Biomedical subjects
Publications and source records attributed to D Schmidt.
Ingestion of ethanol, 1 g/kg, did not influence the phenytoin half-life in 5 volunteers after single i.v. administration of 3 mg/kg phenytoin. The control phenytoin half-life was 12.4 h (SD +/- 4.4); with ethanol ingestion it was 12.3 h (SD +/- 5.2).
A prospective study with regard to a cytostatic drugs combination treatment, partly synchronized and carried out in team work, of advanced ovarian carcinoma is being accomplished at the II. Women's Clinic of the University of Munich. The team consists of one oncologically orientated internal specialist, one radiotherapist, and one surgeon. The therapeutic procedure should be discussed; a report is given about the experiences gained so far in 41 patients, i.e. until May 1st, 1975.
Little is known about the influence of phenytoin and ethosuximide on primidone. Therefore we studied three groups of patients: 28 receiving primidone alone, 16 on comedication of primidone with phenytoin and 9 on primidone plus ethosuximide. Antiepileptic drug determinations were done with Kupferberg's gas chromatographic method. The results show that the addition of phenytoin--but not ethosuximide--does increase the plasma concentration of phenobarbital derived from primidone but not of primidone itself. The phenobarbital/primidone plasma concentration ratio is with 4.2 +/- 0.7 (+/- S.E.) significantly (P less than 0.001) higher in patients receiving primidone and phenytoin as compared to those on primidone alone (1.6 +/- 0.2) or together with ethosuximide (1.4 +/- 0.7). The effect of phenytoin occurs and persists for several days after the steady state plasma concentration of phenytoin has been reached. This effect is probably not due to induction of enzymes hydroxylating primidone but rather to inhibition of the metabolism and/or excretion of phenobarbital. A case of phenobarbital intoxication due to addition of phenytoin to primidone medication is described in detail.
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The secretaries in community mental health centers have functions that transcend their job descriptions. Their performance of these functions contributes to the success or failure of their centers' therapeutic programs. The Mental Health Training Institute of North Carolina initiated two separate pilot training programs within 1971-1972, aimed at heightening the secretaries' appreciation of their role within their centers and at facilitating their integration into the therapeutic team. This paper is a discussion of the second of these two programs.
Diphenylhydantoin, primidone, and phenobarbital were determined in saliva and plasma of 164 patients by gas-liquid chromatography. The saliva ratio was about one-tenth in patients on diphenylhydantoin, 0.32-0.38 on phenobarbital alone and with other drugs, 0.97 and 0.96 on primidone alone and with other drugs. The S/P ratio of phenobarbital was similar in patients treated with primidone alone or with co-medication. For diphenylhydantoin and primidone, the S/P and CSF/plasma ratio were similar; for phenobarbital the S/P ratio was lower due to the difference in pH of saliva and CSF. Thus the concentration in saliva serves as a measure of the nonprotein-bound or free concentration in plasma with the advantage that saliva is easy to obtain. Co-medication does not change the S/P ratio for the three drugs studied. The high correlation between levels in plasma and in saliva allows the plasma levels to be predicted from the concentration in saliva.
