Vincristine and intestinal pseudo-obstruction in children: report of 5 cases, literature review, and suggested management.

Summary: Intestinal pseudo-obstruction is a rare complication resulting from a variety of disorders. Symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, and malnutrition. Vincristine-related pseudo-obstruction has been reported in the literature, but its description in children and recommendations for management are lacking. A review of the literature revealed 21 reported pediatric cases of vincristine-related pseudo-obstruction. Most have, however, been attributed to a drug interaction with itraconazole, accidental vincristine overdose, or liver failure. Potential genetic causes are rarely addressed. We present here 5 cases of pseudo-obstruction related to vincristine without any identifiable predisposing factors, and a suggested algorithm for management

Noninvasive imaging of 5-HT3 receptor trafficking in live cells: from biosynthesis to endocytosis.

Sequential stages in the life cycle of the ionotropic 5-HT(3) receptor (5-HT(3)R) were resolved temporally and spatially in live cells by multicolor fluorescence confocal microscopy. The insertion of the enhanced cyan fluorescent protein into the large intracellular loop delivered a fluorescent 5-HT(3)R fully functional in terms of ligand binding specificity and channel activity, which allowed for the first time a complete real-time visualization and documentation of intracellular biogenesis, membrane targeting, and ligand-mediated internalization of a receptor belonging to the ligand-gated ion channel superfamily. Fluorescence signals of newly expressed receptors were detectable in the endoplasmic reticulum about 3 h after transfection onset. At this stage receptor subunits assembled to form active ligand binding sites as demonstrated in situ by binding of a fluorescent 5-HT(3)R-specific antagonist. After novel protein synthesis was chemically blocked, the 5-HT(3) R populations in the endoplasmic reticulum and Golgi cisternae moved virtually quantitatively to the cell surface, indicating efficient receptor folding and assembly. Intracellular 5-HT(3) receptors were trafficking in vesicle-like structures along microtubules to the cell surface at a velocity generally below 1 mum/s and were inserted into the plasma membrane in a characteristic cluster distribution overlapping with actin-rich domains. Internalization of cell surface 5-HT(3) receptors was observed within minutes after exposure to an extracellular agonist. Our orchestrated use of spectrally distinguishable fluorescent labels for the receptor, its cognate ligand, and specific organelle markers can be regarded as a general approach allowing subcellular insights into dynamic processes of membrane receptor trafficking.

Phase I and phase II xenobiotic reactions and metabolism of the food-borne carcinogen 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline in aggregating liver cell cultures.

Aggregating fetal liver cell cultures were tested for their ability to metabolize xenobiotics using ethoxycoumarin-O-deethylase (ECOD), as marker of phase I metabolism, and glutathione S-transferase (GST), as marker for phase II reactions. Significant basal activities, stable over 14 days in culture were measured for both ECOD and GST activities. The prototype cytochrome P450 inducers, 3-methylcholanthrene (3-MC) and phenobarbital (PB), increased ECOD and GST activities reaching an optimum 7 days after culturing, followed by a decline in activity. This decline was partially prevented by 1% dimethyl sulfoxide (DMSO) added chronically to the culture medium. DMSO was also found to induce ECOD activity and to a lesser extent GST activity. Furthermore, it potentiated in a dose-dependent manner the induction of ECOD by PB. The food-borne carcinogen 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) is metabolically transformed through a number of pathways in vivo. It was therefore used to examine the metabolic capacity in fetal and adult liver cell aggregates. Metabolism of MeIQx was mainly through N2-conjugation, resulting in formation of the N2-glucuronide and sulfamate conjugates for non-induced fetal liver cells. These metabolites were also found in large amounts in non-induced adult liver cells. Low levels of cytochrome P450-mediated ring-hydroxylated metabolites were detected in both non-induced fetal and adult liver cells. After induction with arochlor (PCB) or 3-MC, the major pathway was ring-hydroxylation (cytochrome P450 dependent), followed by conjugation to beta-glucuronic or sulfuric acid. The presence of the glucuronide conjugate of N-hydroxy-MeIQx, a mutagenic metabolite, suggested an induction of P450 CYP1A2. The metabolism of MeIQx by liver cell aggregates is very similar to that observed in vivo and suggests that aggregating liver cell cultures are a useful model for in vitro metabolic studies in toxicology.

