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Biomedical subjects

C Kretschmar

Publications and source records attributed to C Kretschmar.

At least 19 recordsLinked to original sources
PubMed2007

Pre-radiation chemotherapy with response-based radiation therapy in children with central nervous system germ cell tumors: a report from the Children's Oncology Group.

BACKGROUND: This Phase II study was designed to determine response to chemotherapy and survival after response-based radiation (RT) in children with CNS germ cell tumors. PROCEDURE: Children with germinomas and normal markers received cisplatin 100 mg/m(2) + etoposide, alternating with vincristine + cyclophosphamide (CPM) 2 g/m(2)/d, for four cycles. Children with nongerminomatous tumors or with abnormal markers received doubled doses of cisplatin and CPM. For germinoma patients in complete response (CR), RT was decreased from 50.4 to 30.6 Gy. High-risk patients received neuraxis RT: 50.4 Gy local + 30.6 Gy neuraxis in CR; 54 Gy local + 36 Gy if less than CR. RESULTS: Of 12 germinoma patients, 4 had cerebrospinal fluid (CSF) human chorionic gonadotropin (HCG) 6.9-21 mIU/ml. Of 14 nongerminomatous patients, HCG in serum or CSF was >50 mIU/ml in 9, alpha-fetoprotein (AFP) abnormal in 9. Four germinoma patients attained CR, six PR, one SD, one not evaluable after resection. Two nongerminomatous patients had CR, three PR, three SD, one PD, four not evaluable after resection; one inadequately treated patient had progressive disease (PD). Both PD patients died; one SD patient died during a seizure. Eleven germinoma patients are PF at median 66 months; one patient in CR refused RT, had PD at 10 months, received RT, and was PF at 56 months. Eleven of 14 nongerminomatous patients were PF at median 58 months. CONCLUSION: Response (germinoma, 91%; nongerminomatous, 55%) and survival are encouraging after this regimen plus response-based RT.

Adolescent↗
PubMed1998

[The clinical picture and stability of non-cognitive symptoms in patients with Alzheimer's disease].

The purpose of this study was to investigate noncognitive symptoms in Alzheimer's disease in order to identify symptom patterns and to study stability of such patterns prospectively. Furthermore, variables were examined which could be associated with certain types of symptom patterns or could be predictors of change of these patterns. Forty-eight patients with the clinical diagnosis of probable Alzheimer's disease were included in this study and were assessed weekly over a three-week period. Noncognitive symptoms were rated according to the Behavioral Abnormalities in Alzheimer's Disease Rating Scale (BEHAVE-AD) and the Dementia Mood Assessment Scale (DMAS) and to a set of items specifically assessing misidentifications. By means of principal component factor analysis different noncognitive symptom patterns were obtained yielding a four-factor solution. They were mapped as rational domains with respect to clinical experience: 'depression', 'apathy', 'psychotic symptoms/aggression', 'misidentifications/agitation'. Demographic and clinical variables were not associated with the factor solutions and did not predict change of the factor values. The results demonstrate that in Alzheimer's disease there are distinct noncognitive symptom patterns with at least short-term prospective stability. None of the examined clinical variables, such as age at entry, the status of the patients (outpatient or inpatient) or dementia severity, exerted substantial influence on the noncognitive symptom patterns. Further investigations should concentrate on the pathological and prognostical correlates of noncognitive symptom patterns in Alzheimer's disease.

Affect↗
PubMed1998

Presentation and stability of noncognitive symptom patterns in patients with Alzheimer disease.

The purpose of this study was to investigate noncognitive symptoms in Alzheimer disease to identify symptom patterns and to study stability of such patterns prospectively. Furthermore, variables were examined that could be associated with certain types of symptom patterns or could be predictors of change of these patterns. Forty-eight patients with the clinical diagnosis of probable Alzheimer disease were included in this study and were assessed weekly over a 3-week period. Noncognitive symptoms were rated according to the Behavioral Abnormalities in Alzheimer's Disease Rating Scale and the Dementia Mood Assessment Scale and to a set of items that specifically assess misidentifications. By means of principal component factor analysis different noncognitive symptom patterns were obtained, yielding a four-factor solution. They mapped onto rational domains with respect to clinical experience: depression, apathy, psychotic symptoms/aggression, and misidentifications/agitation. Demographic and clinical variables were not associated with the factor solutions and did not predict change of the factor values. The results demonstrate that in Alzheimer disease there are distinct noncognitive symptom patterns that hold at least short-term prospective stability. None of the examined clinical variables, such as age at entry, the status of the patients (outpatient or inpatient), or dementia severity, exerted substantial influence on the noncognitive symptom patterns. Further investigations should concentrate on the pathological and prognostic correlates of noncognitive symptom patterns in Alzheimer disease.

