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Biomedical subjects

J Frölich

Publications and source records attributed to J Frölich.

At least 19 recordsLinked to original sources
PubMed2004

[Pharmacological treatment in adults with attention deficit hyperactivity disorder].

Treatment in adults with attention deficit hyperactivity disorder predominantly relies on pharmacotherapeutic approaches especially with psychostimulants. Empirical studies indicate that their clinical effectiveness may be as high as in children and adolescents, especially in higher dosages. However, due to the high prevalence of comorbidities, e.g. depression, psychopharmacological treatment requires an extended use of other substance groups, especially antidepressants. An optimal treatment response necessitates the choice of an adequate substance depending on the leading clinical symptoms and a procedure of an individual titration of different dosages. This article reviews the current empirical results in the pharmacological treatment of ADHD in adults and provides possible treatment strategies for clinical practice.

Adult↗
PubMed2003

[Sleep disorders in hyperkinetic children--correlation with arousal disorders, differential diagnosis and comorbidity].

OBJECTIVES: Sleep disorders are frequently observed in Attention Deficit-Hyperactivity Disorder (ADHD). At the same time, however, there is little evidence of their prevalence and their specific characteristics. Also unclear is a possible pathogenetic relationship between disturbed sleep and the core symptoms of ADHD. There are still very few findings on the role of comorbid internal and neurological disorders like sleep apnea and restless legs syndrome in the differential diagnosis of ADHD. METHODS: We present an overview of the current literature, describing the most important results concerning sleep disorders in ADHD. RESULTS: A principal goal of future assessments is to ascertain whether sleep problems in children with ADHD represent unspecific concurrent symptoms or whether they play a substantial role in the pathogenesis of ADHD. CONCLUSIONS: Moreover a possibly increased risk of comorbid sleep-disordered breathing disorder might be an important issue in the differential diagnostic considerations with regard to ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed2002

[Multimodal therapy concept in hyperkinetic disorder. Drugs alone are not enough].

For the treatment of attention deficit/hyperactivity disorder, both medical and behavioral therapeutic concepts have been shown to be effective. Somewhat problematical, however, is the fact that a large percentage of these children retain residual symptoms that need treating over a longer period of time. The value of a multimodal therapeutic approach (combination of medication and behavioral treatment including counseling of parents, teachers and the patient) remains controversial. Over the long-term, and account being taken of a number of indicators extending beyond the core symptoms, however, the multimodal treatment concept would appear superior to treatment solely with psychostimulants. For effective treatment accurate titration and the recording of the changes occurring under medication are important.

Attention Deficit Disorder with Hyperactivity↗
PubMed2001

Pericardial effusions in anorexia nervosa.

Anorexia nervosa is an eating disorder that may be accompanied by cardiac symptoms of varying severity. So far disturbances like arrhythmias, mitral valve prolapse and loss of cardial ventricle mass have been described. Other somatic complications consist of electrolyte and acid-base imbalances, which in turn influence cardiac function. Between 1990 and 1999 we observed ten case reports from inpatient anorexic female adolescents, who developed pericardial effusions in the course of their illness. The diagnosis and course was revealed by echocardiography. No signs of heart failure could be noticed. In eight patients pericardial effusion remitted completely or partly by a concurrent increase in weight. A distinct pathophysiology for the development of pericardial effusion could not be revealed, but a correlation to restoration of weight seems to exist. Our report suggests that pericardial effusions are more frequent cardiac complications in anorexia nervosa than previously known. In most cases the clinical significance is doubtful.

Adolescent↗
PubMed1998

[Diagnosis and differential diagnosis of sleep disorders in children].

Sleep disorders in children are very common and their impact on emotional and cognitive functions is considerable. Clinical work necessitates an interdisciplinary access to the subject because the scope of sleep medicine is related to various medical disciplines (e.g. paediatric neurology, pulmology and child psychiatry). Although many sleep problems are seen in both children and adults diagnoses, symptoms and pathogenetic factors are quite different in the two groups. In childhood especially parent-child interactional factors and developmental aspects of the sleep architecture and the sleep-wake cycle have to be taken into account leading to different diagnostic and therapeutic approaches. In this article we focus on important developmental aspects of childrens' sleep problems. Their relationship to neurologic, paediatric and psychiatric diseases is demonstrated and finally clear indications to diagnostic procedures, especially polysomnography, are given.

Child↗
PubMed1997

[Individualized diagnosis in children with hyperkinetic disorders].

Individualized diagnostic procedures assess the individual pattern of emotional and behavioural problems. Different individualized assessment procedures were developed. The advantages of individualized assessment are discussed. The Individual Problemlist is presented as an instrument of the individualized diagnostics. In a sample of N = 76 children with hyperkinetic disorders aged six to ten years together with the parents and the teachers the therapeutic important problems of the child in the family and in the school were developed by using the Individual Problemlist. The frequency of the individual problems are presented. Using a single subject design the employment of this instrument for monitoring is elucidated.

