Prediction of response to chlorpromazine treatment in schizophrenics

A dose of 50 mg of chlorpromazine (CPZ) was given to 6 untreated schizophrenic patients and 8 healthy volunteers at 7:00 a.m. before breakfast. Blood samples were taken 3, 6, 9 and 24 hrs after for the analyses of CPZ and its metabolites by gas chromatographic techniques. In the cases of schizophrenic patients, the CPZ treatment was continued. Serum drug levels were monitored and clinical response assessed. The drug levels in serum of another group of patients already under long term treatment were also determined. Although wide inter-patients variations in serum drug levels after a single dose administration were observed, the CPZ level in the patients decreased faster than in the normal subjects. Patients showing high levels of the metabolites such as demethylated CPZ and CPZ sulfoxide after a single dose of CPZ tended to achieve poorer clinical improvement in CPZ therapy, agreeing with the results that poor responders to long term CPZ treatment revealed relatively high levels of the metabolites of CPZ compared with CPZ level. The results indicate that the study of a single dose administration prior to initiating treatment with CPZ can be used to determine how an individual patient would respond to CPZ therapy and be a valuable tool in the rational pharmacotherapy of schizophrenic patients.

[Subarachnoid hemmorrhage and aneurysmal change of cerebral arteries due to metastases of chorioepithelioma (author's transl)]

An episode of subarachnoid hemorrhage was seen on a 22-year-old married woman, which followed vaginal spotting and convulsive seizure. The neurological examination revealed bilateral papilledema, retinal hemorrhage, neck stiffness, Kernig's sign abducens paresis on the right. The chest X-ray film showed a spherical mass lesion in the right lung. The pelvic examination disclosed no pathological findings, however, HCG (human chorionic gonadotropin) in the urine increased significantly. Intracranial metastasis of chorioepithelioma was the tentative diagnosis at the admission and the right caroid angiography was performed, which demonstrated a fusiform aneruysm of the right middle cerebral artery beside arterial shift indicating a metastatic mass lesion in the parietal lobe. At surgery the tumor was removed and the arterial change was resected. Histologically the tumor was verified and the aneurysm was produced by metastasis of the tumor to the intima and interruption of the internal elastic membrane. She was placed on the anticarcinogenic agent and later the mass lesion in the chest was operated and irradiated. The postoperative carotid angiography showed another berry-shaped aneurysm arising from the right calloso-marginal artery. After the serial treatment with Actinomycin D the aneurysm disappeared completely and the arterial branch distal to the aneurysm was thrombosed. The patient is still alive 3 years after the onset of illness. An emphasis was placed that the neurosurgeon should be aware of cerebrovascular changes due to metastasis of the chorioepithelioma while making diagnosis of subarachnoid hemorrhage of the female patients who belong to the reproductive age. Intracranial aneurysmal change due to metastatic infiltration to the arterial wall was reported.

Ring enlargement through acyloin condensation of cycloalkane-1,2-dicarboxylic esters

Cycloalkane-1,2-dicarboxylic esters of 11-, 12-, and 13-membered rings were prepared from cyclododecanone. Acyloin condensation of these esters in the presence of trimethylchlorosilane followed by acidic hydrolysis afforded 13-, 14-, and 15-membered cycloalkane-1,2-diones in 71–74% yields. The diketones were reduced by treatment with triethyl phosphite and alkali hydroxide into corresponding acyloins.