Progress in the pharmacotherapy of Parkinsonism.
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Biomedical subjects
Publications and source records attributed to A Williams.
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Maximum inspiratory pressure, inspiratory capacity, and minute ventilation were measured in a group of infants prior to extubation to determine whether these parameters predicted successful extubation. Data obtained suggested that maximum inspiratory pressure and inspiratory capacity more accurately assessed the patient's ability to tolerate extubation than minute ventilation, pH, PCO2, or respiratory rate. A maximum inspiratory pressure of greater than 33 torr and an inspiratory capacity of greater than 150 ml/m2 were predictive of successful extubation.
Nineteen cases of villonodular synovitis as identified in 14 horses are presented. Physical and radiographic findings are discussed and the surgical correction described. Case histories indicate that surgical extirpation of the lesion is corrective and that rest without surgical intervention is ineffective. Radiation therapy following surgery does not appear to be necessary.
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Because there is biochemical evidence of decreased GABAergic function in Parkinson's disease, sodium valproate, an inhibitor of GABA catabolism, was administered to eight Parkinsonian patients. Valproate treatment did not significantly alter any Parkinsonian feature, but tended to increase the dyskinesia in the "on-off" patients. The increased dyskinesias were not a result of altered peripheral metabolism of L-dopa. Despite obtaining high plasma levels of valproate, no consistent alteration of CSF GABA levels could be demonstrated. Thus, in these patients, an effect of valproate on GABA metabolism is unproven, and in turn, the role of GABA in Parkinsonism and dyskinesia uncertain.
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When isoniazid and pyridoxal are mixed in equimolar quantities a hydrazone is formed which is able to complex with iron. The oral administration of this compound to rats in single doses of 25--100 mg/kg leads to an increase in faecal iron excretion up to 8 times the normal level. In tissue culture the compound is able to remove iron from Chang cells. The results suggest that this compound may be of potential value for the oral therapy of iron overload.
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Eight out of 12 unselected patients with Shy-Drager syndrome were found to have severe bilateral paresis of vocal cord abduction by fibre-optic laryngoscopy. This commonly presented as increased snoring followed by episodes of inspiratory and expiratory stridor and sometimes by sleep apnoea. Respiratory failure eventually developed in four cases and was reversed by tracheostomy. In another patient tracheostomy relieved severe attacks of sleep apnoea. This complication was not necessarily associated with advanced disease, and it should be considered in all patients with Shy-Drager syndrome as appropriate treatment can lead to a useful extension of life.
Two recent sporadic cases of progressive Parkinsonism after encephalitis are described. Both patients had two oligoclonal protein bands in their CSF. These bands were not present in patients with idiopathic Parkinson's disease and might, therefore, be useful for diagnostic purposes, particularly when the history of encephalitis is uncertain.
Like patients with chronic liver disease, those with coma due to fulminant hepatic failure may show arterial hypoxaemia even in the absence of pulmonary complications, and in both it is attributed to increased intrapulmonary arteriovenous admixture. This study is concerned with the structural alterations in the pulmonary circulation of patients who have died from fulminant hepatic failure. Precise quantitative morphometric techniques applied to the injected and inflated lung have shown the major abnormality to be a diffuse dilatation of the pulmonary vascular bed affecting arteries and veins of all structural types. At an intra-acinar level the diameter of arteries accompanying respiratory bronchioles was 232.97 micron (+/-SD 46.35) compared with 177.76 micron (+/-SD 30.43) in controls (P less than 0.01). In two-thirds of the patients pleural spider naevi were seen and, throughout the lung, similar significant dilatation of precapillary vessels; but in only one patient were precapillary anastomoses shown. While intrapulmonary venous admixture undoubtedly contributes to hypoxia in fulminant hepatic failure, its exact relation to the structural changes is not yet determined.
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It has recently become apparent that some victims of sudden infant death syndrome (SIDS) are chronically hypoxemic before death. In this study, the structural alterations in the pulmonary circulation of 15 victims of SIDS were examined using precise quantitative morphometric techniques applied to the injected and inflated lung. Increased muscularity of the pulmonary circulation has been demonstrated, as evidenced by the extension of muscle into arteries not usually muscularized during the first year of life, and by an increased thickness of the medial wall in some patients. This confirms the findings of Naeye and further justifies the shift of investigative efforts from the events immediately surrounding death to a search for chronic abnormalities.
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