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A few minutes after sucking a lozenge for a sore throat a 68-year-old man developed an anaphylactic shock. At a heart rate of 110/min there was no palpable blood pressure. A red confluent exanthem, predominantly of the trunk, was noted. After brief intensive-care treatment the patient was completely well again and diagnostic tests for allergy were performed. The prick test for the 14 individual ingredients of the throat lozenge produced massive reddening and urticaria on the test arm with carbowax, a polyethylene glycol which serves as a vehicle in the remedy and does not have to be listed. Later there were an urge to cough and urticaria all over the trunk. There was no systemic reaction. Neither specific IgE antibodies nor any complement-consuming reaction could be demonstrated. Thus the precipitating mechanism remains unexplained.

The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5 g + dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU + 0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients, in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases. Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars should be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too (1.6%), after subcapital fractures in 0.5%, after pertrochanteric fractures in 2.1% and after subtrochanteric fractures in 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal bleeding had to be remarked in 1.0% of the patients of the HDHE-group and in 2.1% of the ASA-DHE-group, fatal infections in 0.5% of the patients of the HDHE-group and in 1.6% of the ASA-DHE-group. Fatal cardinal infarction could be seen under HDHE in 1.9% of the patients, under ASA-DHE no fatal cardial infarction occurred.(ABSTRACT TRUNCATED AT 400 WORDS)

The treatment of neonatal apnea and bradycardia with methylated xanthines--theophylline and caffeine--is generally accepted. Besides the desired effects of these drugs they induce a wide range of side effects including relaxation of smooth muscles and increased gastric secretion. The aims of this study were, at first to investigate the coincidence of periodic breathing (PA) and acid gastro-esophageal reflux (GER) in neonates (n = 15) without therapy; at second to examine the influence of the consecutive medication with theophylline and caffeine on these parameters in patients (n = 10) with recurrent episodes of bradycardia and apnea. A 24 h esophageal pH-monitoring and 24 h cardiorespirography were performed simultaneously under standarized conditions. In the 15 neonates studied a weak correlation was found between the time spent breathing periodically and the duration of GER; the overlap of PB and GER was minimal. Theophylline and caffeine medication resulted in a marked reduction of PB which was more pronounced than it could be expected from maturation. The total time of a 24 h esophageal pH-monitoring was subdivided in an early postprandial time (FPP: first two hours after the beginning of a meal) and a late postprandial time (SPP: remaining time until the following meal). An increased duration of acid GER was observed during the SPP under therapy with theophylline and even more distinct with caffeine treatment.

Since 1971 pyrimethamine-sulfadoxine (Fansidar, Roche) has been used worldwide for prophylaxis and therapy of chloroquine resistant Plasmodium falciparum malaria. The drug monitoring team of the producing firm has received reports of a number of cutaneous adverse reactions, some severe, and a few even with fatal outcome. Liver reactions were also encountered, with severe cases only in the recent literature. We report on two patients with hepatitis in temporal relationship to pyrimethamine-sulfadoxine, the first with a second event after later exposure to the same drug. After discontinuing the medication the liver function abnormalities returned to normal limits within a few weeks. Liver biopsy and a positive lymphocyte transformation test against sulfadoxine, a component of Fansidar, strongly suggest that Fansidar was the cause of hepatic injury.

The pharmaceutical preparation Eucebral-N contains 80 mg etofylline and 100 mg cyclandelate. The drug is used curatively and preventively for peripheral and central circulatory disturbances. This report describes a study in which subjective statements of old patients from a home for the aged have been objectivated and evaluated. The results of the study, evaluated with usual statistical methods are: the communication ability, the state of confusion as well as the psychomotorical retardation could be improved significantly after 4 weeks', administration of the drug.

Vasospastic complications have been reported in five patients following the use of heparin-dihydroergotamine for thrombo-embolic prophylaxis. The most important diagnostic procedure is angiography, which shows characteristic findings. Intraarterial prostaglandin is a promising form of treatment. Experience with two patients is reported.