Phosphatidylinositol 4,5-bisphosphate clusters act as molecular beacons for vesicle recruitment.

Synaptic-vesicle exocytosis is mediated by the vesicular Ca(2+) sensor synaptotagmin-1. Synaptotagmin-1 interacts with the SNARE protein syntaxin-1A and acidic phospholipids such as phosphatidylinositol 4,5-bisphosphate (PIP2). However, it is unclear how these interactions contribute to triggering membrane fusion. Using PC12 cells from Rattus norvegicus and artificial supported bilayers, we show that synaptotagmin-1 interacts with the polybasic linker region of syntaxin-1A independent of Ca(2+) through PIP2. This interaction allows both Ca(2+)-binding sites of synaptotagmin-1 to bind to phosphatidylserine in the vesicle membrane upon Ca(2+) triggering. We determined the crystal structure of the C2B domain of synaptotagmin-1 bound to phosphoserine, allowing development of a high-resolution model of synaptotagmin bridging two different membranes. Our results suggest that PIP2 clusters organized by syntaxin-1 act as molecular beacons for vesicle docking, with the subsequent Ca(2+) influx bringing the vesicle membrane close enough for membrane fusion.

Plasma levels of the enantiomers of thioridazine, thioridazine 2-sulfoxide, thioridazine 2-sulfone, and thioridazine 5-sulfoxide in poor and extensive metabolizers of dextromethorphan and mephenytoin.

Concentrations of total (R) + (S) and of the enantiomers (R) and (S) of thioridazine and metabolites were measured in 21 patients who were receiving 100 mg thioridazine for 14 days and who were comedicated with moclobemide (450 mg/day). Two patients were poor metabolizers of dextromethorphan and one was a poor metabolizer of mephenytoin. Cytochrome P450IID6 (CYP2D6) is involved in the formation of thioridazine 2-sulfoxide (2-SO) from thioridazine and also probably partially in the formation of thioridazine 5-sulfoxide (5-SO), but not in the formation of thioridazine 2-sulfone (2-SO2) from thioridazine 2-SO. Significant correlations between the mephenytoin enantiomeric ratio and concentrations of thioridazine and metabolites suggest that cytochrome P450IIC19 could contribute to the biotransformation of thioridazine into yet-unknown metabolites, other than thioridazine 2-SO, thioridazine 2-SO2, or thioridazine 5-SO. An enantioselectivity and a large interindividual variability in the metabolism of thioridazine have been shown: measured (R)/(S) ratios of thioridazine, thioridazine 2-SO fast eluting (FE), thioridazine 2-SO slow eluting (SE), thioridazine 2-SO (FE+SE), thioridazine 2-SO2, thioridazine 5-SO(FE), and thioridazine 5-SO(SE) were (mean +/- SD) 3.48 +/- 0 .93 (range, 2.30 to 5.80), 0.45 +/- 0.22 (range, 0.21 to 1.20), 2.27 +/- 8.1 (range, 6.1 to 40.1), 4.64 +/- 0.68 (range, 2.85 to 5.70), 3.26 +/- 0.58 (range, 2.30 to 4.30), 0.049 +/- 0.019 (range, (0.021 to 0.087), and 67.2 +/- 66.2 (range, 16.8 to 248), respectively. CYP2D6 is apparently involved in the formation of (S)-thioridazine 2-SO(FE), (R)-thioridazine 2-SO(SE), and also probably (S)-thioridazine 5-SO(FE) and (R)-thioridazine 5-SO(SE).

Replacement of (R)-methadone by a double dose of (R,S)-methadone in addicts: interindividual variability of the (R)/(S) ratios and evidence of adaptive changes in methadone pharmacokinetics.

METHODS: Twenty-two patients receiving (R)-methadone maintenance treatment were switched to a double dose of (R,S)-methadone: blood samples were collected before and after the change, and the concentrations of the enantiomers were measured. In the second period, during racemic methadone treatment, important interindividual variability in the stereoselective disposition of the enantiomers of methadone was measured, with (R)/(S) ratios ranging from 0.63 to 2.40. This point should be taken into account particularly with respect to therapeutic drug monitoring of racemic methadone. RESULTS: A significant decrease P < 0.005 in the mean serum concentration/dose ratios of the active (R)-enantiomer before and after the change was measured (mean 3.97 and 3.33). CONCLUSION: Although of small amplitude (16%), this decrease confirms previously described adaptive changes in methadone pharmacokinetics during racemic methadone maintenance treatment and may necessitate, in some patients, a dose adjustment.

