Dose finding study of telenzepine (1.5 vs. 3 vs 5 mg once daily) in acute treatment of duodenal ulcer. A double-blind, randomized, multicenter parallel group comparison

Three different doses of the M1-selective antimuscarinic compound telenzepine were investigated in the treatment of acute duodenal ulcer in a randomized, double-blind dose-range finding study. In four investigating centers, 120 patients with endoscopically proven, florid duodenal ulcer were treated with either 1.5 mg, 3 mg or 5 mg telenzepine once daily at bedtime (40 patients per dose group). After two weeks of treatment differences in the healing rates were statistically not significant. After four weeks the ulcers of 26 (65%) patients in the 1.5 mg group and 34 (85%) and 31 (78%) in the 3 mg and 5 mg groups, respectively, were completely healed. Only the difference in the healing rates between the 1.5 and 3 mg groups was significant at p less than 0.05. Mean reductions in ulcer area were 90% (1.5 mg), 97% (3 mg) and 93% (5 mg) after four weeks; 1.5 vs. 3 mg, p less than 0.025. These results show that telenzepine dose-dependently accelerates ulcer healing and that maximal effect is obtained with the 3-mg dose. The ulcer symptoms were dose-dependently alleviated. Dry mouth of moderate or severe intensity was stated more frequently under 5 mg telenzepine (by 14% of patients) than under 1.5 and 3 mg (5% each). The antimuscarinic side effect "disturbed accommodation" was rarely found. It is concluded that once daily administration of 3 mg in the evening must be regarded as the optimal dosage regimen of telenzepine.     

Trommsdorff and his relations to dentistry

In the mirror of the publication "Kallopistria oder die Kunst der Toilette für die elegante Welt" (1805) the scarcely noticed relations to dentistry in the total work of the Erfurter university professor and dispensing chemist J. B. Trommsdorff (1770-1837) are represented. Thw new details og the correlation pharmacy-dentistry at the beginning 19th century are presented.     

Low T3 syndrome and chronic inflammatory rheumatism

For the clarification of pathogenesis and clinical relevance of decreases of the triiodothyronine (T3) level in patients with chronic inflammatory rheumatism in a group of 63 patients with clinically, paraclinically and roentgenologically diagnosed rheumatoid arthritis (59 times) and with SLE (4 times), respectively, parallel were determined parameters of the thyroid gland function and of the rheumatic activity as well as a subtile drug anamnesis for the medication of antirheumatic drugs was established. In 33 of the 63 patients who were included into the study decreases and low normal values, respectively, for the total T3 (TT3 less than 1.5 nmol/l) were found. In comparison to the remaining 30 patients with normal TT3 a typical constellation of paraclinical parameters of the thyroid gland with distinct reduction of TT3 and free T3 (FT3), low normal total T4 (TT4), slight increase of the reverse T3 (rT3), moderate decrease of the basal and stimulated TSH and an only very small restriction of the binding capacity of the thyroid hormone (TBG) were found. A clinically relevant hypothyroidism is thus to be excluded with certainty. Antirheumatic drugs, in particular steroidal ones (glucocorticoids) may on principle also induce such paraclinical constellations, related to the thyroid gland. In our investigations a therapy with antirheumatic drugs is causally scarcely considered, since both in the group of patients with decrease of T3 and without decrease comparable quantities of antirheumatic drugs including glucocorticoids were administered and the cortisol values in the plasma do not differ. The investigations confirm our already formerly expressed supposition that also in rheumatics a "low-T3-syndrome" is existing as it is otherwise described in consumptive extrathyroidal diseases (NTI).(ABSTRACT TRUNCATED AT 250 WORDS)     

