[Assessment of the psychic sequelae of traumatisation]. / Begutachtung psychisch reaktiver Traumafolgen.

This article deals with the question why experts quite frequently arrive at totally opposite judgements in clinical psychotraumatological expert opinions. This often leads to intense controversially conducted arguments resulting in lengthy proceedings. The reasons for this will be presented for two cases taken from expert opinions issued for the "Soziales Entschädigungs- und Ausländerrecht" (Laws for Social Reparations and Foreigners). A brief synopsis on the legal background will be given and solutions suggested.

The influence of seizure type on the efficacy of plasma concentrations of phenytoin, phenobarbital, and carbamazepine.

Plasma concentrations of phenytoin, phenobarbital, or carbamazepine were monitored prospectively during successful single-drug therapy in 78 patients who had various types of epileptic seizures. Mean plasma concentrations necessary for complete control of tonic-clonic seizures alone were as follows: phenytoin, 14 micrograms/mL (n = 28); phenobarbital, 18 micrograms/mL (n = 10); and carbamazepine, 5.5 micrograms/mL (n = 2). Epilepsy with simple or complex partial seizures alone or together with tonic-clonic seizures was completely controlled at the following plasma concentrations: phenytoin, 23 micrograms/mL (n = 25); phenobarbital, 37 micrograms/mL (n = 5); and carbamazepine, 7 micrograms/mL (n = 7). Higher plasma concentrations of phenytoin, phenobarbital, and carbamazepine are necessary for control in epilepsy with simple or complex partial seizures compared with epilepsy with tonic-clonic seizures alone. The efficacy of plasma concentrations of phenytoin, phenobarbital, and carbamazepine varies with the type of seizure.

[Model experiments on breathing under sand]. / Modellversuche zur Atmung unter Sand.

Remarkable autopsy findings in persons who had suffocated as a result of closure of the mouth and nose by sand (without the body being buried) induced us to investigate some aspects of this situation by means of a simple experiment. A barrel (diameter 36.7 cm) with a mouthpiece in the bottom was filled with sand to a depth of 15, 30, 60, or 90 cm. The subject tried to breathe as long as possible through the sand, while the amount of sand inspired was measured. Pressure and volume of the breath, as well as the O2 and CO2 content were also measured. A respiratory volume of up to 31 was possible, even when the depth was 90 cm. After about 1 min in all trials, the subject's shortness of breath forced us to stop the experiment. Measurement of O2 and CO2 concentrations proved that respiratory volume in and out of the sand shifts to atmospheric air without gas exchange, even when the sand depth is 15 cm. Sand aspiration depended on the moisture of the material: when the sand was dry, it was impossible to avoid aspiration. However, even a water content of only 5% prevented aspiration, although the sand seemed to be nearly dry.

Therapeutic plasma levels of phenytoin, phenobarbital, and carbamazepine: individual variation in relation to seizure frequency and type.

The range and clinical features that influence the individual variation of the therapeutic plasma concentration of phenytoin, phenobarbital, and carbamazepine were studied in 84 epileptic patients on single-drug therapy. Complete cessation of seizures was observed at plasma concentrations of 17.9 (3 to 50) micrograms/ml phenytoin, 24.5 (3 to 43) micrograms/ml phenobarbital, and 6.5 (4.8 to 9.7) micrograms/ml carbamazepine. Fifty-one percent of the 53 patients receiving phenytoin were completely controlled at either below or above the 10 to 20 micrograms/ml range, suggesting that individual dosage adjustment is preferably based on clinical judgment rather than numerical limits of published therapeutic ranges. Fifty patients with therapeutic plasma concentrations of or above 15 micrograms/ml phenytoin, 25 micrograms/ml plasma concentrations of or above 15 micrograms/ml phenytoin, 25 micrograms/ml phenobarbital, or 6 micrograms/ml carbamazepine more often had partial epilepsies, complex partial seizures and, most markedly, a higher number of seizures in the first year of epilepsy and during the year prior to the present drug therapy, when compared with 34 patients with lower therapeutic plasma concentrations. The variation in therapeutic plasma concentration is primarily related to the type and to the severity of the individual epilepsy, as indicated by the seizure frequency at the onset of the epilepsy or prior to the treatment.