摘要:

Studies of the cephalic vascular system have markedly contributed towards an understanding of the mechanisms of migraine pain. Whereas cerebral blood flow changes, and thereby changes in the arterioles, correlate poorly with migraine headache, abnormal regulation of the large cranial arteries seems to play a significant role in relation to migraine pain. Thus, vasodilation of extra‐ and intracranial conductance arteries has been described both during spontaneous migraine attacks and during experimentally provoked vascular headaches. Whether dilation of these arteries is the key mechanism of migraine nociception or is merely associated with another more important nociceptive mechanism remains to be shown. Studies of vascular regulatory mechanisms have not only pointed towards a possible locus of migraine pain, but have also been helpful in demonstrating a new molecular mechanism of migraine—the key effect of the small messenger molecule nitric oxide. It is likely that nitric oxide is the most important molecule responsible for the induction of migraine atta

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00149.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In spite of some data being added to our knowledge of the effect of antiplatelets in secondary prevention of brain ischemic lesion in recent years, the main reasons to perform a second European Stroke Prevention Study (ESPS 2), which started in 1987–1988, were: (a) clarify the relative roles of aspirin (ASA) and dipyridamole (DP) alone or in combination; (b) confirm the efficacy of small doses of ASA and, so doing, decrease the number of drop‐outs due to ASA side effects; (c) join information to the effect of antiplatelets in complete stroke. General characteristics of the sample of 6602 patients are presented and compared with other major trials and series. The patients in the four treatment arms (aspirin, dipyridamole, aspirin + dipyridamole and placebo) are compared. The more relevant features and risk factors known to influence long term prognosis are described and discussed. The small proportion of patients included with TIA (23.7%) and the comparability among treatment groups are stressed. No relevant differences have been found, among groups, on the sex or age distribution, prevalence of hypertension, diabetes, previous vascular events or atrial fibrillation, nor in the characteristics of the accident leading to the inclusion in tr

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00150.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Carnitine may be involved in the pathogenesis of the chronic fatigue syndrome (CFS). However, no information about the cellular metabolism of carnitine in CFS patients is currently available. Therefore, we aimed to measure the levels of carnitine (total, free and short‐chain) in both peripheral blood lymphocytes (PBLs) and sera from patients with CFS. The serum levels of total, free and short‐chain were comparable in CFS patients, considered as the whole group, to those in healthy control subjects, even though a trend indicating slightly reduced serum concentrations of free carnitine was observed in male patients with CFS. In contrast, the concentrations of total, free and short‐chain carnitine in PBLs from patients with CFS were significantly lower than in cells from healthy controls. Our study indicates that patients with CFS require exogenous carnitine supplementation. The low carnitine concentrations in PBLs from patients with CFS probably reflect the carnitine deficiency occurring in other tissues, including the skeletal muscles. The low cellular concentrations of carnitines may help to explain both the immunological abnormalities and the impaired energy metabolism in skeletal mu

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00151.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Using a new ELISA method we have measured the IgM concentration in the serum and the cerebrospinal fluid CSF from 110 neurological patients. Among there, 41 had multiple sclerosis (MS), 48 other inflammatory diseases (OID), including 30 AIDS, and 21 non‐inflammatory neurological diseases (NID). A highly significant correlation was established between results with native IgM and the dithiothreitol reduced IgM. An intrathecal synthesis (ITS) of IgM was detected using the CSF IgM/CSF albumin ratio, the IgM index and a quantitative formula in 33 patients: nine MS, 23 OID (including 18 AIDS) and one NID. The frequency of IgM ITS was 22% in MS patients, 48% in the OID (60% in AIDS) and 5% in the NID groups. This ITS was not impaired by an increase in serum IgM concentration or by a blood–CSF barrier damage. These facts confirm that intrathecal immunity is not a “steady‐state” related to the general immunity but a specific response restricted to the central nervous system. Conversely, CSF IgM increase and IgM ITS were closely related (p<10−6). In addition, IgM ITS and IgG ITS were found to be highly correlated in OID, especially in AIDS patients: such correlation was not observed in the MS group. No significant correlations were observed between IgM ITS and any of the clinical parameters in MS patients. These results suggest the probable specificity of IgM ITS in