Affective Symptoms↗
PubMed1994

Controlled trial of high- versus low-dose aspirin treatment after percutaneous transluminal angioplasty in patients with peripheral vascular disease.

Percutaneous transluminal angioplasty of aortoiliac and femoropopliteal atherosclerotic lesions can provide long-lasting hemodynamic improvement. High-dose aspirin is commonly prescribed as reocclusion prophylaxis, but low doses would be preferable because of fewer adverse effects. We performed a double-blind, randomized, controlled clinical trial in patients with peripheral vascular disease with lesions appropriate for angioplasty. We compared the efficacy and side effects of two doses of aspirin (50 mg vs. 900 mg daily) during a period of 12 months after angioplasty. A total of 359 patients were evaluated: 175 were randomly assigned to treatment with 900 mg aspirin daily and 184 to 50 mg aspirin daily. Thirty-nine patients developed restenosis at the angioplasty site; the cumulative percentage of event-free survival after 1 year (patency rate) was 85% in 900 mg group and 84% in 50 mg group. An equivalence test showed the two groups equivalent with respect to restenosis rates (P = 0.0003 for an equivalence region of < 10% difference. Nine patients (5%) in the 900 mg group had serious gastrointestinal side effects (peptic ulcer, 8; erosive gastritis requiring transfusion, 1) compared to two ( peptic ulcer) in the 50 mg group (P = 0.03). The results of our study show that a dose of 50 mg aspirin a day is as effective as 900 mg for the prevention of restenoses after lower limb angioplasty, and that severe gastrointestinal side effects are less frequent.

Aged↗
PubMed1993

[Dose-dependent side effects of acetylsalicylic acid therapy. Results of a prospective randomized clinical study in patients with peripheral arterial occlusive disease].

BACKGROUND AND METHODS: In 359 patients with peripheral arterial occlusive disease who had undergone percutaneous transluminal angioplasty (PTA), a randomized double-blind, controlled clinical study was done to investigate the tolerability of acetyl salicylic acid (ASA) given for reocclusion prophylaxis. A comparison was made between a conventional daily dose of 900 mg ASA and a dose of 50 mg ASA. RESULTS: Within an observation period of one year following PTA, 35 patients (20%) in the 900 mg group, and 32 patients (17%) in the 50 mg group left the trial because of side effects (p = NS). Under the higher dose, however, severe gastrointestinal side effects (ulcer, haemorrhagic gastritis requiring transfusion) were significantly more common (nine patients delta 5.1% vs two patients delta 1.1%, respectively; p = 0.03). Overall, 107 patients (30%) reported subjective side effects such as upper abdominal pain, a sensation of fullness or nausea during the course of the trial. 62 of these patients were from the 900 mg group (35%) as compared with 45 patients (24%) in the 50 mg group (p = 0.02). Self-scoring of epigastric pain on the basis of a visual analogue scale revealed a score of 1.3 (95% confidence interval 0.9 to 1.6) in the 900 mg group and 0.8 (95% confidence interval 0.6 to 1.0) in the 50 mg group. The subjective pain intensity showed a uniform time course for all three types of symptom, with a maximum after three months. CONCLUSION: Our results confirm the superior tolerability of the lower dose, in particular in elderly patients. For long-term treatment, the smallest possible effective dose should be chosen.

Aged↗
PubMed1993

Enhanced synthesis of cysteinyl leukotrienes in atopic dermatitis.

Synthesis of cysteinyl leukotrienes was assessed in patients with atopic dermatitis (AD; n = 8) and healthy volunteers (n = 8) by measuring urinary excretion of leukotriene E4 (LTE4), the main index metabolite of cysteinyl leukotrienes in man. Using this non-invasive method we demonstrated a significant (P < 0.05) 4.5-fold increase in excretion of LTE4 compared with healthy volunteers. The identity of LTE4 was unequivocally demonstrated by gas chromatography-mass spectrometry/mass spectrometry (GC-MS/MS). LTE4 was routinely measured by radioimmunoassay (RIA), and quantitative measurement of LTE4 by RIA was validated by GC-MS/MS. There was a linear correlation between LTE4 measured by RIA and by GC-MS/MS (r = 0.994). In representative samples, LTE4 was also quantitatively assessed by GC-MS/MS. In these samples, LTE4 values obtained by GC-MS/MS differed < 10% from those obtained by RIA. The present findings suggest that cysteinyl leukotrienes play a role in AD.

Adult↗
PubMed1992

Enhanced synthesis of cysteinyl leukotrienes in psoriasis.

