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The authors demonstrated that isradipine reduces the blood pressure assessed at rest in patients with mild to medium severe hypertension. The antihypertensive action was enhanced by administration of beta-blockers. In a loading test the pressor response to strain was reduced in particular as regards diastolic pressure; from this in may be concluded indirectly that a vasodilatating effect is involved. The authors recorded a rise of plasma renin activity which may be associated with previous vasodilatation. Parameters of lipid metabolism were influenced by isradipine. The indifference of isradipine as regards the effect on functions indicated by biochemical screening was again confirmed in the present investigation. The undesirable effects typical for calcium antagonists were manifested in a very small percentage of the investigated subjects and in a small number of repeated examinations. The reason for discontinuation of treatment in one patient was an effects which does not threaten the patient (flush). Isradipine is an effective antihypertensive drug with very good tolerance.

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Roentgen-cephalometric studies were carried out in 26 adult males with complete bilateral cleft lip and palate. They were subdivided two times in two subgroups, with and without premaxillary setback, and with and without prolongation of the columella. The subgroups were compared mutually, as well as with a group of controls including 50 males matched in age. Premaxillary setback during childhood resulted in a more marked retrusion of the maxilla in adulthood. A simultaneous slighter oral slope of the premaxilla led to a normalization of the upper face height. Skeletal deviations acted on the configuration of the soft profile, in particular of the nasolabial transition: the slope of the columella towards the profile was reduced and so was the nasolabial angle. Thus the region appeared more markedly sunken. This surgical procedure should be used only in an exceptional situation in a small or posteriorly rotated mandible. Prolongation of the columella resulted in an excessive nasal depth. This was not caused by an adequate elevation of the tip of the nose which corrected a flattening of the tip, but rather by the sunken upper lip. An unfavourable effect exerted also a larger deepening of the nasolabial transition after a prolongation of the columella. However a slighter prolongation of the columella did not allow a sufficient elevation of the nasal tip. It is therefore necessary to seek a compromise.

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X-ray cephalometric studies were carried out in 114 adult males with cleft lip and with or without cleft palate. According to the type and extent of the cleft they were subdivided into 4 groups and were compared with a control group of 50 normal males matched in age. Investigated were the parameters of the skeletal and soft facial profile. The results showed that cleft lip alone is associated with deviations of local character concerning only soft tissues within the oronasal region. The ascertained deviations included a flattening of the nose, reduction of the height, concavity and prominence of the upper lip, increased height of the upper lip vermilion and a more horizontal slope of the columella leading to a reduction of the nasolabial angle. Cleft lip and palate was associated with deviations of global character related predominantly to the extent of retrusion of the upper and lower jaw. The skeletal profile was altered and its deviations were reflected by changes of the soft profile. Of the deviations of soft tissues per se were most important the flattening of the nose and reduction of the height and thickness of the upper lip, which underlined the presence of retrocheilia. Maxillary retrusion was more marked in complete than in incomplete unilateral clefts, while mandibular retrusion and maxillary dentoalveolar retroinclination were more marked in bilateral than in unilateral clefts. Occlusion was always impaired. In unilateral involvement, especially in complete clefts the more horizontal slope of the columella resulted in a marked reduction of the nasolabial angle. Incomplete clefts, similarly as cleft lip alone were not associated with a reduction of thickness of the upper lip and showed an increase of the vermilion height. Because of the persisting protrusion of the premaxilla bilateral clefts were accompanied by only a slight flattening of the skeletal profile and by an excessive nasal depth after the prolongation of the columella. The nasolabial angle was unchanged. The concavity of the upper lip was reduced in complete unilateral and bilateral clefts. Certain characteristics of the oronasal region disclosed a similarity between incomplete cleft lip and palate (in unilateral involvement) and cleft lip alone, however global deviations (due to skeletal changes) were identical with those recorded in complete clefts.

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X-ray cephalometry was used for the assessment of the configuration of the skeletal and soft tissue profile in 81 adult males with isolated cleft palate. They were assessed in three subgroups, i. e. with complete and incomplete clefts and with clefts of the soft palate alone and were compared with a matched group of controls consisting of 50 normal males, as well as with the situation in the earlier examined series with unilateral cleft lip and palate. In isolated cleft palate both the upper and lower jaws were retruded. The maxilla was most markedly retruded in incomplete clefts and most slightly in clefts of the soft palate alone, while the mandible showed the smallest degree of retrusion in complete clefts. The configuration of the skeletal profile was similar as in unilateral cleft lip and palate, yet positive overjet was on the average restored in all types of isolated cleft palate. A more favourable configuration of the profile was present in patients with cleft soft palate alone, in the absence of an impairment of sagittal jaw relations. Changes in the configuration of the soft profile were due mainly to skeletal deviations. The retrusion of skeletal framework of the middle face was to a large degree masked by the larger thickness of the upper lip, in complete clefts also of the lower lip. Therefore the prominence of the upper lip was only slightly impaired and slight flattening of the face occurred only in complete clefts. The more horizontal slope of the columella resulted in a reduction of the nasolabial angle. Some deviations from the described pattern occurred in clefts of the soft palate alone (steeper slope of the upper lip with an unchanged nasolabial angle, normal thickness of the upper lip a. o.). The findings are suggestive of a differing facial physiognomy in isolated cleft palate.

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After a placebo run-in phase of four weeks' duration, 1.25 mg or 2.5 mg isradipine twice daily orally was administered for one year to 23 patients who had been diagnosed as hypertensive. Good control of blood pressure was recorded in the majority of patients until the third month of treatment. After five months, it was necessary to add a beta-blocker to the treatment regimens of some of the patients in order to maintain the target blood pressure of 140/90 mm Hg. Patients were exercise-tested using bicycle ergometry. After three months, diastolic blood pressure was significantly lower during exercise when comparing the treatment values with those taken at the end of the placebo run-in (baseline values). Values for systolic blood pressure did not differ between treatment and baseline. These results may be explained by the decrease in peripheral vascular resistance produced by isradipine. After one year, the results were modified by the administration of the beta-blocker bopindolol (Sandonorm, Sandoz Pharma Ltd., Basle, Switzerland). Total cholesterol, high-density lipoprotein cholesterol, and apolipoprotein B levels did not change during treatment. Triglycerides were lower after three months, but slightly higher after one year, with an average value lying within the normal range. The influence of isradipine on plasma renin activity (PRA) and aldosterone levels was followed by measuring values at rest and during exercise. It was found that PRA was higher during the first three months, then inversely inhibited to lower levels. Aldosterone levels were also increased after three months, but without a subsequent decrease. The results are compared with those obtained with diltiazem in a similar treatment regimen.

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The paper offers therapeutic experience with guanfacine (Estulic Sandoz) in large and small doses in patients with hypertension. A daily dose of 3-4 mg of guanfacine led to a decrease in blood pressure in about half of patients with moderate to severe hypertension. However, therapy had to be discontinued in several instances due to frequent occurrence of adverse side effects. The recently recommended smaller doses (2 x 1 mg) of guanfacine indicated primarily in patients with renal dysfunction or diabetes mellitus resulted in an extremely good therapeutic response; the frequency of undesirable effects was about the same as with other antihypertensive therapeutic protocols. The drug seems to offer more benefits in special indications with a concomitant disease rather than as a third drug of a combination used in severe hypertension.

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