[TREATMENT OF THROMBOTIC COMPLICATIONS IN THE INJURED PERSONS IN POLYTRAUMA]

Comparative results of treatment of thrombotic complications in the injured persons with combined trauma of trunk in two groups were adduced. The scheme of prophylax3 is and treatment of thrombotic complications was proposed; application of this scheme have permitted to reduce their rate in 5 times, from 54.5 to 11.2%.

[Peyronie's disease: comparative results of conservative treatment]

Long-term clinical experience with conservative treatment of Peyronie's disease has demonstrated that clinical efficacy of this therapy comprises maily anesthesia while erectile problems are not solved. Introduction of the drugs into the fibrous plaque is not adequate and hard to perform. Some drugs affect only some components of pathogenesis. For stabilization of the process it is recommended to use transdermal electrophoresis or phonophoresis. The search for new effective drugs and methods continues.

[Pathogenetic basis for using prodectin and teonicol, redergin and aescuzan in complex treatment of chronic gastritis]

The study of the microvessels in bioptates of gastric mucosa and micro haemocirculation in the conjunctiva of 254 patients with chronic gastritis revealed that exacerbation of the gastric process is going on the background of hard terminal bloodstream disorders. They have the generalized character and picture of the typical chronic relapsing trombohaemorrhagic syndrome. The use of Prodectin (250 mg), Teonicolum (150 mg), Redergin (1 tab.) and Aescuzan (25 dr.) 4 times per day during 3 weeks helps to eliminate the microcirculatory disorders and exacerbation of the chronic gastritis.

Drug monitoring studies as a method of analyzing response criteria

Two multicenter drug monitoring studies are presented. Some methodological problems are dealt with and the validity of such studies is discussed in terms of differential indication. In a first study (Lehmann et al., 1993) the results of a 12-week xanthinol niacinate treatment (500 to 3000 mg daily) in a cohort of 10,134 outpatients suffering from cerebrovascular insufficiencies were recorded systematically by nonreactive evaluation methods. The therapy was found to be most successful in patients with the target symptoms vertigo, tiredness, lack of concentration, affective disorder, and disturbances of vigilance and vitality. The most frequent side-effects were flush or heat sensations in 9.1% of the patients and gastrointestinal complaints in 3.3%. In a second study (Klieser et al., 1994) we systematically collected data from 219 patients with Major Depressive Disorder during five weeks of treatment with fluoxetine (20 mg daily). The results showed that depressively inhibited, anxious patients with a depression of minor severity, who showed a relatively marked improvement within the first week of treatment, profited the most from this therapy. The first study was designed to use nonreactive evaluation methods. Correlation analyses helped to identify the types of patient with a good response to treatment. The second study was organized on the model of conventional controlled pharmacological studies with the application of commonly used scales. The differential indication was to be inferred from the uni- and multivariate comparison of responders and nonresponders. In the light of these two studies, the problems of target definition, sample design, target variables, practicability, statistical analysis, and validity are discussed.

[The efficacy of using antiaggregants in chronic glomerulonephritis with grade-I chronic kidney failure]

Both short-term and long-term effectiveness of xantinole nicotinate as well as trentale and combinations thereof with dipyridamole has been demonstrated in patients with chronic glomerulonephritis presenting with grade 1 chronic renal insufficiency, which fact can be accounted for by their vasoactive and antiaggregant actions. Particular regimens have been developed to treat the medical condition in question with the above drug preparations, comparative evaluation was done of their effects on the clinical course of the illness as well as on the effective renal plasma flow, concentration of nitrogenous remainder in blood and urine, concentration of medium size molecules in blood. It is advisable that antiaggregants be administered long term (from several months to several years).

