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Biomedical subjects

L J Findley

Publications and source records attributed to L J Findley.

At least 127 records · Page 7Linked to original sources
PubMed1982

Acquired pendular nystagmus: its characteristics, localising value and pathophysiology.

Investigations were made of 16 patients with acquired pendular nystagmus and a further 32 cases reported in the literature were reviewed. Amongst our own patients two thirds had multiple sclerosis, almost one third a cerebrovascular accident or angioma and two had optic atrophy with squint. The nystagmus took forms which could be monocular or binocular, conjugate or disconjugate and could involve movements about single or multiple axes. Spectral analysis was used to characterise the amplitude and frequency of the movements and to estimate the degree of relationship (coherence) between movements of the two eyes or between movements of one eye about several axes. The oscillations ranged in frequency from 2·5 Hz to 6 Hz, with typical amplitudes between 3° and 5°. In a given patient all oscillations, regardless of plane, were highly synchronised. Somatic tremors of the upper limb, face and palate associated with the nystagmus were often at similar frequencies to the eye movement. The other ocular signs common to all our patients were the presence of squint with failure of convergence. Most patients also had skew deviation or internuclear ophthalmoplegia or both. The major oculomotor systems, that is, saccades, pursuit, optokinetic and vestibulo-ocular reflexes could be intact. It is inferred that the mechanism responsible for the pendular nystagmus lies at a level which is close to the oculomotor nuclei so that it can have monocular effects but is not part of the primary motor pathways. It is possible that this mechanism normally subserves maintenance of conjugate movement and posture of the eyes. The periodicity of the nystagmus is likely to arise from instability in a certain type(s) of neurone, for the associated somatic tremors have similar characteristics and yet involve very different neuronal muscular circuitry. Prognosis for cessation of the nystagmus is poor. In five patients with multiple sclerosis it was suppressed by intravenous hyoscine with, however, unacceptable subsequent side effects.

Adult↗
PubMed1982

Central sleep apnea. Improvement with acetazolamide therapy.

Respiratory rhythm during sleep may be dependent on blood pH with apneas being associated with alkalosis. Acidification may therefore have therapeutic value in some forms of sleep apnea. We administered acetazolamide to six patients with symptomatic central sleep apnea, a disorder of respiratory rhythm with little or no upper airway obstruction. Sleep studies were carried out before and after one week of drug therapy, during which time the mean arterial pH decreased from 7.42 to 7.34. All six patients had significant improvement, demonstrating a 69% reduction in total apneas. Five of the six patients reported better-quality sleep and decreased daytime hypersomnolence. Subsequent studies in normal subjects showed that acetazolamide, like other agents known to produce a metabolic acidosis, shifted the hypercapnic ventilatory response to the left 5 +/- 0.54 mm Hg. This may be important in mediating the observed decrease in apneas.

Acetazolamide↗
PubMed1982

Blood transfusion in adult Jehovah's Witnesses. A case study of one congregation.

Jehovah's Witnesses, a religious group that prohibits certain types of medical treatment, eg, blood transfusions, tissue transplantations, and abortions, has 535,000 practicing members in the United States. We believe physicians should be informed of these beliefs to treat this large group of people properly. We studied one congregation's medical needs and beliefs in Denver by mailing a questionnaire to the 70 adult members. Their responses indicated that all of the members believe that accepting a blood transfusion is morally wrong. Seventeen members (29%) had refused a blood transfusion for themselves, and 27 members (46%) had had "bloodless" surgery performed on themselves or a family member. A majority of the congregation indicated they would consider suing a physician who would force them to receive a blood transfusion. Of the 43 members (73%) of the congregation who had regular physicians, eight members (19%) said their physicians were unaware of their refusal to accept blood products. The members of this congregation seek a physician who can respect their beliefs, understand bloodless surgical procedures, and vigorously treat every member within the limits of their religious beliefs.

Adult↗
PubMed1981

A novel method of recording arm movements. A survey of common abnormalities.

A novel technique uses a Schottky barrier photodetector to record abnormal movements of the arms in diseases of the nervous system. The method transduces displacement of the freely moving limbs, producing recordings that readily relate to clinical observation and provide quantification. This article gives examples of the use of the technique for examining ataxia in finger-to-nose testing, tremor, and cog-wheel phenomena in common neurological conditions.

Arm↗
PubMed1981

Phenylethylmalonamide in essential tremor. A double-blind controlled study.

A randomised double-blind placebo-controlled trial of phenylethylmalonamide, the major metabolite of primidone was performed in eight patients with essential tremor. Phenylethylmalonamide was given in a daily dose of 400 mg for one week and 800 mg for a second week. The compound had no statistically significant effect on the amplitude of tremor assessed by an accelerometric method, tests of performance, clinical evaluation and patient self assessment. No side effects occurred. Serum levels of phenylethylmalonamide on a daily dose of 400 mg were 11-27 micrograms/ml and on 800 mg daily were 16-48.5 micrograms/ml.

Adult↗
PubMed1981

Nomifensine: effect in Parkinsonian patients not receiving levodopa.

