Search PubMed⌕ Search

Biomedical subjects

J Biller

Publications and source records attributed to J Biller.

At least 91 records · Page 5Linked to original sources
PubMed1989

Use of high dose naloxone in acute stroke: possible side-effects.

The effects of high dose naloxone in humans have not been studied extensively. We treated 36 patients who had acute ischemic cerebral infarction with high doses of naloxone to evaluate potential efficacy and toxicity. All patients were treated with a 160-mg/m2 (4-mg/kg) loading dose followed by 80 mg/m2.h (2 mg/kg.h) x 24 h. There were no statistically significant changes in group mean arterial pressure, respiratory rate, or heart rate in response to the loading dose or infusion, although clinically significant changes did occur in four patients. Twenty-three patients had adverse reactions possibly related to naloxone, the most common of which were nausea (n = 20), bradycardia and/or hypotension (n = 3), myoclonus (n = 1), and hypertension (n = 1). Seven patients had naloxone discontinued for possible adverse reactions. All adverse reactions abated with discontinuation of naloxone and/or pharmacologic therapy when indicated. No deaths were attributable to naloxone treatment. High dose naloxone appears to be well tolerated in the majority of elderly patients with acute cerebral infarction.

Adult↗
PubMed1989

Etiology of stroke in patients with Wernicke's aphasia.

We reviewed 49 patients with Wernicke's aphasia resulting from a stroke. Their aphasia was classified on the basis of comprehensive neuropsychological testing. Wernicke's aphasia was more common in older patients and in men. Cerebral infarction occurred in 38 patients (78%) and intracerebral hemorrhage in seven (14%); the remaining four patients (8%) developed aphasia after surgery for aneurysmal subarachnoid hemorrhage. Embolic events were the most common etiology of Wernicke's aphasia in the 38 patients with cerebral infarction, with cardiac emboli in 40% and large-vessel atheroemboli from a carotid source in 16%. In patients with Wernicke's aphasia secondary to infarction, an embolic source should be sought. Patients with Wernicke's aphasia should have computed tomography to exclude intracerebral hemorrhage before institution of anticoagulant therapy.

Adult↗
PubMed1989

A randomized trial of aspirin or heparin in hospitalized patients with recent transient ischemic attacks. A pilot study.

In a randomized pilot study we compared the efficacy of temporary anticoagulation with intravenous heparin sodium to the efficacy of aspirin in preventing cerebral infarction in hospitalized patients with recent (less than 7 days) transient ischemic attacks (TIAs). Fifty-five patients (33 men, 22 women) aged 36-81 (mean 62.7) years met entry criteria and agreed to participate. Symptoms prompting hospitalization were referable to the carotid distribution in 43 patients (34 hemispheric, nine retinal); 12 patients had vertebrobasilar distribution TIAs. Twenty-seven patients received heparin and 28 received aspirin. Patients were treated until surgery or until long-term medical therapy was instituted, 3-9 (mean 5.5) days in the heparin group and 3-15 (mean 5.8) days in the aspirin group. Recurrent TIAs occurred in eight patients given heparin and in seven treated with aspirin. Infarction occurred in one patient in the heparin group and in four patients in the aspirin group (three brain, one retinal infarction). Initial symptoms in these five patients were referable to the carotid distribution in two and to the vertebrobasilar distribution in three. All patients but the one with a retinal infarction had recurrent TIAs prior to stroke. Our pilot study suggests that hospitalized patients with recent TIAs are at high risk for recurrent TIAs (15 of 55, 27%) and brain infarction (five of 55, 9%) and that patients with recent vertebrobasilar distribution TIAs have a marginally significantly higher risk (odds ratio 6.83, 95% confidence interval 0.65-88.66) of infarction than patients with recent carotid distribution TIAs.

Adolescent↗
PubMed1989

Anterior choroidal artery territory infarction: a small vessel disease.

