[Experiences in the determination of serum indomethacin levels in patients with rheumatic diseases--a contribution to the "reliability" in clinico-pharmacological studies].
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Biomedical subjects
Publications and source records attributed to C Reinicke.
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Increasing knowledge about undersirable drug interactions make necessary new differential-therapeutic considerations. It is attempted to meet the problem in its general importance and - without any over-refinements which have nothing to do with practice - to draw conclusions for pharmacotherapy.
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It is given a short, oriented to practice survey on the at present internationally most usual non-steroidal antirheumatic drugs. Picture of effect and efficiency, side-effects, indications and contraindications of these remedies are described and compared. The description comprises salicylates, phenylbutazone, indomethacin, flufenamine acid and mefenamine acid, ibuprofene as well as new substances (benorylate, clofezone, nuflumine acid, azapropazone, bumadizone calcium, naproxene and others). In their qualitities of effect the new drugs do not essentially differ from the classical antirheumatic drugs. However, they partly reveal a more favourable relation between desirable and undesirable effects.
Taking into consideration the special therapeutic problems in rheumatology a short survey oriented to practice on the treatment with cortisonoids is given. The pharmacology of these compounds is dealt with in short. Emphases of the description are general principles of treatment, indications and dosage in systemic and local treatment, side effects, problems of long-term treatment, application of ACTH, the cortisonoid withdrawal syndrome, prophylaxis of therapy complications and references to the reduction of the dose or to the withdrawal of the treatment with cortisonoids.
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Age-related changes of diastolic left ventricular (LV) function consist of increased diastolic wall stiffness (reduced compliance) and diminished velocity and extent of relaxation. There is a shift of ventricular filling from early to late diastole. Atrial contribution to LV filling increases, which helps maintain stroke volume. In normal cardiovascular aging this diastolic dysfunction is compensated. However, the aging heart is sensitized against influences aggravating diastolic dysfunction such as arterial hypertension, LV hypertrophy, myocardial ischemia (coronary heart disease), tachycardias/ tachyarrhythmias. In diastolic heart failure LV is unable to fill adequately at normal diastolic pressures, resulting in symptoms of pulmonary congestion and, less often, low output despite normal LV size and contraction. Diastolic heart failure may be misinterpreted as systolic dysfunction and, eventually, treated in an unsuitable manner. In order to obtain data on the incidence of diastolic heart failure among inpatients of a department of geriatrics of a municipal hospital, the results of 253 patients undergoing echocardiography in the course of 1 year were analyzed. The investigations comprised 70 males and 183 females, aged 81.3 (61-98) years on average. In 164 cases, symptoms of heart failure were present. Only in 48 of them (29%) LV proved to be dilated. In the majority, LV size was normal (116 patients; 71%): systolic function was compromised in 53 cases, whereas 63 patients (38% of all cases with heart failure) had a normal systolic function. Most of the latter (48 patients) had diastolic dysfunction, whereas an adequate echocardiographic evaluation was not possible for technical reasons in the remaining 15 cases. It is highly probable, however, that they had diastolic LV dysfunction as well. Thus, the results show a high frequency of LV dysfunction in elderly inpatients, which underlines the importance of diastolic heart failure in this age group.