Histologic features in autoimmune hepatitis

In order to see if the term of "plasma cell hepatitis", dating back to the early sixties, is still valid as a morphological diagnosis for autoimmune chronic hepatitis (AICH), and to find out if the existence of several subgroups is reflected by histopathology, we investigated 26 patients with chronic hepatitis, who met the criteria of autoimmune hepatitis based on tests for antinuclear, anti-smooth muscle antibodies (SMA) and on immunoassays for liver-kidney-microsomal (LKM) antigen, liver membrane antigen (LMA), and soluble liver antigen (SLA). In our material autoimmune hepatitis represent the entire spectrum of chronic hepatitis with variable inflammatory activity ranging from chronic persistent hepatitis to severe inflammatory lesions in chronic active hepatitis with transition to cirrhosis. When compared to viral chronic hepatitis A and non-A, non-B, however, characteristic features can be evaluated consisting in broad hypocellular areas of collapse and microacinar transformation of hepatocytes with hydropic swelling being the predominant type of cell lesion. Eosinophilic clumping and acidophilic necrosis were insignificant. Plasma cells were not a constituent feature of AICH. From this histopathologic pattern it may be concluded that the disease seems to run a sluggish course in most patients, however, in few cases a dramatic development may determine the disease with fatal acute episodes which are terminated by death or fade into slow progression. The different subgroups could not be distinguished by histopathology.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Role of Horizontal Connections in Generating Long Receptive Fields in the Cat Visual Cortex

The cells in the primary visual cortex possess numerous functional properties that are more complex and varied than those seen in the cortical input. These properties result from the network of intrinsic cortical connections running across the cortical layers and between cortical columns. In the current study we relate the long receptive fields that are characteristic of layer 6 cells to the input that these cells receive from layer 5. The axons of layer 5 pyramidal cells project over long distances within layer 6, enabling layer 6 cells to collect input from regions of cortex representing large parts of the visual field. When layer 5 was locally inactivated by injection of the inhibitory transmitter GABA, layer 6 cells lost sensitivity over the portion of their receptive fields corresponding to the inactivated region of layer 5. This suggests that the extensive convergence in the projection from layer 5 to layer 6 is responsible for generating the long receptive fields characteristic of the layer 6 cells.     

Measured attenuation correction methods

Accurate attenuation correction is a prerequisite for the determination of exact local radioactivity concentrations in positron emission tomography. Attenuation correction factors range from 4–5 in brain studies to 50–100 in whole body measurements. This report gives an overview of the different methods of determining the attenuation correction factors by transmission measurements using an external positron emitting source. The long-lived generator nuclide⁶⁸Ge/⁶⁸Ga is commonly used for this purpose. The additional patient dose from the transmission source is usually a small fraction of the dose due to the subsequent emission measurement. Ring-shaped transmission sources as well as rotating point or line sources are employed in modern positron tomographs. By masking a rotating line or point source, random and scattered events in the transmission scans can be effectively suppressed. The problems of measured attenuation correction are discussed: transmission/emission mismatch, random and scattered event contamination, counting statistics, transmission/emission scatter compensation, transmission scan after administration of activity to the patient. By using a double masking technique simultaneous emission and transmission scans become feasible.This article was presented at the 1st EEC workshop on accuracy determination in PET, January 19–20th. 1989 Pisa, Italy (COMAC-BME Concerted Project Characterization and Standardization of PET Instrumentation)     

Aspects of three dimensional reconstruction for a multi ring positron tomography

An important feature of multi ring positron tomographs is the inter plane septa, the purpose of which is to reduce random and scattered coincidences. In general, such septa also eliminate the coincidence lines of response between pairs of detectors more than one ring apart. The operation of a camera without septa must result in an increase not only in the true coincidence rate, but also in the singles, and therefore in the dead time and randoms rate, and in the scattered coincidences. A configuration option in the coincidence hardware of the 8 ring, 15 slice ECAT 931/08-12 enables a full set of 64 sinograms to be acquired when the septa are removed. The detector normalisation and transmission data for studies with the septa out can be obtained using a rotating pin source. To take maximum advantage of the additional signal, the emission data must be reconstructed using a fully three dimensional reconstruction algorithm. This paper presents an analysis of some phantom studies acquired without septa and reconstructed in three dimensions. The results are compared with data acquired with septa for the same phantoms imaged under similar conditions. It is found that, with the septa removed, the signal to noise for a uniform, 20 cm diameter cylinder improves by a factor of 2.8 in the centre of the field of view, whereas in regions distant from the centre in the axial direction, the signal to noise decreases due to the increase in scatter and randoms. An improvement in signal to noise is observed in 6 cm of the 10 cm axial length of the tomograph.This article was presented at the 1st EEC workshop on accuracy determination in PET, January 19–20th. 1989 Pisa, Italy (COMAC-BME Concerted Project Characterization and Standardization of PET Instrumentation)     