40 patients with essential hypertension were subjected to an analysis of efficacy and safety of the three-component-combination Briserin (Reserpine, Clopamide, Dihydroergocristine). After double-blind and randomized allocation, one group received the two constituents Reserpine/Clopamide, another the full combination Briserin and a third first Reserpine/Clopamide and Briserin afterwards. Both types of treatment proved equi-effective in terms of blood pressure reduction with the blood pressure values falling below 150/90 mm Hg within one week. The most important finding resided in the improved orthostatic tolerance due to Briserin. Maximal systolic pressure drop during standing and the tachycardia associated were significantly reduced by Briserin, i.e. by the influence of Dihydroergocristine. In addition, there was a corresponding difference in terms of subjective complaints due to orthostasis. The same held true for general symptoms related to hypertension such as headache, dizziness, undue tiredness and sleeplessness. Patients preferred treatment with Briserin as compared to the other regimen. The discussion deals with the clinical-pharmacological impact of the orthostatic regulation quality within the framework of antihypertensive treatment.

The risk of haematoma formation in the spinal canal following spinal or epidural anaesthesia given in the presence of s.c. heparin-dihydroergotamine (DHE) for prevention of postoperative thromboembolic complications was examined. The data were obtained from a study that compared the effectiveness of s.c. heparin-DHE and i.v. Dextran 70. Heparin-DHE was administered two hours before anaesthesia and surgery and during the postoperative course. All patients underwent elective or emergency operations of the musculo-skeletal system. The s.c. heparin-DHE group consisted of 187 patients operated under spinal (82 patients) or epidural (105 patients, 66 of whom received an epidural catheter) anaesthesia. There were no clinical signs to suggest the presence of an epidural haematoma nor were there any neurological symptoms. The same was true in the dextran group. Specific neurological examinations were not carried out, but the clinical results were controlled by means of a questionnaire filled out by the patients 6 weeks postoperatively. We conclude that s.c. heparin-DHE or i.v. dextran 70 has been used safely in the presence of spinal or epidural anaesthesia in these patients.

127 outpatients, 78 with acute purulent sinusitis and 49 with acute tonsillitis, were treated for 7 days with a benzylpyrimidine -sulphonamide combination. In this double-blind and randomized study 59 patients received co- tetroxazine (100 mg tetroxoprim and 250 mg sulphadiazine) b.i.d., whilst the reference substance, co-trimoxazole (160 mg trimethoprim and 800 mg sulphamethoxazole) was given to the remaining 68 patients b.i.d. The test criteria were the therapeutic efficacy and both subjective and objective tolerance. An improvement in clinical symptoms and signs occurred in both conditions under each therapeutic regimen. Clinical therapeutic success was rated very good or good in 96.6% treated with co- tetroxazine and in 97.1% of patients treated with co-trimoxazole. In the former group therapy failed in 1 patient with sinusitis and in 1 with acute tonsillitis . In 98.3% of patients treated with co- tetroxazine the tolerance was very good or good, whilst the respective figure for co-trimoxazole was only 91.2%. 6 patients suffered from side effects ( gastric spasm, gastralgia , nausea, vomiting, diarrhoea) which were so severe in 2 cases that treatment had to be prematurely terminated. The generally good tolerance to both preparations was confirmed by the results of the laboratory investigations.

A patient is presented who suffered for 3 years from increasing photosensitivity with chronic eczematous lesions in sun-exposed areas. He had taken one Neotri (triamterene, xipamide) tablet daily for 6 years. After discontinuation of the drug, phototesting and a photopatch test failed to reveal pathological reactions. Eczematous lesions, however, were induced in test areas upon systemic photochallenging with Neotri. One year later, after the antihypertensive medication had been changed from Adalat (nifedipine) to Teneretic (atenolol, chlortalidone) the eczematous photosensitive reaction recurred. Since both xipamide and chlortalidone have a chlorsulfamoyl-substituted aromatic ring in common, it seems that a photoallergic cross-reaction occurred.