Gemcitabine, oxaliplatin and 5-FU in advanced bile duct and gallbladder carcinoma: two parallel, multicentre phase-II trials.

BACKGROUND: Gemcitabine, oxaliplatin and 5-fluorouracil (5-FU) are active in biliary tract cancer and have a potentially synergistic mode of action and non-overlapping toxicity. The objective of these trials was to determine response, survival and toxicity separately in patients with bile duct cancer (BDC) and gallbladder cancer (GBC) treated with gemcitabine/oxaliplatin/5-FU chemotherapy. METHODS: Eligible patients with histologically proven, advanced or metastatic BDC (n=37) or GBC (n=35) were treated with gemcitabine (900 mg m(-2) over 30 min), oxaliplatin (65 mg m(-2)) and 5-FU (1500 mg m(-2) over 24 h) on days 1 and 8 of a 21-day cycle. Tumour response was the primary outcome measure. RESULTS: Response rates were 19% (95% CI: 6-32%) and 23% (95% CI: 9-37%) for BDC and GBC, respectively. Median survivals were 10.0 months (95% CI: 8.6-12.4) and 9.9 months (95% CI: 7.5-12.2) for BDC and GBC, respectively, and 1- and 2-year survival rates were 40 and 23% in BDC and 34 and 6% in GBC (intention-to-treat analysis). Major grade III and IV adverse events were neutropenia, thrombocytopenia, elevated bilirubin and anorexia. CONCLUSION: Triple-drug chemotherapy achieves comparable results for response and survival to previously reported regimens, but with more toxicity.

Randomized controlled trial comparing highly purified (HP-hCG) and recombinant hCG (r-hCG) for triggering ovulation in ART.

BACKGROUND: A randomized controlled trial (RCT) comparing highly purified human Choriogonadotrophin (HP-hCG) and recombinant hCG (r-hCG) both administered subcutaneously for triggering ovulation in controlled ovarian stimulation (COS) for Assisted Reproductive Technology (ART). METHODS: Multi-centre (n = 4), prospective, controlled, randomized, non-inferiority, parallel group, investigator blind design, including 147 patients. The trial was registered with www.clinicaltrials.gov, using the identifier: NCT00335569. The primary endpoint is the number of oocytes retrieved, while the secondary endpoints include embryo implantation, pregnancy and delivery rates as well as safety parameters. RESULTS: The number of retrieved oocytes was not inferior when HP-hCG was used as compared to r-hCG: the mean number was 13.3 (6.8) in HP-hCG and 12.5 (5.8) in the r-hCG group (p = 0.49) with a 95% CI (-1.34, 2.77). Regarding the secondary outcomes, there were also no differences in fertilization rate at 57.3% (467/815) vs. 61.3% (482/787) (p = 0.11), the number of embryos available for transfer and cryopreservation (2PN stage) and implantation, pregnancy and delivery rates. Furthermore, there were no differences in the number and type of adverse events reported. HP-hCG was therefore not inferior to r-hCG. CONCLUSIONS: HP-hCG and r-hCG are equally efficient and safe for triggering ovulation in ART and, both being administered subcutaneously, equally practical and well tolerated by patients.

Y-90 Ibritumomab Tiuxetan (Zevalin (R)) Consolidation of First Remission In Advanced Stage Follicular Non Hodgkin's Lymphoma Updated Results After a Median Follow up of 662 Months From the International, Randomized, Phase III First Line Indolent Trial (FIT) In 414 Patients