Aged↗
PubMed1998

Phase I trial of 9-aminocamptothecin in children with refractory solid tumors: a Pediatric Oncology Group study.

PURPOSE: A phase I trial of 9-aminocamptothecin (9-AC) was performed in children with solid tumors to establish the dose-limiting toxicity (DLT), maximum-tolerated dose (MTD), and the pharmacokinetic profile in children and to document any evidence of activity. PATIENTS AND METHODS: A 72-hour infusion of 9-AC dimethylacetamide formulation was administered every 21 days to 23 patients younger than 21 years of age with malignant tumors refractory to conventional therapy. Doses ranged from 36 to 62 microg/m2 per hour. Pharmacokinetics were to be performed in at least three patients per dose level. The first course was used to determine the DLT and MTD. RESULTS: Nineteen patients on four dose levels were assessable for toxicities. At 62 microg/m2 per hour, three patients experienced dose-limiting neutropenia and one patient experienced dose-limiting thrombocytopenia. Pharmacokinetics were performed on 15 patients (nine patients had complete sets of plasma sampling performed). The pharmacokinetics of both lactone and total 9-AC were highly variable. The percentage of 9-AC lactone at steady-state was 10.8% +/- 3.6%. Total 9-AC and its lactone form had a terminal half-life of 8.1 +/- 3.8 and 7.1 +/- 3.9 hours, respectively, and a volume of distribution at steady-state (Vdss) of 21.2 +/- 13.3 L/m2 and 135.3 +/- 52.5 L/m2, respectively. Hepatic metabolism and biliary transport had an important role in 9-AC disposition. CONCLUSION: The recommended phase II dose of 9-AC administered as a 72-hour infusion every 21 days to children with solid tumors is 52 microg/m2 per hour. Neutropenia and thrombocytopenia were dose limiting.

Adolescent↗
PubMed1997

[Nootropic drug evaluation for general practice].

Treatment with "nootropic drugs" of patients suffering from dementia is often described as arbitrary. To define the potential usefulness of nootropic drugs, effects and side effects, economic aspects in comparison to other treatment approaches were studied. A summary of literature published concerning these criteria underlines the efficacy of nootropics in improving the symptoms at the beginning and in postponing the progress of the disease. The majority of substances does not lead to severe side effects. There are not enough studies comparing the effects of the substances or on prophylactic effects. Delayed admission to care units leads to a positive cost effect of nootropics. Thus, also for economic reasons it seems advisable to treat patients with nootropics. Better effects are gained when nootropic treatment is combined with training and changing of the structure of the environment. A proposal for a rational treatment with nootropics is derived from the data.

Alzheimer Disease↗
PubMed1996

[Medicamentous therapy of alcoholic polyneuropathy. Randomized double-blind study comparing 2 vitamin B preparations and a nucleotide preparation].

In a randomized double-blind study involving 303 patients with alcoholic polyneuropathy the efficacy and tolerability of the combinations thiamine/pyridoxine, benfotiamine/pyridoxine, and the nucleotides of cytidine and uridine administered orally for 21 days were compared. Pain and paraesthesia, measured on a visual 10-cm-long analogue scale, as also pallaesthesia and the strength of the dorsiflexion and plantar flexors of the foot, clearly improved in all treatment groups. Clinically relevant differences in efficacy were not observed. All the drugs tested were well tolerated.

Adult↗
PubMed1995

A phase I study of acivicin in refractory pediatric solid tumors. A Pediatric Oncology Group study.

Forty-two patients with progressive solid tumors and brain tumors were entered in this Phase I study of the glutamine antagonist acivicin given intravenously over thirty minutes daily for five days. The major toxicities encountered were myelosuppression and central nervous system toxicity (nightmares and somnolence). The maximum tolerated dosage on this schedule was 26 mg/M2 daily for five days. Six patients including three patients with brain tumor had stable disease.

Adolescent↗
PubMed1994

[Dementia and disorders of the thyroid gland].

Cognitive deficits pretending dementia can be caused by thyroid dysfunction. The literature addressing pathophysiology and therapy of thyroid dysfunction is reviewed. A shorter duration and less severe course of thyroid dysfunction seem to indicate a better response to therapy. There are not studies on the latency between therapy and response. It is recommended to measure at least TSH in the differential diagnosis of dementive syndromes. Degenerative dementia can occur in coincidence with thyroid dysfunction. Therapy would improve at least symptoms caused by the thyroid dysfunction.

Dementia↗
PubMed1992

[Transitional objects as regression phenomena in demented patients].

