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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Akute Vergiftung ; Methaqualon ; Metaboliten ; Biosynthesenachweis ; Immunoassay ; Gaschromatographie ; Kombinierte Massenspektrometrie ; Key words Acute poisoning ; Methaqualone ; metabolites ; biosynthesis ; Immuno-assay ; Gaschromatography ; Mass spectrometry ; combined
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Clinical course. We present a potentially fatal case of acute methaqualone (M) poisoning with very low serum concentrations of M but extremly high levels of its metabolite, 2-methyl-3-(2-hydroxymethyl-phenyl)-4 (3H)-chinazoline (Met-1). A 23-year-old man was admitted to the intensive care unit 2 days after ingestion of 4–5 g M in an suicidal attempt. On admission he was somnolent and poorly responsive to painful stimuli. Physical examination revealed a heart rate of 95 bpm, a blood pressure of 125/65 mmHg, and a normal body temperature. His chest was clear to auscultation, respirations were shallow, and the skin was cyanotic. The electrocardiogram was unremarkable. The chest radiograph showed a normal heart size without pulmonary infiltrates or venous congestion. The pupils were dilated but reactive to light. The neurologic examination was further remarkable for increased limb reflexes, myoclonia, and positive pyramidal signs. During the next 2 days the patient became comatose and developed respiratory insufficiency due to non-cardiogenic pulmonary oedema, which was confirmed by chest radiograph and haemodynamic investigations by means of right heart catheterisation. He required mechanical ventilation for 6 days. Finally, he recovered completely and was discharged in good condition. Diagnostics. A lumbar puncture revealed neither blood nor pleocytosis in the cerebrospinal fluid. Cranial computed tomography was carried out on an emergency basis, but no abnormality was disclosed. An electroencephalogram did not exhibit any significant pathological findings. Testing for infectious diseases or porphyria gave negative results. Toxicological screening based on enzyme immunoassays (ELISA) was negative for alcohol, tricyclic antidepressants, benzodiazepines, barbiturates, and morphine, but gave a positive result for M. From the moment of admission daily blood samples were taken and analysed by combined gas chromatography and mass spectrometry. These showed very low levels of M but extremely high levels of Met-1. Therapy. After gastric lavage, continous enteric lavage with activated charcoal and mannitol was initiated to minimise intestinal absorption. Since M was hardly detectable in the serum, haemoperfusion was not regarded as indicated for drug elimination and treatment was restricted to general supportive measures. To rule out a central anticholinergic syndrome, an anticholinesterase drug (physostigmine) was administered but remained without therapeutic effect. Conclusions. The presented case is the first report of a life-threatening intoxication after M ingestion primarily caused by Met-1. It supports the significance of this metabolite for the toxic effects of the drug. A toxicological screening test based on ELISA proved helpful due to its cross-reactivity with metabolites. In cases similar to ours, resin haemoperfusion may be indicated to remove the metabolites despite low detectable concentrations of the parent substance in the serum.
    Notes: Zusammenfassung Ein 23jähriger Mann wird in somnolentem, psychomotorisch agitiertem Zustand aufgenommen. Der Patient bietet eine Progredienz der neurologischen Symptomatik, entwickelt ein ARDS und wird beatmungspflichtig. Nach sechs Tagen kann der Patient vom Respirator entwöhnt werden. Nach vier Tagen hellt die Bewußtseinslage des Patienten auf, und er wird gesund entlassen. Ein toxikologisches Schnellscreening ergibt den Verdacht einer Methaqualon (M)-Intoxikation. Beginnend vom Aufnahmezeitpunkt werden serielle Serumproben mittels kombinierter Gaschromatographie-Massenspektrometrie analysiert. Ergänzend zum Schnelltest ergeben sich von Beginn an niedrige M-Konzentrationen und extrem hohe Konzentrationen des Metaboliten 2-Methyl-3-(2-hydroxymethyl-phenyl)-4 (3H)-chinazolin ( Met-1 ). Aufgrund der niedrigen M-Konzentrationen im Serum und der in der Akutphase noch nicht bekannten Serumspiegel von Met-1 wurde keine Indikation für eine sekundäre Giftelimination durch ein extrakorporales Verfahren gestellt. Der dargestellte Fall ist die Erstbeschreibung potentiell letaler Serumkonzentrationen von Met-1. Toxikologische Schnelltests auf immunologischer Basis können aufgrund ihrer Kreuzreaktion mit den Metaboliten in der Diagnosefindung richtungweisend sein. Für ähnliche Fälle ist die Indikation zur Hämoperfusion als therapeutische Konsequenz zu diskutieren.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 5 (1926), S. 943-944 
