Effects of prophylactic lidocaine in suspected acute myocardial infarction. An overview of results from the randomized, controlled trials.

The effects of prophylactic lidocaine hydrochloride on early ventricular fibrillation and death in patients with suspected acute myocardial infarction were investigated in an overview of 14 randomized trials. During follow-up intervals of one to four hours in the trials of intramuscular lidocaine infusion (6961 patients) and 24 to 48 hours in the trials of intravenous lidocaine injection (2194 patients), a total of 103 cases of ventricular fibrillation and 137 deaths were recorded. Overall, allocation to lidocaine was associated with a reduction in the odds of ventricular fibrillation of about one third, with a 95% confidence interval that ranged from a 3% to a 56% reduction.

The role of the personal computer in the cardiac catheterization laboratory: an integrated approach to information management.

A personal computer-based data management system for the cardiac catheterization laboratory is described. This is a cooperative effort on the part of the Dutch academic hospitals, through the Interuniversity Cardiology Institute, to put in place a more uniform structure for data collection and reporting in the context of cooperative studies. The major design criteria included the necessity that the system provide a clear and present benefit to the users in terms of their day-to-day work.

Healon as intravitreal substitute in retinal detachment surgery in 40 patients.

Forty patients with hypotony during retinal detachment surgery were treated with intravitreal Healon. Healon was very well tolerated, except for a transient rise in the intra-ocular pressure in 19 out of 40 patients. A relationship between the rise in intra-ocular pressure and the mount of Healon used was not found.

Radical vitrectomy and silicone-oil injection in the treatment of proliferative vitreoretinopathy following retinal detachment.

Eighteen consecutive patients with proliferative vitreoretinopathy following retinal detachment were treated with radical pars-plana vitrectomy and silicone oil injection. At least 6 months follow-up demonstrated fully attached retinas in 12 patients, partly attached retinas in 3 patients and primary failure in 3 patients. The visual fields revealed serious defects in 50% of those patients with attached retinas.

Comparison of vitreous replacement with Healon and with HPMC in rabbits' eyes.

Ten rabbits underwent vitreous aspiration and replacement by either Healon or Hydroxy Propyl Methyl Cellulose 2%. Four weeks' observation did not reveal noticeable differences between Healon and HPMC with regard to anterior chamber reaction, intra-ocular pressure or cataract. The vitreous reaction in eyes with HPMC was much more severe than in Healon eyes, with typical white precipitates and vitreous bands.

Intramuscular lidocaine for prevention of lethal arrhythmias in the prehospitalization phase of acute myocardial infarction.

In a randomized controlled study examining the value of an intramuscular injection of lidocaine in the prehospitalization phase of suspected acute myocardial infarction, paramedics used an automatic injector to administer 400 mg of the drug into the patient's deltoid muscle before transport to the hospital. In a 33-month period, 7026 patients with acute chest pain were seen. Of the 6024 patients randomized (2987 to the lidocaine group and 3037 to the control group), 1935 (32 per cent) proved to have an acute myocardial infarction.

Congenital corneal opacity (Peters' anomaly) combined with buphthalmos and aniridia.

A case history of a newborn infant is discussed. At birth he showed bilateral buphthalmos with aniridia and congenital corneal opacities, agreeing with Peters' anomaly. A keratoplasty was performed.

[Internal hemorrhoids--roentgen symptoms and differential diagnostic demarcation from rectal and anal cancer].

The main indication for colon barium enema examination is occult bleeding or bleeding noticed by the patient himself. The radiologist has to take into account all clinical details that could lead to bleeding and to document them. The most frequent causes of rectal bleeding are hemorrhoids and diverticulosis/itis which in marked cases may have a tumor-like appearance.

Ventricular fibrillation and transient arrhythmias after defibrillation in patients with acute myocardial infarction.

Ventricular fibrillation (VF) and transient arrhythmias after defibrillation were analyzed from the recordings of 28 patients containing at least one episode of ventricular fibrillation. An R-on-T extrasystole initiated VF in 60% of the episodes. Other initiating factors were a late premature beat (24%), stable ventricular tachycardia (VT) (7%), accelerating idioventricular rhythm (5%) and cardioversion of VT (5%) with a sinusoidal waveform.

Exercise capacity with transdermal nitroglycerin in patients with stable angina pectoris.

Transdermally delivered nitroglycerin (TTS-NTG) through a rate-controlling membrane yields stable blood levels for 24 h. We studied the effect of TTS-NTG (25 mg per 10 cm2) on exercise induced angina in 10 patients with stable angina pectoris, all in NYHA class III, who were not under treatment with other cardiac drugs. In a pre-study exercise test, all patients had angina pectoris and more than one mm ST depression.

[Present status and possibilities of radiotherapy in the interdisciplinary treatment of malignant tumors of the stomach, pancreas and bile ducts. III. Extrahepatic bile ducts and gallbladder].

The malignant tumors of the gall bladder and the extrahepatic bile ducts belong to those having the most unfavorable prognosis. Similarly to the carcinomas of the pancreas, most of these tumors are in a very advanced stage when they are diagnosed. The survival times have not been improved by radical and ultraradical operation techniques, the operation mortality, however, has increased.

[Current state and possibilities of radiotherapy in the inter- disciplinary treatment of malignancies of the stomach, pancreas and biliary tract. II. Pancreatic cancer].

The extremely unfavorable prognosis of the carcinoma of the pancreas is due to the fact that a curative operation - even by ultraradical surgery - is already impossible in 75 to 90% of patients at the moment of diagnosis. Contrary to expectation this situation has not been essentially improved by the introduction of modern, non-invasive examination methods such as ultrasound and computed tomography. Thus medical science is confronted again with the task of searching for operation modalities, especially for patients whose tumors are curatively inoperable but still restricted to the pancreatic region.

[Current state and possibilities of radiotherapy in the inter- disciplinary treatment of malignancies of the stomach, pancreas and bile ducts. I. Stomach cancer].

Surgery is undoubtedly the therapy of choice in case of the advanced carcinoma of the stomach. In spite of more and more radical and extended operation techniques, the extremely unfavorable prognosis could not be improved. Based on experiences gained with palliative irradiations, the efficacy of radiotherapy can be considered to be proved.

[Afterloading method for the irradiation of malignant bile duct obstructions].

A new method is presented for the irradiation of malignant bile duct obstructions employing the percutaneous transhepatic drainage canal and based on the application by means of the afterloading system of Iridium-192 into the bile duct. This method allows for the first time to apply high doses directly to the tumors within the bile ducts without causing damages to the surrounding sain tissues.