Clozapine response in early treatment-resistant schizophrenia.

Eleven consecutive schizophrenic patients with a mean duration of illness of 2.2 (range 0.9-3.8) years and early signs of resistance to conventional neuroleptics were studied prospectively in a 26-week open trial with clozapine (mean dose 192.5 mg at week 8 and 225.0 mg at end-point). Of the ten patients who completed the study, nine improved by 20% or more on total Brief Psychiatric Rating Scale (BPRS) scores; six (good responders) showed more than 30%, and four (fair responders) 21-26% improvement on total Positive and Negative Syndrome Scale (PANSS) scores. The improvement was observed mainly within the first 8 weeks. Duration of illness correlated negatively (P=0.047) with the decrease of positive PANSS scores. The duration of illness of the fair responders was more than twice that of the good responders. Clozapine appears to be a safe and effective treatment alternative for early treatment-resistant schizophrenic patients. These patients seem to respond to relatively low clozapine doses. Early rather than late transfer to clozapine in this population may be of benefit for later clinical outcome.

The effect of clozapine on the course of illness in chronic schizophrenia: focus on treatment outcome in out-patients.

Forty-eight consecutive schizophrenic patients treated with clozapine (mean daily dose 436 mg) for at least 1 year (mean 7.6, range 2.2-14.8 years) were studied retrospectively. The most favourable changes in the course of illness were observed in 39 out-patients, whose duration of hospitalization per year continuously and significantly declined after the introduction of clozapine. The out-patients who continued with clozapine treatment for more than 10 years (n = 8) did not need hospitalization at all during the last year of the observation period. The improvement in social functioning in the out-patient group correlated positively with the duration of clozapine medication (r = 0.384, p = 0.016) and with the duration of hospitalization (r = 0.372, p = 0.020) after introduction of clozapine. Out-patients with disorganized schizophrenia (later called hebephrenic according to the Finish version of DSM-III) showed more noticeable clinical (U = 226, p = 0.032) and social (U = 233, p = 0.024) improvements than non-hebephrenic patients. There appears to be a subgroup of hebephrenic patients who benefit from clozapine more than patients with other types of schizophrenia.

[Poisoning by hypochlorite-containing disinfectants. A retrospective analysis of 594 cases of poisoning]. / Vergiftungen durch hypochlorithaltige Sanitärreiniger. Eine retrospektive Analyse von 594 Vergiftungsfällen.

Hypochlorite-containing disinfectants or bleaching fluids, if inhaled, may lead to life-threatening poisoning (56% of moderately severe cases, 5% of severe cases) through the immediate liberation of chlorine gas, if they are used together with another cleansing fluid which is very acid. A rough estimate suggests that there must be about 700 cases of such poisonings per year in the Federal Republic of Germany. The characteristic symptom is a respiratory distress syndrome when the liberated chlorine gas is inhaled. Toxic pulmonary oedema and cardiovascular failure can occur if the poisoning takes a fulminating course.

Urinary free T4 and T3 in healthy infants and during noise exposure.

There is concern about noise exposure in the hospital environment and its effects on infants. Stress reactions, however, are difficult to measure, especially in this age group. Urinary T4 and T3 have proved to be equivalent to catecholamine determinations in helicopter pilots and in motion sickness. They represent the free fraction of thyroid hormones in serum. Timed collections of urine were made in 78 healthy infants and in 43 infants exposed to standardized noise. T4 and T3 were determined by RIA on Sephadex columns. Medians and ranges are given for day and night and before, during and after noise exposure.

[A panorama of medical history of acute iron poisoning (author's transl)]. / Ein medizingeschichtliches Panorama der akuten Eisenvergiftung.

The paper describes briefly the fatal course taken by some of the 720 acute cases of poisoning with iron compounds as documented in literature between 1826 and the present time. The various concomitant conditions and the genesis, as well as the fatal disease pattern, are communicated. The various pathogenetic factors and nosological variants of acute iron poisoning, as well as the epidemiology of juvenile iron poisoning, are discussed. Finally, the paper points to numerous deficiencies in the exact diagnosis of acute cases of iron poisoning.

[Studies on noise stress caused by infant incubators (author's transl)]. / Untersuchungen über die Geräuschbelastung von Säuglingen in Inkubatoren.

