Biomedical subjects
Publications and source records attributed to D Larbig.
In 2 patients digitalized with digoxin or betamethyldigoxin, postmortal glycoside concentrations were determined in 7 different skeletal muscle specimens by radioimmunoassay. In the same specimens, planimetric measurements of histochemical fibre types I and II were carried out. There were higher glycoside concentrations in predominantly type I fibre muscle biopsies.
After extraction of myocardial and skeletal muscle biopsy and autopsy specimens tissue glycoside concentrations can be determined by radioimmunoassay. Total tissue extraction of digoxin and beta-methyl-digoxin varies between 87 and 95%, the variation coefficient for repeated determinations is 10.2%. Glycoside concentrations of left ventricular papillary muscle obtained after mitral valve replacement were 69.0 +/- 25.05 ng/g with a tissue to serum relation of 46.6 +/- 8.96:1 and a correlation coefficient of r = 0.8442. In autopsy left ventricular papillary muscle glycoside concentrations were 105.2 +/- 27.35 ng/g with an almost identical tissue to serum relation of 46.2 +/- 9.57:1 and a corresponding serum concentration of 2.3 +/- 0.63 ng/ml. In adults glycoside concentrations of autopsy specimens of the right ventricle were significantly lower by 28 to 30% than those of the left ventricle. Glycoside concentrations of skeletal muscle specimens (m. pectorialis major) were 14.7 +/- 10.35 ng/g with a tissue to serum relation of 9.7 +/- 3.00:1 (r = 0.8377), which corresponds to approximately 1/5 to 1/4 of the concentrations of the left ventricular myocardium.
A 35-year-old women developed symptoms of multiple system disease. Three months later she was admitted to hospital and died six days after admission, with signs suggestive of mitral stenosis. Postmortem examination indicated primary chorion carcinoma of the right ovary with metastases to the left atrium, lungs, brain, kidneys, pancreas, mesenteric arteries, and spleen. The signs and symptoms, and the morphological and histological findings at necroscopy, are discussed.
The clinical diagnosis of mitral-valve prolapse was made in ten patients on the basis of a late systolic murmur with or without a click. In each case the echocardiogram confirmed the diagnosis. In five it was further confirmed by angiocardiography. The late systolic murmur, with or without click, accentuated after nitroglycerin, is characteristic for mitral-valve prolapse.
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Serum glycoside concentration was 2.3 ng/ml or more in 299 patients digitalised with digoxin or digoxin derivatives. Mean serum glycoside concentration was 3.4 +/- 1.3 ng/ml (range 2.3-11.00 ng per ml). Usually, high serum concentrations were associated with advanced den or digoxin-derivative overdosage occurred in only 10% of patients. Almost three quarters of those with intoxication had impaired renal function. There was some evidence that low body-weight increased the potential risk of intoxication.
Six healthy individuals were digitalized orally with beta-methyl-digoxin. The serum glycoside concentration, determined radioimmunologically at the end of the digitalization period was 1.2 +/- 0.22 ng/ml. At this period of time renal excretion attained 55.9% of the daily administered oral dose. The calculated renal clearance of beta-methyl-digoxin was 63 +/- 8.1 ml/min e. g. 57.5 +/- 8.3 ml/min/1.73 m2. After discontinuation of the glycoside the serum half life was 54 h. During the digitalization period the cardiac glycoside effects could be measured by ECG changes, especially a shortening of the QT interval as well as a shortening of the left ventricular ejection time and the pre ejection period, corrected for the heart rate.
6 healthy controls received daily doses of 0.6 mg beta-methyl-digoxin for 3 days and further 0.3 mg for the following 5 days each. After the first 3 days sodium content in the red cells increased from 4.8 to 6.6 meg/kg significantly in parallel to the glycoside level of 1.5 ng/ml (1.2 times 10-9 M). At the same time magnesium in the cells fell significantly from 4.1 to 3.7 meg/kg. There was no change in the concentration of potassium, calcium or chloride at this time. While the glycoside level dropped during the following 5 days under 0.3 mg of methyl-digoxin to 1.2 ng/ml (1 times 10-9 M), sodium content in the cells increased further up to 8.3 meq/kg and was paralleled by a decrease in potassium content from 84.6 to 82.0 meq/kg. There were no changes in plasma electrolyte concentrations during the experiments. Our results confirm the concept of Hoffman that there are two transport pathways in human red cells which differ basically in their dependencies of the sodium and potassium composition of the external medium and the concentration of glycoside needed to inhibit the transport. Our data evidence that red cell electrolyte contents reflect levels of digoxin. They might be useful to follow up the therapeutical effect of cardiac glycosides.
In 13 adult patients serum-glycoside concentrations, renal glycoside elimination and endogenic creatinine clearance were determined before, during and in the first 4 days following the operation. A postoperative digitalis cumulation has not been seen. But there was a diminished digitalis tolerance in the immediate postoperative phase. Two patients got ventricular bigeminus. The low potassium values at the same time may possibly affect the sensitivity of digitalis.
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