Drug monitoring study (phase IV) of xantinolnicotinate (Complamin) in general practice

For 30 years, xantinolnicotinate has been on the market for the treatment of impaired brain function, i.e., organic brain syndromes of various etiologies. Controlled double-blind phase-III clinical trials have shown that xantinol-nicotinate is an effective drug in the treatment of dementia. Nevertheless, it is also important to assess xantinolnicotinate under routine treatment conditions in order to learn what type of patient is preferably treated, which ADRs can be observed how often, and whether the efficacy claimed by phase III studies can still be seen under routine treatment conditions. Theoretically, the more complex treatment situation in routine practice could lead to major changes in the selection of patients, the type and frequency of ADRs, or efficacy. The treatment of 10,134 patients was monitored in a treatment observation study. Results show that target illnesses are not cases of 'pure dementia', but more complex cases, in which multimorbidity plays an important role, so that the older term 'cerebrovascular insufficiency' seems more appropriate to describe this group of patients. Another interesting group is made up of younger patients suffering from a variety of psycho-organic syndromes. The assessment of therapeutic efficacy, e.g., with the SCAG, shows highly significant improvements during treatment, which are well comparable to those reported in controlled studies. The success of treatment was most expressed in the target symptoms "dizziness", "fatigue", "disturbance of concentration", "affective disorders", and "disturbance of vigilance and vitality". In 87% of these cases, no adverse drug reactions were reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of xanthinol nicotinate in the revival of monkeys subjected to acute haemorrhagic shock

The therapeutic potential of xanthinol nicotinate in the revival of anaesthetised monkeys subjected to acute blood loss was investigated. The arterial pressure was lowered to 40 +/- 5 mmHg by rapid arterial bleeding and was maintained at this level for 2 h. Shed blood was then returned through infusion, to the animals. Animals alive at the end of 72 h observation period were considered as survivors. The test drug was infused 1/2 h prior to and 1/2 h, 1 h, 1 1/2 h and 2 h after the onset of oligaemic hypotension. The animals which received normal saline instead of test drug were treated as control. The physiological and biochemical parameters recorded prior to and after the onset of oligaemic hypotension were heart rate, pulse pressure, electrocardiogram, electroencephalogram (EEG), lactic acid, creatine phosphokinase, urea and glucose. The results showed tachycardia, narrowing of pulse pressure, depression of ST segment with occasional T inversion, slowing of EEG with increase in amplitude, rise in blood lactic acid, creatine phosphokinase, urea and glucose. The magnitude of these responses were proportional to the duration and severity of shock. These changes were markedly attenuated in the drug treated group. Enhancement of survival was observed in drug treated groups as compared to control. It was 10 per cent in control as against 60, 86, 71, 57 and 50 per cent in the groups which received the test drug 1/2 h prior to and 1/2 h, 1 h, 1 1/2 h and 2 h after the onset of oligaemic hypotension. It is concluded that the beneficial effect of the drug in the revival of monkeys subjected to acute haemorrhagic shock may be due to better maintenance of tissue perfusion.

[Disorders of organic hemodynamics of the liver and their correction in suppurative cholangitis]

The blood flow in the portal vein and hepatic artery was studied by means of ultrasonic Doppler flow measurement to investigate organic and regional hemodynamics of the liver in purulent cholangitis. The blood flow in the portal vein was found to be significantly diminished in patients with acute cholangitis and hepatic failure. Hepatic microcirculation was studied on a experimental model of obstructive jaundice and obstructive purulent cholangitis in rats by polarographic measurement of hydrogen clearance. Considerable reduction of the volume rate of the local blood flow was noted, and the degree of the reduction was related to the severity and duration of the disease. Decompression of the biliary tract by external drainage improved the local blood flow rate which, however, diminished again in prolonged external drainage. The use of pharmacological agents for correction of microcirculation in decompression of the biliary tract led to total and rapid correction of the volume rate of the local blood flow.