Cysteinyl leukotriene synthesis was investigated in patients with psoriasis. A non-invasive test requiring no stimulation was employed by measuring the major index metabolite of LTC4, which appears in urine. The presence of this metabolite, LTE4, was shown unequivocally by gas chromatography-mass spectrometry. Routinely LTE4 was quantitated by specific radio immunoassay after its isolation by reversed-phase high-performance liquid chromatography. Furthermore, in representative samples amounts of LTE4 obtained by radioimmunoassay were validated by gas chromatography-mass spectrometry. We demonstrate a significant (p less than 0.01) more than fourfold increase of urinary LTE4 in psoriasis compared to healthy volunteers. Urinary LTE4 was log normally distributed with geometric mean values (95% confidence intervals) of 11 (9-14) nmol LTE4/mol creatinine in healthy volunteers (n = 11) and 51 (28-95) nmol LTE4/mol creatinine in psoriasis (n = 9). The present study shows that cysteinyl leukotriene synthesis is enhanced in patients with psoriasis and that measurement of urinary LTE4 is a useful parameter to monitor its rate of synthesis.

Adult↗
PubMed1986

[Vipoma. 9-year observations using currently available therapy methods].

A now 61-year old man with hypersecretion of vasoactive intestinal polypeptide (VIP) due to carcinoma of the tail of the pancreas was treated and followed for nine years. Combined administration of lomustin (2.5 mg/kg on day 1) and 5-fluorouracil (30 mg/kg on days 2-6) over eight courses at six-week intervals achieved clinical remission for 13 months. No clinical improvement was observed with streptozocin (500 mg/m2 on days 1-5) for two courses four weeks apart. Treatment had to be discontinued after the second course because of the onset of (rarely observed) neurotoxic side-effect of bilateral peroneal paresis. High doses of somatostatin (6.9 micrograms/kg hourly intravenously) immediately and markedly reduced stool quantity. But at a lower dose (3.4 micrograms/kg hourly i.v.) there was no noticeable effect. In the further course of the disease, massive attacks of diarrhoea at varying intervals were best controlled in intensity and duration by prednisolone (50-60 mg daily). Other drugs which have been recommended for such cases (indometacin, lithium, trifluoperazine, nicotinic acid and clonidine) had no worth-while effect. In future long-acting somatostatin analogues may provide better prospects for long-term treatment.

Adenoma, Islet Cell↗
PubMed1981

Cimetidine increases steady state plasma levels of propranolol.

1 The influence of cimetidine (1000 mg daily) on propranolol steady state plasma levels has been studied in seven normal volunteers. Cimetidine was used as a 200 mg normal release tablet whereas propranolol was given as a 160 mg slow release formulation once daily. 2 After 1 day of cimetidine treatment (day 9 of the study) the mean (Css) and minimal (Css min) propranolol steady state plasma levels increased significantly from 24.1 +/- 14.9 ng/ml (mean +/- s.d.) to 39.2 +/- 27.7 ng/ml (P = 0.01) and from 14.8 +/- 9.3 ng/ml to 27.1 +/- 21.2 ng/ml (P = 0.03), respectively. The apparent oral clearance (Clo) was reduced from 6.7 +/- 4.3 l/min to 4.6 +/- 3.11/min (P = 0.006). 3 A prolongation of cimetidine administration to 5 days (day 13 of the study) intensified this effect significantly (P = 0.02): Css of propranolol was elevated from 23.2 +/- 14.4 ng/ml to 44.9 +/- 26.7 ng/ml (P = 0.003); Css min was increased from 14.1 +/- 10.2 ng/ml to 28.4 +/- 17.9 ng/ml (P = 0.02) while Clo decreased from 6.9 +/- 4.1 1/min to 3.3 +/- 1.61/min (P = 0.006). 4 We conclude that the drug interaction between propranolol and cimetidine leads to significant elevations of propranolol steady state plasma concentrations which may cause a clinically relevant enhancement of the effect of a given dosage. This requires careful observation of patients under concomitant treatment with propranolol and cimetidine.

Adult↗
PubMed1980

Effects of dietary variation in linoleic acid content on the major urinary metabolites of the E prostaglandins (PGE-M) in infants.

1. EFA deficiency is associated with the impairment of prostaglandin E synthesis, which is reflected by the decrease of the urinary excretion of PGE-M. 2. Excessive administration of Intralipid results in increase of the relative concentrations of linoleic acid content in plasma, RBC, and tissues with a concomitant decrease of its higher homologue, arachidonic acid. These changes are associated with diminished PGE-M excretion similar to that seen in EFA deficiency. Further investigation is needed into the pathophysiologic consequences of EFA deficiency and the excessive administration of linoleic acid since both are associated with altered prostaglandin biosynthesis and turnover in the new-born infant, particularly among those stressed low birth weight infants whose nutritional status and management are an indication for these modes of therapy.

Dietary Fats↗