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  • 1
    ISSN: 1432-1041
    Keywords: nimodipine ; subarachnoid haemorrhage ; pharmacokinetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Patients with a ruptured supratentorial aneurysm undergoing early surgery after the subarachnoid haemorrhage were treated postoperatively with nimodipine to prevent delayed ischaemic dysfunction. It was given first as a continuous intravenous infusion 2 mg/h (mean dose 0.5 µg/kg/min) for at least 7 days, and then orally (45 mg × 6) for at least a further 7 days. During the i.v. infusion, the mean plasma concentration was 26.6±1.8 ng/ml. The plasma clearance ranged from 0.57 to 1.77 l/kg/h and was negatively correlated with the age of the patient. Immediately prior to successive oral doses, the mean plasma concentration was 13.2 ng/ml (range〈3–38.8 ng/ml). The peak level was usually found after 1 h; it ranged from 7.0–96.0 ng/ml. Mean bioavailability was 15.9%. The nitropyridine metabolite was found in measurable concentrations only after oral treatment with nimodipine. In some cases, the concentration of metabolite exceeded that of the parent compound. The three patients investigated who developed delayed ischaemic dysfunction had plasma concentrations well within the range in patients who did not, so it seems unlikely that the therapeutic failure could be attributed to individual deviations in the pharmacokinetics of the drug.
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  • 2
    ISSN: 0942-0940
    Keywords: Ruptured cerebral aneurysms ; subarachnoid haemorrhage ; early operation ; delayed ischaemic deficit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A prospective open multicenter study on the preventive effect of nimodipine on symptomatic vascular spasm was performed in 120 (consecutive) patients with aneurysmal subarachnoid haemorrhage (SAH). All patients underwent early surgery (i.e. within 72 hours post SAH) and were in neurological grades I–III in Hunt and Hess. Grade IV and V as well as patients with significant intracerebral haematoma are not included. On preoperative CT, SAH was mild in 28 cases, moderate in 56 and severe in 36 cases. 25 patients (21%) were in grade I, 63 patients (53%) in grade II and 32 patients (26%) in grade III. The ruptured aneurysm was located on the anterior cerebral artery complex in 57 patients, on the internal carotid artery complex in 35, on the middle cerebral artery in 24 patients and on the basilar artery in 4 patients. After occlusion of the ruptured aneurysm, the lipophilic calcium channel blocker nimodipine was administered in the following manner: 1. Intraoperative, topical irrigation of the exposed arteries. 2. Intravenous infusion until day 7–14 after SAH followed by peroral medication for another week. Nimodipine was well tolerated and neither significant hypotension nor any other adverse reaction attributable to the drug was observed. Ischaemic cerebral dysfunction of delayed onset with permanent neurological deficit occurred in 2 patients (2%). Another 8 patients showed transient ischaemic symptoms. At 6 months follow-up, 93 % of the patients were classified as having made a full recovery, 16% as being minimally disabled, 5% as being moderately disabled and 3% as being severely disabled. Three patients had died. The present study supports the concept that preventive nimodipine treatment may reduce delayed ischaemic deficit in early aneurysm surgery.
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  • 3
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 4
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: —The influence of insulin-induced hypoglycemia upon carbohydrate substrates, amino acids and ammonia in the brain was studied in lightly anaesthetized rats, and the changes observed were related to the blood glucose concentration and to the EEG. Calculations from glucose concentrations in tissue, CSF and blood indicated the presence of appreciable amounts of free intracellular glucose at blood glucose concentrations above 3 μmol/g. When the blood glucose concentration fell below 3 μmol/g, there was no calculated intracellular glucose and decreases in the concentrations of glycogen, G-6-P, pyruvate, lactate and of citric acid cycle intermediates were observed. At blood glucose levels of below 1 μmol/g the tissue was virtually depleted of glycogen, G-6-P, pyruvate and lactate.When the blood glucose concentration was reduced below about 2·5 μmol/g there were progressive increases in aspartate and progressive decreases in alanine, GABA, glutamine and glutamate, and at blood glucose concentrations below 2 μmol/g the ammonia concentration increased. It is suggested that most of the changes observed can be explained as a result of a decreased availability of pyruvate and of NADH. The decrease in the concentration of free NADH was reflected in reductions of the lactate/pyruvate and malate/oxaloacetate ratios at an unchanged intracellular pH.Slow wave activity appeared in the EEG when the hypoglycemia gave rise to reduction of the intracellular glucose concentration to zero. Convulsive activity continued until carbohydrate stores in the form of glycogen and G-6-P were depleted. When this occurred the EEG became isoelectric. In all convulsive animals the concentration of the nervous system activity inhibitor, GABA, was decreased and stimulant, aspartate, was increased.
