[Tongue injuries in the horse--2 case reports].
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Animals↗
Biomedical subjects
D Haack
Publications and source records attributed to D Haack.
Effect of total parenteral nutrition upon intracranial pressure in severe head injury.
Animal investigations suggest that administration of hyperosmolar total parenteral nutrition (TPN) solutions may potentiate cerebral edema following head injury. Intravenous nutrition (TPN) is often required after head injury due to intolerance to enteral feeding (EN). This study evaluates the effect of TPN on intracranial pressure (ICP) measurements in severely brain-injured patients. Ninety-six severely brain-injured patients were randomly assigned to receive TPN or EN and were studied from hospital admission until 18 days postinjury. The TPN was started within 48 hours postinjury and the EN was started when tolerated. Peak daily ICP was not significantly different on admission and over time (overall mean +/- standard error of the mean 32.01 +/- 1.62 for TPN versus 32.5 +/- 1.25 for EN). Intracranial pressure was greater than 20 mm Hg in 75% of TPN patients and 73% of EN patients. Conventional therapy failed to control elevated ICP in 36% of TPN patients and 38% of EN patients. Of these patients, subsequent barbiturate therapy failed to control ICP in 56% of TPN patients and 64% of EN patients. Serum osmolality was not significantly different between groups at admission or over the course of the study. The TPN group tended to have higher mean serum glucose levels for the first 13 days postinjury, while the EN group had a higher mean serum glucose content thereafter, but these differences were not statistically significant. This study shows that TPN can be given safely to the severely brain-injured patient without causing serum hyperosmolality or affecting ICP levels or ICP therapy.
Brain Injuries↗
The effect of nutritional support on outcome from severe head injury.
Fifty-one brain-injured patients with peak 24-hour admission Glasgow Coma Scale (GCS) scores of 4 to 10 were prospectively randomly assigned to receive total parenteral (TPN) or enteral (EN) nutrition. Patients were studied from hospital admission to 18 days postinjury. Outcome was assessed by the Glasgow Outcome Scale at 3 months, 6 months, and 1 year postinjury. The TPN group received a significantly higher cumulative mean intake of protein than the EN group (mean +/- standard error of the mean: 1.35 +/- 0.12 vs. 0.91 +/- 0.9 gm/kg/day; p = 0.004). Mean cumulative caloric balance was also significantly higher in the TPN than in the EN group (75.6% +/- 5.13% vs. 59% +/- 4.26%; p = 0.02). Nitrogen balance was significantly more negative in the EN group during the 1st week postinjury (p = 0.002). The incidence of pneumonia, urinary tract infections, septic shock, and infections was not significantly different between groups. Classic nutritional assessment parameters such as anergy screens, total lymphocyte counts, and albumin levels were not significantly different between groups. The 11 patients in the EN group who did not tolerate tube feedings for 1 week postinjury had a significantly higher incidence of septic shock (p = 0.008). The change over time in GCS scores between groups was significantly different, with the TPN group showing a mean four-point increase in GCS score compared with a three-point increase in the EN group (p = 0.02). At 3 months the TPN group had a significantly higher percentage of favorable outcomes (43.5% vs. 17.9%, respectively; p = 0.05). At 6 months, 43.5% of the TPN group had a favorable outcome while 32.1% of the EN group had a favorable outcome (p = 0.29). By 1 year, 47.8% of the TPN group and 32.1% of the EN group had a favorable outcome (p = 0.20). In conclusion, more calories and protein usually can be administered to acute brain injury patients via the TPN route than by EN feedings via nasogastric or nasoduodenal routes. Traditional parameters for nutritional assessment are not useful in studying the efficacy of nutritional support during the first 2 weeks after head injury. Neurological recovery from head injury occurs more rapidly in patients with better early nutritional support.
Craniocerebral Trauma↗
[Hormone receptor status in breast cancer in comparison with histologic tumor type].
In 66 cases of carcinoma of the breast the estradiol receptors was determined and in 16 cases the progesterone receptor additionally, too. This was done in order th decide about endocrine therapy. The results of estrogen and progesterone receptors estimations were compared and correlated both the type of carcinoma and the degree of its histologic differentiation.