A double-blind technique was used for studying the psychic and somatic effects of premedication with flunitrazepam, innovar and a placebo in 116 patients. Innovar and the placebo produced the same results. Flunitrazepam reduced anxiety and apprehension and had a significantly higher amnesic effect. Premedication with Innovar increased not only a feeling of fatigue and heaviness but also anxiety and tension in the patients. When assessing the psychic effects of premedication attention must be paid to the subjective impressions on the part of the patient.

Case report of a 51 years old woman with an acute generalized pustulosis. The histopathological findings in the epidermis were those of pustular psoriasis. But vascular findings in the corium were suggestive of a drug reaction, as was the history of a drug-induced onset of the disease in the course of an infect of the upper respiratory tract. Thus exanthematic pustular psoriasis may be considered as both diseases, psoriasis and drug reaction.

The influence of contrast medium (0.63 ml/kg body weight Natrium-Methylglucamin-Jothalamat, Conray 70) on pressures and volumes of the left ventricle were studied in six anesthetized mongrel dogs (mean body weight 36 +/- 6 kg). Under closed-chest conditions radiopaque markers were implanted into the endocardium of the left ventricle by means of a special catheter via the right carotid artery. The positions of the markers were calibrated in terms of volume by injections of contrast medium during diastole (flow rate 14 ml/s). Thus it was possible to determine left ventricular volumes without additional administration of contrast medium. Before and during injection, volumes determined from the position of the markers and pressure (catheter-tip manometer) were evaluated in each cycle. After injection, the parameters were determined every minute over a period of ten minutes. Immediately after injection of contrast medium there was a short period in which the following parameters changed: decrease of ventricular systolic pressure, of mean aortic pressure, of maximal dp/dt, of minimal dp/dt, and, after a short increase, of enddiastolic pressure. About one minute after the end of injection, the parameters were about the initial values. These transitory changes were explained by the initial negative and vasodilating effect of the contrast medium. The chamber volumes and stroke volume did not change during and after injection. Because of the constant heart rate cardiac output did not change. The ejection fraction was diminished even before injection, no further changes were found. These experimental results show that, even in ventricles with reduced function, contrast medium injected with a slow flow rate during diastole only leads to small and transient changes of left ventricular hemodynamics.

100 out-patients with subacute or acute stages of pharyngitis, tonsillitis, pharyngotonsillitis or angina participated in a randomized 3 day trial on antiseptic mouth-sprays comparing one containing a combination of chlorhexidine, tramazoline and aluminiumtrilactate with one containing only hexetidine. At the beginning of therapy and 3 days afterwards the local symptoms rubor and tumefaction of the throat, dysphagia, fur, swelling and tenderness of the cervical superficial lymph nodes were classified according to a graded scale. Using the combination these symptoms were markedly improved in 34 patients, improved in 7; 8 showed no alteration and one patient showed a deterioration (n = 50). With the monosubstance 18 patients showed good improvement, 11 an improvement, 17 no change and 3 patients a deterioration (n = 49), one patient needed penicillin-treatment during the trial. Under treatment with the combination the symptoms rubor and tumefaction of the throat showed a significant better improvement. The possible role played by a vasodilator are discussed.

Immediately after application of various contrast media a number of functional parameters of thyroid function were determined. Especially after application of Biliscopin which is strongly bound to plasma proteins, a significant rise of the free thyroid hormone fractions, a significant increase in the binding capacity of specific transport proteins and a decrease of the total concentration of thyroid hormones was noticed. It is therefore recommended that neither in the early phase within the first hour, nor in the late phase within 10 days after application of contrast media, blood for determination of parameters of thyroid function should be collected, since otherwise misleading results may be obtained.

