No abstract

Bei den trizyklischen Antidepressiva oder Thymo(ana)leptika handelt es sich um Pharmaka, die eine spezielle antidepressive sowie psychomotorisch aktivierende Wirkung aufweisen und bei denen der neuroleptische Effekt in den Hintergrund tritt. Die Thymoleptika, die für unsere Betrachtung von Interesse sind, gehören neben den Monoaminoxidase-Hemmern zur Gruppe der Antidepressiva. Chemisch können diese Verbindungen vom Chiorpromazin abgeleitet werden (Abbildung 1), das seit 1952 in der psychiatrischen Therapie verwendet wird. Dabei wurden entweder die Substituenten oder der Kern der Phenothiazine so verändert, daß Substanzen mit anderer therapeutischer Breite oder gar mit anderen Indikationen entstanden. Die trizyklischen Thymoleptika umfassen im wesentlichen die in Tabelle 1 aufgeführten Gruppen (64). I CH3 (CH2 )3-N 1CH3 In, ipram in I CH3 (CH2)3 N '"CH3 Chiorpromazin H CH CH (CH2)2 N ( 'CH3

Ten days after surgical treatment of a gastric perforation a 70-year-old woman developed progressive dyspnoea and hypertension without any signs of deep vein thrombosis. Emergency echocardiography revealed acute cor pulmonale with a dilated right atrium and ventricle, as well as paradoxical ventricular septal motion. In addition it demonstrated an elongated, extremely mobile thrombus stuck in a patent foramen ovale with most of it floating in the right atrium, the remainder in the left atrium. Within 2 hours of the ultrasound examination she went into fulminant pulmonary embolism with circulatory arrest and paradoxical embolization from the atria to the brain, after which the intraatrial thrombus was no longer detectable. She was successfully resuscitated and thrombolysis was immediately started with tissue-plasminogen activator (100 mg over 90 min), with ensuing stabilization of the circulation. The patient was gradually weaned off the ventilator over the following few days, but she died 10 days after the resuscitation from the severe cerebral damage.

After one day of dizziness a 28-year-old man experienced a syncope on getting up. ECG revealed a 3 degrees atrioventricular (AV) block unresponsive to drug treatment. A temporary pacemaker was implanted. Erythema migrans 4 weeks before admission suggested Lyme carditis, and the diagnosis was confirmed serologically (ELISA increased polyvalently, IgM antibody titre 1:64, IgG antibody titre 1:512). On antibiotic treatment with amoxicillin (1 g three times daily) and prednisolone (initially 80 mg daily, with gradual dose reduction) the sinuatrial block regressed within 10 days. Holter monitoring still demonstrated occasional sinoatrial conduction disturbances for some days, until sinus rhythm was permanently re-established. This case illustrates that transitory AV block can be the sole manifestation of sporadic Lyme disease in Europe and should therefore be included in the differential diagnosis of any acute cardiac disease.

6 patients with severe self-poisoning were treated by charcoal-haemoperfusion in our centre up to now. In four of them (all suffering from sleeping drug overdosage) the treatment was successful. Two patients with intoxications by agrochemicals died in spite of haemoperfusion. Side effects of haemoperfusion were drops of blood pressure and platelet count, depletion of immune bodies, and adsorption of remedies. Up to now, the indication for haemoperfusion has to consider these secondary actions of encapsulated charcoal as inevitable.