To investigate the cause(s) of infarction in the anterior choroidal artery territory, we studied 31 patients (18 men, 13 women) aged 19-82 (mean 58) years, with infarction in this territory documented by computed tomography. All patients were evaluated within 30 days after infarction and had carotid artery studies (arteriography in 17, duplex ultrasound in 14). Fifteen patients had echocardiography. Risk factors for atherosclerosis were chronic hypertension in 20 patients, smoking in 17, diabetes in 10, age greater than 69 years in eight, and elevated serum cholesterol concentration in three. The percentage of patients with extracranial carotid artery stenosis (four of 31, 13%) and the severity of stenosis (mild in two, moderate in two) were similar to that reported in neurologically asymptomatic individuals. The percentage of patients with intracranial carotid artery stenosis (one of 17, 6%) or potential cardiac sources of emboli (two of 31, 6%) was also low. Our findings suggest that infarctions in the anterior choroidal artery territory usually result from small-vessel disease. Associated carotid artery stenosis and potential sources of cardiac emboli are rare and may be coincidental.

Adult↗
PubMed1989

Measurements of acute cerebral infarction: a clinical examination scale.

We designed a 15-item neurologic examination stroke scale for use in acute stroke therapy trials. In a study of 24 stroke patients, interrater reliability for the scale was found to be high (mean kappa = 0.69), and test-retest reliability was also high (mean kappa = 0.66-0.77). Test-retest reliability did not differ significantly among a neurologist, a neurology house officer, a neurology nurse, or an emergency department nurse. The stroke scale validity was assessed by comparing the scale scores obtained prospectively on 65 acute stroke patients to the patients' infarction size as measured by computed tomography scan at 1 week and to the patients' clinical outcome as determined at 3 months. These correlations (scale-lesion size r = 0.68, scale-outcome r = 0.79) suggested acceptable examination and scale validity. Of the 15 test items, the most interrater reliable item (pupillary response) had low validity. Less reliable items such as upper or lower extremity motor function were more valid. We discuss methods for improving the reliability and validity of brief examination scales to be used in stroke therapy trials.

Cerebrovascular Disorders↗
PubMed1989

Measurements of acute cerebral infarction: lesion size by computed tomography.

As part of a prospective therapy study of 65 patients with acute, nonhemorrhagic, cerebral infarction, computed tomographic scans of the head were obtained at admission, 7-10 days, and 3 months. The scans were analyzed for the presence, site, size, and volume measurement of the infarction. At 7-10 days, the mean infarction volume as measured by computed tomography was 55 cm3 or about 4 x 4 x 3.5 cm (range = 0-507 cm3). At 3 months, the mean infarction volume decreased by 25% to 41 cm3. For the 26 scans showing infarction at the time of admission, the mean lesion volume was 33 cm3 at admission, 51 cm3 at 7-10 days, and 49 cm3 at 3 months. With lesion size at 7-10 days expressed as percentage of total brain volume, the mean infarction size was only 5%. Of the 49 patients with lesions revealed by computed tomography at 7-10 days, 20 had an infarction of 1% or less of total brain volume, while only six had an infarction of 20% or more of total brain volume. The lesion volumes as measured by the 7-10-day computed tomography correlated with the neurologic examination scores on admission (Spearman's rank-order correlation = 0.78) and with the scores at 1 week (Spearman's rank-order correlation = 0.79).

Acute Disease↗
PubMed1989

Use of antithrombotic drugs in the treatment of acute ischemic stroke: a survey of neurologists in practice in the United States.

In an attempt to determine the opinions and practices of neurologists regarding the use of antithrombotic drugs in the treatment of acute ischemic stroke, we conducted a survey of 349 randomly selected neurologists from throughout the United States. Responses were received from 247 (71%), and 219 identified themselves as primary or consulting physicians for patients with acute ischemic stroke. During the previous 12 months, these 219 physicians estimated that they had seen a total of 14,636 patients within 24 hours of acute ischemic stroke, and 22% of these patients were treated with heparin. The most frequently reported indications were prevention of recurrent cerebral embolism (82% of physicians) and progressing stroke (70%). Despite the frequent use of heparin, only 6.4% of neurologists felt that it has been shown to be effective, and 16.4% felt that it has been shown to be of no value. The primary concern about the use of heparin was lack of proven efficacy in 48% and safety concerns in 41%. Results of a future trial testing the efficacy of antithrombotic drugs would be useful for most neurologists in their management of patients with acute or progressing ischemic stroke.