The FIT trial was conducted to evaluate the safety and efficacy of 90Y-ibritumomab tiuxetan (0.4 mCi/kg; maximum dose 32 mCi) when used as consolidation of first complete or partial remission in patients with previously untreated, advanced-stage follicular lymphoma (FL). Patients were randomly assigned to either 90Y-ibritumomab treatment (n = 207) or observation (n = 202) within 3 months (mo) of completing initial induction therapy (chemotherapy only: 86%; rituximab in combination with chemotherapy: 14%). Response status prior to randomization did not differ between the groups: 52% complete response (CR)/CR unconfirmed (CRu) to induction therapy and 48% partial response (PR) in the 90Y-ibritumomab arm vs 53% CR/CRu and 44% PR in the control arm. The primary endpoint was progression-free survival (PFS) of the intent-to-treat (ITT) population. Results from the first extended follow-up after a median of 3.5 years revealed a significant improvement in PFS from the time of randomization with 90Y-ibritumomab consolidation compared with control (36.5 vs 13.3 mo, respectively; P < 0.0001; Morschhauser et al. JCO. 2008; 26:5156-5164). Here we report a median follow-up of 66.2 mo (5.5 years). Five-year PFS was 47% in the 90Y-ibritumomab group and 29% in the control group (hazard ratio (HR) = 0.51, 95% CI 0.39-0.65; P < 0.0001). Median PFS in the 90Y-ibritumomab group was 49 mo vs 14 mo in the control group. In patients achieving a CR/CRu after induction, 5-year PFS was 57% in the 90Y-ibritumomab group, and the median had not yet been reached at 92 months, compared with a 43% 5-year PFS in the control group and a median of 31 mo (HR = 0.61, 95% CI 0.42-0.89). For patients in PR after induction, the 5-year PFS was 38% in the 90Y-ibritumomab group with a median PFS of 30 mo vs 14% in the control group with a median PFS of 6 mo (HR = 0.38, 95% CI 0.27-0.53). Patients who had received rituximab as part of induction treatment had a 5-year PFS of 64% in the 90Y-ibritumomab group and 48% in the control group (HR = 0.66, 95% CI 0.30-1.47). For all patients, time to next treatment (as calculated from the date of randomization) differed significantly between both groups; median not reached at 99 mo in the 90Y-ibritumomab group vs 35 mo in the control group (P < 0.0001). The majority of patients received rituximab-containing regimens when treated after progression (63/82 [77%] in the 90Y-ibritumomab group and 102/122 [84%] in the control group). Overall response rate to second-line treatment was 79% in the 90Y-ibritumomab group (57% CR/CRu and 22% PR) vs 78% in the control arm (59% CR/CRu, 19% PR). Five-year overall survival was not significantly different between the groups; 93% and 89% in the 90Y-ibritumomab and control groups, respectively (P = 0.561). To date, 40 patients have died; 18 in the 90Y-ibritumomab group and 22 in the control group. Secondary malignancies were diagnosed in 16 patients in the 90Y-ibritumomab arm vs 9 patients in the control arm (P = 0.19). There were 6 (3%) cases of myelodysplastic syndrome (MDS)/acute myelogenous leukemia (AML) in the 90Y-ibritumomab arm vs 1 MDS in the control arm (P = 0.063). In conclusion, this extended follow-up of the FIT trial confirms the benefit of 90Y-ibritumomab consolidation with a nearly 3 year advantage in median PFS. A significant 5-year PFS improvement was confirmed for patients with a CR/CRu or a PR after induction. Effective rescue treatment with rituximab-containing regimens may explain the observed no difference in overall survival between both patient groups who were - for the greater part - rituximab-naïve.

Evaluation of the GlideScope (R) for tracheal intubation in patients with cervical spine immobilization by a semi-rigid collar

Background: In patients with cervical spine injury, a cervical collar may prevent cervical spine movements but renders tracheal intubation with a standard laryngoscope difficult if not impossible. We hypothesized that despite the presence of a semi-rigid cervical collar and with the patient's head taped to the trolley, we would be able to intubate all patients with the GlideScopeR and its dedicated stylet. Methods: 50 adult patients (ASA 1 or 2, BMI ≤35 kg/m2) scheduled for elective surgical procedures requiring tracheal intubation were included. After standardized induction of general anesthesia and neuromuscular blockade, the neck was immobilized with an appropriately sized semi-rigid Philadelphia Patriot® cervical collar, the head was taped to the trolley. Laryngoscopy was attempted using a Macintosh laryngoscope blade 4 and the modified Cormack Lehane grade was noted. Subsequently, laryngoscopy with the GlideScopeR was graded and followed by oro-tracheal intubation. Results: All patients were successfully intubated with the GlideScopeR and its dedicated stylet. The median intubation time was 50 sec [43; 61]. The modified Cormack Lehane grade was 3 or 4 at direct laryngoscopy. It was significantly reduced with the GlideScopeR (p <0.0001), reaching 2a in most of patients. Maximal mouth opening was significantly reduced with the cervical collar applied, 4.5 cm [4.5; 5.0] vs. 2.0 cm [1.8; 2.0] (p <0.0001). Conclusions: The GlideScope® allows oro-tracheal intubation in patients having their cervical spine immobilized by a semi-rigid collar and their head taped to the trolley. It furthermore decreases significantly the modified Cormack Lehane grade.