Two demented patients, one with primary degenerative dementia and one with multi-infarct dementia, each showed attachment to a soft toy animal, which fulfilled the criteria of a transitional object as described by Winnicott. This could be regarded as a regression phenomenon, according to the basic pathogenetic concept that cerebral disease causes a dissolution of the highest central nervous functions.

Aged↗
PubMed1990

myc gene amplification and expression in primary human neuroblastoma.

Although N-myc amplification in neuroblastomas correlates with poor prognosis, not all neuroblastomas which fail to respond to therapy have N-myc amplification. To determine whether other modes of myc gene activation underlie progression of some neuroblastomas, 45 were analyzed for amplification of N-myc, c-myc and L-myc and 26 were studied for transcription of these oncogenes. N-myc amplification was found in 6 of 45 tumors; no tumor had amplification of c-myc or L-myc. Transcription of both N-myc and c-myc occurred in 21 of 26 neuroblastomas. No tumor without N-myc amplification had a level of N-myc expression near that of a tumor or cell line with amplification. One tumor with N-myc amplification was the only specimen with N-myc but not c-myc expression. Five samples had c-myc but not N-myc expression; all had histological features of ganglioneuroma. DNA index did not correlate with myc gene amplification or expression. It is concluded that N-myc and c-myc are commonly expressed in primary untreated neuroblastomas, but in the absence of N-myc amplification, expression of these genes does not appear to correlate with disease progression.

Adolescent↗
PubMed1990

Central nervous system neurocytoma and neuroblastoma in adults--report of eight cases.

The clinical features, pathologic findings and treatment courses of eight adults with central nervous system small-cell neuronal tumors were reviewed. Five patients had central neurocytomas, two patients central nervous system neuroblastomas, and one patient a neurocytoma-like spinal cord tumor. The neurocytomas were intraventricular, moderately cellular tumors with bland nuclei and perinuclear halos. Patients with neurocytoma were treated with surgery, radiation therapy, and/or chemotherapy, and have followed favorable clinical courses. The neuroblastomas were intraparenchymal, hypercellular tumors with necrosis and frequent mitoses. Patients with neuroblastomas were treated with surgery, radiation therapy and chemotherapy, with some clinical response, but overall poor survival. One of the two patients developed extracranial metastasis. The spinal cord tumor had histologic features of neurocytoma, and responded well to biopsy and radiation therapy. The cases are compared with the varieties of small-celled neuronal tumors described in the literature, and pathologic, histogenetic and treatment implications are discussed.

Adult↗
PubMed1990

[Meningioma in psychiatry. Clinico-pathologic contribution to differential cerebral organic psychosyndrome diagnosis in middle and advanced age].

A clinico-pathological follow-up of mentally ill patients of the Rheinische Landesklinik Düsseldorf between 1960 and 1984 revealed intracranial space-occupying processes in 47 of 1023 post mortem examinations (4.6%). 9 of the 47 cases (19%) were meningiomas. 5 patients of those clinically not diagnosed as having meningioma had signs of raised intracranial pressure at post mortem, in 4 others the meningioma was in incidental finding of presumably lacking clinical significance. 4 other meningioma patients were diagnosed while alive; 2 of them were operated on the tumor. Short- and longterm psychiatric features of meningioma patients bear many similarities with mental symptoms due to other causes in middle and old age with also similar problems in differential diagnosis. There is no raised incidence of meningioma among patients presenting psychiatrically. "Endoform" features in psychopathology are rarely encountered in meningioma patients. According to the pertinent literature an operation in due time ameliorates or abolishes predominantly psychiatric illness in about 80% of meningioma patients.

Aged↗
PubMed1989

Diagnostic instruments differentiating dementia--depression.

It is an overall knowledge, that dementia and depression are the most common diagnosis in old age psychiatry. This fact has long since been known, in fact first descriptions of cognitive disorders during the course of endogenous depression can already be found at the beginning of the century in works of Gaupp and Kraepelin. On the other hand there are depressive symptoms in people with later evident dementia that can be found years before cognitive disorders are evident. These short introductory remarks show the need of early diagnosis to enable us to more efficient therapy. The following paper gives a survey of the recent and efficient diagnostic possibilities for practible clinical work as well as it shows new research aspects in this field.

Aged↗
PubMed1988

[Polyacrylamide gel electrophoresis of cellular proteins from parasitic flagellates of the order Trichomonadida].

Some Trichomonas hominis and Dientamoeba fragilis strains were compared by electrophoretic patterns of total proteins from trophozoites. Easily distinguished patterns divided T. hominis in different types. Significant differences were also seen comparing T. hominis and D. fragilis whilst among strains of D. fragilis electrophoretic protein patterns were mostly found to be accordant.

Animals↗