RESUMO
We examined 46 male patients with idiopathic Parkinson's disease to see whether tremor at onset was as useful a predictor of benign clinical outcome as tremor predominance after several years. When we compared patients with tremor at onset (n = 27) with those whose disease began with brady-kinesia/rigidity (n = 9), or gait disorder (n = 10), we found no significant differences after a mean of 7 years in motor, cognitive, or affective status. Sixteen of the tremor-onset patients continued to have tremor predominance with minimal gait disorder after about 7 years. These tremor-predominant patients had significantly better motor outcome and somewhat better cognitive outcome than either tremor-onset patients who subsequently developed gait disorder (n = 11) or patients without tremor at onset (n = 19). Tremor predominance after several years appears to be a better predictor of a benign clinical course of Parkinson's disease than tremor at onset.
Assuntos
Cognição , Movimento , Doença de Parkinson/fisiopatologia , Tremor/fisiopatologia , Depressão/etiologia , Depressão/fisiopatologia , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Rigidez Muscular/complicações , Rigidez Muscular/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/psicologia , Tremor/complicações , Tremor/psicologiaRESUMO
Status epilepticus has been associated with disseminated intravascular coagulation (DIC), but little is known regarding the pathogenesis of this uncommon association. We describe a 41-year-old woman with status epilepticus resulting in death in whom laboratory data demonstrated profound activation of the coagulation and fibrinolytic systems; autopsy findings were consistent with DIC. The occurrence of DIC in status epilepticus may be related to widespread endothelial damage secondary to seizure-induced hyperpyrexia. Body temperature should be closely monitored in patients with prolonged seizures.
Assuntos
Coagulação Intravascular Disseminada/complicações , Estado Epiléptico/complicações , Adulto , Evolução Fatal , Feminino , HumanosRESUMO
Five cases of presumed nicotine withdrawal delirium among brain-injured patients treated in a neurologic intensive care unit are presented. Each patient had a history of heavy tobacco use and experienced dramatic and sustained clinical improvement within hours of transdermal nicotine replacement. These preliminary observations suggest that nicotine withdrawal may be an under-recognized cause of delirium in patients with acute brain injury.
Assuntos
Delírio/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Nicotina/efeitos adversos , Síndrome de Abstinência a Substâncias/complicações , Administração Cutânea , Adulto , Idoso , Delírio/fisiopatologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Nicotina/administração & dosagem , Síndrome de Abstinência a Substâncias/fisiopatologiaRESUMO
OBJECTIVE: To evaluate the efficacy of an air-circulating cooling blanket for reducing body temperature in febrile neuro-ICU patients treated with acetaminophen. METHODS: Two-hundred twenty consecutively admitted neuro-ICU patients whose tympanic membrane temperature reached or exceeded 101 degrees F (38.3 degrees C) were randomly assigned to receive acetaminophen (650 mg every 4 hours) alone (n = 107) or acetaminophen plus air blanket therapy (n = 113). After 24 hours of treatment, the authors compared the proportion of subjects who attained treatment success (T < or = 99 degrees F) or treatment failure (T > or = 101 degrees F for 2 consecutive hours) using the chi(2) test and the time to reach these endpoints using Kaplan-Meier survival analysis. MAIN RESULTS: Air blanket therapy resulted in a small increase in the proportion of subjects with treatment success (44% versus 36%, chi(2) p = 0.19, log rank p = 0.10) and a similar small reduction in the proportion of patients with treatment failure (42% versus 53%, chi(2) p = 0.11, log-rank p = 0.21), compared with treatment with acetaminophen alone. Approximately one third of patients in both groups remained febrile after randomization and "failed" after the first 2 hours of treatment. Twelve percent of patients assigned to air blanket therapy refused or were unable to tolerate treatment, compared with 2% of patients treated with acetaminophen alone (p = 0.005). CONCLUSIONS: Treatment with an air-circulating cooling blanket did not effectively reduce body temperature in febrile neuro-ICU patients treated with acetaminophen. More effective interventions are needed to maintain normothermia in patients at risk for fever-related brain damage.
Assuntos
Roupas de Cama, Mesa e Banho , Regulação da Temperatura Corporal , Crioterapia , Febre/fisiopatologia , Febre/terapia , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/terapia , Adulto , Idoso , Temperatura Corporal/fisiologia , Feminino , Febre/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicaçõesAssuntos
Cruzamento , Animais , Antibacterianos/farmacologia , Feminino , Alemanha Ocidental , Cavalos , Klebsiella/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Pênis/microbiologia , Salmonella/isolamento & purificação , Sêmen/microbiologia , Staphylococcus/isolamento & purificação , Streptococcus/isolamento & purificação , Doenças do Colo do Útero/microbiologiaAssuntos
Doença das Mucosas por Vírus da Diarreia Viral Bovina/diagnóstico , Doenças dos Bovinos/diagnóstico , Cervos , Vírus da Diarreia Viral Bovina/isolamento & purificação , Pestivirus/isolamento & purificação , Complicações Infecciosas na Gravidez/veterinária , Animais , Doença das Mucosas por Vírus da Diarreia Viral Bovina/patologia , Bovinos , Feminino , Alemanha Ocidental , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/patologiaRESUMO
By means of a descriptive study the progress of silvatic rabies in Rheinland-Pfalz is reported, starting from its first occurrence in 1955. During the period of 30 years a total of 35,090 animals of 48 different species has been examined on rabies, yielding 26,6% infected animals. The annual fractions of positive results fluctuated around this mean value with small deviations. The percentage for wild animals (35.9%) exceeded that of domestic animals (14.8%) significantly. The number of the annual rabid foxes showed no dependence on the hunting indicator of population density (HIPD) but correlated well with the dimension of the rabies-infected area.
