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Biomedical subjects

T Schirop

Publications and source records attributed to T Schirop.

14 recordsLinked to original sources

Determinants of the quality of life of patients with diabetes under intensified insulin therapy.

OBJECTIVE: The concept of quality of life (QOL) is understood as a multidimensional construct made up of physiological, psychological, and social aspects, but their particular weightings for the global QOL are rarely investigated. We examined 1) the general QOL of patients with diabetes, 2) the significance of the individual QOL aspects for the overall assessment of QOL, and 3) the modulating function of coping mechanism and particular personality traits. RESEARCH DESIGN AND METHODS: A total of 116 diabetes patients under intensified insulin therapy were studied, as were 107 patients with inflammatory bowel disease, 66 patients with chronic hepatitis C, and 229 students who served as control subjects. The examination was based on eight standardized QOL and personality questionnaires (354 items) and assessed by means of linear structural regression models (AMOS 3.6). RESULTS: The QOL of diabetes patients appears to be higher than the QOL of other chronically ill patients. Social, psychological, and physical aspects contribute to the overall QOL, although physical complaints receive a comparatively low weighting. Coping behavior and particular personality traits covary with all QOL aspects, giving these variables greater significance for the QOL than the existence of secondary illnesses. CONCLUSIONS: The hypothesis that the various factors involved in the multidimensional construct QOL receive different weightings was confirmed, making a simple summary score for the general QOL appear unjustifiable. In addition, all aspects that are commonly understood as parameters of QOL are influenced by external factors, such as coping behavior, based on individual personality characteristics.

Activities of Daily Living↗

[Quality of life of diabetic patients with intensified insulin therapy].

Patients with diabetes mellitus (86 IDDM, 30 NIDDM) under intensified insulin therapy did not differ from healthy control groups in life quality components chosen in the presented study. From interrelations between subjective parameters it is concluded that, besides sufficient somatic treatment, a satisfactory relationship between patient and physician has an important impact for individual life quality, whereas objective somatic parameters, like existence of long-term diabetic complications, had comparatively less importance. Aside from knowledge of disease progress and treatment procedures, a satisfactory doctor-patient relationship seems to improve adherence to therapy and patient's trust in their own coping potentials with disease progress and changing psychosocial circumstances.

Activities of Daily Living↗

Hemoperfusion in acute camphor poisoning.

After ingestion of an unknown dose of a 10% camphor spirit (maximum dose 200 ml), a 54-year-old female was found in coma, having developed grand-mal-like seizures and respiratory failure. For detoxification, gastric lavage and hemoperfusion with amberlite XAD4 were performed. During hemoperfusion, seizures ceased, but no marked influence on the clinical course of the intoxication--especially on grade of coma--was observed. For further evaluation of the efficacy of treatment, camphor plasma elimination kinetics during hemoperfusion were compared to plasma elimination kinetics determined in a volunteer after an oral dose of 200 mg of camphor. Although the plasma compartment was almost completely (89%-95%) cleared of camphor by hemoperfusion, only a total of 35 mg of camphor was removed due to its high apparent volume of distribution (estimated 2-4 l/kg). The plasma elimination half-life was not affected by hemoperfusion, which may be explained by the saturation of metabolizing enzymes, still incomplete absorption, or metabolic interference of isopropanol. In the case presented here, neither the clinical course of the intoxication nor plasma level data gave evidence for a pronounced beneficial effect of hemoperfusion.

Acute Disease↗

Hemoperfusion in severe chlorprothixene overdose.

Two to twelve hours after suicidal ingestion of an estimated dose of 10 g chlorprothixene, a 31-year-old female was admitted to the emergency ward of the clinic with cardiorespiratory arrest. After successful resuscitation, the further clinical course was complicated by persistent ventricular extrasystoles and ventricular fibrillation which necessitated repeated defibrillation. Since the patient did not respond satisfactorily to supportive treatment, a combined hemoperfusion/hemodialysis was performed. Under extracorporeal detoxication, elimination of chlorprothixene from plasma was accompanied by substantial improvement of the patient's clinical condition, although only about 1.6% of the estimated dose had been removed. This case seems to indicate that evaluation of the therapeutic efficacy of hemoperfusion should not be based exclusively on the relation of the amount of the eliminated drug to total absorbed dose.

Adult↗

Acute poisoning with pine oil - metabolism of monoterpenes.

A patient attempting suicide ingested 400-500 ml pine oil and was admitted to the clinic. Since more than the lethal dose had been ingested hemoperfusions with activated charcoal and amberlite and a hemodialysis were performed. The composition of the ingested pine oil was determined by gaschromatography/mass spectrometry. Four monoterpenes were identified: 57% alpha-pinene, 8% beta-pinene, 26% carene, 6% limonene and 3% other hydrocarbons. The blood and urine monoterpene concentrations were continuously monitored. The data suggest that monoterpenes are poorly resorbed in the gastrointestinal tract. The resorbed portion of the hydrocarbons cumulates in the lipophilic body compartments and is slowly metabolized and then excreted by the kidneys. The main metabolic pathways are hydratation, hydroxylation, rearrangement, and acetylation. Five metabolites were identified.