Acute Disease↗
PubMed1989

A dose escalation study of ORG 10172 (low molecular weight heparinoid) in stroke.

An intravenous infusion of a low molecular weight heparinoid, with a reduced risk of hemorrhage, may be an alternative to heparin in the management of acute ischemic stroke. To evaluate this hypothesis, we studied the safety of the heparinoid, ORG 10172, in a dose-escalation study in 26 patients. The drug was administered as a loading bolus followed by a 7-day infusion in five rates with target anti-factor Xa levels from 0.2 to 1.0 U/ml. The drug was well tolerated; no major bleeding complications or thrombocytopenia occurred. There were no deaths or hemorrhagic transformation of cerebral infarctions. The results indicate that ORG 10172 at doses to achieve a level of 1.0 U/ml or less may be used safely in management of acute cerebral infarction.

Adult↗
PubMed1988

Magnetic resonance imaging in young adults with cerebral infarction due to moyamoya.

The number, size, and location of cerebral infarctions, and blood flow in the middle cerebral artery as seen on proton magnetic resonance imaging were assessed in six white adults with angiographically documented moyamoya. Findings were correlated with clinical presentation, computed tomography, and angiography. Large hemispheric infarctions were found in five hemispheres, predominantly in watershed regions. Subcortical infarctions (n = 56) were found in all hemispheres. They were predominantly located in the centrum semiovale, in the distal beds of supply of the penetrating branches of the anterior and middle cerebral arteries. Infarction of the putamen was found in three hemispheres, caudate nucleus in four, globus pallidus in two, and anterior limb of the internal capsule in two. There were none in the posterior limb of the internal capsule, thalamus, brain stem, or cerebellum. Middle cerebral artery flow was visualized as a signal-void flow sign in only three hemispheres. Cerebral infarctions due to moyamoya are bilateral, multiple, often small, and asymptomatic, affecting predominantly the carotid circulation in watershed regions. Subcortical infarctions in the centrum semiovale and large hemispheric infarctions in hemodynamically compromised areas are the predominant findings.

Adolescent↗
PubMed1988

Successful treatment of idiopathic secretory diarrhea of infancy with the somatostatin analogue SMS 201-995.

The somatostatin analogue SMS 201-995 has been reported to be effective in treating adult secretory diarrhea due to vasoactive intestinal polypeptidoma. We report the effectiveness of this drug in treating severe refractory secretory diarrhea of uncertain etiology in an infant. The patient developed diarrhea within the first few days of life, with mean stool output of 250 ml/kg.day (expected 10 ml/kg.day). Small bowel biopsy showed mild focal enteritis. Serum levels of known gastrointestinal secretagogues were normal. No tumor was detected. Diarrhea was not adequately controlled by various drug treatments. Addition of subcutaneous SMS 201-995 produced a significant sustained decrease in stool output to 80-100 ml/kg.day. During SMS 201-995 treatment, no metabolic, hormonal, or growth abnormalities were noted. SMS 201-995 was discontinued after 9 mo because of patient irritability. Stool output rose immediately to 173 ml/kg.day, and remained stable for 6 mo. It is concluded that SMS 201-995 was a safe and effective treatment in this single childhood case of severe idiopathic secretory diarrhea.

Antidiarrheals↗
PubMed1988

Seasonal variation of stroke--does it exist?

A relationship between seasonal climate changes and the occurrence of stroke has been postulated. We reviewed the seasonal occurrence of stroke in 2,960 patients seen at the University of Iowa from 1978 through 1985. Stroke was classified as cerebral infarction (CI; n = 1,357, 46%), transient ischemic attacks (TIAs; n = 913, 31%), subarachnoid hemorrhage (SAH; n = 476, 16%) and intracerebral hemorrhage (ICH; n = 214, 7%). Local climatological data were obtained from the National Oceanic and Atmospheric Administration. Poisson regression was used to analyze the data. The occurrence of TIA and SAH was not influenced by seasonal climatic variables. There was a significant increase in the rate of referral for CI during warmer months (p = 0.027). The amount of rainfall did not influence the rate of CI. Conversely, the rate of referral for ICH was significantly less during warm weather (p = 0.027) and rainy weather (p = 0.014). A possible inverse seasonal relationship in temperate climates between CI and ICH deserves more investigation.

