More on ganciclovir-induced "psychosis".
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Ganciclovir↗
Biomedical subjects
H B Schiff
Publications and source records attributed to H B Schiff.
Aphemia. Clinical-anatomic correlations.
A syndrome of dysarthria following the appearance of small left frontal-lobe lesions has been recognized for many years but identified by numerous labels. Varied terminology has led to confusion in the literature and inadequate recognition of this syndrome as a distinctive clinical entity. We gathered clinical and anatomic (computed tomographic) data on four patients with this dysarthric syndrome and reviewed cases from the literature that contained sufficient clinical and anatomic data for comparison. These patients had a distinctive syndrome of dysarthria without aphasia, caused by small lesions of the motor system for articulation: pars opercularis, inferior prerolandic gyrus, or white matter deep to those regions. This syndrome should be distinguished from Broca's aphasia, Broca's area aphasia, transcortical aphasia, and subcortical aphasia. Aphemia is not mild Broca's aphasia; it is severe dysarthria, at times in the setting of transient Broca's aphasia.
Aged↗
Lithium in aggressive behavior.
A patient with intractable aggression was treated with lithium carbonate. On the basis of the authors' study and their review of the literature, they conclude that lithium may exacerbate the interictal aggression sometimes noted in patients with temporal lobe spike activity.
Adult↗
Acute renal failure in marathon runners.
The Comrades Marathon is a gruelling test of man's stamina and only trained athletes participate. It is surprising that of over 2,000 contestants each year on a 90-km (56.25-mile) course, severe cardiac and renal damage does not occur more often. We are able, however, to report 10 cases over 9 years when renal damage did occur. 3 cases required haemodialysis; 1 had peritoneal dialysis; 2 patients had renal biopsies. Possible idiosyncratic factors are discussed as is the pathogenesis of acute tubular necrosis.
Acute Kidney Injury↗
Myoglobinuria, rhabdomyolysis and marathon running.
Rhabdomyolysis, secondary to exertion is known to result in myoglobinuria and is occasionally associated with acute renal failure. In this study myoglobinaemia occurred in 25 of 44 runners completing a 99 km marathon. A marked rise in the values of myoglobin, lactate and the enzymes creatine kinase (CPK), aspartate transaminase (AST) and lactic dehydrogenase (LDH) was noted. A linear correlation was demonstrated between the level of serum myoglobin and the serum concentrations of urate, CPK, AST and LDH. Both the myoglobin itself and the increased concentration of urate may contribute to the acute renal failure. The pathophysiology of rhabdomyolysis during exertion is discussed in the context of other causes of myoglobinuria. A classification of rhabdomyolysis and myoglobinuria is suggested.
Acute Kidney Injury↗
Three months in Cala, Transkei.
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Female↗
Acetylcholinesterase inhibition in dementia with Lewy bodies: results of a prospective pilot trial.
OBJECTIVE: Dementia with Lewy bodies (DLB) is the second commonest form of dementia. The response to acetylcholinesterase inhibition (AChEI) could be greater in DLB than in Alzheimer's disease (AD) because cholineacetyl-transferase levels are more reduced in the former. This preliminary trial seeks to compare performances in cognitive tasks before and after tacrine administration in DLB and AD subjects. METHODS: Six DLB and 6 AD patients were enrolled in an open, nonrandomized, intervention trial using 80 mg/day tacrine. Patients met ADRDA or DLB consortium criteria for probable diseases. Subjects were matched for Mini Mental State Examination (MMSE) score, age and sex. Mattis Dementia Rating Scale (DRS), Controlled Oral Word Association Test (FAS) and Boston Naming tests were administered at baseline and at 6 months into treatment. RESULTS: AD and DLB groups did not differ in initial mean total DRS scores. In the primary analysis, both groups declined during the course of treatment (-7.3 +/- 4.2 and -16.8 +/- 39.2 DRS points, respectively). Due to the large variability in DLB posttreatment scores, this group was divided post hoc into responders (DLBr) and nonresponders (DLBnr). The DLBr group outperformed the DLBnr group at baseline (p < 0.05) and, notably, in follow-up DRS test scores (p < 0.001). Two-way MANOVA comparing both DLB subgroups with either the entire AD cohort or similarly stratified AD subgroups showed a significant interaction (F = 7.6; p < 0.015), attributed mostly to declines in DLBnr group scores (p < 0.01). Surprisingly, on DRS memory subscale and FAS tests, there were significant improvements in DLBr scores (p < 0.02). A baseline MMSE (or DRS memory) score >/=15 predicted a positive response to tacrine in DLB. Acceleration of parkinsonism occurred in all DLB subjects. CONCLUSION: Results from a primary analysis of the therapeutic effect of 80 mg/day tacrine in DLB and AD were negative. However, post hoc analysis showed that mild to moderate DLB responds favorably to AChEI relative to AD through stabilization of global cognitive decline and improvements in specific cognitive areas. These results could be useful in the planning of a more definitive study.
Aged↗