Indices based on early systolic ejection rates are theoretically more sensitive to ventricular performance than indices based on the entire systolic ejection (SE) period (mean ejection phase indices-MEPI): mean systolic ejection rate (MSER), mean normalized systolic ejection rate (MNSER) and mean velocity of circumferential fiber shortening (MVcf). The volume ejected in early systole is an indicator of the early rate of ejection. Accordingly, ventricular volume changes were determined by ventriculographic analysis for each thrid of SE in ml/sec (SER), as normalized systolic ejection rate (NSER), and as percent of stroke volume (PSV). In ten normal controls all these indices were higher in the first third compared to the other thirds of SE. Seven patients with diffuse ventricular disease had depressed values in the first third of SE. Despite "normal ventriculograms and normal MEPI, eight patients with left anterior descending coronary artery stenoses (greater than 60%) also had definitely depressed ejection indices during first third of systole. Detailed wall motion analysis in this group showed anteroapical hypokinesis isolated to the first third of SE. These data show that indices based on early SER are more sensitive than MEPI (MVcf, MNSER) for detecting abnormalities in ventricular performance in coronary artery disease;
Clinical and histopathological findings are described in 6 cases of chronchial carcinoma metastatic to the choroid of the eye. These findings show that especially in bronchial carcinoma, metastases of the choroid often are the first symptoms of the disease even before the primary site of the tumor is recognized. As these metastases often grow in a manner quite different from that of other uveal metastases, they are likely to be mistaken for uveal melanomas. Yet the right diagnosis is decisive for the right therapy. While in case of melanoma the eye has to be enucleated, x-ray therapy should be employed in metastatic carcinoma. Thus the patient can be prevented from becoming blind and from enucleation. The effect of x-ray treatment on the carcinoma cells in the choroid is demonstrated histologically in one of the cases.
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The application of the Neurolept-Analgesia to great gynaecological operations was tested in 50 Wertheim-radical-operations with removal of the glands, in comparison to a group of 50 patients whose operations were executed under the usual narcosis. There were controlled: blood-pressure, pulse, respiration, common dosing of the narcotica, dosing of the analgetica, and the patients' post-operative condition. Under NLA, the course of the operation was characterized by stability of circulation and a considerably reduced post-operative recovery, the comparative group, however, did not show so favourable results that can be proved mathematically. The application of the Neurolept-Analgesia as described thoroughly in this paper, has to be considered as especially suitable for executing gynaecological operations.
Three cases with chronic progressive external ophthalmoplegia are presented. They showed an upper lid, retraction which was due to a better preservation of lid elevator function as compared to ocular elevator function.
A 46-year-old patient shows paracentral scotomas in the oblique meridians of the visual fields. Additionally there exists pathologically cupped, atrophical disks which lead to the tentative diagnosis of "low-tension glaucoma". As the scotomas are bitemporally located a tumor near the chiasm must be the cause for these field defects. During the operation a chromophobe adenoma of the pituitary gland was found in the patient. We pointed out that even arcuate scotomas which cross the vertical meridian of the visual field can be caused by an intra- or parasellar tumor. As Hoyt has shown in his investigations in animals one could suppose that these scotomas can be developed from direct compression of the chiasm.
The clinical eye signs of 31 myasthenic patients are presented and those signs important for an early diagnosis are then discussed: lid symptoms caused by fatigue (Simpson-test), characteristic lid twitches as well as alternating asymmetrical eye muscle pareses. The importance of an investigation with the tangent scale in the course of which tensilon is injected is pointed out. False diagnosis and differential diagnostic signs are then considered (disseminated sclerosis, aneeurysm, encephalitis, pseudopulbarparalysis). - Our electronystagmographical investigations of saccadic eye movements showed hypometric, alternating saccades with occasional nystagmuslike jerks. After Tensilon injection hypermetric saccades (overshoots) were observed which depended on a disproportion of the supranuclear oculomotor centers and the eye muscles. The "muscleparetic" nystagmus is a pathologically increased endposition nystagmus. The hypometric nystagmuslike jerks during a saccadic eye movement are caused by insufficient phasic innervation.
3 cases of cyclical convergent strabismus (48 hour rhythm) were investigated. In contrast to intermittant strabismus, cyclical strabismus is not fatigue dependant. An alteration in the rhythm of the cyclical esotropia was produced by wearing prisms, red glasses or occlusion for several days. This observation indicates that centrally inaugurated rhythm processes can be altered by peripheral sensory influcences. In the case of our third patient, who was not operated upon, there was a cyclical strabismus which persisted from the age of 4 to 19 years, before changing to a constant convergent strabismus. The other two patients, following strabismus surgery, had a small angle esophoria with good fusion and stereopsis.
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