[The correction of microcirculatory disorders in patients with circulatory encephalopathy]

The state of microcirculation was studied by bulbar biomicroscopy in 18 healthy persons and 53 patients with dyscirculatory encephalopathy before and after treatment with vasoactive drugs (xanthinol nicotinate, Cavinton, Sermion). It was found that the microcirculation changes depended on the stage of the disease. It was found that the above drugs produced a positive effect on the microcirculation, the values of which normalized by the end of the course of treatment, especially after their direct administration.

[Effect of xanthinol niacinate on the autoimmunity and capillary permeability in patients with stable stenocardia]

A three-month antianginal therapy with long-acting nitrates and xanthinol nicotinate given in various daily doses have shown that there is a positive clinical effect, a reduction in the level of immune complexes and IgG in most patients, which is followed by a decrease in capillary permeability and dienic conjugate levels both in erythrocytes and plasma.

Treatment of intermittent claudication with antiplatelet agents

In a double-blind study, 296 patients with intermittent claudication (Fontaine stage II) were treated with 250 mg ticlopidine twice daily, 500 mg aspirin every third day plus 75 mg dipyridamole three times daily, or 300 mg xanthinol nicotinate three times daily for 6 months. Ticlopidine and aspirin/dipyridamole, but not xanthinol nicotinate, improved platelet aggregation, reduced beta-thromboglobulin, platelet factor IV and fibrinopeptide A concentrations, and increased antithrombin III concentrations and red blood cell filterability. No changes in lipid profiles, platelet count or fibrinogen were recorded following any treatment. The doppler systolic blood pressure ratio was improved in patients treated with ticlopidine or aspirin/dipyridamole, but not with xanthinol nicotinate. It is concluded that antiplatelet treatment is useful for the treatment of limb arteriopathy.

Efficacy of xantinolnicotinate in patients with dementia

Activation of cerebral metabolism and improvement of microcirculation by influencing rheological parameters are claimed to be the underlying pharmacological principles responsible for the efficacy of xantinolnicotinate. This dual mechanism of action led the authors to perform a double-blind, randomized, placebo-controlled study in patients with mild to moderate dementia (DSM III), characterized by a score of 40-90 on the Sandoz Clinical Geriatric Scale (SCAG), with a separate randomization for patients with Multi-Infarct Dementia (MID) and Senile Dementia of Alzheimer Type (SDAT). It was calculated that 150 patients would have to be recruited for each group. Allocation to the respective group (MID or SDAT) was based on the Hachinski Ischemic Score and computer tomogram. Preceded by a 2-week placebo run-in period, a 12-week treatment period followed with either 3 x 1 g xantinolnicotinate (Complamin) or placebo. Prior to the study, the physician's rating of the global therapeutic effect from the clinical global impression (CGI) was designated as the primary criterion of efficacy. Secondary efficacy criteria were SCAG, the BGP nursing rating, and, as psychometric variables, tests from the Nuremberg Psychogeriatric Inventory (NAI). The improvement compared to placebo was statistically significant for the CGI in both treatment groups (p less than 0.0001) and hence independent of etiology. Concerning the nurses' rating (BGP), apart from a marginally statistically significant difference for the factor "need of help" in the SDAT group, no remarkable changes were registered during treatment. However, in the SCAG the differences between verum and placebo were significant (MID p less than 0.0002; SDAT p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

[The dynamic changes in the regional volumetric cerebral blood flow and local vascular reactivity in acute craniocerebral trauma in animals with alloxan diabetes]

The authors studied the condition of regional volumetric cerebral blood flow and local vascular reactivity in experimental mild and moderate craniocerebral trauma in 31 animals with alloxan diabetes and in 29 animals with isolated brain injury. It is shown that alloxan diabetes aggravates cerebral vascular disorders occurring in injury to the skull and brain. Vasoactive agents Cavinton and xantinol nicotinate promote regression of the changed cerebral blood flow.