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00152.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Parkinsonism is the principal motor disorder of multiple system atrophy (MSA). In order to explore the pathophysiology of parkinsonism in MSA, we analysed 182 pathological reports from the literature and 35 from the United Kingdom Parkinson's Disease Society Brain Bank, and have also examined published post‐mortem andin vivoneurochemical data. This review indicates that the brains of MSA patients who had parkinsonism in life show degeneration principally in anatomically related regions of the nigrostriatal dopaminergic pathway and of the striatum as well as in the globus pallidus. This degeneration affects both “direct” and “indirect” striatal outflow pathways. The degree of dopaminergic response in any one subject at any one point in the evolution of the disease probably relates both to the severity and extent of striatal pathology and also to the balance between degeneration in “indirect” and “direct” striatal outflow pathways and in the pallidum, especially its external part Abnormal oligodendroglial cytoplasmic inclusions are also found in large numbers in most of the basal ganglia structures that show cell loss and gliosis. The precise consequences of their additional presence in motor cortex remain unknown, but disturbance of function in supplementary motor area could also contribute to the extrapyramida

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00153.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Parkinson's disease has been the object of several therapeutic strategies based upon replacement of the degenerating dopaminergic neurons. Adrenal medullary transplants were tried initially, because of the biochemical relationship between chromaffin cells of the medulla and dopaminergic neurons of the substantia nigra. Compared to transplant of fetal neurons, autologous grafts of adrenal medullary tissue has the advantage of using a readily available source of tissue without the problems of immunosuppression. However, these cells have not proven to be as effective as fetal neurons, probably because they do not fully differentiate into neurons. In animal models, brief treatment with nerve growth factor can facilitate such differentiation. This study is a clinical evaluation of the efficacy of adrenal medullary cell transplantation, combined with nerve growth factor infusion.Two patients were selected who were moderately to severely affected (Hoehn–Yahr stage 2 in on‐phase and stage 4 in off‐phase). After adrenalectomy, small pieces of medulla were prepared and implanted stereotactically into the dorsal putamen on one side of the brain. A catheter filled with mouse beta‐nerve growth factor (NGF) was placed close to the grafts. Infusion of NGF was continued for one month.Despite a progressively deteriorating course prior to surgery, both patients showed improvement on the rating scales postoperatively. There was also significant improvement in timed motor tests. Motor readiness evoked potentials showed increased voltage over the operated hemisphere.The study points to methods and feasibility of supplying nerve growth factor intraparenchymally to the human brain. Possible implications with respect to other growth factors, particularly Glial cell‐line Derived Neurotrophic factor (GDNF) are

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00154.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

To investigate the prevalence and symptomatology of depression in Parkinson's disease (PD), we have studied 506 unselected patients attending the neurology services in French general hospitals during a 5 month period defined for prospective inclusion. 246 patients (48.6%) were suspected of depression according to different methods of evaluation and 168 (33.2%) were defined as definite or probable depression. According to the Montgomery and Asberg scale, 46 cases (9%) had a severity score suggestive of major depression. As a function of the cut‐off score defined for severity, these patients represented from 23.2 to 43.7% of the depressive population with PD. There was no significant difference between depressed and non depressed PD patients as a function of the patient's current age or age at onset of PD. A significantly higher rate of depression was found among women with PD. A past history of depression was a risk factor for mood disorder after onset of PD. The severely depressed patients had a significantly longer duration of PD and a higher score of cognitive impairment than mildly or moderately depressed and non depressed patients with PD. Depressed patients had a significantly more advanced stage of disability than non‐depressed patients with

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00155.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In this paper we describe the case of a patient who underwent left breast radical mastectomy and corresponding removal of her axillary lymphonodes, for an infiltrating lobular cancer with massive colonizing (16 of 19 lymphonodes examined), stage T2N2M0. During chemotherapy with cyclophosphamide, methotrexate and 5 fluoruracil (CMF), the patient presented a symptomatology characterized by anarthria and dysphagia. These symptoms were the consequences of multiple cerebral hemorrhages unrelated to alterations in the coagulation process. The temporal relation with the pharmacological treatment and the lack of other explanations of the induced phenomenon lead us to hypothesize a cytotoxic mechanism due to the CMP treatment

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00156.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The recent progress in molecular biology research has changed the past concepts on Alzheimer's disease (AD) and other nervous system amyloidoses. This paper compiles the basic principles of molecular biology of AD and reviews their clinical impact The new data about the function and metabolism of amyloid precursor protein and the more recent information on the role of the apolipoprotein E have provided new insight into the pathogenesis of this disease. Although further investigations are still required to assemble these data into a theory that completely explains the development of the disease and changes the present symptomatic therapeutic strategies to an entire preventive or curative approach, the recent research results in this field are relevant for the diagnostic and therapeutic management of AD patients.

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00157.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00158.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY