Biomedical subjects
A Agnoli
Publications and source records attributed to A Agnoli.
[On-off phenomena in Parkinson's disease. Continuous dopaminergic stimulation].
Explore the source record for details and available documents.
[Mother and children with primary headache. A psychometric and psychological study].
Explore the source record for details and available documents.
[Brain infarct caused by trauma-induced intracranial pressure elevation. Clinical and computerized x-ray tomography findings].
Of 327 patients admitted to hospital with signs of trauma-induced raised intracranial pressure 41 had infarcts demonstrated by computed tomography (CT). The most common site was the area supplied by the posterior cerebral artery, usually ipsilaterally. Experience so far indicates that the infarcts are most commonly caused by transient, dynamically produced occlusion of the artery, more rarely by venous congestion, resulting from the raised intracranial pressure. Comparison of the morbidity and mortality rate of patients with and without infarction after trauma with signs of raised intracranial pressure indicates that an infarct clearly worsens prognosis. Infarcts can be easily distinguished from contusional foci by CT, although both have decreased density, because the former spread within the supply area of a vessel and, similarly to embolic or arteriosclerotic infarcts, produce contrast enhancement after administration of contrast media as an expression of a disturbed blood-brain barrier.
A multidimensional approach to the assessment of clinical validity in a study on CCVD treatment: dihydroergocristine versus placebo.
An example of multidimensional assessment procedure applied to the study of treatment effects in a type of pathological aging is presented in this paper. Data discussed here come from a clinical trial performed to evaluate the effects of an ergot derivate, dihydroergocristine, in CCVD memory deficits. The multidimensional assessment procedure consisted of behavioral, clinical, and psychometric measures aimed to identify both the results related to drug activity (experimental validity), and the implications that these eventual drug-induced changes have on the everyday life patients' competence (clinical validity). 97 out-patients (both sexes were represented), with a mean age of 61.21 y (SD 7.29), who suffered from mild to moderate chronic cerebro-vascular disturbances were included in this double-blind study only when they met rigid inclusion criteria. The experimental period was 12 weeks. Results indicate a pattern of convergent, statistically significant, changes which evidence how treatment-associated memory changes are accompanied by an improvement of emotional and physical well being and by a modification of behavioral structure which is characterized by greater efficiency and greater responsiveness to stimuli.
A clinical and neurophysiological evaluation of clotiazepam, a new thienodiazepine derivative.
The effects of 3 different dosages of clotiazepam, a new short-acting thienodiazepine derivative, were evaluated by using psychometric ratings and EEG spectrum analysis. A random double-blind study versus placebo was performed on 8 patients affected by generalized anxiety disorder (DSM III). The effects of acute administration of clotiazepam 5 mg, 10 mg, 20 mg and placebo per os were evaluated by using HRSA and a time-signed semiquantitative scale for anxiety. The results of the trial confirm the effectiveness of clotiazepam in the treatment of anxiety symptoms, mainly in the reduction of peak anxiety levels, with dose-dependent characteristics. The modifications of the EEG parameters which resulted were dose-dependent and short-lasting with slight sedative findings.
Nuclear magnetic resonance imaging in the aging brain.
43 patients aged over 55 years with different clinical diagnoses but with the common aspect of impairment of the cognitive functions underwent a 0.5 Tesla magnetic resonance imaging (MRI) investigation in order to obtain further information about the pathological causes underlying the clinical syndromes. The occurrence of white matter signal alterations (periventricular lucency) and of multifocal ischemic areas represented the most frequent and atypical finding. Independently of the clinical focal symptomatology, these data might well represent a marker of a diffuse tissue sufferance due to a chronic mild cerebral hypoperfusion. The incidence of similar findings in 'normal' elderly subjects must be assessed before giving them a definite relevance in the evaluation of the pathological aging.
MRI study on Parkinson's disease in relation to the severity of the disease.
Explore the source record for details and available documents.
Multicenter trial of L-Deprenyl in Parkinson disease.
