ABSTRACT
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Subject(s)
Humans , Female , Adult , Pneumoperitoneum/drug therapy , Pneumoperitoneum , Capnography/instrumentation , Insufflation/methods , Capnography/methods , Capnography/trends , Lymphangioma/drug therapy , Muscle RelaxationABSTRACT
INTRODUCTION: The aim of this study is to show if the exploration of the autonomic nervous system is useful to improve the specificity of clinical criteria of Parkinson's Disease (PD) and Multiple System Atrophy (MSA). PATIENTS AND METHODS: 20 patients with PD and 13 patients with MSA were studied. After 12 hours in off medication, NE and GH were measured in supine position and NE after 5 minutes standing. Later, GH levels were recorded at 15, 30, 45 and 60 minutes after a dose of 0.005 mg/kg of apomorphine. Finally, analysis of the symptoms of autonomic dysfunction and levodopa test were carried out. RESULTS: Sympathetic response to postural changes was significantly higher in patients with PD (NE increase in relation to basal: PD: 170.90 +/- 110.08 pg/ml; MSA: 91.33 +/- 73.79 pg/ml; p = 0.029). No differences were found in the response of GH to apomorphine (GH peak at 45 minutes: PD: 2.37 +/- 2.7 ng/ml; MSA: 1.69 +/- 1.90 ng/ml; ns). The symptoms of autonomic dysfunction were more frequently in patients with MSA. The stridor was specific to MSA. Improvement in motor scores in the levodopa test was higher in patients with PD (PD: 39.7 %; MSA: 17.89; p = 0.019). DISCUSSION: Sympathetic response to postural changes, description of symptoms of autonomic dysfunction, and motor response to levodopa test are useful tools in order to improve specificity of the diagnostic criteria of PD and MSA. The GH test with apomorphine was not useful for a differential diagnosis.
Subject(s)
Autonomic Nervous System/physiology , Multiple System Atrophy/diagnosis , Parkinson Disease/diagnosis , Aged , Antiparkinson Agents/therapeutic use , Apomorphine/therapeutic use , Autonomic Nervous System Diseases/diagnosis , Autonomic Nervous System Diseases/pathology , Autonomic Nervous System Diseases/physiopathology , Diagnosis, Differential , Female , Humans , Levodopa/therapeutic use , Male , Middle Aged , Multiple System Atrophy/drug therapy , Multiple System Atrophy/physiopathology , Norepinephrine/metabolism , Parkinson Disease/drug therapy , Parkinson Disease/physiopathologyABSTRACT
Introduction. El objetivo de este estudio es valorar si mediante la exploración del sistema nervioso vegetativo se consigue mejorar la especificidad de los criterios diagnósticos de la enfermedad de parkinson (EP) y de la atrofia multisistémica (AMS). Pacientes y métodos. Se han estudiado 20pacientes con EP y 13 pacientes con AMS. En ausencia de medicación durante 12 horas se determinaron la noradrenalina (NA) y la hormona de crecimiento (GH) en decúbito y la NA tras 5 min en bipedestación. Después se determinó la GH a los 15, 30, 45 y 60 min de una dosis de 0,005 mg/kg de apomorfina. Se analizaron las manifestaciones clínicas de disfunción vegetativa. Finalmente se realizó una prueba aguada de levodopa. Resultados. La respuesta simpática al cambio postural (incremento de NA respecto a la basal) fue superior en los pacientes con EP (EP: 170,90+/-110,8 pg/ml; AMS: 91,33+/-73,79 pg/ml; p=0,029). No hubo diferencias en la respuesta de la GH a la apomorfina (GH 45 min: Ep: 2,37 +/-2,7 ng/ml;AMS: 1,69+/-1,90 ng/ml; ns). Los síntomas de difusión vegetativa fueron más frecuentes en los pacientes con AMS. El estridor fue específico de la AMS. El beneficio obtenido en la prueba de levodopa fue superior en los pacientes con EP (EP: 39,7%; AMS: 17,89; P=0,019). Discusión. La respuesta simpática a los cambios posturales, la descrpción de los síntomas de disfunción vegetativo y la respuesta motora en la prueba de levodopa son útiles para mejorar la especificidad de los criterios diagnósticos de la EP y de la AMS. El test de la GH con apomorfina no ha sido útil para el diagnóstico diferencial
Introduction. The aim of this study is to show if the exploration of the automatic nervous system is useful to improve the specificity of clinical criteria of Parkinson´s (PD) and Multiple System Atrophy (MSA). Patients and methods. 20 patients with PD and 13 patients with MSA were studied. After 12 hours in off medication, NE and GH were measured in supine position and NE after 5 minutes standing. Later, GH levels were recorder at 15, 30, 45 and 60 minutes after a dose of 0.005 mg/kg of apomorphine. Finally, analysis of the symptoms of autonomic dysfunction and levodopa test were carried out. Results. Sympathetic response to postural changes was significantly higher in patients with PD (NE increase in relation to basal: PD 170.90+/-110.08 pg/ml; MSA: 91.33+/-73.79 pg/ml; p=0.029). No differences were found in the response of GH to apomorphine (GH peak at 45 minutes: PD: 2.37+/-2.7 ng/ml; MSA: 1.69+/-1.90 ng/ml; ns). The symptoms of autonomic dysfunction were more frequently in patients with PD (PD: 39.7%; MSA: 17.89; p=0.019). Discussion. Sympathetic response to postural changes, description of symptoms of autonomic dysfunction, and motor response to levodopa test are useful tools in order to improve specificity of the diagnostic criteria of PD and MSA. The GH test with apomorphine was not useful for a differential diagnosis