Bicyclic Monoterpenes↗

[Reaction of blood sugar and serum insulin to intravenous longterm treatment with Actovegin. Clinical double-blind study (author's transl)].

In a randomised double-blind study involving 20 diabetics and 20 patients with normal carbohydrate metabolism, the influence of a 14 days' course of intravenous infusion of protein-free calf blood extract (0.5 ml Actovegin/kg/day) and equivalent amounts of physiological saline solution on blood sugar and serum insulin was investigated by the oral glucose tolerance test (100 g Dextro-OGTT). In diabetic carbohydrate metabolism Actovegin was shown to improve the glucose tolerance significantly without alteration of the serum insulin, thus possessing antidiabetogenic activities. With normal carbohydrate metabolism, however, the behaviour of blood sugar and serum insulim was not changed by Actovegin.

Aged↗

[Drug emergencies].

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Dose-Response Relationship, Drug↗

[On the toxicology of carbromal. III. Role of active metabolites in humans acutely poisoned with carbromal-containing sedatives (author's transl)].

Carbromal is metabolized extensively in humans. The major metabolites known to date are bromoethylbutyramide, ethylbutyrylurea and inorganic bromide. After ingestion of a therapeutic dose of 1.0 g carbromal (4.2 mmoles) by four healthy volunteers highest concentrations in serum were found to be for carbromal 30 mumoles/l, for bromoethylbutyramide up to 20 mumoles/l and for ethylbutyrylurea 2--3 mumoles/l. In patients acutely poisoned by carbromal-containing sedatives serum concentrations measured were in the range of 200 mumoles/l carbromal, 350 mumoles/l bromoethylbutyramide and 50 mumoles/l ethylbutyrylurea. These patients were comatose, apneic, had isoelectric encephalographic records and decreased body temperature. The degree of central nervous depression as judged by clinical signs was found to correlate with the serum concentrations of carbromal and of bromoethylbutyramide. Pharmacological activity and acute toxicity of carbromal and its two metabolites were examined in rats and compared with the activity of phenobarbitone. For intraperitoneal injection LD-50 values were found to be for carbromal 1.8 mmoles/kg, for bromoethylbutyramide 1.5 mmoles/kg, for ethylbutyrylurea 5.0 mmoles/kg and for phenobarbitone 0.9 mmoles/kg. Carbromal and bromoethylbutyramide severely decreased body temperature. The relative narcotic activity was estimated to be for carbromal = 100; bromoethylbutyramide = 66; ethylbutyrylurea = 33; phenobarbitone = 100. The anticonvulsive activity against pentetrazol-induced generalized seizures was nearly identical for carbromal, bromoethylbutyramide and phenobarbitone. Anticonvulsant activity of ethylbutyrylurea was two to three times less than that of carbromal. Inorganic bromide was found to increase the narcotic activity of carbromal and of bromoethylbutyramide. The findings show that the clinical signs of central nervous system depression seen in patients acutely poisoned with carbromal are caused mainly by unchanged carbromal and by its metabolite bromoethylbutyramide.

Adult↗

[Influence of vasoactive substances on blood sugar and serum insulin in normal and diabetic carbohydrate metabolism (author's transl)].

The effect of the following vasoactive substances, which are used in the treatment of peripheral arterial occlusive diseases, was investigated in a randomized study in 36 patients with normal and 52 patients with diabetic carbohydrate metabolism by intravenous infusion on the behaviour of blood sugar and serum insulin (IMI) during simultaneous oral glucose tolerance tests (100 g oligosaccharides). The substances used and the doses given were as follows: protein-free calf-blood extract (Actihaemyl, 0,5 ml per kg body weight), bencyclane (Fludilat, 200 mg), naftidrofuryl (Dusodril, 200 mg, pentoxifyllin (Trenal, 200 mg). The results obtained with the simultaneous treatment and oral glucose tolerance test were compared with a second OGTT carried out at an interval of 3-4 days under the same conditions but without administration of the substances (in a cross-over procedure) and the results of these experiments were compared with those obtained from an untreated control group. In subjects with a diabetic metabolic state, Actihaemyl led to a significant reduction of the blood sugar after oral glucose load (p less than 0,05) without producing any change in serum insulin. The same behaviour was exhibited by Fludilat for the total area integral and by Trental for the first 60 min after the oral glucose load. The change in the blood sugar behaviour was only significantly different from the untreated controls with Actihaemyl (p less than 0,05). In subjects with a normal metabolic state neither blood sugar nor serum insulin (IMI) were altered by any of the substances investigated.

Actihaemyl↗

Blood glucose and serum insulin levels following acute and chronic pentoxifylline administration.

Twenty-two patients with normal carbohydrate metabolism and 16 diabetic patients, all 38 having peripheral occlusive arterial disease, took part in an investigation into the effect of pentoxifylline on blood glucose and serum insulin following an oral glucose tolerance test (OGTT). Pentoxifylline was administered by the i.v. route and the investigation took the form of an acute study (200 mg) and a 14-day chronic study (400 mg). Neither acute nor chronic medication elicited any change in blood glucose or serum insulin. Pentoxifylline does not affect blood glucose.

Blood Glucose↗