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Biomedical subjects

M Fink

Publications and source records attributed to M Fink.

At least 127 records · Page 7Linked to original sources
PubMed1996

Toxic serotonin syndrome or neuroleptic malignant syndrome?

Administration of medications which affect brain dopamine and serotonin levels are occasionally associated with neurotoxic behavioral and autonomic syndromes, variously described as the neuroleptic malignant (NMS) and the toxic serotonin (TSS) syndromes. Based on concepts of the presumed brain mechanisms of action of the drugs, different corrective interventions have been recommended. We describe a case of neurotoxic syndrome with characteristics indistinguishable from NMS in which the offending agents are those which affect the serotonin and not the dopamine systems. The patient recovered with lorazepam and electroconvulsive therapy (ECT). We argue that NMS and TSS are examples of a non-specific generalized neurotoxic syndrome, and not specific syndromes: and that these are subtypes of catatonia. Patients today should be treated with benzodiazepines, and if these fail, with ECT, interventions which are effective in relieving catatonia.

Antidepressive Agents, Tricyclic↗
PubMed1996

Convulsive therapy in schizophrenia?

Schizophrenia is a clinical syndrome of extraordinary importance and complexity. Its early identification is difficult, and our concepts of its main characteristics have undergone many changes in the past century. Electroconvulsive therapy (ECT) was introduced as a treatment for dementia praecox. The initial reports were salutary, and the treatment was widely applied until it was replaced by psychoactive drugs. ECT was reintroduced in the 1970s in the treatment of therapy-resistant disorders. The initial reviews argued that ECT was not applicable in patients with schizophrenia, a conclusion based mainly on experience with chronic forms of the disorder. This article assesses the role of ECT in schizophrenia today. We find it to be an effective treatment for psychosis. ECT is particularly applicable in patients with first-break episodes, especially those marked by excitement, overactivity, delusions, or delirium; in young patients, to avoid debilitating effects of chronic illness; and in patients with syndromes characterized by catatonia, positive symptoms of psychosis, or schizoaffective features.

Chronic Disease↗
PubMed1996

Catatonia. I. Rating scale and standardized examination.

To facilitate the systematic description of catatonic signs, we developed a catatonia rating examination, rating scale and screening instrument. We constructed a 23-item rating scale and a truncated 14-item screening instrument using operationalized definitions of signs ascribed to catatonia in published sources. Inter-rater reliability was tested in 44 simultaneous ratings of 28 cases defined by the presence of > or = 2 signs on the 14-item screen. Inter-rater reliability for total score on the rating scale was 0.93, and mean agreement of items was 88.2% (SD 9.9). Inter-rater reliability for total score on the screening instrument was 0.95, and mean agreement of items was 92.7% (SD 4.9). Diagnostic agreement was high based on criteria for catatonia put forth by other authors. Seven per cent (15/215) of consecutively admitted patients to an academic psychiatric in-patient facility met criteria for catatonia. It is concluded that catatonia is a distinct, moderately prevalent neuropsychiatric syndrome. The rating scale and screening instrument are reliable and valid. Their use facilitates diagnosis, treatment protocols, and cross-study comparisons.

Catatonia↗
PubMed1996

Catatonia. II. Treatment with lorazepam and electroconvulsive therapy.

Case material and retrospective studies support the use of both lorazepam and ECT in treating catatonia, but few prospective investigations exist and none employ quantitative monitoring of response. In this study we test their efficacy in an open, prospective protocol, and define a "lorazepam test' with predictive value for treatment. Twenty-eight patients with catatonia were treated systematically with parenteral and/or oral lorazepam for up to 5 days, and with ECT if lorazepam failed. Outcome was monitored quantitatively during the treatment phase with the Bush-Francis Catatonia Rating Scale (BFCRS). In 16 of 21 patients (76%) who received a complete trial of lorazepam (11 with initial intravenous challenge), catatonic signs resolved. A positive response to an initial parenteral challenge predicted final lorazepam response, as did length of catatonic symptoms prior to treatment. Neither demographic variables nor severity of catatonia predicted response to lorazepam. Four patients failing lorazepam responded promptly to ECT. It is concluded that lorazepam and ECT are effective treatments for catatonia. The rating scale has predictive value and displays sensitivity to change in clinical status.

Adult↗
PubMed1996

Time reversal focusing applied to lithotripsy.