Subject(s)
Humans , Parkinson Disease/physiopathology , Autonomic Nervous System Diseases/physiopathology , Multiple System Atrophy/physiopathology , Diagnosis, Differential , Norepinephrine/blood , Growth Hormone/blood , Levodopa , Apomorphine , Sensitivity and Specificity , Posture/physiologyABSTRACT
Twelve patients with Parkinson disease and psychosis were included in an open-label 12-week trial of ziprasidone. Two patients withdrew from the treatment because of adverse effects. The remaining 10 patients reported a significant improvement in psychiatric symptoms. Altogether, there was no deterioration of motor symptoms (UPDRS III score: basal 40.4 +/- 11.1, first month 41.1 +/- 10.8; final visit, 37.7 +/- 13.3). Two patients (20%) suffered a slight deterioration in motor symptoms and another patient suffered deterioration of gait. No analytic alterations or serious adverse effects that could limit the use of ziprasidone were observed. Although controlled trials are needed, the findings suggest that ziprasidone may be effective in parkinsonian patients with psychosis.
Subject(s)
Antipsychotic Agents/therapeutic use , Parkinson Disease/complications , Piperazines/therapeutic use , Psychotic Disorders/drug therapy , Thiazoles/therapeutic use , Aged , Aged, 80 and over , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Female , Humans , Hypotension, Orthostatic/physiopathology , Male , Middle Aged , Parkinson Disease/psychology , Piperazines/administration & dosage , Piperazines/adverse effects , Psychiatric Status Rating Scales , Psychotic Disorders/psychology , Thiazoles/administration & dosage , Thiazoles/adverse effectsABSTRACT
This study reports 3 cases of pure hemisensory syndrome due to lacunar infarction at the pons, demonstrated by magnetic resonance. In all patients somatosensory evoked potentials were abnormal. In two out of the 3 cases these potentials remained abnormal even after clinical exploration normalized. Due to the distribution of the sensitive pathways it may be assumed that the hemisensory syndrome would be caused by lesions located from the cortex to the pons. By means of clinico-pathological correlations the hemisensory syndrome was attributed to lesions exclusively located at the cerebral cortex or at the thalamus. However, in 1984 the first case of hemisensory syndrome due to pontine infarction was demonstrated by computerized tomography. After this report a series of approximately 10 patients have been published in the english and french literature. None of them had data on somatosensory potentials. In our experience the study of somatosensory evoked potentials has a high sensitivity. It appears that the distribution of the sensitive defect is independent of the location of the structural lesion.
Subject(s)
Cerebral Infarction/complications , Pons , Sensation , Aged , Cerebral Infarction/pathology , Dominance, Cerebral , Evoked Potentials, Somatosensory , Humans , Male , Middle Aged , Nervous System Diseases/etiology , Paresthesia/etiology , Pons/pathologyABSTRACT
An investigation was made of the effect of emergency endoscopic sclerotherapy on the evaluation of digestive hemorrhage (HDA) secondary to gastroduodenal ulcer disease in two consecutive groups of patients. The control group included 92 patients and the sclerotherapy group contained 63. Both groups had the same management and basic treatment of hemodynamic stabilization, anti-H2 agents and alkaline . The sclerotherapy group also received a local injection of 1/10,000 (5-12 ml) adrenaline and 1% polydocanol (5-12 ml) if direct signs of hemorrhage (active bleeding, red clot, visible vessel) were seen at the time of early endoscopy. Surgery was indicated in the presence of persistent, recurrent or massive digestive hemorrhage. Thirty-two percent of the control group and 34% of the sclerosis group presented direct signs of hemorrhage at the time of endoscopy. Both groups were homogeneous with respect to sex distribution, NSAID intake, hemoglobin, presence of shock and etiology (33.3% and 36.3%, respectively, had duodenal ulcer). The average age was significantly higher in the control group than in the sclerotherapy group. Neither the presence of any endoscopic sign nor etiology contributed to the evolution of digestive bleeding. It is concluded that emergency endoscopic sclerotherapy with injection of adrenaline and polydocanol has a clearly favorable effect on the evolution of bleeding secondary to gastrointestinal ulcer disease evidencing direct signs on endoscopy.