Decrease in LDL and increase in HDL concentrations in type II hyperlipoproteinaemic patients on low-dose combination therapy of cholestyramine and Complamin

A low-dose combination of Complamin retard (1 g t.i.d.) and cholestyramine (4 g b.i.d.) was compared with each agent alone in 2 serial open trials without dietary restriction using type IIa and IIb hyperlipoproteinaemic patients. Complamin alone produced decreases in LDL and VLDL cholesterol concentrations (up to 20%) whereas cholestyramine alone produced only a modest reduction in LDL (up to 15%). The combination produced marked, progressive reductions in total cholesterol (up to 35%) and LDL (up to 40%); reductions in VLDL (up to 45%), total triglyceride (up to 60%) and free fatty acids (up to 60%) were found only in type IIb patients. The average increase in HDL-cholesterol from the 2 studies for combination therapy was 35%. No side-effects were reported or measured and compliance was excellent. The results demonstrate the potential of a method of achieving beneficial actions on lipoprotein levels with a well-tolerated therapy.

[Effect of komplamin and nikoshpan on brain circulation and metabolism in the postischemic period]

Intravenous administration of komplamin to anesthetized cats before the brain ischemia or in the early period following ischemia prevents the development of the postischemic phenomenon of the cerebral blood flow nonrecovery and beneficially influences the cerebral metabolism: restores oxygen and glucose consumption by the brain, decreases pyruvic acid level in the arterial and venous blood, attenuates the phenomenon of acidosis. Nikoshpan improves the blood supply to the brain, restores oxygen and glucose consumption by the brain in the postischemic period only if administered before the brain ischemia.

[Treatment of sudden deafness with xantinolnicotinate (Complamin) in increasing dosage]

Twenty-nine patients affected by typical unilateral sudden hearing loss were treated with Xantinolnicotinate (Complamin) by a 21 days infusion of 1.5 g-30 g in 500 ml NaCl 0.9% followed by 3 months 1,000 mg sustained release tablets t.i.d. An improvement in hearing was achieved in 90.5% of the cases and in 52% returned to normal. Tinnitus improved in 92% of cases and resolved completely in 54%. The results of speech and sound audiograms correlated well, and showed significant recovery in the first 3 weeks. The infusion therapy was terminated prematurely in 4 patients because of near normalization of hearing (maximum dosage: 15 g Complamin). Adverse reactions only occurred during the infusion therapy. For ethical and therapeutic reasons a placebo control group was not included. To compensate for this the audiograms of impaired and 'normal' ears were compared. The changes in hearing and tinnitus are therefore to be regarded as the result of spontaneous remission and drug efficacy.

[Effectiveness of teonikol in the treatment of patients with suppurative surgical infection and diabetes mellitus]

The investigation of peripheral blood circulation in 103 patients with a purulent surgical infection and concomitant diabetes mellitus has shown it to be considerably altered. A direct correlation of parameters of peripheral hemodynamics has been established both with the degree of diabetes mellitus and with the character and degree of the purulent process. Teonikol when used in the complex treatment results in positive shifts in hemodynamic parameters.

[Effect of complamin on the levels of ACTH, cortisol and lipids in the blood of elderly patients with ischemic heart disease]

Blood ACTH, cortisol and lipid levels, as well as complamin effects thereon, were studied in 116 elderly and old coronary patients. Changes of lipid metabolism were not identical in coronary patients of different age. They were particularly unfavorable in old age. ACTH and cortisol levels and the ACTH/cortisol ratio change with age, and the highest hypercortisolemia is found in old age. Complamin regulates lipid metabolism and blood ACTH and cortisol in coronary patients of advanced age. The ACTH/cortisol ratio is however unaffected by treatment and remains stable in all age groups.