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1440
    Keywords: Surface markers ; Acute lymphoblastic leukemia ; Oberflächenmarker ; Lymphoblastenleukämien
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 47 Patienten mit unreifzelliger lymphatischer Leukämie wurden die mononukleären Zellen des peripheren Blutes, in einigen Fällen auch lymphatische Zellen des Knochenmarkes, hinsichtlich ihrer Membranmarker untersucht. Folgende Marker wurden verwendet: die Rosettenbildung mit Schaferythrozyten, der Nachweis von Oberflächenimmunglobulinen, des Fc-Rezeptors sowie des Komplementrezeptors. Bei 6 der 23 unbehandelten Patienten bildete der Großteil der Blasten Spontanrosetten mit Schaferythrozyten (T-ALL), bei zwei dieser 6 Patienten waren am Großteil der Lymphoblasten auch Komplementrezeptoren nachweisbar. Bei einem weiteren Patienten waren an den Lymphoblasten sowohl Fc- als auch Komplementrezeptoren vorhanden. 16 der 23 Patienten waren Marker negativ (O-ALL). Wurden die beiden Gruppen — eine mit Markern, eine ohne Marker — hinsichtlich ihres klinischen Bildes und Verlaufes verglichen, so zeigte sich, daß die Marker positiven Leukämien fast durchwegs dem männlichen Geschlecht angehörten und häufig einen Mediastinaltumor entwickelten. Ferner lag die Remissionsrate in dieser Gruppe deutlich niedriger als in der Gruppe der Marker negativen Leukämien. Bei 24 Patienten in Remission, die durchwegs unter zytostatischer Erhaltungstherapie standen, waren sowohl die Rosetten-bildenden Lymphozyten als auch die Lymphozyten mit Oberflächenimmunglobulinen und Fc-Rezeptoren vermindert. Der Anteil an Rosetten-bildenden Lymphozyten korrelierte mit dem klinischen Verlauf insoferne, als bei Patienten mit schlechtem klinischen Verlauf diese Verminderung ausgeprägter war als bei Patienten mit günstigem Verlauf.
    Notes: Summary In 47 patients with acute lymphoblastic leukemia surface markers were evaluated on mononuclear cells of the peripheral blood as well as in some cases on bone marrow lymphocytes. The lymphocytes were characterized by their binding capacity for sheep red blood cells, the demonstration of Fc-receptors, complement receptors as well as surface immunoglobulins. In 6 of 23 untreated patients the blasts bound sheep red blood cells spontaneously (T-ALL), in two of these six cases the lymphoblasts had simultaneously receptors for complement. In a further patients the lymphoblasts had complement- and Fc-receptors. The blasts of 16 of 23 patients were negative in respect to the markers tested (O-ALL). By comparing two groups of patients—one with positive cells, one unreactive—the clinical features differed: the marker positive group showed a predominance of male patients, 5 of 7 patients had a massive mediastinal mass and the remission rate was lower than in the group with positive blasts. 24 patients in remission under maintance treatment had a decreased percentage of rosette forming lymphocytes as well as lymphocytes with surface immunoglobulins and Fc-receptors. There existed some correlation between the percentage of rosette forming lymphocytes and the clinical course: patients with complications had lower percentages of rosette forming lymphocytes than patients with a favourable course.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1440
    Keywords: Respiration control ; Sleep apnea ; CO2 and oxygen response ; Hypoxia ; Sudden infant death syndrome ; Atemsteuerung ; Schlafapnoen ; Hypoxie ; CO2- und O2-Antwortkurven ; plötzlicher Kindestod
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Wir untersuchten das Verhalten verschiedener Variabler, die mit der Atemregulation bei Säuglingen bis zu einem Alter von 6 Monaten in Verbindung stehen, um ein eventuelles Risiko für das Auftreten eines SIDS-Ereignisses (sudden infant death syndrome) identifizieren zu können. Bei 23 von insgesamt 114 untersuchten Säuglingen waren bereits ernste oder lebensbedrohende Apnoeanfälle während chirurgischer Eingriffe unter Narkose beobachtet worden. Diese Babies wurden als Risikogruppe bezeichnet, während die restlichen untersuchten Säuglinge als Kontrollgruppe galten. Wir konnten zeigen, daß praktisch alle Risikosäuglinge Apnoen während des Schlafes hatten, die eine Länge von 8 s überschritten. Lediglich 22% aller Kontrollsäuglinge hatten Apnoen dieser Länge. Von den aufgezeichneten Atemkurven berechneten wir als statistischen Parameter den mittleren Atemsausfall in s pro min (MA-Wert). Dieser MA-Wert war bei der Risikogruppe im Vergleich mit der Kontrollgruppe statistisch signifikant erhöht. Durch kontinuierliche Aufzeichnungen der transkutanen $$P_{O_2 } $$ -Werte konnte darüber hinaus noch gezeigt werden, daß die Babies der Risikogruppe zu einer Hypoxämie während des Schlafes neigen. Übereinstimmend mit dieser Beobachtung ist auch der Anstieg der 2,3-DPG-Konzentration und der Abfall der Dichte der Erythrocyten bei Risikosäuglingen. Verabreichung leicht hypoxischer Gasgemische führte besonders bei der Risikogruppe