The accidental intra-arterial injection of drugs intended for intramuscular injection is discussed and causes the well-recognised Nicolau syndrome. The published cases of this syndrome have usually related to the administration of Benzathinepenicillin, this is explained by injection into the superior gluteal artery and this may affect the internal and common iliac arteries. The clinical presentation of the Nicolau syndrome include immediate pain at the injection site followed discoloration and oedema. Arterial embolic symptoms occur in the lower extremities and may lead to necrosis. 3 cases of Nicolau's syndrome are described seen between 1974 and 1979 at the Paediatric Surgical Clinic in Wrocław.

A clinical double-blind study of the effectiveness of the benzopyrone product 5.6-benzo-alpha-pyron + 3',4',7-tris-(hydroxy-ethyl)-rutin (coumarin + troxerutin, Venalot) was investigated in 560 patients following medio-lateral episiotomy. The compound was investigated at various dose levels, and its active components coumarin and troxerutin separately. It was shown that the symptoms of posttraumatic inflammation like edema, rubor around the incision wound, and posttraumatic pain as well as consumption of analgesics and the postoperative scar formation were beneficially influenced by the drug. As a guideline for dosing, 1 mg/kg/d related to the coumarin content, was calculated. The efficacy of the combination of the active compounds was superior to that found with the components applied separately. The significance of episiotomy as clinical model for posttraumatic inflammation in general is discussed and application of the benzopyrone product above all in plastic surgery is suggested.

The local tolerance of a new mode of application of Cotrimoxazole (Eusaprim i.m.) was tested in 104 patients by 12 general practitioners in the region of Northern Bavaria. The patients received 1--2 injections, after which the assessment of local tolerance of the injection was done.. Parameters were the subjective statements by the patients and the objective findings by the physicians. 102 out of 104 patients reported about a good or acceptable tolerance. The physicians found a good tolerance in 99 cases and an average one in 5 patients.

Low-molecular heparin-dihydroergotamine had been applied once a day to 103 patients and heparin-dihydroergotamine twice a day to 97 patients as part of a double-blind, controlled, consecutive, and randomised clinical study, with 200 abdominal surgery patients being involved. High-risk patients above 40 years of age and potentially affected by thrombotically predisposing factors were almost equally represented in both groups. Evidence to postoperative thrombosis was phlebographically produced in either group. No fatal pulmonary embolism was found to be among ten deaths. No significant differences of clinical relevance were found to exist between both groups with regard to coagulative values, intra-operative and postoperative blood and drainage loss, and complications due to bleeding. No accumulated occurrence of major postoperative complications was recordable from either group. The vascular status of all patients was unchanged from beginning to end of the period of observation. The following conclusion was drawn as a result of the study: One single NMH/DHE injection daily is comparable with two HDHE applications per die for action and undesired side-effects.

We report on a 27-year-old patient with recurrent cholestatic hepatitis in whom the symptoms developed each time after travelling in tropical areas. Our primary diagnosis was recurrent non-A-non-B-hepatitis after exclusion of other forms of infectious hepatitis, but careful exploration identified Fansidar as the causative agent of liver damage.

We treated 20 febrile episodes in 14 patients with granulocytopenia under 1.0 x 10(9)/L. 6 episodes were pretreated, in 14 Imipenem/Cilastatin was the initial therapy. The age was between 36 and 78 years, mean 57 years. Predominant underlying disease was acute leukemia. 8 out of 20 episodes became afebrile. Counting only proven bacterial infections the response rate was 6 out of 12. There was a statistical difference between not pretreated and pretreated patients. The treatment had no success in the latter. There was also a significant difference between febrile episodes of patients with granulocytes increasing under treatment to those remaining unchanged. 5 of 6 of the first group but none of the 9 episodes of the second group resolved. 7 patients died while on treatment between the 9th and 32nd day after therapy had started. There was no connection between the Imipenem treatment and the deaths. Tolerance of therapy was good. The most common side effect was nausea, which was reversible with reduction of the infusion rate. Most important advantage of imipenem is the easy handling and the low inconvenience to the patient. We had only moderate efficacy in our series.

