ISSN:0014-3022    

DOI:10.1159/000117143

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Cortical remote effects of right deep-seated lesions were studied with two cerebral blood flow measurement methods (two-dimensional xenon-133 inhalation and 99mTc HMPAO SPECT) in a population of 13 right-handed stroke patients. A neuropsychological battery of tests suitable for assessment of possible visual neglect was performed. Neglect was present in 7 cases. A regional cortical hypoperfusion was observed in all patients. However, in neglect patients it was more extended and involved the right inferior parietal region suggesting a causal relationship between cortical dysfunction and neuropsychological deficit. This finding supports the model attributing neglect to a unilateral attention-arousal defect in a cortico-limbic-reticular loop.

ISSN:0014-3022    

DOI:10.1159/000117144

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Although it has now been established that surgery is the best way to treat patients with symptomatic tight carotid stenosis, the fact remains that perioperative risks are not negligible. Patients with significant contralateral stenosis and/or no collateral flow capacity through the anterior communicating artery are likely to be at higher risk during surgery. We examined a series of 52 patients pre- and postoperatively with transcranial Doppler (TCD) and compared the results to perioperative stump pressures. Our intention was to find out whether the results of the TCD examination of the circle of Willis could be correlated to the perioperative stump pressures, and whether TCD gives reliable information about the collateral flow. We found relatively high stump pressures in patients with potential function of any communicating artery, and in the group with no collateral function most patients had low stump pressures. We also found that preoperative flow velocity fall in the middle cerebral artery (MCA) on compression of the ipsilateral internal carotid artery correlated with perioperative stump-pressure indices. However, we were unable to predict stump pressures in individual patients by flow velocity measurements in the MCA preoperatively.

ISSN:0014-3022    

DOI:10.1159/000117145

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

246 migraine patients (International Headache Society definition, 1-6 severe attacks per month) were randomised into a multicentre, cross-over study comparing subcutaneous (s.c.) sumatriptan 6 mg administered by an auto-injector (Glaxo device) with usual acute migraine treatments. Patients were treated for 2 months or up to 12 attacks, and then crossed over to the alternative treatment for the same duration. Usual treatments were: analgesics (including combinations), 49%; ergotamine, 24%; NSAIDs 19%; DHE, 7%. Rescue medication was allowed 2 h after the first dose. Headache was assessed on a 4-point self-rating scale (0: none, 1: mild, 2: moderate, 3: severe). Other migraine symptoms were assessed as present or absent. Quality of life was assessed before the study and at the end of each treatment period. Two hundred and seventeen patients were eligible for the cross-over analysis. At 2 h post-dosing, an average of 78% of attacks per patient were successfully relieved (grade 3 or 2 to 1 or 0) by s.c. sumatriptan, compared with 34% for the usual treatments (p < 0.001) and 63% of attacks per patient were completely relieved (grade 0) by s.c. sumatriptan compared with 15% for the usual treatments (p < 0.001). Sumatriptan-treated patients used rescue medication for 19% of their attacks, compared to 59% for comparator drugs (p = 0.001). Results for patient preference were: s.c. sumatriptan, 85%; usual treatments, 10%; no preference, 5% (p < 0.001). Sumatriptan was significantly superior to comparator drugs for all other efficacy end-points (p < 0.001). Improvements in quality of life scores were 3 times higher in sumatriptan-treated patients than in those taking usual treatments (p < 0.0001); the tolerability of both treatments was good. In conclusion, s.c. sumatriptan was superior to the usual acute treatments for both the relief of all migraine symptoms and the improvement in quality of life. Copyright © 1995 S. Karger AG, Base

ISSN:0014-3022    

DOI:10.1159/000117146

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We carried out lymphocytapheresis (LCP) in combination with the administration of immunosuppressive drugs in patients with myasthenia gravis (MG), who were resistant to conventional immunosuppressive therapy, and examined its efficacy and effects on peripheral blood lymphocyte subsets. LCP was carried out once a week for 1 month (one course, 4 times) using a continuous-flow blood cell separator. Immunosuppressive medication (prednisolone or prednisolone and azathioprine) was continued during the course of treatment. After LCP, clinical improvement was noted in 5 of 6 patients. Anti-AChR antibody titers and the number of lymphocytes were significantly reduced in all patients. A significant decrease in CD4+CD45RA- (memory) T cell level and significant increase in CD4+CD45RA+ (naive) T cell level were also observed. In the patients having good response to LCP, follow-up evaluation showed long-term clinical improvements, as well as the memory T cell level staying at the decreased level. Our study suggests that LCP in combination with the administration of immunosuppressive drugs can suppress the disease activity of MG.

ISSN:0014-3022    

DOI:10.1159/000117147

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000117148

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We evaluated the hypothesis that if hypotension or hypoperfusion is a major cause of border zone brain infarction, infarcts following cardiac surgery will be likely to be located in the vascular border zone areas, whereas cerebral perfusion would be lower compared with non-border zone infarcts. Ten of 37 patients with brain infarction following cardiac surgery had an infarct in one of the vascular border zones on CT. Haemodynamical characteristics and clinical features did not differ between border zone infarcts and remaining infarct subgroups. We conclude that compared with stroke series brain infarcts following cardiac surgery are more frequently located in one of the vascular border zone areas, but peri-operative haemodynamic compromise alone does not sufficiently explain this difference. Other possible mechanisms, such as showers of (micro-)emboli, should also be considered.

ISSN:0014-3022    

DOI:10.1159/000117149

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

To understand endocrine function and to determine which endocrine systems are likely to be affected, 6 patients with mitochondrial encephalomyopathies were studied. Three patients had myoclonus epilepsy and ragged-red fibers, and the other 3 patients had mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes. Clinically, short stature (5/6), amenorrhea (2/3), impotency (3/3), and poor development of secondary sexual characteristics (4/6) were noted. The endocrinological studies including triiodothyronine, tetraiodothyronine, thyrotropin, adrenocorticotropin, Cortisol, parathyroid hormone and blood sugar were normal. However, there were low serum concentrations of estradiol (2), and progesterone (2) in 3 female patients. Two patients (1 man and 1 woman) had growth hormone deficiency and 1 had low testosterone level. Hypothalamopituitary dysfunction was confirmed after a series of stimulation tests. We conclude that patients with mitochondrial encephalomyopathies are common to have gonadal dysfunction. Although target organ may play a role, hypothalamopituitary lesion may be responsible for this abnormality.

ISSN:0014-3022    

DOI:10.1159/000117150

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Autonomic nerve function was evaluated in 30 alcoholics and 30 healthy subjects by means of cardiovascular function tests, pupil cycle time (PCT), and sympathetic skin responses (SSR). Nutritional status was assessed by anthropometric parameters. Autonomic cardiovascular dysfunction was classified as early involvement in 5 patients, definite in 8, severe in 6 and atypical in 3. PCT was abnormal in 17 alcoholics. The duration of PCT became progressively longer as the severity of cardiovascular involvement increased. SSR was absent in 4 alcoholics in the palm and in 16 in the sole. These findings indicate that sympathetic and parasympathetic mediated functions are abnormal in chronic alcoholics with a similar frequency, involving different sites of the autonomic nervous system under variable patterns. Significant correlations between nutritional status and autonomic neuropathy were found.

ISSN:0014-3022    

DOI:10.1159/000117151

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000117152

出版商:S. Karger AG    

年代:1995

数据来源: Karger