    Notes: Summary We have examined the behavior of several variables which are related to respiratory control in 114 infants (up to 6 months of age) in order to assess the risk for the sudden infant death syndrome (SIDS). 23 of the infants had already had demonstrable serious or life threatening apneas or respiratory problems during surgical anesthesia. These infants were assigned as a risk group, and the rest of the investigated babies was taken as a control group. We found that practically all infants of the risk group had apneas during sleep, which lasted longer than 8 s each. Only 22% of the infants of the control group had apneas of such a duration. As a statistical parameter, calculated from at least 1 hour recording of respiration, we defined the mean apnea duration (MA-value) as average value of apnea duration time in seconds per minute of recording. The MA-value proved to be significantly elevated in the infants of the risk group. The trend to hypoxia in the infants of the risk group was also indicated by the observation of lower transcutaneous $$P_{O_2 } $$ -values (tc- $$P_{O_2 } $$ ) during sleep, when compared with control infants. In agreement with this observation is the increase of the 2,3-DPG concentration and the decrease of the density of erythrocytes of the infants of the risk group. Breathing hypoxic gas mixtures tended to depress respiration in all infants tested, and, especially in the risk group, to elicit irregular respiratory patterns. On the other hand, we observed that inhalation of pure oxygen markedly stimulated respiration in all infants investigated. We conclude from these observations that a risk for SIDS may be related to a particular response pattern of the respiratory center during the early postnatal life. We are able to distinguish infants with a higher risk for SIDS from other children by determination of the MA-value during sleep.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1440
    Keywords: Lymphocytes ; Lymphocytes ; Ig determinants ; subpopulations ; Hypogammaglobulinaemia ; Lymphocyten ; Lymphocyten-Ig-Determinanten ; Lymphocyten-Subpolulationen ; Hypogammaglobulinämien
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Unter Verwendung125I markierter monospezifischer Antiseren gegen menschlicheμ-,γ-,α-,κ-undλ-Ketten bestimmten wir den Prozentsatz Ig-tragender Blutlymphocyten bei Patienten mit primären und symptomatischen Hypogammaglobulinämien. Zwei Patienten mit geschlechtsgebundenen Hypogammaglobulinämien, 2 mit IgA-Defekten, 4 mit transitorischen Hypogammaglobulinämien und 13 mit symptomatischer. Hypogammaglobulinämien (7 multiple Myelome, 2 M. Waldenström und 4 chronische Lymphadenosen) wurden untersucht. Bei erwachsenen Kontrollen fanden wir im Mittelκ-Ketten an 18,5%,λ-Ketten an 2,8%,μ-Ketten an 12,1%,γ-Ketten an 10,5% undα-Ketten an 3,9% der Blutlymphocyten. Prinzipiell ähnliche Ergebnisse wurden bei gesunden Kindern, bei Patienten mit transitorischen Hypogammaglobulinämien und solchen mit IgA-Defekten erhalten. Im Gegensatz dazu fehlten Ig-tragende Lymphocyten in beiden Fällen mit geschlechtsgebundener Hypogammaglobulinämie weitgehend. Normale Werte wurden bei ihren Eltern und bei den untersuchten Geschwistern erhalten. Trotz einer deutlichen Verminderung zumindest eines der Serum-Ig fanden sich bei Patienten mit multiplen Myelomen normale oder lediglich leicht herabgesetzte Zahlen Ig-tragender Lymphocyten. Bei Kranken mit M. Waldenström waren IgM-tragende Lymphocyten stark vermehrt. Trotz verminderter Serum-Ig Spiegel waren die anderen Ig-Klassen an der Zelloberfläche in etwa normaler Häufigkeit nachzuweisen. Diese Diskrepanz war bei Patienten mit chronischer Lymphadenose besonders ausgeprägt, bei denen eine extreme Vermehrung Ig-tragender Lymphocyten mit normalen oder verminderten Serum-Ig-Spiegeln einherging. Die Ergebnisse werden im Hinblick auf eine Störung der B-Zellreifung diskutiert.