Validation interne de la version française du NEO-PI-R et influence de l'âge, du sexe et de la profession

We have examined the internal validity of the French translation of the NEO PI-R personality test which measures the « big five » (Rolland, 1993). The impact of age, gender and professional categories on the NEO PI-R scales was assessed. A large sample (n=731) of subjects of different age, gender and profession and a sample of Swiss students (n=261) responding anonymously were used. Factor analyses confirmed the structure of the instrument (5 domains) and the structures of the domains in terms of facets (six facets within each domain). On the other hand, the age has a significant impact on all the domains of the NEO PI-R; the gender has an impact on the scores on N (neuroticism), O (openness) and A (agreeableness), and the profession has an impact on the domains E (extraversion), O (openness) and A (agreeableness). The scores on several facets are also affected by those three variables. Our study gives the researchers and the practitioner a reference score table according to the studied variables.

The hierarchical structures of the NEO-PI-R and the 16PF5

The present study compares the higher-level dimensions and the hierarchical structures of the fifth edition of the 16 PF with those of the NEO PI-R. Both inventories measure personality according to five higher-level dimensions. These inventories were however constructed according to different methods (bottom-up vs. top-down). 386 participants filled out both questionnaires. Correlations, regressions and canonical correlations made it possible to compare the inventories. As expected they roughly measure the same aspects of personality. There is a coherent association among four of the five dimensions measured in the tests. However Agreeableness, the remaining dimension in the NEO PI-R, is not represented in the 16 PF 5. Our analyses confirmed the hierarchical structures of both instruments, but this confirmation was more complete in the case of the NEO PI-R. Indeed, a parallel analysis indicated that a four-factor solution should be considered in the case of the 16 PF 5. On the other hand, the NEO PI-R's five-factor solution was confirmed. The top-down construction of this instrument seems to make for a more legible structure. Of the two five-dimension constructs, the NEO PI-R thus seems the more reliable. This confirms the relevance of the Five Factor Model of personality.

Die loutrophóros im Hochzeits-und Begräbnisritual des 5. Jahrhunderts v. Chr. in Athen