Adenocarcinoma↗
[Detection of dermatomycoses in horses with the dermatophyte test medium Fungassay].
For the inoculation of the dermatophyte-test-medium Fungassay, 200 skin scrapings from horses, 13 from cattle and 13 from artificially infected guinea pigs were used. As control methods, the alkali method, the fluorescent microscope technique and the usual mycological culture were available. For the analysis of skin scrapings, the Fungassay culture mediums are clearly inferior to the usual mycological culture. Fewer dermatophytes were isolated and false positive as well as false negative results occurred. The cultivation of Trichophyton verrucosum failed on the dermatophyte-test-medium.
Animals↗
[Fluorescence microscopy detection of dermatophytes with Blankophor].
It is the first time that a fluorescent microscopic rapid-stain process is compared with the alkali method and with mycological culture examination. 810 skin scrapings primarily from horse, cat, and dog were available for analysis. The preparation of the samples for the fluorescent microscope test is easy and quick. The fluorescent stain solution keeps sufficiently long. When the slide preparations are looked at under the fluorescent microscope, the mycological elements light up and can easily be distinguished under survey enlargement. This leads to a considerable reduction of evaluation time. The microscopic proof of dermatophytes is considerably improved by the introduction of the fluorescent microscopic technique into mycological diagnosis, as this process is clearly superior to the alkali method. Dermatophytes are identified and finally evaluated after finishing the cultural analysis. Furthermore, the fluorescent microscopic proof of yeasts of the kind of Pityrosporum yeasts and of Demodex mites is possible. The not inconsiderable costs of the technical equipment may stand in the way of general and routine use of the fluorescent microscope for diagnosing dermatophytes. However, for laboratories with a large number of submitted skin scrapings, this process can be rated as a useful enrichment of their diagnostic potential.
Animals↗
[Corticotropin releasing factor (CRF) stimulation test in asthmatic patients with different steroid medications].
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Adolescent↗
[Stimulation of the adrenal cortex in long-term steroid therapy. Increase of free cortisol in the urine following depot ACTH administration].
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Adrenal Cortex↗
Serial dexamethasone suppression tests in psychiatric illness: Part III. The influence of intervening variables.
The effects of different intervening variables on dexamethasone suppression test (DST) results were evaluated in depressed, schizophrenic, and manic patients. There was a significant correlation between age and DST results in major depression. Some "isolated peaks" of DST nonsuppression were explained by low dexamethasone serum levels. In schizophrenic and manic patients, the dexamethasone concentrations increased to above the normal range during the study period. A significant negative correlation between dexamethasone concentrations and DST results was found in schizophrenia and mania, but not in depression. Dexamethasone levels were generally higher in men than in women. Weight loss and hospital admission affected the DST in individual cases, whereas length of episode and drug withdrawal did not. Thus, the intervening variables accounted for some of the abnormal DST results, but other factors such as severity of illness, nonspecific stress, or possibly depression itself emerged as the main causes of abnormal DST results.
Adolescent↗
Pharmacokinetics and pharmacodynamics of glucocorticoid suspensions after intra-articular administration.
Triamcinolone acetonide, triamcinolone hexacetonide, and a combination of betamethasone phosphate and acetate were given intra-articularly in different doses. Plasma levels of the steroids were measured and pharmacokinetic parameters were calculated. As a pharmacodynamic parameter for systemic steroid activity, plasma hydrocortisone levels were monitored for 3 weeks. Results indicate complete absorption from the site of injection over a period of 2 to 3 weeks. Because of its lower solubility, triamcinolone hexacetonide is absorbed slower than triamcinolone acetonide, thus maintaining synovial levels for a longer time and creating lower systemic corticoid levels. Endogenous hydrocortisone suppression correlated with exogenous steroid levels. Threshold concentrations for maximum suppression were determined.
Absorption↗
[Pharmacokinetics of fluocortolone in long term therapy of patients with rheumatic and hematologic diseases].