    Notes: Summary Using125I labelled monospecific antisera against human,μ-,γ-,α-,κ- andλ-chains we investigated the percntage of surface Ig-bearing lymphocytes in patients suffering from primary or acquired hypogammaglobulinaemias. Two patients with sex-linked hypogammalobulinaemia, 2 with IgA defects, 4 with transitory hypogammaglobulinaemia and 13 patients with secondary hypogammaglobulinaemia (7 with multiple myeloma, 2 with M. Waldenström, 4 with chronic lymphocytic leukaemia) were studied. In healthy adult controlsκ-chains were found in the average on 18.5%.λ-chains on 2.8%,μ-chains on 12.1%,γ-chains on 10.5% andα-chains on 3.9% of blood lymphocytes. Comparable results were obtained in children, in patients suffering from transitory hypogammaglobulinaemia and in those with IgA-defects. In contrast, lymphocytes bearing Ig-determinants were almost absent in both cases with sex-linked hypogammaglobulinaemia (normal values were obtained in both parents and the siblings investigated). In patients with multiple myeloma, despite a low level of at least one immunoglobulin in the serum, normal or only slightly reduced numbers of lymphocytes with Ig-determinants were observed. In patients with M. Waldenström IgM-bearing lymphocytes were markedly increased, but the other Ig classes were represented in normal numbers despite reduced serum levels. In patients with chronic lymphocytic leukaemia the disagreement between very high numbers of lymphocytes bearing at least L-chain determinants on their surfaces and the Ig serum levels was striking. The results are discussed in regard to a maturation defect of B-lymphocytes in hypogammaglobulinaemias.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 145 (1986), S. 357-360 
    ISSN: 1432-1076
    Keywords: Endorphines ; Regulation of respiration ; Sleep apnoea syndrome ; SIDS ; Naloxone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effects of intravenous injections of the opiate antagonist naloxone (0.005–0.4 mg/kg body weight) on respiratory pattern, apnoea duration and frequency were investigated in six infants with severe sleep apnoea syndrome. Since several authors found elevated plasma- and CSF-levels of endogenous opioids (endorphines) in infants with sleep apnoea syndrome, we wanted to determine whether the impairment of the control mechanisms of respiration during sleep is due to an effect of endogenous opioids. Independent of the dose, naloxone did not exert any effect on respiratory pattern and occurrence of periodic apnoea. We were unable to prove that endorphines play a major role in pathogenesis of sleep apnoea syndrome in infancy and possibly in sudden infant death syndrome (SIDS). We speculate that elevated levels of endorphines reported by some investigators rather seem to be a consequence of hypoxic stress than a cause for sleep apnoeas.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 146 (1987), S. 313-314 
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1076
    Keywords: Congenital central hypoventilation syndrome (Ondine's curse syndrome) ; Siblings ; Polygraphic recordings
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Congenital central hypoventilation syndrome (CCHS, Ondine's curse syndrome) is a rare respiratory disorder; less than 100 cases have been reported. Familiality of the disease has been discussed, but only few familial cases have been reported so far. In this report we describe the occurrence of CCHS in two male siblings. Diagnosis was established only at the age of 4 years in the first case, although the patient had disease related symptoms since early infancy. The second patient was one of dizygotic twins, he was diagnosed with CCHS at the age of 8 months. Up to that age only moderate desaturations had been observed. The other twin was unaffected by the disease. Both patients were successfully treated by nocturnal positive-pressure ventilation via a specially adapted face mask. They show satisfactory physical and neurologic development.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1076
    Keywords: Erythroleukaemia ; Myeloblastoma ; Spinal cord compression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Severe neurological impairment as the first symptom of acute leukaemia is a rather uncommon finding. We report the case of a 10-month-old infant who presented with acute paralysis of the lower extremities due to cord compression by an epidural tumour composed of malignant erythrocyte precursor cells. Diagnosis of erythroleukaemia (EL) was made by needle biopsy of the spinal epidural mass and confirmed by bone marrow aspiration. Antileukaemic treatment in combination with radiotherapy to the epidural tumour led to haematological remission and neurological recovery with disappearance of the mass lesion as demonstrated by MRI. However, haematological relapse occurred with death of the patient 7 months after diagnosis. This is the first reported case of EL presenting with paraparesis due to an epidural tumour. The clinical symptoms, results of cytogenetic and immunological studies and the clinical course are described.
    Type of Medium: Electronic Resource
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