摘要:

Chemotherapy has become an important modality in the management of children with brain tumors. Factors that impede improved effectiveness of anti-neoplastic drugs are being identified and addressed. Specific agents have emerged that show anti-brain tumor activity alone or in combination therapy. Use of these agents requires facility regarding their dosing, routes of delivery, mechanisms of action, metabolism and toxicities. Multi-institution cooperative group trials provide the optimum means by which to evaluate the effectiveness of chemotherapy in children with brain tumors.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Opsoclonus-myoclonus is a pervasive neurological syndrome of children and adults. Although rare, it raises important clinical and neurobiological issues. This article provides an overview of the clinical and laboratory features, differential diagnosis, treatment, and outcome of opsoclonus-myoclonus. It pursues immunologie, genetic, electrophysiologic, neurochemical, and other clues to a pharmacologic model. Key questions include how and where the brain is injured, reversibility of the injury, possible targets for pharmacologie intervention, and which new studies are needed.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In one well-equilibrated parkinsonian patient treated with combined L-dopa and carbidopa (Sinemet), we have observed changes in treatment efficacy while receiving spiramycin (Rovamycine) for an intercurrent respiratory infection. A preliminary study of the pharmacokinetics of L-dopa and its main metabolites 3-O-methyldopa (3-OMD) and dihydroxyphenylacetic acid (dopac) in two parkinsonian patients treated with Sinemet has revealed a marked decrease in the AUC0–360of these two metabolites after a 3-day course of Rovamycine. In order to confirm this interaction, we have studied the modifications of the pharmacokinetics of L-dopa, 3-OMD, dopac, and carbidopa in eight male healthy volunteers after a single dose of Sinemet 250 (L-dopa, 250 mg and carbidopa, 25 mg) before and after a 3-day course of Rovamycine. Our study confirms this interaction. After spiramycin, we observed a marked reduction in AUC0–360for L-dopa (p< 0.001), 3-OMD (p< 0.001), and carbidopa (p< 0.001), and an increase in AUC0–360for dopac (p< 0.01). The L-dopa elimination half-life was increased (p< 0.012); differences in peak plasma concentrations did not attain statistical significance. We think that these modifications in L-dopa pharmacokinetics after spiramycin are due to nonabsorption of carbidopa secondary to modified gastrointestinal motility.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A 46-year-old female motorcyclist, who suffered injuries to the brain stem in a traffic accident, showed hypotensive and bradycardiac responses to thyrotropin-releasing hormone (TRH) given to counter consciousness disturbance. The cardiodepressive responses to TRH were reduced with i.v. pretreatment with atropine sulfate, suggesting an involvement of the vagal nervous system in the development of the responses. Furthermore, this patient had complicated impairments in the sympathetic nervous system, which were revealed by the results of testing baroreceptor reflex sensitivity to pharmacological alterations in blood pressure. We thus speculate that the hypotensive and bradycardiac effects of TRH observed in this patient may result from derangements of the sympathetic nervous system caused by the injuries. This case report is believed to be a novel description of the cardiodepressive effects of TRH.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report a case of a 62-year-old black woman who, 8 months prior to death, developed confusion, apraxias, disorientation, and difficulties with her vision. There was no dementia. Computed tomography (CT) scan and magnetic resonance imaging (MRI) suggested a tumor in the right posterior parietal white matter. A biopsy of the lesion displayed granulomatous angiitis and severe cerebrovascular amyloidosis, but no tumor was identified. Chronic inflammation with an occasional multinucleated giant cell was seen about the amyloid-infiltrated vessels. The cortex demonstrated gliosis but no plaques or tangles. Subsequently, the patient was treated with steroids and Cytoxan, with an improvement in her neurologic status. She died of opportunistic bronchopneumonia 8 months after the initial onset of her symptoms. On postmortem examination, the biopsied area of the brain showed atrophy with gliosis. Amyloid angiopathy was present but in much lesser degree than in the biopsy. Scant perivascular inflammatory infiltrates were seen only focally, and no giant cells were observed. The amyloid, both in the biopsy and autopsy material, was of the Alzheimer A4 type. This case suggests that steroid and cytoxan treatment ameliorated the angiitis and the amyloid angiopathy as well. The pertinent literature is discussed.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID