摘要:

SummaryThere has been an increase in recent years in the number of reported cases of meningitis and brain abscesses caused by fungi. This increase is due to the availability of better diagnostic techniques for fungal infections and the ever-increasing population of immunocompromised hosts (1,2). The patients most susceptible to invasive fungal infections include those with hematologic malignancies; those receiving hyperalimentation, corticosteroids, or cytotoxic drugs; transplant recipients; injection drug abusers; and those with the acquired immunodeficiency syndrome (AIDS). Although many fungi infect only immunologically impaired patients, some will infect normal hosts as well. The successful treatment of central nervous system (CNS) fungal infections is highly dependent on the underlying immune status of the host, as well as on the prompt initiation of appropriate antifungal therapy. However, the diagnosis of these infections may be difficult, and proper therapy often delayed. Furthermore, information on treatment regimens ranges from extensive, as in the case of cryptococcal meningitis, to scanty or nonexistent in the case of rare, opportunistic fungi. For > 3 decades, the standard antifungal agent for the treatment of CNS fungal infections has been amphotericin B. However, the effectiveness of amphotericin B is often limited by poor CNS penetration, fungal resistance, and toxicity (3). Because of the problems associated with use of amphotericin B, newer azole antifungal agents have been developed, some of which are efficacious in the therapy of fungal meningitis. We give an overview of the antifungal agents currently available for clinical use and their utility in the treatment of fungal meningitis.

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe inflammation in the subarachnoid space (SAS) that develops in the course of bacterial meningitis may have a role in eradicating the infection, but also, ultimately, is the cause of the neurological sequelae associated with this infection. The presence of an inflammatory exudate in the SAS leads to alterations in the blood-brain barrier, altered cerebrospinal fluid dynamics, cerebral edema and increased intracranial pressure, and loss of cerebral autoregulation. Our increasing understanding of the pathophysiology of meningeal inflammation has led to therapeutic interventions to limit the degree of meningeal inflammation and neurologic sequelae. The inflammatory cascade that leads to alterations in central nervous system physiology will be reviewed as well as the experimental evidence and clinical trials demonstrating the efficacy of adjunctive therapy in reducing meningeal inflammation and decreasing the incidence and severity of neurological sequelae in bacterial meningitis.

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryRecent investigations have shown that neuronal excitation can lead to a variety of changes in intracellular signaling that ultimately result in altered gene expression. In particular, the excessive neuronal activation seen with seizures leads to the induction of certain “immediate-early” genes that are transcription factors. These transcription factors presumably facilitate the subsequent expression of various “intermediate-late” or effector genes. Given the growing numbers of genes that appear to be modulated by seizures, it appears that seizures initiate a tremendous cascade of changes in gene expression over both the short and the long term. In this article, I discuss two main classes of gene products that are modulated by seizure activity: heat shock proteins and calcium binding proteins. By using both in vivo and in vitro systems, we and others are exploring the conditions that lead to altered expression of genes and the potential significance of such changes in expression. Although the functional meaning of the altered gene expression remains unknown, it seems likely that some of these changes will ultimately be related to certain components of neuronal vulnerability and epileptogenesis.

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryRenewed interest in the regulation of core temperature as a means of treating central nervous system disease has been fueled by a wealth of literature describing the physiology of lowered core temperature. Hypothermia is now recognized for its anesthetic and cerebroprotective effects and is being applied in an increasing number of clinical paradigms.

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe folic acid (FOA) level was determined in serum and erythrocytes in 100 epileptic patients and 100 control patients using a luminescence assay. A lowered FOA concentration in serum, erythrocytes, or both was observed in 15% of the epileptic patients and in 2% of the control group. In the epileptic patients, the FOA in the serum and in the erythrocytes was significantly lower than that in the control group. Patients receiving carbamazepine monotherapy had a significantly lower FOA level in the erythrocytes than did patients receiving phenytoin monotherapy. The FOA level showed a negative correlation to the duration of epilepsy. None of the patients with lowered FOA had a normal mental status. The course of the supplementation treatment with 5 mg folinic acid (or FOA) of four patients with FOA deficiency could be monitored psychopathometrically. All four patients showed an improvement in their well-being and the majority of measured variables of the cognitive performance.

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryFifty cocaine-dependent patients completed a 2-week double-blind, double-dummy, parallel-group comparison of four dosage levels of diethylpropion and placebo. This clinical trial was designed to evaluate both diethylpropion's ability to attenuate cocaine cue-induced craving and its potential for development as a medication with cocaine-agonist properties. The results indicated that diethylpropion was not superior to placebo and confirmed earlier reports that craving for cocaine diminishes over the course of an inpatient hospitalization. Moreover, the results showed that the cocaine cue-induced craving paradigm employed is effective in stimulating craving for cocaine. Medications that are effective in attenuating this type of “conditioned” craving may have relevance to the breaking of the cycle of relapse and the long-term treatment of cocaine dependence. Diethylpropion may not be an appropriate candidate for future medication development because of its lack of obvious therapeutic efficacy and the emergence of a significant number of side effects. However, a cocaine-agonist medication strategy may be appropriate for a subgroup of cocaine-dependent patients with coexisting attention deficit-hyperactivity disorder.

ISSN:0362-5664    

出版商:OVID    

年代:1995

数据来源: OVID