ZUSAMMENFASSUNG Gegenstand dieser Arbeit sind rund hundert rotfigurige Darstellungen von den beiden als Lutrophoren bezeichneten Tongefässen, der dreihenkligen Lutrophoros-Hydria (LH) und der zweihenkligen Lutrophoros-Amphora (LA). Die Untersuchung geht von der Prämisse aus, dass Darstellungen der Lutrophoros einen gewissen Variantenreichtum des Brauchtums widerspiegeln können, sonst aber verbindlichen, in sich schlüssigen Vorstellungen entsprechen, die sich die Gemeinschaft von diesem Ritualobjekt macht. In Anlehnung an die herrschende Meinung wird zudem vorausgesetzt, dass LA und LH ausschliesslich im nuptialen und funeralen Bereich vorkommen, doch ist bisher in der archäologischen Forschung ihre Rolle im einzelnen ungeldärt. Anhand von literarischen Quellen und ikonographischem Material wird untersucht, inwiefern sich LA und LH in ihrer Verwendung und Bedeutung in bezug auf Hochzeit und Begräbnis unterscheiden und inwieweit der Begriʂ57;f loutrophóros auf sie zutrifft. KAPITEL I Nach frühen Quellentexten muss die Bezeichnung loutrophóros im Hochzeitsritual für eine Person und beim Begräbnis eines ehelos verstorbenen Mannes für ein Objekt verwendet worden sein. In späteren Zeugnissen wird ergänzend die Lutrophoros für die Hochzeit als hydria-ähnliches Gefäss bezeichnet, ebenso die Lutrophoros auf dem Grab; für letztere wird zusätzlich eine Kinderʂ57;gur mit Wassergefäss vorgeschlagen, was archäologisch bislang nicht bezeugt ist. Die Aussagen der Texte zum Begriff loutrophóros stimmen trotz verschiedener Widersprüche im Gesamten darin überein, dass die Aufstellung der Lutrophoros auf dem Grab von ehelos Verstorbenen eine Entsprechung zum Ritual für Hochzeitsleute darstellt; die rituelle Verwendung der Lutrophoros auf dem Grab muss also eine nuptiale Bedeutung haben. Die Untersuchung des Begriffs loutrá (,,Hoch- zeitsba") im nuptialen Bereich zeigt, dass die Lutrophoros in engem Zusammenhang mit der Quellnymphe Kallirrhoë, der Braut - nýmphè genannt - und dem Heiligtum der Nymphe, dem Hauptfundort der Lutrophoren, gesehen werden muss; allerdings bleibt die spezifische Bedeutung der loutrá ungewiss. Am ehesten werden sie dem Gedeihen der neu entstandenen Verbindung gedient haben, die sich in Anlehnung an Hesiods Werke und Tage als Neugründung eines oíkos oder als Weiteiterführung des väterlichen oíkos durch den Bräutigam umschreiben lässt. Für die bislang immer wieder vorgeschlagenen Deutungen der loutrá als Ritual für Fruchtbarkeit oder zur Reinigung gibt es frühestens ab dem 4. ]h. v. Chr. Hinweise. Die Untersuchung des Begriffs loutrá für die Waschung vor der Bestattung und ein Vergleich zwischen verschiedenen Bezeichnungen für Grab- spenden (choaí, loibaí, loutrá) und der aufgestellten Lutrophoros auf dem Grab führen entgegen bisheriger Auffassungen zum Schluss, dass die Lutrophoros auf dem Grab als Entsprechung zum Hochzeitsritual gesehen wurde und dass diesem Brauch die für Athen bekannte Vorstellung zugrunde liegt, die Verstorbenen zufrieden zu stellen. Die aufgestellte Lutrophoros könnte zum Ausdruck bringen, dass die Hinterbliebenen das der verstorbenen Person zustehende Recht auf Verehelichung gebilligt hätten. Kapitel II Beim ikonographischen Material, das sich hauptsächlich aus Vasenbildern zusammensetzt, stehen die dargestellten Gefässvarianten LA und LH im Zentrum. Nach dem ikonographischen Modell von C. Bérard fassen wir die dargestellten LA und LH im linguistischen Sinn als ikonische Zeichen auf, die nicht weiter zerlegbar sind; LA und LH stellen je eine ,,unité formelle minimale " dar. Die zentrale Frage lautet, ob Bedeutung und Verwendung der beiden ,,unités formelles minimales" LH und LA - trotz ihrer unterschiedlichen Form -in bezug auf die Funktion der loutrophóros bei der Hochzeit und beim Begräbnis ehelos Verstorbener übereinstimmen oder ob die unterschiedliche Form von LA und LH zum Ausdruck bringen soll, dass sie eben gerade nicht die gleiche Funktion haben. Beide Auffassungen sind in der bisherigen Forschung stark vertreten: R Wolters und seine Anhänger gehen davon aus, dass LA und LH gleichwertig sind; G. Kokula und mit ihr andere nehmen eine unterschiedliche, geschlechtsspezifische Verwendung an. In einer ersten formalen Analyse werden Darstellungen von LA und LH auf Lutrophoren, Lebetes gamikoi und Hydrien untersucht. Folgende Skizze zeigt die bekannten Kombinationen von dargestellten Lutrophoren: Aus der formalen Analyse lassen sich vier Schlüsse ziehen: - (ia.b) In der Regel entsprechen sich Bildträger und Bildelement; dieser Kombination muss eine Absicht zugrunde liegen, sie kann nicht willkürlich sein. - (2) Zwei LA mit Darstellungen einer LH (49 Abb. 4oa.b; 50 Abb. 4ia.b) sprechen dafür, dass im Verwendungsbereich der LA auch die LH vorkommen kann; im Gegensatz dazu fehlen aber Darstellungen einer LA auf einer LH, was vermuten lässt, dass im Verwendungsbereich der LH keine LA gebraucht wurden. - (3a.b) Zwei Darstellungen zeigen jede Variante für sich in zwei Exemplaren in der Funktion als Wasserbehälter: zwei LH (I7 Abb. 61b.c; 6za. b); zwei LA (12 Abb. 46. 