Assuntos
Raiva/veterinária , Animais , Animais Domésticos , Animais Selvagens , Animais de Zoológico , Doenças do Gato/epidemiologia , Gatos , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças do Cão/epidemiologia , Cães , Raposas , Alemanha Ocidental , Estudos Longitudinais , Raiva/epidemiologia , Ovinos , Doenças dos Ovinos/epidemiologiaRESUMO
300 cats, sent in for rabies diagnosis, which were obviously not infected, have been further examined with regard to their causes of disease and death. Traumata, uremia and panleucopenia have been observed most frequently. As expected, affections of the central nervous system often have been stated. The results of our investigations have been compared with autopsy statistics on rabies-unsuspected cats, published in literature. Furthermore the preliminary reports have been examined and compared with the anamnesis of 214 rabies-positive cats. The information of preliminary reports on rabies-negative cats and their pathological diagnosis has been discussed in the context of differential diagnosis.
Assuntos
Doenças do Gato/diagnóstico , Raiva/veterinária , Animais , Doenças do Gato/epidemiologia , Gatos , Doenças do Sistema Nervoso Central/epidemiologia , Doenças do Sistema Nervoso Central/veterinária , Diagnóstico Diferencial , Panleucopenia Felina/epidemiologia , Alemanha Ocidental , Raiva/diagnóstico , Raiva/epidemiologia , Uremia/epidemiologia , Uremia/veterinária , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/veterináriaRESUMO
The determination of chloramphenicol residues in animal tissues and eggs by high performance liquid chromatography followed by radioimmunological detection (HPLC-RIA) is described. The method is suited for the verification of positive results greater than or equal to 1 microgram/kg obtained from prescreening with a radioimmunoassay.
Assuntos
Cloranfenicol/análise , Ovos/análise , Animais , Galinhas , Cromatografia Líquida de Alta Pressão , RadioimunoensaioRESUMO
A 42-year-old man was diagnosed with large cell non-Hodgkin's lymphoma 3 years after autologous bone marrow transplantation for Hodgkin's disease. The day before beginning systemic chemotherapy, the patient began to have symptoms of a sensorimotor neuropathy characterized by proximal and distal weakness, lower-extremity areflexia, elevated cerebrospinal fluid protein level, and evidence of demyelination on nerve conduction studies. Symptoms progressed despite two courses of intrathecal methotrexate, for possible lymphomatous meningitis, as well as systemic chemotherapy. The diagnosis of chronic inflammatory demyelinating polyneuropathy was made. Daily plasma exchange was performed for a total of 10 treatments with immediate improvement and eventual complete recovery in strength, sensation, and gait. A review of the literature confirms that inflammatory demyelinating polyneuropathy is a highly unusual but important cause of peripheral nervous system dysfunction. The potential for complete response to plasma exchange should be recognized in patients with symptoms, signs, and nerve conduction studies suggestive of chronic inflammatory demyelinating polyneuropathy.
Assuntos
Transplante de Medula Óssea , Doença de Hodgkin/terapia , Linfoma não Hodgkin/complicações , Segunda Neoplasia Primária/complicações , Polirradiculoneuropatia/etiologia , Adulto , Transplante de Medula Óssea/efeitos adversos , Humanos , Masculino , Transplante AutólogoRESUMO
The determination of nicarbazin residues in foodstuffs of animal origin by two different methods, polarography, HPLC with electrochemical detection, is described. By applying pulse polarography at the dropping mercury electrode to acetonitrile extracts of animal tissues and eggs, a detection limit of 50 micrograms/kg and mean recoveries of 79% were obtained. The same extracts were used for the HPLC determination with electrochemical detection. This led to a detection limit of 1 microgram/kg. Additional rapid confirmation can be obtained from HPLC using an internal standard (nifursol) and comparing peak area proportions of both substances at varied polarization voltages. The quantitative determination of nicarbazin in chicken eggs by both polarography and HPLC was found to be in good agreement.
Assuntos
Carbanilidas/análise , Ovos/análise , Nicarbazina/análise , Animais , Cromatografia Líquida de Alta Pressão , Resíduos de Drogas/análise , Eletroquímica , PolarografiaRESUMO
The authors evaluated the 60-Second Test (SST), a brief test of mental concentration, as a supplement to the Glasgow Coma Scale (GCS) for monitoring verbally responsive patients in the neuro-intensive care unit. The SST demonstrated excellent reliability and was abnormal in 79% of patients assigned a top GCS score of 15. However, both tests had poor responsiveness to clinically identified changes in level of consciousness (LOC). The SST is sensitive to subtle alterations in LOC but, like the GCS, may have limitations as a monitoring tool in the neurocritical care setting.