Biomedical subjects
Publications and source records attributed to A Lieberman.
We treated a case of congenital membranous stenosis of the esophagus successfully by transendoscopic incision. We discuss various types of true congenital esophageal stenosis and their treatment, to distinguish these rare anomalies from the more frequently encountered acquired variety.
This study provided a comprehensive program to treat visual perceptual disturbances associated with right brain damage (RBD). Three types of previously evaluated perceptual remediation were integrated into a sequentially administered remediation program: basic visual scanning, somatosensory awareness and size estimation training, and complex visual perceptual organization. The purpose of the study was to evaluate the immediate (at rehabilitation discharge) and long-term (four months after discharge) effects of this treatment program on patients with RBD. The effects of treatment on ADL and mood state were also examined. Seventy-seven RBD stroke rehabilitation inpatients were studied--including 48 Experimental (E) and 29 Control (C). At rehabilitation discharge, the E group relative to the C group showed greater gains in all three types of perceptual functioning. Four months after discharge from rehabilitation, the C group continued to show gains in perceptual functioning while the E group had reached a plateau. Longitudinal decreases in levels of self-reported anxiety and hostility, but not depression, were noted only for the E group.
A 22-month-old girl with the syndrome of hypoventilation, pulmonary hypertension, cor pulmonale and pulmonary edema due to adenoidal hypertrophy is described. Adenoidectomy resulted in relief of all symptoms and signs within 24 h. Hemodynamic study using pulmonary artery catheter showed that the pulmonary artery pressure returned to normal 48 h after relief of the obstruction. The normal left ventricular end-diastolic pressure, measured throughout the period of obstruction, in the presence of severe pulmonary edema, could suggest a non-cardiogenic "low pressure" pulmonary edema. However, the highly negative pleural pressure which existed during upper airway obstruction indicated an elevation of transmural left ventricular end diastolic pressure (compared to pulmonary wedge pressure) and thus, suggested that the pulmonary edema in this syndrome is secondary to both - right and left heart failure.
Thrombosed arteriovenous malformations (AVMs) in children are rare lesions that may present with headaches or a seizure disorder. Thirteen patients (4 months to 21 years of age) with this lesion were examined with computed tomography (CT). In 11 patients surgical confirmation was obtained, and the other two patients were examined with follow-up CT scans. Angiography either showed an avascular mass (7/13) or was negative (6/13). CT showed a lobulated lesion (8/13), peripheral location (11/13), and minimal surrounding edema (8/13). All of the lesions were hyperdense prior to the administration of contrast material and all enhanced either slightly or not at all following contrast material administration. It is concluded that these characteristic CT features aid in making the diagnosis of thrombosed AVM. The major differential diagnosis is small intracerebral neoplasm.
A case of brain stem infarction after chiropractic manipulation of the cervical spine is presented. Proposed mechanisms and sites of possible arterial injury are discussed. A diagnosis of vertebral artery occlusion was made using conventional brachial angiography. Digital intravenous angiography, a relatively new and less invasive vascular imaging technique which was used as an adjunct for evaluating the remainder of the cervicocephalic vessels, documented the vertebral occlusion. Chiropractic manipulation, which is increasing in popularity, may be a cause of potentially devastating neurologic disease.
A case of brain stem infarction after chiropractic manipulation of the cervical spine is presented. Proposed mechanisms and sites of possible arterial injury are discussed. A diagnosis of vertebral artery occlusion was made using conventional brachial angiography. Digital intravenous angiography, a relatively new and less invasive vascular imaging technique which was used as an adjunct for evaluating the remainder of the cervicocephalic vessels, documented the vertebral occlusion. Chiropractic manipulation, which is increasing in popularity, may be a cause of potentially devastating neurologic disease.
Sleep apnea syndrome (SAS) often presents a difficult therapeutic problem to the clinician since many of the accepted modes of therapy are associated with only partial success or with a number of long-term complications. We present three patients with obstructive SAS in whom dramatic clinical improvement occurred following repair of a deviated nasal septum. The subjective improvement was associated with a diminution in the number and duration of obstructive apnea episodes as observed during a standard sleep study. Because of its simplicity and low rate of complication, we propose that repair of a deviated nasal septum be further evaluated as a mode of therapy for this condition.
The antiparkinsonian activity of several dopamine agonists was investigated in an animal model and clinically in parkinsonian patients. The semisynthetic ergoline, pergolide, the partial ergoline, LY 141865 and the 8-alpha-aminoergoline, CU 32-085 were found to be effective antitremor agents in monkeys with ventromedial tegmental lesions. The administration of pergolide or LY 141865 results in a relief of tremor with a concomitant occurrence of severe abnormal involuntary movements, while the administration of CU 32-085 results in a relief of tremor with the occurrence of only minor abnormal involuntary movements. Clinical studies have revealed that pergolide is an effective drug in patients with advanced Parkinson's disease, and it reduces the "on-off" phenomena. The possible regulation of dopamine neurotransmission by the norepinephrine neuronal systems was reviewed. Preliminary data suggest that clonidine may interact with presynaptic dopamine receptors.
Visual evoked potentials (VEPs) and contrast sensitivity measurements were determined in normally sighted patients with Parkinson's disease (PD). Prolonged latencies of the first major positive (P100) wave of the VEP elicited by an alternating vertical grating were noted. The delay in latency was positively correlated with the severity of the movement disability. Subjective testing of contrast thresholds demonstrated significant elevation of thresholds in PD. Electroretinographic oscillatory potentials were elicited to determine if the delay in P100 latency was of retinal origin. No specific lesion could be identified to account for the abnormality in VEP or in contrast testing results.