[Effect of complamine and nicospan on the cerebral blood flow and its regulation in changes in blood pressure]

Acute experiments on anesthetized cats under the conditions of artificial respiration were made to study the action of intravenous injection of complamine (75 mg/kg) and nicospan (0.5 ml/kg) on the cerebral blood flow (CBF), arterial blood pressure in venous vessels of the head (VP) and autoregulatory reactions (AR) of cerebral vessels at different levels of arterial blood pressure. The results of experiments indicate that both drugs provoke phasic (dilatation-constriction) responses of cerebral vessels, reduction of the CBF and a decrease in BP and VP. Unlike complamine, nicospan often caused at first a short-term increase in the CBF and VP followed by their lowering as compared with the initial values. Both the drugs brought about alterations in AR of cerebral vessels toward lower levels of BP.

[Course and prognosis in sudden deafness]

Follow up audiograms were done at periods up to 15 years after sudden deafness on 69 patients. The average value of the pure tone threshold continued to decrease linearally at about 1.15 dB per year. In a few cases (21%) however, improvement in hearing was observed even up to 12 years after sudden deafness. 28.6% of the patients recovered later without having shown any improvement in hearing during treatment with infusions. On the other hand 8.3% of the patients had a relapse. The immediate improvement in hearing following in patient treatment showed no correlation to the subsequent audiogram. Neither basic diseases, accompanying tinnitus, vestibular involvement or delayed treatment showed any influence on long-term development of hearing. The results of treatment with different medicaments reached a plateau. No significant effect could be determined for long-term treatment with vasodilators. In view of the high rate of spontaneous remissions the success of treatment for sudden deafness must be critically evaluated.

[Modification of pathologic fatty acid patterns in old age by combined clofibrinic and nicotinic acid treatment]

71 patients (42 men and 29 women, aged between 45 and 76) with primary hyperlipoproteinaemia (HLP) types IIa, IIb and IV, were treated with clofibric acid (Regadrin) and nicotinic acid derivatives (Radecol, Jupol) over a three-year period. Every four months, they underwent gas chromatographic analyses of the fatty acid spectrum (fa) in the fractions of cholesterol ester (Chol.E) and triglyceride (TGL) of the serum. The therapy resulted in an increase in the linoleic, linolenic, arachidonic, and eicosapentaenoic acids, and a fall in the palmitic, palmitoleic, stearic, oleic and eicosatrienic acid levels in the Chol.E fraction in the case of HLP types IIa and IIb, and in the TGL fraction in the case of HLP types IIb and IV. Selective competitive inhibition by unesterified fatty acids, blocked lipolysis, an impaired hepatogenic fatty-acid metabolism, an affected LCAT and an increased esterification of polyunsaturated fatty acids are discussed as possible mechanisms. The increase in polyunsaturated fatty acids and the decrease of saturated and monounsaturated fatty acids must be considered, as they are interrelated with the prostaglandin metabolism, to be a positive and vasoprotective effect which assumes special importance in middle and older age.

[Effect of a 3-month-interval running exercise in combination with vasodilative therapy on microcirculation of the lower leg in peripheral arterial circulation disorders (stage I and II)]

The authors report results of a three-month-interval running exercise under continuous vasodilatory therapy (Radecol and Jupal) in cases of peripheral arterial blood disturbances (stage I and II). Apart from control examination with the whipping test, the ultra-sound-Doppler method, phlebemphraxis-plethysmography, the paper reports above all the effects of interval running on the peripheral microcirculation of the working muscles which were determined by means of Xenon-133-clearance-half-life. Independent of the type of drug therapy used, significant (1 per cent) improvements of peripheral haemodynamics were found regarding the therapeutic regime presented.

