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Biomedical subjects

J H Friedman

Publications and source records attributed to J H Friedman.

At least 127 records · Page 7Linked to original sources

Spinal cord infarction. Report of 8 cases and review of the literature.

While the incidence of spinal cord ischemia is not known, it is generally considered to be rare. Diagnosis of presumed spinal cord ischemia requires the appropriate clinical picture and exclusion of other possible etiologies. Definitive diagnosis usually requires postmortem examination. During a 52-month period, 8 patients with presumed spinal cord infarction were evaluated at a 238-bed community hospital. These cases accounted for 1.2% of all admissions for stroke. Infarction of the spinal cord was confirmed on postmortem examination in 2 cases. All 6 surviving patients regained substantial motor function. Bowel and/or bladder dysfunction returned to normal in 3 patients. The literature is reviewed, and the cases are discussed in relation to the pertinent anatomic, pathogenic, and clinical aspects of spinal cord infarction.

Adult↗

Orienting of visual attention in progressive supranuclear palsy.

Orienting of visual attention was studied in 8 patients with progressive supranuclear palsy (PSP) and 8 parkinsonian control subjects. While maintaining fixation on the centre of a visual display, subjects made simple reaction time (RT) key press responses on detecting visual targets which appeared above, below, to the left or right, equidistant from fixation. On each trial the target was preceded by a preparatory cue, either a peripheral luminance change or a central arrow, to summon attention to one of the four locations. The orienting of attention was measured as a facilitation in detection RT at the cued location. For the parkinsonian controls, this facilitation was equal for horizontal and vertical directions, whereas for both types of cues, PSP patients were slower moving attention in the vertical than in the horizontal plane. Midbrain retinotectal pathways are important not only for controlling eye movements, but also for orienting attention.

Aged↗

Respiratory muscle dysfunction in Parkinson's disease.

Patients with Parkinson's disease may have more difficulty performing repetitive motor acts than single motor acts because of bradykinesia and skeletal muscle rigidity. We thought that repetitive ventilatory tasks might be similarly limited and that this dysfunction would likely contribute to respiratory muscle fatigue. We studied 9 patients with Parkinson's disease who had no evidence of restrictive or obstructive lung disease and 5 normal age-matched control subjects who performed repetitive, forced inspiratory resistive-loaded tasks. The time a given mean airway opening pressure could be sustained, the incremental oxygen cost of breathing, and the work rate of breathing (W) were measured. Although maximal static inspiratory pressures were comparable in both groups, 8 of the 9 patients could not sustain as high a W in the resistive-loaded tasks as could the normal control subjects (41.0 +/- 23.0 versus 67.7 +/- 29.1 J/min; mean +/- SD, p less than 0.01) and the efficiency of breathing was reduced (2.0 +/- 0.8 versus 3.8 +/- 1.4%; p less than 0.01). These findings are similar to derangements of task performance by peripheral skeletal muscle groups in Parkinson's disease.

Aged↗

Acetazolamide responsive hereditary paroxysmal ataxia.

The fourteenth family with an apparently autosomal dominant paroxysmal ataxia is described. As in the seven families described since 1978, acetazolamide completely cured the attacks. A possible mechanism of action of acetazolamide is discussed.

Acetazolamide↗

Hemifacial gustatory sweating due to Pancoast's tumor.

Facial sweating associated with eating develops occasionally after thoracic sympathectomy. Its occurrence has never been previously documented in association with a tumor in the upper chest. This report describes the first case of Pancoast's tumor presenting as hemifacial gustatory sweating.

Adult↗

The relationship of the dexamethasone suppression test (1 mg and 2 mg) to basal plasma cortisol levels in endogenous depression.

The 1 mg and 2 mg dexamethasone suppression tests (DST) were evaluated in two groups of endogenously depressed patients (n = 39 and n = 30, respectively) who also had a 1300-1600 hr basal cortisol assessment. Non-suppressors (on both DSTs) had significantly higher basal plasma cortisol levels and thus were significantly associated with relative cortisol hypersecretion. However, there was only a partial overlap between DST response and basal plasma cortisol, with a large variation of cortisol levels among non-suppressors. The 2 mg DST appears to be more specific for cortisol hypersecretion than the 1 mg DST. If cortisol hypersecretion is to be identified, neither the 1 mg or 2 mg DST is an adequate assessment nor a substitute for a basal cortisol assessment.

Adult↗

Programming and execution of sequential movements in Parkinson's disease.

In separate blocks of a simple reaction time (RT) task, eight Parkinsonian and eight control subjects executed finger press sequences with one (index finger), two (index finger-ring) or three (index finger-ring-middle) components. Programming was inferred from the increase latency to initiate the first component as a function of the length of the entire sequence; and from the systematic decrease in inter-response latencies for the second and third components. Overall RT was slower in the Parkinsonians but the programming effects were comparable in the two groups. Intact basal ganglia function appears not to be necessary for programming sequential finger movements, or retrieving subprograms for execution.

Adult↗

Tardive dystonia in a psychiatric hospital.

Tardive dystonia is a relatively uncommon long term complication of neuroleptic therapy. The prevalence of this syndrome is unknown. This study, of chronic hospitalised psychiatric patients, revealed a tardive dystonia prevalence of 1.5%. Risk factors in this small population appeared to be mental retardation and convulsive therapy.

Adolescent↗

Idiopathic hypoparathyroidism with extensive brain calcification and persistent neurologic dysfunction.

Idiopathic hypoparathyroidism is an uncommon cause of movement disorders. The following case illustrates the persistence of a parkinsonian gait 2 years after the restoration of normal serum calcium levels. The extensive calcifications in the brain presumably account for this as well as for the persistent mild dementia. The importance of identifying hypoparathyroidism early in the course is graphically illustrated.

Brain Diseases↗

Limb dystonia in progressive supranuclear palsy.

Progressive limb dystonia contributed to disability in 8 of 30 patients with progressive supranuclear palsy (PSP). In five, it was present when the patients were on no medication. In four, it had been present before the distinctive ophthalmoplegia permitted a correct diagnosis. The severity of limb dystonia did not correlate with the severity of either ophthalmoplegia or neck dystonia. The importance of dystonia in the pathophysiology of PSP is emphasized, with regard to both the branchial dystonia that underlies several cardinal features of the disease, and to the frequent occurrence of limb dystonia as an early sign.

Aged↗

Akathisia: the syndrome of motor restlessness.

Akathisia is a common but frequently unrecognized complication of antipsychotic medication. Affected individuals report an inner discomfort which they attempt to relieve by increased motor activity. This disorder often causes dramatic changes in behavior which may be misinterpreted as signs that more, rather than less, medication is required. Diphenhydramine therapy is often effective in new-onset akathisia. Anticholinergic agents may also be of value.

Adult↗