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The dopamine levels were found to be low in the putamen and relatively high in the nucleus accumbens in two Parkinson disease patients treated with levodopa up to the time of their deaths. Tyrosine hydroxylase immunocytochemistry revealed a severe degeneration of the nigro-striatal dopamine neuronal system in both postmortem brains. The relatively high dopamine levels in the nucleus accumbens may be responsible for the occurrence of dyskinesias.
Irreversible and progressive renal parenchymal damage and functional impairment occurred in the majority of patients receiving at least six courses (200 mg/m2 of BCNU and/or methyl CCNU at eight-week intervals) of nitrosoureas for therapy of malignant brain tumors. Seventeen of 18 patients who received at least six courses and all nine patients who received more than ten courses developed impaired renal function as judged by elevation of blood urea nitrogen and/or serum creatinine or decrease in filtration rate as determined by inulin clearance. Four patients have developed uremia. Renal tissue obtained from seven patients demonstrated tubular atrophy, interstitial fibrosis and glomerular sclerosis. This remarkably high incidence of renal damage occurred without a phase of acute renal failure and in the absence of significant urinary abnormalities, while producing an insidiously progressive interstitial renal lesion.
The relationship between focal neurologic symptoms, carotid artery stenosis, and cervical bruits was studied in 495 patients. Among the 990 carotid arteries, 562 (57%) were considered to be symptomatic and 505 (51%) were associated with bruit. There was a linear relationship between the degree of stenosis and symptoms. Of the highly stenotic vessels (80% to 99% narrowing), 253 of 350 (72%) were symptomatic; 85 of 104 (82%) occluded vessels were symptomatic. There was a linear relationship between the occurrence of cervical bruit and degree of stenosis, up to but not including total occlusion. The relationship between bruits and focal neurologic symptoms was less direct. Among 562 symptomatic arteries, 297 (53%) had a bruit and 265 (47%) did not. In symptomatic patients, the absence of a cervical bruit should not delay a workup for extracranial vascular disease.
Fourteen patients with spasmodic torticollis and other segmental dystonic syndromes, who were refractory to previous forms of therapy, were selected for treatment with drugs intended to elevate brain gamma-aminobutyric acid (GABA) levels. These patients were simultaneously given diazepam, isoniazid, pyridoxine, and large doses of L-glutamine. Involuntary spasmodic activity improved to varying degrees in 7 patients; in 2 the dyskinesia became worse. Transient alteration of renal or hepatic function occurred in 6 patients and mild euphoria unrelated to neurological improvement in 8. Two patients are still being treated. Deficiency of GABA may be a factor in some patients with these disorders.
We examined the effect of pergolide, a semisynthetic ergot alkaloid, alone or combined with carbidopa and levodopa (Sinemet), on the cardiac rhythm of 12 patients with Parkinson's disease. The patients were selected on the basis of severe Parkinson's disease and stable cardiac rhythm as determined by 1 to 5 days of Holter monitoring. Monitoring was then carried out for an additional period of between 2 and 10 wk while the patients were on pergolide. Seven of the 12 patients had repetitive ventricular rhythms (RVRs). These were isolated, infrequent, and not associated with increases in premature ventricular contractions. The dose at which the RVRs occurred may be a function of the presence or absence of heart disease, but the significance of RVRs remains to be determined.
Pergolide mesylate, a semisynthetic ergoline and a potent, long-acting central dopamine agonist, was tested in 13 patients with advanced Parkinson disease and diurnal oscillations in performance ("wearing-off" or "on-off" phenomena or both) whose response to levodopa had diminished considerably. Among all nine patients who completed the initial clinical trial, pergolide alone (two patients) or combined with levodopa (seven patients) had a marked antiparkinson effect. There was a significant reduction (p less than 0.05) in rigidity, bradykinesia, gait disorder and total Parkinson disease disability score. Pergolide had a marked effect in all the patients with "wearing-off" or "on-off" phenomena or both, resulting in a significant increase (p less than 0.01) in the duration of the time patients were "on." the number of hours in which patients were "on" increased from 3.8 +/- 0.5 (SEM) to 11.4 +/0 ).8 (SEM). The main daily dose of pergolide was 2.4 mg (range, 2 to 5 mg). Ten months later, all nine patients are doing well. Pergolide is an effective drug in patients with advanced Parkinson disease and reduces "on-off" phenomena.
Lisuride hydrogen maleate, a semisynthetic ergoline and potent central dopamine and serotonin agonist, was tested in 10 patients with moderate to marked Parkinson disease whose response to levodopa had diminished. In the group of 10 patients, there was a significant reduction (p less than or equal to 0.05) in bradykinesia, gait disorder, and total Parkinson disease disability score when levodopa was replaced with lisuride. The mean dose of lisuride was 3.6 mg per day. Among the 10 patients, 5 were better on lisuride than on levodopa, and 4 continue on lisuride 1 year later. A decline in efficacy was noted in all four after a mean of 45 months. Adverse effects necessitating discontinuing the drug were mental changes in three patients and nausea in one patient. Lisuride, when used alone, has definite antiparkinsonian activity and is a promising new drug.