[Clinico-experimental long-term study on the combined effect of clofibrin and nicotinic acid on abnormal fatty acid patterns in lipid metabolism disorders in the aged]

Seventy-one patients (forty-two males and twenty-nine females aged forty-five to seventy-six) with disturbances of fat metabolism were treated for three years with clofibric acid and nicotinic acid derivatives. Regular gas chromatographic analyses of the composition of cholesterol ester and triglyceride fatty acids in the serum showed an increase of linoleic, linolenic, arachidonic, and eicosane-pentaenoic acids and a decrease of palmitic, palmitoleic, stearic, oleic, and eicosanetrienic acids during treatment. These changes were far more strongly marked than under monotherapy. Possible causes of the observed changes include selective competitive inhibition of unesterified serum fatty acids, inhibition of lipolysis, effects upon hepatogenic fatty acid metabolism and LCAT, as well as better utilization of alimentary polyunsaturated fatty acids as a result of combination treatment. The increase of polyunsaturated fatty acids and the decrease of saturated and monounsaturated fatty acids with their reciprocal relations to the prostaglandin metabolism may be considered a positive vasoprotective effect which is of particular importance in middle and old age.

Propranolol-induced reverse vascular steal in arteriopathic patients

The vascular steal phenomenon, i.e., the shunting of blood from ischemic to normally perfused areas, has been described in the affected limbs of arteriopathic patients after taking vasodilating drugs. This study was per formed to ascertain whether the reverse situation can be induced, i.e., whether vasoconstriction of the vessels supplying the nonischemic zone could increase the amount of blood reaching the ischemic area. Accordingly, 49 arteriopathic subjects were selected on the basis of the plethysmographic evidence of a reduction of blood flow in the affected limb following an IV injection of xanthinol-nicotinate. In a first group of 10 patients, the reduction of blood supply to the affected limb induced by xanthinol-nicotinate was inhibited when this drug was administered in combination with 5 mg of propranolol. In another 22 patients, the plethysmographic response observed after xanthinol-nicotinate alone was reversed when this drug was injected after 10 mg of propranolol. Actually, the blood perfusion to the affected limb rose significantly at all times of recording as compared to basal values. Finally, in a third group of 10 patients in whom xanthinol-nicotinate induced a significant reduction of blood flow, propranolol did not modify it. The angiographic studies performed in 3 patients confirm the plethysmographic results. Xanthinol-nicotinate alone induces a reduction of the vascular filling in the affected limb, while the combination of the vasodilating drug with 10 mg of propranolol is able to improve the vascular filling in the affected area. These results indicate that the overwhelming action of α-adrenoceptors obtained in the normal area by the β-receptors' blockade favors a beneficial redistribution of blood flow which might be considered a reverse vascular steal.

[Raynaud's phenomenon: diagnostic and therapeutic aspects]

The Authors report their experience concerning 120 patients with Raynaud's Disease (50 pats.) or Syndrome (70 pats.). All patients were studied before and after treatment, by clinical, thermometric, oscillographic and photoplethysmographic observation and by the Doppler examination, in order to evaluate the functional and organic component of the disease. Surgical treatment was reserved to 45 patients with secondary or primitive Raynaud's phenomenon refractory to medical therapy. The treatment of choice was thoracic sympathectomy. The result was excellent in 64% of cases, fair in 26%, and nil in 8%. 75 patients were treated with various drugs for a period of 6 months or 1 year. In 54% of cases the result was excellent, fair in 29%, and nil in 16%. The Authors conclude that diagnosis of Raynaud's Syndrome is above all clinical, that a leading part is played by photoplethysmography and the Doppler examination, and that medical therapy is indicated in the first instance, since it is capable of preventing the rise of those distal trophic disorders that constitute one of the main indications of surgical treatment.

[Occlusion rheoplethysmography]

The investigation of the peripheral circulation by using the all-purpose occlusion rheoplethysmography enables the reaction of rising the venous tone in response to the action exerted by the tissue ischemia products to be quantitatively estimated along with a one-time determination of the arterial and venous hemodynamics of the crus at rest and in reactive hyperemia. The blood flow volume-velocity rates determined by means of the proposed method are of a considerable diagnostic value for characterization of the peripheral hemodynamics in patients with cardio-vascular pathology, in performing pharmacological tests and in medication with drugs displaying vasoactive properties.