Conservative treatment of suppurative hematogenic arthritis of the hip joint

Authors collected from the 82 suppurations of the hip, during the 12 years activity of their Department, the cases treated from some reason conservatively. They had 21 such cases, 17 of them males. The average age of the patients was 38 years and the haematogenous way of the infection could be proven in 15 cases. The scheme of the treatment: very long.lasting giving of broad spectra antibiotics, temporary immobilization with extension, long-lasting relief of weight bearing, if necessary hip spica. The results are assessed critically. In this the tendency of recurrence of the disease, and that the longest follow-up was 10 years, in average however only 3.6 years, play a role. At closing of the material 12 patients stated to be free of complaints, the hip movements were completely retained in 4.9 cases are demonstrated in details and the "strategic" questions of the conservative treatment of the suppurations of the hip are discussed.     

Endocarditis caused by Gemella haemolysans

Summary Gemella haemolysans, a coccus related to theStreptococcaceae, was isolated from the blood of a patient with endocarditis. The patient was successfully treated with a combination of penicillin G and tobramycin, followed by clindamycin. The taxonomy of this organism, especially its relationship toStreptococcus morbillorum is discussed and previously reported cases ofGemella infections are reviewed.

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Endokarditis durch Gemella haemolysans

Zusammenfassung Aus Blutkulturen einer Patientin mit einer Endokarditis wurde einGemella haemolysans-Stamm angezüchtet, ein zu denStreptococcaceae gehöriges Bakterium. Die Patientin konnte mit einer Kombination von Penicillin G und Tobramycin sowie anschließender Clindamycin-Therapie erfolgreich behandelt werden. Die Taxonomie des Erregers, insbesondere seine Verwandtschaft zuStreptococcus morbillorum, wird diskutiert und eine Übersicht über kürzlich beschriebeneGemella-Infektionen gegeben.

     

In vitro Virulenz wundinfizierender Staphylokokken-Isolate von schwerbrandverletzten Patienten

Zusammenfassung 30Staphylococcus aureus Stämme von drittgradig verbrannten Patienten wurden hinsichtlich ihrer Fähigkeit zur Hämolysingenerierung und ihres Vermögens zur Histaminfreisetzung aus Mastzellen (RPMC) untereinander verglichen. Die bakteriellen Kulturüberstande von 8 Stämmen aus Wundbiopsien zeigten signifikant niedrigere in vitro Aktivitäten als die übrigen Staphylokokken-Kulturüberstände. Bei dem Vergleich der in vitro Aktivitäten der gewaschenen Bakterienzellen ergab sich ein umgekehrtes Verhältnis. Diese Befunde zeigen, daß beiS. aureus Isolaten, welche zum Zeitpunkt einer invasiven Brandwundeninfektion isoliert werden können, die mikrobiellen Pathogenitätsfaktoren an die Bakterienzelle gebunden bleiben.

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In vitro measurement of pathogenicity ofStaphylococcus aureus isolated from heavily burned patients

Summary The hemolysin and histamine releasing activity of 30S. aureus strains isolated from third degree burns of heavily burned patients was detected. The culture supernatants (cs) ofStaphylococcus aureus isolated during episodes of invasive burn wound infection displayed significantly lower amounts of hemolysin and histamine releasing activity as compared to cs of bacteria isolated when no sign of septicemia was present. In contrast, when washed bacterial cells were analysed, a reversed ratio could be observed. These data clearly indicate that in strains isolated during invasive burn wound infection pathogenicity factors remain attached to the bacterial surface of the staphylococci investigated.

Gefördert durch das Bundesamt für Zivilschutz (ZS 8-122-42)