The pharmacokinetics of fluocortolone (Ultralan oral) and its effect on plasma cortisol levels were investigated during long-term treatment of patients with rheumatic and haematological diseases with different doses of fluocortolone. Fluocortolone was administered in the morning and plasma levels of fluocortolone and cortisol were measured in samples obtained 1.5, 3, 4, and 5 h p. adm. by means of specific radioimmunoassays. Maximum concentrations of fluocortolone in plasma (Cmax) and areas under the fluocortolone plasma level curves (AUC) increased linearly with the dose. The peak time (tmax = 2.04 +/- 0.85 h) and the plasma half-life (t1/2 = 1.53 +/- 0.52 h) were independent of the dose administered. Cortisol suppression as indicated by morning cortisol levels below 50 ng/ml plasma was not observed with doses below 10 mg/d.
Adult↗
The influence of dimetindene maleate on the endogenous hydrocortisone synthesis suppressing potency of betamethasone.
Plasma hydrocortisone (cortisol) levels in 7 healthy volunteers were measured following administration of 0.25 mg betamethasone or 0.25 mg betamethasone and 1 mg dimetindene maleate. The H1-receptor antagonist dimetindene maleate did not influence the hydrocortisone suppressing activity of betamethasone, which was proved by comparison with the published plasma hydrocortisone levels of 162 young healthy untreated volunteers.
Adult↗
Development of plasma 21-deoxycortisol radioimmunoassay and application to the diagnosis of patients with 21-hydroxylase deficiency.
Specific 21-deoxycortisol (21-DF) antiserum was raised in New Zealand white rabbits using a 21-DF-3,20-oxime-bovine serum albumin complex. Plasma radioimmunoassay of 21-DF was developed and used together with a radioimmunoassay of 17-hydroxyprogesterone (17-OH-P) for diagnosis of patients with 21-hydroxylase deficiency of congenital and postpubertal forms. The assays were performed in plasma extracts after isolation by paper chromatography. The response of plasma 21-DF and 17-OH-P to i.v. ACTH (25 IU) was studied in 15 adult controls and compared to 8 women with the late onset form of 21-hydroxylase deficiency and 23 women with idiopathic hirsutism. Normal 21-DF values for women were 6.9 +/- 3.6 ng/dl and for men 9.71 +/- 2.73 ng/dl. Newborn children (age: 3-10 days) had a value of 8.3 +/- 4.8 ng/dl. These values are definitely lower than the lowest value ever published. This is possibly due to the specificity of the antibody. During the menstrual cycle the 21-DF values did not change. The baseline and post-stimulated concentrations of hormone were similar in controls and women with hirsutism but were significantly higher in women with the late onset form of 21-hydroxylase deficiency. In the congenital form of 21-hydroxylase deficiency the 21-DF values (baseline) were high. In general, the 21-DF and 17-OH-P values have shown parallel changes. However, one case of 21-hydroxylase deficiency with elevated 21-DF but normal 17-OH-P was observed. The use of 21-DF for the diagnosis of 21-hydroxylase deficiency is suggested.
17-Hydroxycorticosteroids↗
Comparative accuracy of five intravenous-fluid controllers.
The accuracy of five gravity-feed infusion-control devices was compared using a gravimetric method. Two nonvolumetric drop-counting devices (IVAC 230 and, IMED 350) and three volumetric devices (Quest/Cutter Infusor, Anatros Rateminder, and IVAC 260) were compared at four different flow rates (10, 40, 125, 250 ml/hr) using four different solutions and two head heights (30 and 100 cm). The mean error rates for the IVAC 230 and the IVAC 260 devices were consistently high and negative (-6.32 and -12.60%, respectively). The mean error rates for the IMED, Anatros, and Quest/Cutter devices were 2.2, 1.8, and 0.7%, respectively. Conversion charts must be used to account for variation in drop size when different solutions and flow rates are used in the IVAC 230 and IMED 350 devices. At the low flow rates, the 60-drop/ml sets were more accurate than the 20-drop/ml sets. Of the volumetric devices, the Quest/Cutter Infusor and the Anatros Rateminder were more accurate than the IVAC 260. The Quest/Cutter Infusor was the most accurate of all controllers tested. For volumetric devices that use drop-counting technology, selecting an internal fluid code on the basis of solution ingredients is still necessary. For the new volumetric devices, conversion charts and fluid code selection are not necessary to achieve a high level of accuracy.
Evaluation Studies as Topic↗
The pharmacokinetics of fluocortolone and prednisolone after intravenous and oral administration.
