The effects of nifedipine, a potent calcium antagonist, were studied in patients with unstable angina, coronary spasm and myocardial ischemia. Data from two separate groups of patients studied in the cardiac catheterization laboratory indicate that intracoronary injection of nifedipine promptly reversed coronary spasm—whether provoked or spontaneous—in five of six patients. In other patients, direct intracoronary injection of the drug was compared with intravenous administration. After intracoronary injection, local mechanical cardiac action virtually ceased, and the ventricular wall became thinner during systole. Thus, a specific inhibitory action on contractile energy expenditure could be demonstrated in the presence of increased coronary flow. This “oxygen-sparing” effect was tested in a group of 31 patients with symptomatic unstable angina whose pain at rest, with ST-T changes, had not responded to 8 hours of treatment with maximal beta adrenergic blockade, nitrates and bed rest. The addition of 6 × 10 mg of nifedipine rendered 27 of these patients asymptomatic within 1.5 hours. In the four patients who did not respond, coronary arteriography demonstrated severely stenotic lesions. Two of the four patients subsequently responded to intraaortlc balloon pumping and bypass surgery; one patient had a myocardial infarction and one who had a 90 percent reduction in the diameter of the left main coronary artery, died. It is concluded that nifedipine should be added to beta adrenergic blockade therapy if the latter does not appear to be immediately effective. This combination has not been shown to cause any hemodynamlc deterioration, and only a minority of the patients treated sustained a myocardial infarction during the first 3 months of follow-up. The use of nifedipine in unstable angina deserves further clinical evaluation.
<b>Background:</b> Theophylline can still have a role in the management of stable COPD but its use remains controversial mainly due to its narrow therapeutic window. Doxofylline, another xanthine, is an effective bronchodilator and displays a better safety profile with respect to theophylline. <b>Aim:</b> We have carry out a quantitative synthesis to compare the efficacy and safety profile of different xanthines in COPD. <b>Methods:</b> A network meta-analysis on xanthines (aminophylline, bamiphylline, doxofylline, enprophylline, theophylline) and COPD was carried out in agreement with PRISMA and PROSPERO. The primary endpoints were the impact of xanthines on the lung function and the risk of adverse events (AEs), via normalizing data on safety as a function of person-week. Data obtained from 1158 COPD patients were selected from 16 studies and analyzed by using a full Bayesian approach. <b>Results:</b> The combined surface under the cumulative ranking curve (SUCRA) analysis of efficacy (change from baseline in forced expiratory volume in 1 second [FEV1]) and safety (risk of AEs) showed that doxofylline was superior to aminophylline (comparable efficacy and significantly better safety), bamiphylline (significantly better efficacy and comparable safety), and theophylline (comparable efficacy and significantly better safety) (Figure 1). <b>Conclusions:</b> The overall efficacy/safety analysis suggests that doxofylline seems to be the best xanthine for the treatment of COPD.
Calcium has a central role coupling stimulus to cellular activities such as secretion and contraction. Because calcium is critical for airway smooth muscle contraction, degranulation of mast cells and secretion of mucus, there has been great interest and hope in the use of calcium channel blockers in the treatment of asthma. We here discuss the effects of calcium channel blockers and also review clinical studies of these drugs in asthma, focusing on recent findings. There have been several recent reviews on this topic (1,2) and it is now possible to evaluate the role of these drugs in the management of asthma.
A new 100 cm long 16.5 French valvuloplasty introducer was used in 12 consecutive patients (mean age 73 years, five males and seven females) undergoing aortic balloon valvuloplasty for severe aortic stenosis. The long‐sheath was introduced into the ascending aorta along the stiff part of an exchange guidewire. The valvuloplasty procedure, which included a complete diagnostic catheterization in three patients, lasted 113 ± 47 min (211 ± 81 min in the previous 18 procedures performed with a conventional approach, P < 0.05). Introduction of balloon catheters (3 × 12 mm trefoil balloon in the 12 cases and 2 × 19 mm bifoil balloon in 2 of these cases) was possible in all patients and an increased stability of the balloon during inflation was observed. No systemic embolization or vascular complications occurred at the puncture site. The long‐sheath technique appears to be a valuable adjunct for aortic valvuloplasty in that it provides easier and quicker access for even the largest balloons and additional support and stability during balloon inflation. In our experience, this reduced the practical difficulties and the duration of the procedure.
Abstract Measurement of serum bile acids has been claimed to be a sensitive and specific biochemical test of hepatic function. We have prospectively measured post‐prandial serum glycocholate (cholylglycine) concentrations in 31 patients with alcoholic liver disease and compared these measurements with those of bromsulphalein (BSP) retention, prothrombin time, and serum albumin. In the patients with early (non‐cirrhotic) alcoholic liver disease ( N = 14) BSP retention was abnormal significantly more frequently than was serum cholylglycine concentration (100% vs 29%, p < 0.001). In contrast, amongst patients with late (cirrhotic) alcoholic liver disease, BSP retention and serum cholylglycine were abnormal with equal frequency (94%). In both groups of patients BSP retention and serum cholylglycine were abnormal significantly more often than were prothrombin time and serum albumin concentrations. We conclude that moderately severe hepatocellular dysfunction is required before serum cholylglycine can become a reliable biochemical indicator of liver disease.
