint of prognosis severity. Likewise, the authors discuss; the prevalence of asymptomatic myocardial ischemia as a distinct manifestation form of myocardial ischemia; the way of selecting the cases; the anti-ischemic treatment that gave good results in diminishing morbidity and mortality induced by ischemic cardiopathy.

The authors analyze the medicolegal files including 3,786 consecutive autopsies, of which 402 sudden coronary cardiac deaths. Autopsy was completed by histologic examination and toxicologic tests (alcoholemia). In the category of coronary cardiac sudden deaths there were 53 coronary thromboses (13.2%) and 36 recent myocardial infarction (8.95%). In 1,196 (31.6%) of 3,786 alcoholemia determinations the results were positive in 111 (27.6%), the difference between the two frequencies not being statistically significant (t less than 1.96). Alcoholemia was positive in 6 of 53 cases of coronary thromboses (11.3%, p less than 0.01), and in 36 cases of recent myocardial infarction alcoholemia was positive in 7 cases (19.5%; t less than 1.96).

In 94/116 (81%) cases of pure and isolated mitral stenosis (MS), ECO-2D permitted the correct determination of the surface of the mitral opening (SMO). The cases were divided in terms of the SMO size into: extended MS (SMO greater than 2 cm2, n = 28), moderate MS (SMO between 1.1 and 2 cm2, n = 54), and narrow MS (SMO less than or equal to 1 cm2, n = 12). The SMO size influenced significantly the values of several noninvasive indices of the MS severity: the Wells index, the 2-C1DM noise interval, the NYHA class, the cardiothoracic index (expressed as an average, the +/- standard deviation for each group), and also the incidence of the atrial fibrillation, AQRS greater than or equal to 70 degrees, of the radiographic aspect of the pulmonary stasis or of the right cardiac failure (given in percent for each group). Anyhow, none of these parameters, taken alone, permitted the correct assessment of the MS severity. The sensibility, specificity and predictive value of the above-mentioned criteria were not sufficient for the detection of the narrow MS (SMO less than or equal to 1 cm2). ECO-2D is the most exact noninvasive method for appreciating the anatomical state of the mitral valvular apparatus in MS and for selecting the patients for the surgical correction.

Of a group of 272 patients subjected to gastric resection for gastric-duodenal ulcer, the "dumping" syndrome was found in 46 (17%). The most frequent (39.7%) was in the Reichel-Polya anastomosis type and the less frequent (9%) in pyloroplasties. The test of induced hyperglycemia by ingesting 15 g/kg body glucose did not show differences in the values of the maximum glycemia in the patients with the "dumping" syndrome versus the other group. The surface of the anastomosis opening and the length of the gastric stump were appreciated with a central imaging endoscope. The surface of the anastomosis opening was found larger in those with a "dumping" syndrome and Reichel-Polya's resection, although the differences are not statistically significant; likewise, there seems to be a less length of the gastric stump and a higher weight difference in those with the "dumping" syndrome. The lack of pyloric sphincter seems to be very important in producing the "dumping" syndrome due to the fact that the alimentary bolus is not fractionated and its sequential evacuation in duodenum and jejunum does not take place.

In 48 patients (p) with hypertensive crisis (HC) the effect of nifedipine (N) sublingual 10-20 mg alone (group I, n = 19, mean control AH +/- SD 232 +/- 15.3/132.5 +/- 4.9 mmHg) or associated with furosemide and clonidine (group II, n = 29, AT 249 +/- 21/131.8 +/- 13.6 mmHg). In both groups the AT fell significantly starting five minutes after the administration of N (except diastolic AT in group II); the values measured at 45 min. being 177 +/- 32/105.4 +/- 13 mmHg in group I and 164.6 +/- 44.4/100.1 +/- 16.3 mmHg in group II (the mean proportional difference at 45 min. for systolic AT was 24.6 +/- 11.4% in group I and 28.7 +/- 12.2% in group II; for diastolic AT 20.5 +/- 9.4% in group I, and 27 +/- 12.2% for group II). The good clinical results consisted of lowering of the AT values below critical levels and clinical improvement in 42 p (87.5%). Tolerance to N was good, in a single case was hypotension associated with fainting, both being promptly treated by simple means. CONCLUSIONS. 1. N administered sublingual, 10-20 mg, alone or associated with furosemide has in most patients a rapid hypotensive effect, lowering AT below critical limits within 45 min; 2. the drug is readily administered and without the risk of side effects and can be used in the field in the emergency treatment of hypertension.

The paper reports on the bioavailability of niphedipine in various pharmaceutic preparations administered in a single dose of 10 mg, per os, to volunteer subjects: Niphedipine dragees (Terapia, Cluj-Napoca), Adalat capsules (Bayer); Adalat coated tablets (Bayer and Birlaşik Alman Ilac Fabricalari, Istanbul) and Corinfar dragées (VEB Arzneimittelwerk, Dresden). In the blood samples collected, niphedipine was determined by a gas-chromatographic procedure. Pharmacokinetic analysis of the experimental data was made by a digital computer. Bioavailability of niphedipine was the best with Adalat capsules. The relative bioavailability of the other products was: tablets (Adalat); 93%; dragées (Niphedipine): 92%; dragées (Corinfar 86%). Absorption speed of Niphedipine decreases in the order: capsules, tablets, indigenous and imported dragées. Statistical analysis (Student test) shows that the differences in bioavailability among the preparations are not important. Efficiently therapeutic plasmatic concentrations are maintained for about 6 hours after a single dose of 10 mg administered as tablets and dragées and for 8 hours in the case of capsules. Important differences exist between the maximum concentration of niphedipine in blood, following some differences in the absorption speed, achieved after administration of capsules, on the one hand, and of tablets and dragées on the other hand. Choosing the type of tablet depends, therefore, on the nature of the affection treated. Niphedipine (Terapia) has corresponding biopharmaceutic properties and is useful in treating hypertension and for preventing and treating anginal attacks.