The pharmacokinetics of fluocortolone and of prednisolone were examined following a single intravenous injection of 5 mg and oral administrations of 10 and 20 mg to five healthy male volunteers. After intravenous injection the plasma levels of fluocortolone decreased biexponentially with half-lives of 9 +/- 5 min and 1.3 +/- 0.3 h. Total plasma clearance of fluocortolone was calculated to be 7.0 +/- 1.5 ml/min/kg. Oral administrations of fluocortolone revealed maximum plasma levels of 86 +/- 12 ng/ml (10-mg dose) and 174 +/- 34 ng/ml (20-mg dose) after 1.4 +/- 0.2 h. Intravenously administered prednisolone was rapidly distributed (t 1/2 alpha = 5 +/- 3 min) but more slowly eliminated from plasma than fluocortolone (t1/2 beta = 3.1 +/- 0.8 h). Correspondingly a total plasma clearance of 2.2 +/- 0.2 ml/min/kg was calculated. Oral administrations revealed maximum prednisolone plasma levels of 172 +/- 25 ng/ml (10-mg dose) and 278 ng/ml (20-mg dose) after 1.6 +/- 0.7 h. The absolute bioavailability of both corticosteroids was higher than 80% and independent of both dose levels investigated.
Administration, Oral↗
Plasma dexamethasone concentrations and differential suppression response of cortisol and corticosterone in depressives and controls.
After a dexamethasone suppression test (DST), cortisol, corticosterone, and the test substance were determined by a direct radioimmunoassay in 42 samples obtained from 22 depressed patients and 8 controls. The DST results of both glucocorticoids agreed in most of the tests. In all seven cases with elevated but not definitely abnormal post-DST (1600 hr) cortisol levels (transitional range 30-50 ng/ml) the concurrent determination of corticosterone indicated that this corticosteroid may serve as a potent additional discriminator. Dexamethasone plasma concentrations at 1600 hr after a 1-mg test dose of dexamethasone at 2300 hr were significantly (p less than 0.01) lower in cortisol and corticosterone nonsuppressors than in suppressors. Since these data were obtained 17 hr after ingestion of dexamethasone (half-life 3.5-5 hr) any conclusions about an inverse correlation between dexamethasone and corticosteroid plasma concentrations would be speculative. However, the dexamethasone pharmacokinetics might be an important variable and may contribute to some of the recent uncertainty about the DST.
Adult↗
Failure of prophylactically administered phenytoin to prevent post-traumatic seizures in children.
We report the results of a randomized, double-blind, placebo-controlled study to determine whether phenytoin administered soon after a head injury lessens the incidence of late post-traumatic epilepsy in children. 41 patients were randomized into either a phenytoin or placebo group and followed for 18 months. The patients were administered phenytoin or placebo intravenously or intramuscularly within 24 h of hospital admission. The patients were parenterally administered phenytoin or placebo until oral doses could be tolerated. There was no significant difference in the percentage of children having seizures in the treated and placebo groups (p = 0.25).
Brain Injuries↗
Failure of prophylactically administered phenytoin to prevent early posttraumatic seizures.
A randomized double-blind placebo-controlled study was carried out to determine whether phenytoin administered soon after injury lessens the incidence of epilepsy in the 1st week after severe head trauma. In this study, 244 patients were randomized into either a phenytoin or placebo group. The patients in the phenytoin group were administered phenytoin intravenously or intramuscularly within 24 hours of hospital admission. Patients in the placebo group received intravenous or intramuscular diluent. The patients were switched from parenterally administered phenytoin or placebo as soon as oral doses could be tolerated. Over 78% of the phenytoin patients had plasma concentrations of at least 10 micrograms/ml at 1, 3, and 7 days after injury. There was no significant difference in the percentage of patients having early seizures in the treated and placebo groups (p = 0.99). There was no significant difference in the interval from injury to first seizure between the treated and placebo groups (p = 0.41). The early administration of phenytoin did not lessen the occurrence of seizures in the 1st week after head injury. Since the effectiveness of seizure prophylaxis has not been established, the authors suggest that anticonvulsant drugs be administered only after an early seizure has occurred.
Brain Injuries↗