47a.b); im Gegensatz dazu kommen aber beide Varianten gemeinsam in der Funktion als Wasserbehälter nicht vor, vermutlich hat sich der Anwendungsbereich der beiden Varianten unterschieden. (4a.b) Zwei Darstellungen, die beide Varianten gemeinsam zeigen, einmal im Miniaturformat (50 Abb. 41a.b), das andere Mai in monumentaler Grösse (I Abb. 1) - also nicht als Wasserbehälter -, lassen den Schluss zu, dass beide Varianten ein gemeinsames Merkmal haben müssen. Allein die formale Analyse zeigt, dass die von P Wolters angenommene Gleichwertigkeit nicht zutreffen kann. Es muss eine unterschiedliche Verwendung gegeben haben, wie bereits G. Kokula vermutet. In einer zweiten Analyse werden die Darstellungen nach der von P Bruneau vorgeschlagenen Methode in fünf Gruppen mit gleichem Schema aufgelisret. Hier wird die dargestellte LA oder LH im Vergleich zur Gesamtdarstellung ausgewertet, ohne die inhaltliche Klassiʂ57;zierung vorauszusetzen. In einer Gruppe gesondert werden alle Lutrophorendarstellungen untersucht, die thematisch eindeutig zum funeralen Bereich gehören. Die aus der ersten Analyse gewonnene Annahme, dass sich LA und LH in der Verwendung unterscheiden, wird durch die zweite Analyse bestätigt und präzisiert. Für die LA kann keine eindeutige hochzeitliche Verwendung nachgewiesen werden; die LH ist das eigentliche Hochzeitsgefäss. Darüber hinaus zeigt die Untersuchung, dass alle Darstellungen einer LH oder LA inhaltlich dem nuptialen oder funeralen Kontext zugeordnet werden können; gemäss den Darstellungen wurden LA und LH nur bei Hochzeit oder Begräbnis verwendet. Nach dem hier vorgestellten Modell machen LA und LH als ikonische Zeichen eine doppelte Aussage. Sie verweisen einerseits auf den Inhalt, das hochzeitliche Wasser, und darin sind sie bedeutungsgleich. Andererseits beziehen sie sich auf die Adressaten: die LA kommt für Hochzeitsleute nicht in Frage, ihre Verwendung ist auf ehelos Verstorbene beschränkt. Die LH, das Ritualobjekt der Hochzeitsleute, kann vereinzelt auch für Verstorbene gebraucht werden. Diese zunächst irritierende Beobachtung stimmt mit den Texten gut überein, aus denen hervorgeht, dass im Ritual für ehelos Verstorbene eine Entsprechung zum Hochzeitsritual liegt; seine Bedeutung muss daher ebenfalls nuptial sein. Die Kombination von hochzeitlichen und funeralen Elementen ist daher nach dem hier vorgeschlagenen Modell im Funeralbereich - und zwar nur dort - möglich. Ebenfalls in Übereinstimmung mit den Texten lassen sich die beiden Darstellungen erklären, die LA und LH gemeinsam im Miniaturformat oder in monumentaler Grösse zeigen. Da nämlich die Mitgabe der Lutrophoros für ehelos Verstorbene auf die hochzeitlichen loutrá verweist, haben beide Gefässvarianten trotz der unterschiedlichen Verwendung eine gleichwertige Bedeutung, und daraus erklärt sich die gemeinsame Darstellung beider Varianten in einem Format, das die rituelle Verwendung ausschliesst. Durch die zweíte Analyse wird die Auffassung der geschlechtsspeziʂ57;schen Verwendung von G. Kokula entkräftet. LA und LH unterscheiden sich zwar in der Verwendung, diese ist jedoch entgegen bisheriger Annahmen nicht symmetrisch. KAPITEL III Der Vergleich zwischen literarischer und ikonographischer Überlieferung zeigt einerseits das bekannte Problem, dass beide Bildelemente LA und LH nicht zweifelsfrei dem Begriff loutrophóros zugewiesen werden können. Andererseits aber stimmen Bilder und Texte in bezug auf die rituelle Funktion der loutrophóros bei Hochzeit und Begräbnis in einem hohen Mass überein, so dass widersprüchliche Aussagen nicht mehr so stark ins Gewicht fallen wie bislang. Die von einigen Lexikographen - entgegen der íkonographisch dokumentierten LA - vorgeschlagene Kinderstatue als loutrophóros auf dem Grab ehelos Verstorbener beruht vermutlich auf der Auffassung, dass sich das Erscheinungsbild der loutrophóros als Person beziehungsweise Gestalt im Hochzeíts- und Begräbnisritual entspreche. Bei dieser erst in späterer Zeit auftretenden Meinung wird deutlich, dass der ursprünglich adjektivischen Verwendung von loutrophóros, gemäss welcher bei Hochzeit und Begräbnis völlig verschiedene Wasserträger möglich sind, nicht mehr Rechnung getragen wird. KAPITEL IV Die aus den literarischen Quellen und der ikonographischen Überlieferung gezogenen Schlussfolgerungen können auch gegenüber weiteren archäologischen Gesichtspunkten, wie Gefässentwieklung und Fundorte, aufrecht erhalten bleiben. Damit würde das hier vertretene Modell unserer Forderung Rechnung tragen, dass die mit einem Ritualobjekt (hier LH und LA) verbundenen Vorstellungen kohärent sein müssen, aber eine gewisse Bandbreite von rituellen Ausführungsmodalitäten zulassen.