A clinical trial using the anti-depressant nomifensine in Parkinsonism is reported. Eighteen subjects not receiving levodopa participated. The drug had a small, but significant anti-Parkinsonian effect. No troublesome side effects were encountered. In the treatment of Parkinsonism, nomifensine may be considered as an alternative to amantadine or anticholinergics, especially where depression is an added feature.

Aged↗
PubMed1981

Tremor, the cogwheel phenomenon and clonus in Parkinson's disease.

Resting and postural tremor, intention and action tremor, clonus and the cogwheel phenomenon in Parkinson's disease have been characterised in terms of frequency content using spectral analysis. Typical resting tremor ranged in peak frequency from 4 to 5.3 HZ with tremor in each individual varying only by 0.2 to 0.3 HZ. The peak frequency of postural tremor ranged between 6 and 6.2 HZ. Intention tremor appeared to be an exaggeration of postural tremor. Clonus evoked by active or passive stretch at the wrist had a frequency of 6 HZ and appeared to be a continuation of postural tremor. The cogwheel phenomenon was found at frequencies between 6 and 6.5 HZ and between 7.5 to 9 HZ. Action tremor was indistinguishable from the cogwheel phenomenon. Some patients had either a symptomatic resting tremor with a concurrent 6 HZ component of smaller amplitude or a symptomatic postural tremor with a 4-5 HZ component of smaller amplitude. These combinations would produce two peaks in the power spectrum. When this occurred EMG studies showed that individual muscles had two types of rhythmical activation suggesting that the tremors have separate mechanisms. Likewise some patients had a symptomatic 6 HZ tremor on posture with a second peak at 8-10 HZ in the physiological band. Therefore, the 6 HZ postural tremor is not an exaggeration of physiological tremor. On the basis of wave form and frequency similarities postural tremor, the low frequency type of active or passive cogwheeling, intention tremor and clonus possibly involve a common spinal mechanism. Higher frequency cogwheel phenomenon and action tremor may be an exaggeration of physiological tremor. More than 80% of patients with Parkinson's disease manifest tremors at both 4-5 HZ and 6 HZ. This combination would appear to be the strongest objective criterion for the diagnosis of basal ganglia disease.

Electromyography↗
PubMed1981

Metoprolol and propranolol in essential tremor: a double-blind, controlled study.

Single oral doses of propranolol (120 mg), metoprolol (150 mg) and placebo were given in a randomised, double-blind fashion to 23 patients with essential tremor. Both beta blockers were significantly more effective than placebo in reducing the magnitude of tremor. The decrease in tremor produced by metoprolol (47, sem 9%, n = 23) was not significantly different from that observed propranolol (55, sem 5%, n = 23). Tachycardia on standing was antagonised by both drugs to a similar extent. These findings suggest that metoprolol may represent a valuable alternative to propranolol in the treatment of essential tremor. The data is consistent with the hypothesis that the tremorolytic effect of beta blockers in these patients may be unrelated to peripheral beta-2 adreno-receptor blockade, being possibly mediated by other central or peripheral modes of action of these drugs. However, it cannot be excluded that at the dose used, metoprolol had lost its relative cardio-selectivity and that the reduction in tremor was mediated by competitive antagonism at beta-2 receptor sites in skeletal muscle.

Adult↗
PubMed1981

The value of chest roentgenograms in acute asthma in adults.

Chest roentgenograms were obtained in 90 episodes of acute asthma in adults coming to an emergency room. Of these 90 roentgenograms, 50 (55 percent) were interpreted as normal, 33 (37 percent) showed hyperinflation, and 6 (7 percent) showed minimal interstitial abnormalities unchanged from previous roentgenograms. One (1 percent) showed a new alveolar infiltrate in a patient with allergic aspergillosis. There was no significant correlation between chest roentgenogram interpretation and hospitalization. Our data show that the incidence of specific abnormalities on chest roentgenogram in adults with uncomplicated acute asthma is low and suggests that the information obtained from the roentgenogram is rarely helpful to outpatient management. Chest roentgenograms probably are indicated only when there is clinical evidence of pneumonia, a complication of asthma, or a pulmonary disorder that mimics asthma.

Adolescent↗
PubMed1981

Tremor.

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Aged↗
PubMed1980

Mechanism of rotatory eye movements in opsoclonus.

'Rotatory nystagmus', in which the visual axis of the eye moves involuntarily in the horizontal and vertical planes describing a closed loop trajectory, was analysed by means of combined video and electro-oculography in a patient with multiple sclerosis having numerous ocular signs of cerebellar disease. The rotations were sporadic, isolated single cycles having stereotyped, crescentiform loop shapes. Each consisted of a combination of a single cycle of vertical ocular flutter, the onset of which was followed 40 to 50 milliseconds later by a single cycle of horizontal ocular flutter. The timing relationship between flutters suggest that the vertical and horizontal systems had become somehow entrained. Rotatory nystagmus is saccadic in nature and arises from a unique timing relationship between vertical and horizontal flutter.

Adult↗