Induction of parkinsonism by intraventricular bethanechol in a patient with Alzheimer's disease.
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Biomedical subjects
Publications and source records attributed to R Clasen.
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After withdrawal of 400 ml whole blood and subsequent infusion of 500 ml of a colloidal plasma substituent, the intravascular and renal colloid elimination was investigated in 40 test subjects. The individual colloidal solutions could no longer be demonstrated in the intravascular space after the following times: 10% hydroxyethyl starch 200/0.5 (anthrone method) after six weeks, 10% dextran 40 (anthrone method) after two weeks, 6% hydroxyethyl starch 200/0.5 (anthrone method) after four weeks and 5.5% oxypolygelatine (hydroxyproline method) after two days. Colloidal plasma substitutes are polydisperse solutions with various molecular weights and degree of hydroxyethylation and therefore, also have a large number of different elimination constants. With repeated application, the intravascular colloid concentration shifts in favour of the molecules with a longer half life which are difficult to eliminate. The elimination of the clinically employed dextran 40 and oxypolygelatine solution could be best described with an open two-compartment model. As a result of its greater heterogeneity, the elimination of the moderately high molecular weight hydroxyethyl starch 200/0.5 could only be characterized approximately even assuming three elimination constants. In the first four days, the hydroxyethyl starch 200/0.5 was more rapidly eliminated compared to dextran 40. However, subsequently a very much lower elimination from the intravascular space was found for about 3% of the administered hydroxyethyl starch 200/0.5. Oxypolygelatine was eliminated especially rapidly. Accordingly, the greatest renal clearance was found for oxypolygelatine, which showed a close relation to the molecular weight. On the other hand, a rapid elimination simultaneously is followed by a correspondingly lower volume effect.
The effects of administration of a new, middle-molecular 10% hydroxyethyl starch 200/0.5 (HAES-steril) were compared to 10% dextran 40 (Rheomacrodex) in 20 hypovolaemic volunteers after withdrawal of 400 ml blood. The total increase of blood volume after 500 ml of 10% hydroxyethyl starch 200/0.5 was 10.19 +/- 1.1 ml/kg (754 ml), after 500 ml of 10% dextran 40 14.10 +/- 1.1 ml/kg (1032 ml), which was significantly higher (p less than 0.01) and in correspondence with the known volume expanding properties of 10% dextran 40. The volume effect after administration of both substances was stable, as demonstrated by the ability to compensate the loss of 400 ml blood for more than 8 hours. The maximal increase of the colloid osmotoc pressure after 10% hydroxyethyl starch 200/0.5 was 5.3 +/- 0.2 mm Hg, after 10% dextran 40 7.2 +/- 0.4 mm Hg and paralleled the increase of the blood volume. After 10% hydroxyethyl starch 200/0.5 an increase of serum amylase was observed. This hyperamylasemia is caused by the formation of a high molecular hydroxyethyl starch-amylase complex, which cannot be eliminated easily. Urinary volume and endogenous creatinine clearance were increased by administration of both colloids. After dextran 40 a pronounced increase of the urinary viscosity occurred.
The biological availability of digoxin tablets (Lanicor) and beta-acetyldigoxin tablets (Novodigal) was tested after single-dose administration. Plasma levels over 48 hours, the area under the blood-level curves and the cumulative urinary excretion over seven days served as a measure of biological availability. The area under the blood-level curve after 1.0 mg digoxin by mouth was 40.7 +/- 1.7 ng . ml-1 . h and after 1.0 mg beta-acetyldigoxin by mouth 39.1 +/- 1.4 ng . ml-1 h, compared with 56.1 +/- 1.4 after 1.0 mg digoxin intravenously. Seven days later 0.67 +/- 0.12 mg digoxin of the orally administered digoxin, 0.68 +/- 0.12 mg digoxin of the orally administered beta-acetyldigoxin and 0.81 +/- 0.08 mg of the intravenously administered digoxin were excreted in the urine. There was no significant difference in the biological availability of the two drugs (P greater than 0.05).
Changes of individual non-esterified fatty acids in serum were studied in 7 metabolically healthy patients, suffering from idiopathic trigeminal neuralgia, who underwent electrocoagulation of gasserian ganglion under neurolepthypalgesia. The mean concentration of fatty acids increased by about 40% during the strong surgical pain stimulus. The increased lipolysis affected all individual fatty acids in proportion to the ratio of their presence in adipose tissue. The mechanism of pain-induced activation of lipase and possible consequences of alterations in individual non-esterified fatty acids are discussed.
The following report will deal with the application of "Enflurance" in the clinically closed (rebreathing) system. The term clinically closed system defines a procedure where the phase of approach up to MAC and the phase of subsidence is pursued in a half-closed system and the maintenance in a closed system. Enflurane was chosen as volatile anaesthetic, because it has been increasingly applied world-wide on account of its convenient qualities. Besides enormous savings by way of a low consumption of narcotics, this method offers a reduced environmental pollution. In case of sufficient monitoring, this technique proves attractive to smaller hospitals, disaster medicine and central hospitals likewise.
The effects of spinal anaesthesia neuroleptanaesthesia and surgery on the metabolism of carbohydrates and fats were investigated in two groups of 11 young, metabolically healthy patients, undergoing trauma surgical procedures. For both groups the determined parameters glucose, lactate, glycerol, ketone-bodies, NEFA and insulin remained, during the operative and early postoperative phase, within the physiological range without any marked differences. Both anaesthetic procedures seemed to be equally suited for these operations; therefore other criteria should be used as a basis for the selection of the anaesthetic management.
Every stress reaction leads to an increased, hormonelly induced mobilisation of fatty acids, the extent of which may be considered as a parameter of the aggression mechanism. In 15 patients with idiopathic trigeminal neuralgia, who were operated under neurolepthypalgesia, the problem of quantitative alterations of the concentration pattern of fatty acids was investigated during the operation. In contrast to some reports of the literature, the increase of the concentration of total fatty acids was due to corresponding increases of all individual fatty acids. By preoperative administration of the beta-adrenergic blocking agent Pindolol the increase of fatty acids was reduced without a qualitative shifting of individual fatty acids.
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Twenty-three patients had magnetic resonance imaging (MRI) and computed tomography (CT) of the head prior to surgery for medically intractable epilepsy. Eleven patients had neoplasms, mostly astrocytomas. Six of the 11 tumors were seen on CT. In five of the six cases, the MRI showed a focal area of increased signal on T2-weighted images. All 11 tumors were detected by MRI. None of the non-neoplastic lesions produced an abnormal T2-weighted signal area on MRI. Only one of the non-neoplastic lesions was seen on both CT and on MRI. MRI allowed clear discrimination between tumors and non-neoplastic lesions in patients coming to surgery for intractable epilepsy.
A classification of brain edema is provided as well as an extensive review of the animal models from which we have derived most of the basic information we have about the formation and resolution of edema. The clinical aspects of cerebral edema in stroke are discussed and also modern methods for identifying cerebral edema in the human. Attention is given to computed tomography and enhanced CT and advances in their application to this condition. Treatment of cerebral edema in the stroke patient using glycerol, dextran 40, mannitol, steroids, and other drugs is discussed and the need pointed out for controlled clinical trials of the therapeutic effectiveness of these agents.