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Biomedical subjects

K Dietrich

Publications and source records attributed to K Dietrich.

52 records · Page 3Linked to original sources
PubMed1984

Carbamazepine levels in breast milk.

The carbamazepine (CBZ) concentration of breast milk was determined in 19 epileptic patients of whom 13 were receiving CBZ monotherapy. Two lactation periods under CBZ monotherapy were followed in 2 of these 13 patients. The CBZ concentration of the breast milk was 36.4% of the maternal CBZ serum level (mean value). The correlation coefficient was 0.44; the regression line follows the equation y = 0.12X + 1.63. The CBZ concentration was measured in a total of 50 milk samples during the lactation period (cases of monotherapy plus combination therapy). The CBZ concentration ranged from 1 to 4.8 micrograms/ml (mean 2.5 micrograms/ml). The free CBZ concentration in the maternal serum was measured in four patients. The correlation between CBZ in the breast milk and free CBZ levels was 1.6 to 1.8. The ratio of carbamazepine-epoxide (ECBZ) in the milk to ECBZ determined in serum was 0.53. Continuing galactorrhea after delivery was observed in one patient. The CBZ and ECBZ levels determined 3.5 years after delivery were higher in the milk than in the serum. The observations of breast-fed and non-breast-fed children whose mothers were on CBZ monotherapy disclosed poor suckling in only 1 of 15 infants.

Adult↗
PubMed1979

[Miniaturized methods to monitor intracranial pressure. Technical and clinical results (author's transl)].

The prognosis of numerous diseases of the central nervous system is essentially determined by the intracranial pressure (ICP) and its therapeutic influencing. Long-term monitoring of the ICP must therefore be the objective in neurological and neurosurgical patients at risk. For this purpose, miniaturized methods were tested and developed. To monitor the intracranial pressure in patients who were not operated on, a miniature pressure transducer the size of a match head was used which was directly implanted 'percutaneously' in the intensive care unit: After a stab wound had been made in the skin, a 5-mm burrhole is made; the specially constructed miniature coaxial burr which disengages as soon as it touches the dura automatically enables coplanar epidural implantation of the transducer by means of an adapter capsule. The skin is closed without tension. For monitoring the pressure after trepanation, a spiralled miniature pressure transducer is implanted. The equally flattened receiver with lateral membranes is placed intracranially as desired, e.g., epidurally or subdurally, durin the operation. The zero point can be checked from outside without danger of infection. After the end of the measurements the recorder is easily extracted. Up to the present time, the epidural pressure has been reliably monitored for several weeks by this method in 86 patients. Ten comparative measurements showed corresponding cerebrospinal fluid pressures to within a few mm Hg with very good reproduction of frequency and amplitude. Small zero drift and the external zero control give an accuracy of measurement +/- 5 mm Hg independently of the time of measurement. The measurement permits early recognition of progressive intracranial space-occupying lesions. In 14 patients (16%) a measured rise in intracranial pressure was an essential basis for indication for neurosurgical operations. In addition, the pressure measurement provides an objective assessment of the effect of measures to lower the ICP; progressive increases in intracranial pressure which cannot be influenced conservatively can be brought for surgical decompression in good time before the brain has been irreversibly damaged by pressure. In craniocerebral traumata, monitoring the intracranial pressure permits the differentiation of primary damage to the brain stem with uniform, normal intracranial pressure from secondary constrictions of the brain stem with considerable rise of intracranial pressure and disturbed autoregulation. Only in chronic subdural haematomata are considerable displacements of intracranial masses to be seen with only slightly increased ICP ( less than 30 mm Hg). Besides space-occupying lesions, the measurement of pressure also detects generalised epileptic attakcs due to a considerable rise in intracranial pressure caused by hyperemia. Also disorders of respiration are recognised by supervision of ICP. The procedures described seem suitable for routine monitoring of ICP in patients at risk, with little operative effort and minimum danger...

Adolescent↗
PubMed1979

Comparison of the effects of surgical decompression and resection of local edema in the therapy of experimental brain trauma. Investigation of ICP, EEG and cerebral metabolism in cats.

The effect of decompressive trepanation was compared to that of surgical resection of the traumatized tissue in the course of traumatic brain edema in standardized experimental brain trauma. Following a right parietal cold injury, the following parameters were monitored continuously in 12 cats: ventricular pressure, epidural pressure over both hemispheres, arterial and central venous pressure and heart rate. The EEG was evaluated continuously, using a computer (power spectra). After catheterization of the superior sagittal sinus, cerebral arteriovenous differences of glucose, lactate, O2 and CO2 were calculated. 6 animals were treated surgically when showing elevated intracranial pressure ICP and markedly altered EEG. In 3 animals, the right hemisphere was decompressed by extensive resection of bone and dura. In 3 further animals, the softened brain tissue of the cold lesion was resected and the skull defect closed. 6 untreated animals were used in controls. A decompression by skull hemiresection for ablation of the injured cortex abolished the high intracranial pressure, but only the latter method seemed to prevent further damage. This could be demonstrated by the EEG registration, and by the normalization of arteriovenous metabolite differences. Only animals treated with edema resection had a normal arousal reaction and survived the trauma. The results indicate, that only an ablation of the local injury will prevent further damage to the brain. After decompressive trepanation alone, the progression of tissue edema is not interrupted. As can be seen from the literature, the poor results obtained even from extensive decompressive operations in traumatic brain edema, indicate that the further development of edema is independent of the intracranial pressure, whereas the favorable results of resection of lobar contusions show an interruption of the spread of dysbolism.

