Sinus node disease (SND) has caused many controversies about the appropriate stimulation mode. We compared the advantages and disadvantages of VVI, AAI, DDD, and DDI mode. In an additional study, left ventricular function at rest (R) and during exercise (E) was investigated in dual chamber and ventricular stimulation mode with a stimulation rate of 70 ppm (R) and 110 ppm (E). A total of 223 patients (pts) was investigated (67 AAI, 87 VVI, 69 DDI). Hemodynamic disadvantages in VVI mode resulted in a 55% actuarial incidence of atrial fibrillation after five years. In AAI mode, we found another 25% complication rate due to impaired AV conduction (n = 9) or a bradyarrhythmia (n = 6) with slow ventricular response. DDI mode implies the possibility of sustaining a pacemaker mediated tachycardia. Single ventricular stimulation with a high stimulation rate (110 ppm) under E showed a worse left ventricular performance as compared to dual chamber stimulation. DDI mode shows none of the aforementioned disadvantages. To sum it up: Until a dual chamber rate responsive pacemaker becomes available, the DDI mode represents the best stimulation mode for patients with a SND.

I Thirty-three patients with no evidence of endocrine disease, hepatic or renal insufficiency or sleep disorders, were classified in groups 1 to 4 in order of increasing of percentage of ideal body weight (IBW) respectively: < 90% of IBW, 90-120%, 120-180%, and > 180% of IBW. After oral administration of 200 mg butobarbitone, concentration of the intact drug was measured by gas liquid chromatographic assay in urine samples collected during 72 h and at three times in blood. 2 A highly significant negative relationship was found between the cumulative excretion of butobarbitone with urine and the logarithm of the percentage of IBW. In contrast for a given weight, excretion of the drug with urine was found to be weakly correlated with the diuresis. 3 The cumulative urinary elimination of butobarbitone was significantly different between the groups studied, except of the difference between the group 2 and 3 of the patients. No significant difference was found between the renal clearances ofbutobarbitone in the four groups of subjects. 4 We conclude that redistribution of butobarbitone into adipose tissues can explain the obtained results and that obesity modifies the pharmacokinetics of the drug.

15 mongrel dogs receiving allografts were treated with antilymphocyte globulin (ALG; 20 mg/kg b.w. daily). The kinetics and distribution of inflammatory cells invading the transplant were analyzed by transplant aspiration cytology. Only transplant aspiration cytology enables one to observe the direct influence of ALG within the grafts themselves. Although a low-potency ALG was used, ALG-treated animals showed a significant long-term suppression of the in situ inflammation of lymphocytes (p < 0.05) and lymphoblasts (p < 0.05) during the entire experimental period. Other leucocyte populations were influenced to a lesser degree. This in situ reduction combined with a significant prolongation of graft function (p < 0.001) establishes the beneficial effect of ALG in suppressing cell-mediated immune responses in renal allografts.

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