A multicenter trial was conducted at 9 Neurology Departments to evaluate the action of L-Deprenyl, a specific monoamine oxidase-B inhibitor, combined with L-Dopa in the treatment of Parkinson disease. In all, 76 patients were treated, 33 women and 43 men, on stable treatment with L-Dopa+ aromatic decarboxylase inhibitors (DI) for at least 6 months. After a 50% reduction of the L-Dopa dose, all received L-Deprenyl 5 mg twice daily for 35 day. The combined treatment resulted in a definite improvement in rigidity, bradykinesia and, most of all, tremor. Further, at the end of treatment fewer patients had depressive symptoms and the total daily number of hours of wellbeing and normal movement increased. 12 patients presented modest side effects, in no case serious enough to warrant suspension of treatment. The trial shows that with the L-Deprenyl + L-Dopa combination the dose of L-Dopa needed to control the disease can be drastically reduced.
Flunarizine-pizotifen single-dose double-blind cross-over trial in migraine prophylaxis.
The results of a double-blind cross-over clinical trial involving 27 patients with classical or common migraine are described to compare the prophylactic effect of the calcium entry blocker flunarizine with that of pizotifen. Duration of the treatment was two months, with an evening single-dose administration of both drugs. For most parameters, there was no definite difference between flunarizine and pizotifen in migraine prophylaxis. It has been demonstrated previously that pizotifen is an effective drug in migraine prophylaxis, and these results suggest that flunarizine is effective, too. Weight gain as a side effect was less frequent and less severe with flunarizine than with pizotifen; other side effects showed the same incidence with both drugs.
[History and pharmacology of trazodone].
Trazodone, a non-tricyclic molecule, represents the first of a new generation of antidepressants. It is currently marketed in a number of European countries, in the United States and in Latin America. The pharmacological and biochemical data, the mechanism of action and the preferential indications of trazodone are presented and compared to those of imipramine and other tricyclics. Unlike imipramine, trazodone inhibits the adrenergic system. The two molecules have anti-nociceptive properties, similar effects on the serotoninergic system and, after repeated administrations, they both reduce the density of beta-receptors. The clinical implications of the alpha-blocking activity of trazodone are reported. Trazodone is preferable to tricyclic anti-depressants in the treatment of depression in elderly subjects in general, and especially when they present closed angle glaucoma, prostatic hypertrophy, tremor or cardiovascular problems due to hyperactivity of the adrenergic system, as well as in organic depressions and in depression secondary to schizophrenia, alcoholism and in patients with Parkinson's disease.
The role of MAO-b inhibitors in the treatment of Parkinson's disease.
The classical treatment of Parkinson's disease (PD) using L-dopa plus a peripheral decarboxylase inhibitor (DI) often leads after 3-5 years to the onset of the so-called long-term L-dopa syndrome (LTS). LTS could depend on the chronic overload of L-dopa + ID and could be due to a consequent "receptor disease" and derangement of the neuronal functionality mainly in regard to the enzymatic chains, storage mechanisms and hyperactivity of the monoamine oxidase type B (MAO B). Deprenyl is a selective MAO-B inhibitor thought to be able to slow down the catabolism of dopamine and therefore to allow a decrease of the therapeutic regimen of L-dopa while in the meantime to obtain a more stable plasma and tissue levels and a constant therapeutic response. 76 parkinsonian patients were studied. Their L-dopa regimen was halved and 10 days after (-)deprenyl was added. After the decrease of L-dopa therapy a worsening of symptomatology was observed as expected. The association with (-)deprenyl was able to reverse this trend and when the inhibition of MAOB was really effective patients showed an improvement of symptoms even when compared to baseline values. No relevant side effects were observed and no patients dropped out.
Problems in daily motor performances in Parkinson's disease: the continuous dopaminergic stimulation.
Fluctuations in motor performances are the major problem in the longterm management of Parkinson's disease. In this study the clinical effects of L-dopa intravenous infusion were evaluated in 18 parkinsonian patients with fluctuations. 14 out of these were given Lisuride intravenous infusion in a following study. Lisuride is a potent dopamine agonist and it is highly soluble in water. The results obtained with L-dopa were very good and we found a close correlation between oral and intravenous dosage. The dosage of L-dopa infusion ranged between 360-1,250 mg for 12 hours. Lisuride proved to be able to give prolonged mobile state in 8 patients out of 14. The other 6 patients showed a different response to the drug. The dosage used ranged between 0.6 and 2.4 mg per day. No severe side-effects were observed during both studies except for nausea and vomiting occurring during Lisuride infusion.
