The clinical pharmacokinetics of phenytoin.
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Biomedical subjects
Publications and source records attributed to E Martin.
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The authors report a case of probably ectopic secretion of calcitonin in a 35 year old woman suffering from a malignant tumour in a double intra- and extra-spinal form. Hormone levels returned to normal after complete excision of the tumour, in which it was impossible to demonstrate the presence of calcitonin despite a very marked secretory appearance by electron microscopy. Study of the literature concerning the secretion of calcitonin by malignant tumours indicates the high degree of contradiction concerning the origin and the significance of increased radio-immunological levels of this hormone, which it is not possible to use without criticism as a "marker" of carcinomas.
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The effects of Dihydergot (1,0 mg i.m.) and a placebo on orthostatic regulation disturbances were examined during the mobilisation in the first post-operative phase. According to a modified Schellong-test, 100 fresh-operated patients with hyper- rsp. hypodiastolic regulation disturbances were checked on the first post-operative day. In comparison with the placebo, Dihydergot showed a stabilisation of the systolic blood pressure and a decrease of the pulse rate during orthostatic conditions. Neither Dihydergot nor placebo influenced the diastolic blood pressure. Orthostatically caused side effects were observed less frequent within Dihydergot - therapy than under placebo.
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The occurrence and levels of activity of various enzymes of carbohydrate catabolism in culture forms (promastigotes) of 4 human species of Leishmania (L. brasiliensis, L. donovani, L. mexicana, and L. tropica) were compared. These organisms possess enzymes of the Embden-Meyerhof pathway but lack lactate dehydrogenase. No evidence could be found for the production of lactic acid by growing cultures and lactic acid could not be detected either in cell-free preparations or after incubation of cell-free extracts with pyruvate and NADH under appropriate conditions. All 4 species possess alpha-glycerophosphate dehydrogenase and alpha-glycerophosphate phosphatase which together could regenerate NAD, thus compensating for the absence of lactate dehydrogenase. The oxidative and nonoxidative reactions of the hexose monophosphate pathway are present in all 4 species. Cell-free extracts have pyruvate dehydrogenase activity which allows the entry of pyruvate into and its subsequent oxidation through the tricarboxylic acid cycle. All enzymes of this cycle, including a thiamine pyrophosphate dependent alpha-ketoglutarate dehydrogenase, are present. Both NAD and NADP-linked malate dehydrogenase activities are present. The isocitrate dehydrogenase is NADP specific. There is an active glutamate dehydrogenase which could compete with alpha-ketoglutarate dehydrogenase for the common substrate (alpha-ketoglutarate). Replenishment of C4 acids is accomplished by heterotrophic CO2 fixation catalyzed by pyruvate carboxylase. All 4 species have high levels of NADH oxidase activity. Several enzymes thus far not found in any species of Leishmania have been demonstrated. These are: phosphoglucose isomerase, triose phosphate isomerase, fructose-1, 6-diphosphatase, 3-phosphoglycerate kinase, enolase, alpha-glycerophosphate dehydrogenase, alpha-glycerophosphate phosphatase, pyruvate dehydrogenase complex, citrate synthase, aconitase, alpha-ketoglutarate dehydrogenase, glutamate dehydrogenase, and NADH oxidase.
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In a clinical study, the influence of 6 per cent Dextran 60 and 6 per cent hydroxyethyl starch (HES) on blood clotting was measured in 2 comparable groups of surgical patients. Haematocrit, platelets, thromboplastin time according to Quick, partial thromboplastin time and fibrinogen level were determined before and after isovolaemic haemodilution, and subsequently during a period of 14 days. There was no significant difference between the diluents with regard to their effect on blood clotting. Changes within each group may be ascribed to the diluting effect of the plasma substitutes.
The disappointing results of porta-caval anastomosis in the treatment of portal hypertension have led surgeons to treat directly oesphageal varices by interazygoportal disconnection through Vosschulte's ring. An experimental study on 29 dogs, permitted the authors to make several discoveries. The ring introduced through the pylorotomy should have a caliber identical to that of the oesphagus. The course of the stricture then occurs towards mutilant annular fibrosis of all the oesphageal wall. The marked morbidity due to regurgitation linked to stenosis, may be reduced by early instrumental dilatation.
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Nucleotides of cytosine and uracil are readily mercurated by heating at 37-50 degrees in buffered aqueous solutions (pH 5.0-8.0) containing mercuric acetate. Proton magnetic resonance, elemental, electrophoretic, and chromatographic analyses have shown the products to be 5-mercuricytosine and 5-mercuriuracil derivatives, where the mercury atom is covalently bonded. Polynucleotides can be mercurated under similar conditions. Cytosine and uracil bases are modified in RNA while only cytosine residues in DNA are substituted. There is little, if any, reaction with adenine, thymine, or guanine bases. The rate of polymer mercuration is, unlike that of mononucleotides, markedly influenced by the ionic strength of the reaction mixture: the lower the ionic strength the faster the reaction rate. Pyrimidine residues in single- and double-stranded polymers react at essentially the same rate. Although most polynucleotides can be extensively mercurated at pH 7.0 in sodium or Trisacetate buffers, tRNA undergoes only limited substitution in Tris buffers. The mild reaction conditions give minimal single-strand breakage and, unlike direct iodination procedures, do not produce pyrimidine hydrates. Mercurated polynucleotides can be exploited in a variety of ways, particularly by crystallographic and electron microscopic techniques, as tools for studying polynucleotide structure.
Removal of phenytoin by hemodialysis was determined in a uremic patient. The rate of appearance of the drug in dialysate, the plasma concentration with time, and the plasma clearance by dialysis were measured. Plasma protein binding of phenytoin was also determined. In spite of greatly reduced plasma protein binding in the uremic patient, removal rate was observed to be less than 10% of the rate of presentation of the dialyzer. During the 6-hr period of dialysis, the plasma concentration showed little change. The amount collected in the dialyase, 43.6 mg, was only a small fraction of drug in the body. These results indicate that replacement of phenytoin based on the amount of drug removed by dialysis is unnecessary in chronically dialyzed uremic patients. In addition, the utility of hemodialysis in phenytoin overdose is questioned.
In a clinical study we tested the following parameters: free fatty acids, beta-hydroxybutyrate, acid-base-balance, lactate, bilirubin, uric-acid, fructose, xylitole, glucose in blood and urine. The tests were executed in 9 patients who were undergoing stomac operations. The cardio pulmonary system of all patients was normal, and there was a homeostasis in water and electrolytes preoperatively. In combination with the amino-acids we received a ratio of 1:1:1 for glucose, levulose and xylitole. Totally, the patients received 0.36 g per kg body weight and per hour of carbohydrates. Beta-hydroxybutyrate, aceto-acetat, and free fatty acids show normal values under conditions of parenteral nutrition as well as lactate, uric acid, and acid-base-balance. The ratio of the different carbohydrates in serum and urine prove that the infusion time and volume were extremely favourable. The loss of carbohydrates in urine was very low.