In five children neural complications occurred following diphtheria immunization. In two cases, damage was related to the injection (vaccination-induced poliomyelitis), in three cases it could be traced back to a hyperergic reaction to diphtheria toxoid on the cerebral vessels. The latter complication is typical of individuals being immunized against diphtheria. Such complications are extremely rare; by no means can they question the value of active immunization against diphtheria.

The combination of fentanyl and droperidol, Innovar, was compared to flunitrazepam (1-2 mg) in a higher dosage (2.5-5 ml) for i.m. premedication. We measured psychological (ESB) and physiological (blood pressure, heart rate, p.cortisol) stress parameters before and after premedication. Side effects were registered. The day after surgery the patients were asked about the quality of premedication. Flunitrazepam reduced anxiety; Innovar did not. After Innovar the feeling of weakness increased significantly compared to flunitrazepam. Two patients panicked and refused operation. Other severe side effects were not observed. There were slight advantages for flunitrazepam on physiological stress. Patients were more satisfied with flunitrazepam than with Innovar premedication. The results show that Innovar also in a higher dosage cannot be recommended for premedication.

25 patients who underwent maxillo-facial surgery were given dayly via a nasogastric tube 1500 ml of the instant diet Sokoham for nutrition during the postoperative period. The calory intake averaged about 2000 kcal (= 10050 kJ) per day. In 2 patients the nutrition with Sokoham caused persistent diarrhea and has to be interrupted. In 4 patients slight diarrhea appeared for 1 to 2 days. The mean frequency of defecation was 0.7 +/- 1/24 hours. Bodyweight, hemoglobin content of the blood, hematocrit blood gases serum levels of creatinin, urea-nitrogen, electrolytes transaminases and albumin and the parameters of acid base balance, glucose and fat metabolism did not change significantly. The results of nutrition with Sokoham are compared with the results of other instant formula diets which were tested under similar conditions.

Case Report: During enzyme therapy with intramuscular injections of Wobe-Mugos over 3 weeks a female MS-patient developed a severe anaphylactic reaction. The problems of enzyme therapy are discussed.

Low-dose hormonal contraceptives with specifically reduced estrogen are now the drug of choice for the prevention of internal risks. The antiandrogenic hormonal contraceptives have also had to be adapted to this situation. In a study involving 144 women, most of whom were suffering from moderately severe androgenization, Diane-35 (reduced to 0.035 mg ethinyl estradiol) was used as an antiandrogenically active hormonal contraceptive. From the sixth treatment cycle onward acne and seborrhea were significantly improved or already healed. In the 12th treatment cycle the treatment success rate was almost 90%. The side effects occurring with higher-dose hormonal contraceptives were reduced, cycle behavior was acceptable, and the incidence of metrorrhagia corresponded to that found with other micropills.

Application of a commercially available hair lotion containing high concentrations of oestradiol led to uterine bleeding in a 76-year old patient. Histological examination of the endometrium showed typical proliferation. Oestradiol blood levels were in the normal range of the follicular or luteal phase, LH- and FSH-serum concentrations were suppressed. After discontinuing the application of the assay used (20 pg/ml) and gonadotrophins rose to normal postmenopausal levels. These findings prove that after local application of oestradiol on the scalp, percutaneous resorption of the steroid is significant and systemic oestrogen effects have to be taken into account.

The case of a 42-year-old man is reported, who on four occasions developed a hypokalaemic periodic paralysis after an intramuscular injection of "Ambene". The detailed examination of this patient shows, that it is the primary, autosomal dominant inherited form of hypokalaemic periodic paralysis, and not the secondary form, which is caused by a renal or gastrointestinal loss of potassium. Clinical and electrophysiological, as well as histopathological and electron microscopic findings are presented, showing the typical vacuolar myopathy with submicroscopic tubular structures. In the literature there is evidence for an increased sensitivity of the muscle membrane to insulin with an increased potassium-shift inside the cell in hypokalaemic periodic paralysis. "Ambene" is a combination, which contains amongst other substances dexamethasone and the local anaesthetic drug lidocain. In the present case the paresis was possibly caused by a combined effect of dexamethasone with a consequent hyperglycaemia and lidocain with a change in the excitability of the muscle membrane. The pathophysiological mechanism of hypokalaemic periodic paralysis is discussed in terms of the release by the combination of these two drugs. It has not previously been reported that "Ambene" can provoke a hypokalaemic periodic paralysis. This is a severe side effect because of the resulting cardiac and respiratory problems.

