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The bicentenary of William Withering's now famous medical report entitled "An Account of the Foxglove and Some of its Medical Uses" has given us the occasion to analyze the state of the art. Cardiac glycosides in 1985 are considered tobe the basis for medical treatment of myocardial failure, together with diuretics and vasodilators in the more severe cases. Nevertheless, the controversy as to their exact place in the treatment of heart failure with sinus rhythm has never ceased. Although cardiac glycosides are of unquestionable value in tachycardia caused by atrial fibrillation or atrial flutter, the chronic use of these drugs in sinus rhythm is not generally accepted. The development of tolerance has been reported. It is of interest that Withering hirnself wrote: "-let it (foxglove) be continued until it either acts on the kidneys, the stomach, the pulse, or the bowels; Iet it be stopped upon the first appearance of any of these effects, and I will maintain that the patient will not suffer from its exhibition, nor the practitioner be disappointed in any reasonable expectation. " In West Germany alone, more than three million patients (about 5% of the total population) are constantly taking cardiac glycosides. These drugs are the most prescribed medicaments in many countries. Thus, we considered it worthwhile and necessary to review in a critical way today's knowledge about the foxglove; to report new findings and to evaluate old Statements.
Following the monographs by STRAUB (1924) and LENDLE (1935), this is the third contribution to the "Pharmacology of Cardiac Glycosides" within the Handbook of Experimental Pharmacology, which was founded by ARTHUR HEFFTER and con tinued by WOLFGANG HEUBNER. Because of the need created by the length of time that had elapsed since LENDLE'S work, the editorial board requested the rapid ap pearance of this 56th volume, which represents current knowledge of the pharma cology and clinical pharmacology of cardiac glycosides. In order to avoid any delay, numerous authors were invited to contribute because shorter contributions take less time to prepare and are consequently more up-to-date. The disadvantage is that some overlap between certain chapters could not be avoided, despite the editor's efforts. Overlapping can, however, actually be useful, in that differing opinions may be provided and topical issues discussed from varying viewpoints. This re minds the reader that scientific horizons in medicine should often be widened or revised. I would like to thank DR. ALANNA Fox and DR. K. ANANTHARAMAN for their help and advice in the revision of certain chapters. I am also grateful to Springer Verlag, and particularly to MR. WINSTANLEY and MR. EMERSON, for their contribu tion to the completion of this volume through translation and corrections. In con clusion I would like to thank MRS. WALKER, MR. BISCHOFF, MRS. SEEKER, and MR. BERGSTEDT of Springer-Verlag for their helpful support.
Written by the foremost authority in the field, this volume is a comprehensive review of the multifaceted phenomenon of hepatotoxicity. Dr. Zimmerman examines the interface between chemicals and the liver; the latest research in experimental hepatotoxicology; the hepatotoxic risks of household, industrial, and environmental chemicals; and the adverse effects of drugs on the liver. This thoroughly revised, updated Second Edition features a greatly expanded section on the wide variety of drugs that can cause liver injury. For quick reference, an appendix lists these medications and their associated hepatic injuries. Also included are in-depth discussions of drug metabolism and factors affecting susceptibility to liver injury.
In spite of old vintage and 200 years of clinical use, digitalis remains an interesting therapeutic agent, to clinicians as well as to the pharmacologist, the biochemist, and colleagues in other diciplines of theoretic medicine. When a drug, however, has so many attractive facets, it seems proper and aJvis able for the success of a scientific meeting to focus on a number of well-defined aspects. This symposium was devoted to pharmacokinetics, drug metabolism, analytic procedures, blood level determinations, and their interpretation both for thera peutic and toxic situations. Considerable progress has been made during the last years in this area of digitalis research. The time was suitable for a critical reap praisal of facts and theories and for future planning. Our main intention was to relate analytic data and biochemical findings to clinical problems and questions. Despite the undoubtedly basic character of clinical pharmacology, it is neverthe less an applied science which should help to develop the rational basis of thera peutics. We are particularly grateful to the active participants who bore the burden of preparing presentations and - even worse - manuscripts. At the same time we are well-aware that many other active research groups would have been able to contribute in this way, but our program was limited because of the short time available. Their knowledge is included in the discussion parts of the meeting, so we hope a well-balanced description of the present state of affairs emerged in this volume.
The pharmacokinetics of digitalis glycosides have been the subject of extensive re view (IISALO, 1977; ARONSON, 1980; PERRIER et ai., 1977). Research on glycoside kinetics has progressed at a rapid pace, requiring continuing reevaluation of the state of our understanding of this problem. The present article focuses on the effect of disease states (renal, gastrointestinal, thyroid, and cardiac) on the absorption, distribution, and clearance of a number of digitalis glycosides. Evidence is critically reviewed, and interpreted with respect to possible clinical implications. A. Renal Insufficiency I. Strophanthin Strophanthin disposition in renal failure has been evaluated in only two studies. KRAMER et ai. (1970) determined an elimination half-life of 14 h in normals as com pared to 60 h in anuric patients. Similar results were reported by BRASS and Pm LIPPS (1970) using tritiated strophanthin. They found a half-life value of 18 h in healthy individuals as compared to 68 h in anuric patients. The findings clearly in dicate that the elimination half-life of strophanthin is prolonged in renal failure.
Previous edition has subtitle: "a nursing process approach."
This book covers interesting research topics and the use of natural resources for medical treatments in some severe diseases. The most important message is to have native foods which contain high amount of active compounds that can be used as a medicinal plant. Most pharmaceutical drugs were discovered from plants, and still ongoing research will have to predict such new active compounds as anti-diseases. I do believe this book will add significant knowledge to medical societies as well as can be used for postgraduate students.
This excellent volume was designed and edited with two major ideas in mind: firstly, the field of clinical toxicology is changing and an acknowledgement of these changes is warranted; secondly, no comprehensive compilation of recently published case reports of, and clinical studies on, human poisonings is available, which is in sharp contrast to the closely related field of drug-induced side-effects.The book focusses on issues of recent concern, or issues poorly documented in the past. It is important that clinical toxicologists gain a better knowledge of all the available techniques of toxicological analysis. A better understanding of the way a sound interpretation of results should be conducted for the benefit of the patient's management, and a comprehensive set of data on the kinetics of the most common pharmaceutical drugs and many chemicals is required.Human Toxicology is a timely reference work which will be welcomed by a broad audience of toxicology professionals.
The pharmacokinetics of digitalis glycosides have been the subject of extensive re view (IISALO, 1977; ARONSON, 1980; PERRIER et ai., 1977). Research on glycoside kinetics has progressed at a rapid pace, requiring continuing reevaluation of the state of our understanding of this problem. The present article focuses on the effect of disease states (renal, gastrointestinal, thyroid, and cardiac) on the absorption, distribution, and clearance of a number of digitalis glycosides. Evidence is critically reviewed, and interpreted with respect to possible clinical implications. A. Renal Insufficiency I. Strophanthin Strophanthin disposition in renal failure has been evaluated in only two studies. KRAMER et ai. (1970) determined an elimination half-life of 14 h in normals as com pared to 60 h in anuric patients. Similar results were reported by BRASS and Pm LIPPS (1970) using tritiated strophanthin. They found a half-life value of 18 h in healthy individuals as compared to 68 h in anuric patients. The findings clearly in dicate that the elimination half-life of strophanthin is prolonged in renal failure.