Adult↗
PubMed1988

Verapamil-induced carbamazepine neurotoxicity. A report of two cases.

Two patients with signs of carbamazepine neurotoxicity after combined treatment with verapamil showed complete recovery after discontinuation of the calcium entry blocker. Use of verapamil in combination with carbamazepine should either be avoided or prescribed only with appropriate adjustment of the carbamazepine dose (usually reduction of the carbamazepine dose by one half).

Adult↗
PubMed1988

Neurologic manifestations of atrial myxoma. A 12-year experience and review.

We present the results of a 12-year retrospective analysis of 11 patients, eight women and three men, aged 16-76 years, with pathologically documented atrial myxomas. Nine of the 11 patients were found to have a left atrial myxoma; right atrial myxomas were identified in two. Five of the 11 patients (45%) had abnormalities on neurologic examination, and five of five had computed tomographic evidence of nonhemorrhagic cerebral infarction. Neurologic symptoms were the initial presentation in four patients. Six patients reported a history of cardiac disease; eight of the 11 had abnormalities on cardiac auscultation. Echocardiography in 10 patients was diagnostic in all but one. Gated magnetic resonance imaging of the heart in two patients demonstrated myxoma position and movement. Follow-up examinations (varying from 1 month to 7 years after tumor resection) in nine of 11 patients demonstrated no recurrent neurologic symptoms. Cerebral infarction is a common complication of atrial myxomas and may be the presenting feature. Recurrent cerebral emboli before surgery is not uncommon. Cardiac auscultation may be normal, and electrocardiographic changes are often nonspecific. Delayed neurologic events following surgery are rare.

Adolescent↗
PubMed1988

Early diagnosis of basilar artery occlusion using magnetic resonance imaging.

Three patients with a clinical diagnosis of pontine infarction probably due to basilar artery occlusion were studied with magnetic resonance imaging within 24 hours after onset or latest progression of symptoms. The earliest changes on magnetic resonance images were an absence of signal void in the basilar artery suggestive of severe reduction of blood flow or occlusion (flow-void phenomena). The presumed basilar artery thrombosis was best demonstrated as a linear structure isointense or hyperintense with the brainstem in the pontine cistern on T1-weighted parasagittal images and as either absence of flow-void phenomena or higher signal intensity at various levels corresponding to the course of the basilar artery on the axial T2-weighted images. Brainstem parenchymal changes characteristic of infarction were not obvious for at least 12 hours after onset or 90 minutes after latest progression of symptoms and were best shown by both axial and coronal T2-weighted images. Recognition of these magnetic resonance imaging findings may allow earlier diagnosis and treatment of acute ischemia in the vertebrobasilar system.

Adult↗
PubMed1988

Comparison of admission serum glucose concentration with neurologic outcome in acute cerebral infarction. A study in patients given naloxone.

We studied the ability of serum glucose concentration and neurologic deficits at admission in predicting the outcome of acute cerebral ischemia in 65 patients given naloxone. Among our patients, the volume of infarction on computed tomograms and outcome were strongly related to the severity of neurologic deficits found at admission. Neither a history of diabetes nor hyperglycemia when added to the results of the initial neurologic assessment improved prediction of outcome after acute cerebral infarction.

Acute Disease↗
PubMed1988

Cerebral infarction due to moyamoya disease in young adults.

Moyamoya disease was diagnosed as the cause of cerebral infarction in eight young adults (seven women, one man), aged 17-40 (mean 33) years. All had angiographic abnormalities characteristic of moyamoya disease. Single-photon emission tomography showed bilateral carotid circulation hypoperfusion and posterior circulation hyperemia in all seven patients with regional cerebral blood flow studies. All seven women had used oral contraceptives before cerebral infarction. Four patients were treated medically; one died of a second cerebral infarction 9 months after diagnosis. Four patients underwent superficial temporal-to-middle cerebral artery anastomosis; they did well. Moyamoya disease should be included in the differential diagnosis of cerebral infarction as well as intracranial hemorrhage in young adults, particularly women. A possible relation between moyamoya disease and oral contraceptive use deserves investigation.

Adolescent↗