Systemic contact dermatitis may occur when a previously cutaneously sensitised patient is given the hapten orally or by inhalation or injection. Some patients will develop a distinctive clinical picture with eczematous lesions on the neck, in the axillae and in the genital area. Further, a pompholyx on hands and feet might appear. The disease entity is illustrated in a neomycin-sensitive patient who was accidentally given an overdose of the hapten.

A prospective trial was performed on 146 patients, in whom fibrin tissue adhesive was applied during operations. 130 patients, who had received no fibrin glue, served as a control group, and were submitted to the same examinations as the first group of probands. In both groups we could not see any infections with hepatitis B.

Two cases of cardiac arrest about 30 min after intramuscular administration of premedication are analyzed. The patients were two young men without serious diseases in the history. The premedication consisted of Thalamonal (Innovar) and atropine. The cardiac arrest responded readily to treatment and there were no further problems. The indication for Thalamonal for premedication is critically analyzed; our conclusion is that it should be used only with caution.

Despite wide use of physical methods the number of fatal postoperative pulmonary embolisms in surgical patients increased in Kiel until 1976. Because of these results, additional general prophylaxis with 2-3 X 5000 i U of heparin-dihydroergotamine was introduced in 1978. The rate of fatal pulmonary embolism in general surgery proven by autopsy decreased to 0,3% between 1979 and 1983. It should be noted that six of the nine patients who died from pulmonary embolism had also suffered from an infaust disease. This is an excellent result since our study also includes high risk patients after emergency surgery, cases which Kakkar and Gruber did not include in their studies. Due to the extensive analysis of medical records and the pertinent post-mortem reports, the high effectivity of drug induced prophylaxis with 2-3 X 5000 i U of heparin-dihydroergotamine in order to reduce fatal pulmonary embolism in general surgery could be proven.

Today ergotism is becoming more and more important as a complication in the treatment of migraine headache or thrombosis prophylaxis with DHE heparin. Although complete recovery is seldom reported in the current literature, in our case it was possible to resolve a spasm of the left lower limb completely by early diagnosis and adequate pharmacological treatment. The case was well documented by serial angiography.

We report the case of a 74-year-old woman who developed pulmonary edema and shock shortly after ingestion of one tablet of hydrochlorothiazide/amiloride. The clinical findings and course of the disease were characteristic of hydrochlorothiazide-induced pulmonary edema. 14 similar case are reported in the literature. Attention is drawn to this rare but dangerous side effect of a frequently used diuretic.

As shown in bilateral comparison studies addition of crude coal tar (T) to standard antipsoriatic therapy with dithranol and salicylic acid in white petrolatum (CVS) diminished the dithranol-irritation; consequently, accelerated application of increasing dithranol-concentrations shortened the duration of TCSV -therapy.

Thirty patients who had undergone long-term treatment with carotenoids (max. 14 years and 336 g of carotenoids) were examined. Ophthalmoscopy revealed retinal crystals in 20 patients. The retinal crystals were usually located around the macula, forming a ring, and in one case they were even found in the macula itself. No deterioration of visual acuity or visual field defects were found, but there was a markedly dose-dependent prolongation of the duration of dark adaptation.

Abuse of ergotamine-containing suppositories was followed by generalized vessel stenoses in a pregnant 29-year-old migraine patient and led to a space-occupying great brain infarction in the area supplied by the right internal carotid artery. Impressive improvement of clinical, computed tomography and ultrasound findings was observed during treatment with nimodipine. The literature about cerebral symptoms of ergotism is reviewed.