The influence of age and multimorbidity on the pharmacokinetics and metabolism of spironolactone

The pharmacokinetics of the metabolites of spironolactone (canrenone and fluorigenic metabolites) were investigated in 10 geriatric female patients with multimorbidity after a multiple daily oral administration of 100 mg spironolactone under steady state conditions. The concentration determinations were carried out simultaneously with a specific HPLC method and a less specific fluorimetric method. On comparison of the pharmacokinetic parameters with the respective values of a control group of younger healthy female subjects, the serum concentrations in the elderly patients were found to be twice as high. In addition, a statistically significant positive correlation with age was found in the patients for the kinetic parameters investigated. A positive correlation existed between erythrocyte count and the pharmacokinetic parameters of canrenone, especially with the area under the concentration/time curve. No such association was detectable, however, for the total fraction of fluorigenic metabolites (including canrenone). The results of our investigation indicate that, in addition to the known high binding of canrenone to plasma proteins, there is also possibly a (restrictive) binding to erythrocytes.     

Assessment of axis deviation following tibial intramedullary nailing in the standard roentgen image

Evaluation of 87 fixations of the lower leg revealed that standard x-ray film safely enables accurate determination of defective axial and lateral positioning. Assessment of rotatory malpositioning is unsafe and not likely to yield accurate results. The only possibility is to take the x-ray film of the fixed foot; this enables conclusions from measurements performed on the x-ray film with the metal still implanted and the fixation still in place, as reference parameters. Detailed analysis of the x-ray films, however, revealed even further results: delayed and disturbed healing of bone fractures can be detected early from the mechanical measurement data on the x-ray film, so that correction of the fixation nail can be made well in time. Cases treated in this way healed properly and in a well-adjusted manner. Corrections performed with the fixation nail were pseudoarthroses (5 cases), 4 of which healed without complications whereas one healed after removal of the nail and conservative aftercare. Fractures in the distal part of the lower leg seem to be particularly critical. Because of the close proximity of the ankle joint, unsatisfactory stability will result if the nail end is too short.     

Der Knieanprall und seine Verletzungen bei Auto- und Motorradfahrern

Ohne ZusammenfassungMit 22 Textabbildungen (38 Einzelbilder)Herrn Professor Dr. Dr. h. c. K. H. Bauer zum 70. Geburtstag.     

Myocardial infarction without coronary artery changes]

Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.     

6d. Renovasculäre Hypertension

Ohne Zusammenfassung