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  • 5
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: —Concentrations of phosphocreatine, creatine, ATP, ADP and AMP were measured in the cerebral cortex of rats during insulin-induced hypoglycemia. Blood glucose concentrations were related to clinical symptoms in unanaesthetized animals and to the EEG pattern in paralysed and lightly anaesthetized animals. There was an excellent correlation between blood glucose concentration and EEG pattern. In animals showing a pronounced slowing of the EEG or convulsive polyspike activity for up to 20 min, there were no changes in any of the phosphates. However, after prolonged convulsive activity some animals showed clear signs of energy failure, and in all animals with an isoelectric EEG there was a major derangement of the energy state. Since the majority of those animals did not show signs of cerebral hypoxia or ischemia it is concluded that hypoglycemic coma is accompanied by substrate deficiency of a degree sufficient to induce energy depletion of brain tissue.
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  • 6
    ISSN: 1432-069X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Auf die Haut aufgelegte alkoholische Lösungen von Hydrokortisonacetat und Betamethason-17-valerat wurden wegen einer eventuellen Einwirkung auf das ultraviolette Erythem in homo untersucht. Beide Substanzen, vor der Lichtexposition aufgetragen, zeigten eine Hemmung des Sonnenbranderythems (UVB). Ein phototoxisches Erythem, ausgelöst durch 8-Methoxypsoralen und langwellige UV-Strahlung (UVA) wurde dagegen nicht beeinflußt. Die Pigmentierung im UVA-Versuch war auch bei kurzen UV-Belichtungen, die kein Erythem hervorriefen, deutlich.
    Notes: Summary Topical hydrocortisone and betamethasone-17-valerate were tested in alcoholic solution in human skin for their influence on a developing ultraviolet light erythema. Although the normal response was augmented by the ethanol vehicle, both drugs, applied before exposure, inhibited the erythema induced by irradiation of the sunburn range (UVB). They did not inhibit a phototoxic erythema induced by 8-methoxy-psoralen and long-wave irradiation (UVA). The pigmentation caused by the UVA exposure also appeared after UV stimulation which was too weak to evoke erythema.
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  • 7
    ISSN: 1432-069X
    Keywords: Phototoxicity ; Benoxaprofen ; Photohemolysis ; Mouse-tail technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Benoxaprofen (BP), a non-steroidal antiphlogistic drug causing skin and nail photoreactions, has been evaluated for photoactivity using three experimental techniques. In vivo in the mouse, BP was phototoxic in doses of 25 mg/kg in combination with UV-A 54 J. The phototoxic potency could be confirmed in vitro with the Candida albicans test. In vitro, using photohemolysis, BP showed a dose-dependent activity causing 40% hemolysis at a concentration of about 25 μg/ml with UV-a. Also, small UV-B doses caused red cell lysis with a moderate BP concentration. Preirradiation experiments showed that UV-A, but not UV-B, photoproducts could account for some of the activity. The action spectrum of BP photoactivity lies mainly in the UV-A, but may also extend into UV-B. Compared with chlorpromazine in vivo and in vitro, and with doxycycline in vivo, BP showed intermediate phototoxic activity.
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 63 (1982), S. 215-219 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A retrospective study has been carried out on 100 consecutive patients undergoing direct surgery for ruptured aneurysms of the anterior part of the Circle of Willis within 3 days following subarachnoid haemorrhage. All patients were preoperatively in neurological Grades I, II or III. 76% of the patients made a good recovery whilst the morbidity was 10% and the mortality 14%. The results are compared with the estimated results of delayed treatment as well as with the natural history of the disease. The incidence of hydrocephalus requiring a shunt procedure was 2% and the incidence of permanent ischaemic deficits of delayed onset 16%.
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  • 9
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Contact dermatitis 24 (1991), S. 0 
    ISSN: 1600-0536
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A 43-year-old farmer on tricyclic antidenressive drugs developed a severe photodermatitis with associated liver involvement. The lesions spread to covered areas or the skin, suggesting photoallergy clinically. Patch and photopatch testing revealed photoallergy and contact allergy to clomiprumine and contact allergy also to carbamazepine. In addition, the patient had positive patch test reactions to chlorpromazine, balsam of Peru and fragrance-mix, as well as a positive photopatch test to fentichlor. UVA and UVB erythema thresholds were normal. In this patient, an initial episode of photosensitization, probably elicited by clomipramine, was accompanied by contact allergy to this drug and to carbamazepine. The contact sensitivity to clomipramine could also be elicited by oral provocation without UV light. Hypothetically, a photoproduct of clomipramine may have been the original sensitizer, this compound subsequently cross-reacting with clomipramine and, possibly with carbamazepine.
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  • 10
    ISSN: 0942-0940
    Keywords: Bone regeneration ; craniectomy ; craniosynostosis ; dura mater ; Zenker's solution ; skull
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Regrowth of bone after craniectomy for craniosynostosis is still a problem, despite the advent of newer and extensive surgical techniques. A clinical study on 25 consecutive patients was undertaken to determine whether a modification of previous routines could retain the advantages of a tissue fixative, Zenker's solution, while eliminating the drawback of convulsive activity. After brief coagulation, Zenker's solution was sparingly applied to the durai surface for maximally one minute followed by copious irrigation of the surgical field. The results were satisfactory and postoperative complications unrelated to the fixative. The present procedure seems safe, effective, and easy to use.
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