Animals↗
PubMed1977

A new miniaturized system for monitoring the epidural pressure in children and adults.

A new miniaturized epidural pressure transducing system for monitoring intracranial pressure (ICP) has been developed. The system is of the as yet smallest known dimensions. The transducer is implanted automatically coplanar to the dura via a burr hole of 4 mm diameter in the conscious patient without special surgical equipment. Application is possible in adults, children and infants. We have achieved a maximal resolution of 10(-3) mm of Hg. At a full scale range of 100 mm of Hg the zero-point drift is less than 1 mm of Hg/24 h.

Adult↗
PubMedDate not supplied

Cognitive deficits associated with blood lead concentrations <10 microg/dL in US children and adolescents.

OBJECTIVE: Lead is a confirmed neurotoxicant, but the lowest blood lead concentration associated with deficits in cognitive functioning and academic achievement is poorly defined. The purpose of the present study was to examine the relationship of relatively low blood lead concentrations-especially concentrations <10 micrograms per deciliter (microg/dL)--with performance on tests of cognitive functioning in a representative sample of US children and adolescents. METHODS: The authors used data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, to assess the relationship between blood lead concentration and performance on tests of arithmetic skills, reading skills, nonverbal reasoning, and short-term memory among 4,853 children ages 6-16 years. RESULTS: The geometric mean blood lead concentration for children n the study sample was 1.9 microg/dL; 172 (2.1%) had blood lead concentrations > or =10 microg/dL. After adjustment for gender, race/ethnicity, poverty, region of the country, parent or caregiver's educational level, parent or caregiver's marital status parent, serum ferritin level, and serum cotinine level, the data showed an inverse relationship between blood lead concentration and scores on four measures of cognitive functioning. For every 1 microg/dL increase in blood lead concentration, there was a 0.7-point decrement in mean arithmetic scores, an approximately 1-point decrement in mean reading scores, a 0.1-point decrement in mean scores on a measure of nonverbal reasoning, and a 0.5-point decrement in mean scores on a measure of short-term memory. An inverse relationship between blood lead concentration and arithmetic and reading scores was observed for children with blood lead concentrations lower than 5.0 microg/dL. CONCLUSION: Deficits in cognitive and academic skills associated with lead exposure occur at blood lead concentrations lower than 5 microg/dL.

Adolescent↗
PubMedDate not supplied

The economic impact of Staphylococcus aureus infection in New York City hospitals.

We modeled estimates of the incidence, deaths, and direct medical costs of Staphylococcus aureus infections in hospitalized patients in the New York City metropolitan area in 1995 by using hospital discharge data collected by the New York State Department of Health and standard sources for the costs of health care. We also examined the relative impact of methicillin-resistant versus -sensitive strains of S. aureus and of community-acquired versus nosocomial infections. S. aureus-associated hospitalizations resulted in approximately twice the length of stay, deaths, and medical costs of typical hospitalizations; methicillin-resistant and -sensitive infections had similar direct medical costs, but resistant infections caused more deaths (21% versus 8%). Community-acquired and nosocomial infections had similar death rates, but community-acquired infections appeared to have increased direct medical costs per patient ($35,300 versus $28,800). The results of our study indicate that reducing the incidence of methicillin-resistant and -sensitive nosocomial infections would reduce the societal costs of S. aureus infection.

Community-Acquired Infections↗
PubMedDate not supplied

Elevated c-myc messenger RNA in multiple myeloma cell lines.

Oncogene analyses of four human myeloma cell lines provided no indication of gene amplification or rearrangement using DNA probes for the met, raf, abl, mos, erb B, Her-2-neu, fos, myb-7, fms, L-myc, sis, and myb-1 genes. However, a consistent elevation of up to 23-fold in the level of c-myc mRNA was observed in all of the cell lines studied. No restriction fragment length polymorphism (in exons one, two, or three) or c-myc gene amplification has as yet been demonstrated to account for the c-myc mRNA elevation. The c-myc mRNA has a half-life of 25 min which is comparable to that observed in other systems. The elevation in c-myc mRNA is further evidence for the role of the c-myc proto-oncogene in the pathogenesis of myeloma.

DNA Probes↗