The following acoustic effects of incubators were investigated: Noise level and vibration measurements inside incubators. Noise emanation into the vicinity of incubators. Deadening of incubator noise by the hood. The noise intensity inside the incubators was also registered under conditions of intensive care using sound emitting therapeutic and monitoring equipment. The results show that the noise level of incubator motors can be tolerated. This applies to well-serviced incubators only, however. The hood muffles outside noise, particularly in the range of greatest hearing acuity. But there is no protection against noisy intensive-care systems within the incubator. The infants own noise production is considered to contribute substantially to the noise within an incubator.

[Fatal poison disease of a child following massive wasp stings (author's transl)[]. / Tödliche Vergiftungskrankheit eins Kindes nach massenhaften Wespenstichen.

A child aged 4 years was stung by more than 250 wasps. There was no anaphylactic shock. There rather were increasingly heavy ictero-hemorrhagic symptoms with simultaneous insufficient kidney function. On the second day of the disease disorders of the CNS started, as well as circulation insufficiency and disorder of the heart function. According to the signs there was no intravasal coagulation or hemolysis. Heavy doses of corticoids were successless, just as a peritoneal dialysis starting on the 3rd day of the disease. The child died 5 and 1/2 day after the wasps' attack. The pathophysiology and the possible therapeutic consequences of the case as well as rapid protective actions in such a case of insect attack are being discussed.

[Clinical and experimental studies of DBED-Penicilline in bacterial airway-infections in children]. / DBED-Penicillin V (Ospen) bei bakteriellen Luftweginfektionen im Kindesalter. Klinisch-experimentelle Prüfung

Serum concentrations and therapeutic effects of DBED-Penicilline was checked in 22 resp. 26 children, 1-14 years of age. 15 min up to 2 hours and more following oral application of DBED-Penicilline a bactericide serum level was observed. The clinical effectiveness of orally administered DBED-Penicilline was proved in airway-infections of children. The flavor of the drug was well accepted.

[Investigations of serum levels of drugs in children receiving anticonvulsant medication. I. General evaluation of serum concentrations of diphenylhydantoin, primidone and phenobarbitone (author's transl)]. / Untersuchungen über die Medikamenten-Serumspiegel antikonvulsiv behandelter Kinder. I. Allgemeine Auswertung der Serumkonzentrationen von Diphenylhydantoin, Primidon und Phenobarbital

With the aid of our own method of gas chromatography we determined serum concentrations of anticonvulsants in a large number of children who were being treated with diphenylhydantoin, primidone and phenobarbitone. The drugs were being prescribed either as monotherapy, or in combination with each other, or with other substances which have anticonvulsive activity. Regression lines showed good correlations between the quantity of drugs administered (total daily dose) and serum concentrations. The regression lines for diphenylhydantoin and primidone, however, showed no differences, irrespective of whether they were being given alone or in combination. In view of the frequency of symptoms of intoxication and of non-responders, we established a therapeutic range for diphenylhydantoin and primidone (diphenylhydantoin: 5--16 mcg/ml; primidone: 4--14 mcg/ml). The required serum concentrations could be obtained by giving 8--12 mg/kg of diphenylhydantoin, and 15-22 mg/kg of primidone. In spite of the satisfactory correlation between total daily dose and serum concentrations, however, many patients showed departures from this normal behaviour, especially where combination treatments were being conducted. This demonstrates the necessity for routine controls of serum levels.

[Investigations of serum levels of drugs in children receiving anticonvulsant medication. II. Clinical observations (author's transl)]. / Untersuchungen über die Medikamenten-Serumspiegel antikonvulsiv behandelter Kinder. II. Klinische Beobachtungen

Although good correlation can be obtained between total daily dose and serum concentration in treatment with anticonvulsant drugs, many patients still show departures from this relation. The various factors which can influence serum concentrations of the administered drugs were to be domonstrated in a number of children who were receiving anticonvulsants at average dose levels and who developed evidence of overdose, or who failed to respond to therapy. The most important feature is that combined adminstration of several drugs may increase or inhibit metabolisation of the various substances, so that inadequate or excessively high serum concentrations result. Furthermore, irregular intake of the necessary medication must always be taken into account in the case of treatment on an out patient basis. Routine determinations of serum levels of anticonvulsant drugs in these patients are called for because of this.