Migraine and the noradrenergic control of vasomotricity: a study with alpha-2 stimulant and alpha-2 blocker drugs.
Explore the source record for details and available documents.
Headache and noradrenergic involvement: the effects of alpha 2-stimulants and alpha 2-antagonists.
The efficacies of an 2-agonist clonidine and an 2-antagonist mianserin were compared in two treatment groups, common migraine and tension headache sufferers. Forty patients entered this double-blind placebo-controlled study. Placebo, clonidine 0.150 mg, and mianserin 30 mg were each administered for 90 day periods. Headaches were induced by intravenous doses of histamine dihydrochloride. The histamine threshold in the common migraine group was significantly lower than in the tension headache group. In the common migraine group, mianserin decreased headache frequency. In the tension headache group, at 90 days mianserin significantly decreased headache intensity and headache frequency. Clonidine significantly decreased headache intensity at 90 days in the common migraine group. At 90 days, mianserin had significantly reduced the Hamilton Depression Rating Scale (HDRS) mean total score, (in the tension headache group), HDRS mean anxiety cluster scores (in both groups), and the HDRS mean depression cluster score (in the tension headache group). At 90 days, clonidine had significantly reduced the HDRS mean total score (in the tension headache group) and HDRS mean anxiety cluster scores (in both groups).
Vascular headaches and cerebral circulation: an overview.
A complex network of neurotransmission systems underlies the control of the cerebral circulation. Classical neurotransmitters, vasoactive peptides and receptors have been found in cerebral arteries. Central and peripheral structures are also probably involved in the neurogenic control of the cerebral circulation. Vascular and neurotransmission changes reported in vascular headaches suggest that an alteration of the neurogenic control of the brain circulation may be implicated in vascular headaches. In particular, locus coeruleus, which may control the intracerebral adrenergic pathway, can induce vascular changes similar to those of migraine. Moreover, the trigeminal ganglion, which may induce the release of substance P, can change the extracranial and intracranial vasodilator activity. The vascular theory of migraine, proposed by Wolff, is re-evaluated on the grounds of a possible mediation of the vascular responses by neurotransmitters. It is hypothesized that a deficient modulation by enkephalins may cause alterations of locus coeruleus and/or trigeminal ganglion. The problem of pain in vascular headaches is also considered: whether it is of vascular origin or whether it is due to a dysfunction of the central nociceptive pathway. Knowledge of the neurogenic control of the cerebral circulation may be useful in understanding some pathogenetic mechanisms of vascular headaches.
NMR imaging in transient cerebral ischemia.
NMR has proved useful in the detection of Acute Cerebrovascular Disorders (ACVD), providing information related either to the tissue signal intensity and relaxation times, or to the morphological aspects of cerebral structures. Eighteen patients suffering from ischemic Acute Cerebrovascular Disorders were studied. A comparison between NMR imaging and CT scan was performed. Ischemic lesions, presence of edema, presence of reactive gliosis and anatomical vascular anomalies were found.
Flunarizine in common migraine: Italian cooperative trial. I. Short-term results and responders' definition.
In order to assess the effects of flunarizine in long-term prophylaxis of common migraine, 120 subjects (90 female and 30 male) were treated with 10 mg at bedtime and followed-up for two years. The effectiveness of the drug was assessed by investigating the variations of the Headache Index (HI) and of the intake of analgesics. The patients considered responders were those with an at least 60% reduction of the HI compared with the baseline value. To assess side effects, on each follow-up examination the patients were weighed and submitted to the Hamilton Rating Scale for Depression, Toulouse-Pieron test for attention, and arousal test. By the third month of therapy, the average monthly HI had decreased from a baseline value of 16.5 +/- 7.0 to 7.5 +/- 4.2. Also by the third month, 60 subjects had proved responders and 50 non-responders; 10 had dropped out of the study because of side effects or for other reasons. The only statistically significant differences between responders and non-responders were in the baseline HI, which was higher among responders, and in the baseline intake of analgesics, which was higher in non-responders.