Steady state plasma levels of the enantiomers of trimipramine and of its metabolites in CYP2D6-, CYP2C19- and CYP3A4/5-phenotyped patients.

Steady state plasma concentrations of the (L)- and (D)-enantiomers of trimipramine (TRI), desmethyltrimipramine (DTRI), 2-hydroxytrimipramine (TRIOH) and 2-hydroxydesmethyl-trimipramine (DTRIOH) were measured in 27 patients receiving between 300 and 400 mg/day racemic TRI. The patients were phenotyped with dextromethorphan and mephenytoin, and the 8-hour urinary ratios of dextromethorphan/dextrorphan, dextromethorphan/3-methoxymorphinan, and (S)-mephenytoin/(R)mephenytoin were used as markers of cytochrome P-450IID6 (CYP2D6), CYP3A4/5 and CYP2C19 activities, respectively. One patient was a CYP2D6 and one was a CYP2C19 poor metabolizer. A stereoselectivity in the metabolism of TRI has been found, with a preferential N-demethylation of (D)-TRI and a preferential hydroxylation of (L)-TRI. CYP2D6 appears to be involved in the 2-hydroxylation of (L)-TRI, (L)DTRI and (D)-DTRI, but not of (D)-TRI, as significant correlations were measured between the dextromethorphan/dextrorphan ratios and the (L)-TRI/(L)-TRIOH (r = 0.45, p = 0.019), the (L)-DTRI/(L)-DTRIOH (r = 0.47, p = 0.014), and the (D)-DTRI/(D)-DTRIOH (r = 0.51, p = 0.006), but not with the (D)-TRI/(D)-TRIOH ratios (r = 0.29, NS). CYP2C19, but not CYP2D6, appears to be involved in the demethylation pathway, with a stereoselectivity toward the (D)-enantiomer of TRI, as a significant positive correlation was calculated between the mephenytoin (S)/(R) ratios and the concentrations to dose-to-weight ratios of (D)-TRI (r = 0.69, p = 0.00006). CYP3A4/5 appears to be involved in the metabolism of (L)-TRI to a presently not determined metabolite. The CYP2D6 poor metabolizer had the highest (L)-DTRI and (D)-DTRI concentrations to dose-to-weight ratios, and the CYP2C19 poor metabolizer had the highest (L)-TRI and (D)-TRI concentrations to dose-to-weight ratios of the group.