1 The pharmacokinetics, bioavailability and ECG response of verapamil was investigated in seven patients with liver cirrhosis and compared with six normal subjects, using stable labelled techniques whereby both the intravenous and oral dose are given simultaneously. 2 After intravenous administration, plasma concentrations were much higher in the patient group such that the total plasma clearance was reduced from a mean of 1258 ml/min in normals to 616 ml/min in the patient group (P less than 0.0025). The apparent volume of distribution nearly doubled (6.76 v 12.05 l/kg, P less than 0.025) and the terminal half‐life was prolonged four fold (3.7 v 14.2 h, P less than 0.001). 3 Given orally, the peak plasma concentration was higher and occurred earlier in the liver cirrhotic patients. The absolute bioavailability more than doubled (22.0% normals v 52.3% liver cirrhotics, P less than 0.001) and apparent oral clearance was reduced to only 20% of normal (6.38 v 1.30 l/min, P less than 0.001). 4 The delta P‐R interval in the patient group lagged behind the plasma concentration, in contrast to normal subjects. The maximum effect was much greater in the patients (15.4 v 41.6% increase, P less than 0.005) and persisted for a longer period of time. The slope of the plasma concentration‐response curve was the same as in normals after intravenous administration. Plasma protein binding remained unchanged. 5 It is recommended that in liver cirrhotic patients the intravenous dose of verapamil be halved and the oral dose decreased by a factor of five in order to prevent untoward effects. As well as a steady‐state plasma concentration will not be reached until approximately 2 days after the beginning of therapy.

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The purpose of this study is to report on complications experienced after 600 performed mediastinoscopies. Mediastinoscopy was indicated because of: 1. Suspicion of bronchial cancer: n = 292 (48.7%) ( = 48 (8%), d = 244 (40.7%), Suspicion of systemic disease: n = 248 (41.3%), Suspicion of mediastinal tumor: n = 33 (5.5%), Suspicion of metastases in lymph nodes caused by tumors of a different localisation, pleural process of unknown origin n = 27 (4.5%). Complications occurred in 3.7% of all cases; the most frequent of which were haemorrhage in 0.67% as well as paresis of the recurrent nerve in 1% which remained permanent in 0.33%. Furthermore, pneumothorax occurred in 0.8% of the cases, but had to be drained in one case only. Severe complications (eg death, bleeding, irreparable paresis of the recurrent nerve) occurred in 1.2% of all cases. We wish to mention a temporary elevation of the diaphragm on the right side, which can be looked upon as a complication rarely described in literature. We noted this in 1% of all cases and ascribe it to an irritation of the phrenic nerve.During the last two decades collar mediastinoscopy according to Carlens (1) developed into a superior bioptic procedure for evaluating the lymph nodes of the mediastinal zone (2-5). Indications, technique and efficiency of this method are well known in literature (6-16). Less attention has been paid to its side effects and complications (17-20) which form the basis of our report. Material and methodsThe following study presents the analysis of complications subsequent to 600 consecutively performed mediastinoscopies. Indications for mediastinoscopy were: Endoscopy 1 (1979) 9-12 Komplikationen bei der Mediastinoskopie Es wird über Komplikationen nach 600 konsekutiv durchgeführten Mediastinoskopien berichtet. Die Indikationen zu dieser Untersuchung vvaren: 1. Verdacht auf Bronchial-Ca: n = 292 (48,7%) ( = 48 (8%), c3' 244 (40,7%), 2. Verdacht auf Systemerkrankung: n = 248 (41,3%), 3. Verdacht auf Mediastinaltumor: n = 33 (5,5%), 4. Verdacht auf Lymphknotenmetastasen von Tumoren anderer Lokalisation, unklarer Pleuraprozeß: n = 27 (4,5%). Bei insgesamt 3,7% der Fälle traten Komplikationen auf. Die häufigsten Komplikationen waren die Blutung mit 0,67% sowie die Recurrensparese mit 1%, die in 0,33% bleibend war. Weiterhin trat in 0,8% ein Pneumothorax auf, der jedoch nur in einem Fall drainiert werden mußte. Schwere Komplikationen (Todesfall, Blutung, irreparable Recurrensparese) traten insgesamt in 1,2% auf. Es wird auf den rechtsseitigen, voriibergehenden Zwerchfellhochstand hingewiesen, eine in der Literatur ganz selten beschriebene Komplikation. Wir beobachten ihn in 1% der Falle und fiihren diese Komplikation auf eine Irritation des Nervus phrenicus zurück.

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Patients suffering from liver cirrhosis and patients showing no signs of liver or stomach disease (control group) were quantitatively examined for duodenogastric reflux. The duodenogastric reflux was measured by means of bile tracers. The bile tracer used in this study was the tricarbocyanin dye indocyningreen (ICG). The intra-gastric concentration of ICG was photometrically measured after gastric acid was suctioned through a stomach tube. The duodenogastric reflux was calculated in percent in terms of the infused and the biliary secreted ICG amount respectively. Bromthalein was used as an additional tracer in order to control the efficiency of peptic acid removal. A total of 15 patients suffering from liver cirrhosis and 6 patients who showed no signs of stomach or liver disease (control group) were examined. The patients with liver disease showed a reflux of 2.85% +/- 0.76%, the control group (n = 6) showed a reflux of 0.45% +/- 0.39%. The difference is statistically significant (P less than 0.05). Bromthalein aspiration by all patients with liver cirrhosis was 87.95 +/- 2.78% of the amount infused.