Cardiovascular investigation in elderly patients with transient unresponsiveness.
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Biomedical subjects
Publications and source records attributed to A Primavera.
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A 25-year-old male was wounded accidentally in the neck by a metallic fragment, which penetrated his right carotid artery and migrated within the ipsilateral middle cerebral artery. Clinical and laboratory findings over a 16-month-period are reported. Problems arising from the presence of metallic emboli to the cerebral circulation are discussed on the basis of the pertinent literature.
One hundred eight-four sputum specimens from the same number of patients with lower respiratory tract infections were examined to determine the bacterial count and the relationship between the microorganisms isolated and the presumptive pathology. The sputa were subdivided into three groups; "high probability", "low probability", and "contaminated sputa", following the criteria of the microscopic readings: sputum with more than 25 white cells and low numbers of squamous epithelial cells represents true lower respiratory tract infections (high probability); those with fewer than 25 white cells represent non-bacterial infections or non-infected sputa (low probability) while sputa with more than 25 squamous cells per field represent contaminated specimens (contaminated sputa). Statistical analysis was carried out to correlate these data. Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae, and Streptococcus pyogenes showed significant differences in the three groups considered.
A long-term follow-up study was performed on patients with transient global amnesia (TGA) in order to evaluate the prognosis, the recurrence rate and the occurrence of stroke and dementia. 102 patients (57 women, 45 men; mean age 62.8 +/- 9.4 years) were prospectively included and followed up. The follow-up duration ranged between 12 and 241 months with an average value of 82.2 +/- 51.1 (mean +/- SD). The death rate showed no difference from that of sex- and age-matched subjects. TGA recurred in 19 cases (18.63%). Only 4 patients suffered subsequent stroke, and only 3 showed intellectual deterioration. TGA prognosis was shown to be better than that of RIA and lacunar patients.
The relationship between depression and dementia in Parkinson's disease (PD) has rarely been explored. Using a quantitative EEG (qEEG) parameter, we studied four groups of subjects: PD, demented Alzheimer's type and major depressed patients and normal controls. The qEEG data were compared with those of the Mini-Mental State and the Hamilton Depression Scale. The qEEG pattern was different in the four groups of subjects. Moreover, there was a significant correlation between the qEEG data and the other variables, and, particularly, with the cognitive performances. Our findings demonstrate that the qEEG method of assessment may give valuable data for a better classification of dementia syndromes and for a distinction between dementia and pseudodementia.
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Epilepsy is a rare but possible manifestation of thyrotoxicosis. The patient reported here developed recurrent, generalized and focal seizures, as presenting symptoms of a thyrotoxic encephalopathy. Intercritic EEG records showed triphasic waves. Seizures and signs of encephalopathy disappeared and the EEG reverted to normal only after treatment of the thyroid hyperfunction. It is concluded that thyroid function should be evaluated in cases of otherwise unexplained encephalopathy with untreatable seizures and triphasic waves.
The quantified electroencephalogram (qEEG) of patients with senile dementia of the Alzheimer type (SDAT) and normal elderly subjects was related to the Mini-Mental State (MMS) score. A statistically significant correlation was observed between MMS score and some qEEG parameters. This correlation indicates that the use of adequate spectral parameters of qEEG may provide information on the cognitive impairment of elderly subjects and may reduce the false-positive rate at a neuropsychological examination.
Clinical records and EEGs of 114 consecutive patients with clinical diagnosis of Alzheimer's disease have been reviewed. The EEGs of 15 patients (13%) contained triphasic waves. Triphasic waves were always atypical as they occurred singularly or in short bursts, and/or they had occipital predominance, and/or they were bilateral but asymmetrical. Triphasic waves, in all but one patient were recorded in a state of complete alertness. No statistically significant differences were found between the triphasic waves group and the other one, with respect to age, age at onset, illness duration, presence of seizures. Myoclonus was more frequent in patients with triphasic waves (p less than 0.01). Triphasic waves patients had a higher degree of dementia (p less than 0.01), both in cases with rapidly evolving disease and in subjects with relatively slow clinical course.
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Somatosensory-evoked potentials (SEPs) and EEG were recorded in 45 patients with lacunar syndrome due to CT-verified lacunar infarcts. Abnormalities of SEP chronological parameters were observed in 22 subjects. SEP changes occurred independently of clinical features and were related more to the lesion location than to its size.
Total body irradiation (TBI) using high doses (about 10 Gy) with photons in the range between 1 and 10 MV combined with intensive chemotherapy has been used successfully in treatment of acute and chronic leukemia before bone marrow transplantation. One of the principal international guidelines in TBI is to use in vivo dosimetry in order to compare the prescribed dose with that absorbed. The use of in vivo dosimetry is also useful as a retrospective evaluation of any deviation from the prescribed dose greater than +/- 5% for relevant parts of the body, especially in the lung and in other organs at risk. In this paper, Electron Spin Resonance (ESR), using alanine dosimeters, is demonstrated to be a powerful tool for absorbed dose evaluation in TBI by detection of free radicals produced in alanine by ionizing radiation. In this study, we present the results obtained using ESR dosimetry in eleven patients undergoing TBI. The major advantages appear to be: 1. the ESR signal in alanine dosimetry is stable for years without fading: 2. the detection of the ESR signal does not destroy the information and so enables a retrospective judgment of the TBI plan adopted.
Parietal and prerolandic somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded from 40 patients with lacunar syndromes due to CT-verified lacunar infarcts. The control group consisted of 30 age-matched normal controls. Nineteen patients showed SEP abnormalities, mainly an increase of height-covariated latency of cortical components and/or of the central conduction time. Such changes occurred independently of the clinical features of lacunar syndromes, being related more to the lesion location than to its size. SEP studies may be a useful adjunct to the clinical diagnosis of lacunar infarct, possibly also when the CT scans are normal.
Fifty-one brains showing lacunae and 30 with cribriform cavities have been identified out of 191 examined brains. A histologic and immunohistochemical study with the peroxidase-antiperoxidase method for glial fibrillary acidic protein has been carried out in selected cases. The number, site, associated arterial lesions and the microscopic appearance of lacunae and cribriform cavities are reported. Lacunae are small cavities usually, but not always due to softenings; cribriform cavities are dilatations of the perivascular space. Two types of cribriform cavities have been identified, according to the histological appearance of the surrounding tissue: type 1 with normal and type 2 with rarefied and abnormally gliotic surrounding nervous tissue. Sixteen cases showing a cribriform state in the basal ganglia exhibited a pseudobulbar palsy or extrapyramidal rigidity. Pseudobulbar palsy of striate form or parkinsonism may be ascertained in some cases only by histological and immunohistochemical examination.