Time reversal of ultrasonic field allows a very efficient approach to focusing pulsed ultrasonic waves through lossless inhomogeneous media. Time reversal mirrors (TRM) are made of large transducer arrays, allowing the incident acoustic field to be sampled, time reversed and re-emitted. Time reversal processing permits a choice of any temporal window to be time reversed, allowing operation in an iterative mode. In multitarget media, this process converges on the most reflective target, i.e., the dominant scatterer. In this paper, the time reversal process is applied to track, in real time, a moving gall bladder or kidney stone embedded in its surrounding medium. We investigate the feasibility of a piezoelectric shock wave generator in which the focal zone is moved electronically to track the stone during a lithotripsy treatment. We show that TRM allows us to obtain sharp focusing on one bright point of the stone. The time of flight profile is then determined and used in a least-mean-square method to calculate the spatial coordinates of the stone.

Cholelithiasis↗
PubMed1996

Iodine-131 treatment of hyperthyroidism: significance of effective half-life measurements.

UNLABELLED: Our goals were to evaluate the effect of half-life determination and differences in the half-life of 131I between patients with Graves' disease and toxic nodular goiter, and the influence of antithyroid drugs on iodine uptake. METHODS: We reviewed the records of 555 patients who had received radioiodine treatment for Graves' disease and toxic nodular goiter to analyze iodine uptake, half-life values and pretreatment with antithyroid drugs. Two different methods of dose calculation were compared: one using repeated uptake measurements at 24 and 48 hr and 4 or 6 days to define the effective half-life. The other method assumed a half-life of 5 days and uptake at 24 hr only. All patients were treated according to the first method. A follow-up questionnaire was sent to 327 patients (238 responders) to assess the treatment outcome. RESULTS: After comparing the results of the two methods, we found that repeat uptake measurements and determination of effective half-life results in administered activities that differ considerably from those calculated when an assumed, fixed half-life and a single uptake measurement are used. The simpler method would lead to over- as well as undertreatment of the patient. There was a functional difference between patients with Graves' disease and toxic nodular goiter, as reflected by the shorter 131I half-life in Graves' disease (mean 5.0 days) than toxic nodular goiter (mean 6.0 days) and a skewed distribution in toxic nodular goiter. Patients pretreated with antithyroid drugs had shorter 131I half-lives in both categories. Ten percent of the patients required more than one treatment; 94% of the patients with Graves' disease and 45% with toxic nodular goiter had thyroxine substitution 1-5 yr after treatment. CONCLUSION: A dose calculation method that uses three uptake measurements provides sufficient data about the effective half-life of 131I in the thyroid. There is considerable difference in the half-life based on the disease being treated (Graves' disease or toxic nodular goiter). The 131I half-life also is shorter after pretreatment with anti-thyroid drugs. Thus, the simpler method leads to significant uncertainty, leading to over- as well undertreatment of the patient.

Adult↗
PubMed1996

Atrial fibrillation, anticoagulation, and electroconvulsive therapy.

We describe our experience with six patients with atrial fibrillation (AF) during electroconvulsive therapy (ECT). In four, we observed episodic or persistent conversion of AF to normal sinus rhythm (NSR). Four patients, three with cardioversion and one without, received anticoagulation. In published case reports, ECT was successfully performed in three patients with AF without anticoagulation and in three patients with AF who received anticoagulation. In addition, 18 patients received ECT while taking concomitant anticoagulation therapy for reasons other than AF. Despite the potential risk of embolization with AF, we consider ECT may be safely administered to patients with AF. Because of the high incidence of conversion of AF to NSR, anticoagulation therapy with either warfarin or heparin is recommended.

Aged↗
PubMed1996

The "half-age" stimulation strategy for ECT dosing.

Energy levels affect the treatment efficacy and efficiency of electroconvulsive therapy (ECT). United States devices require preselection of energy dosage before stimulating patients, and two strategies have been proposed to determine an effective dosage, i.e., based on the patient's age and measured estimates of seizure threshold. The age method is criticized for overstimulation and an assumed association with increased cognitive effects. Threshold determination strategy is cumbersome and requires multiple stimulations, possibly placing patients at increased cardiovascular risk. In 35 patients, we examined an energy estimate for bilateral electrode placement at half the patient's age in "percent of energy" or joules delivered by the Thymatron and MECTA devices. Each patient required one stimulation in the first treatment to elicit motor seizures averaging 51.7 s. Subsequently, 20 patients were randomly assigned to either threshold titration followed by half-age for the first two treatments or the opposite (AB-BA design). Half-age energy was 7 J (30%) higher than titration estimates, corresponding to 55% energy of the age method. The relation of half-age and titration estimates were confirmed in energy dosing records from two independent centers. Energy dosing by half-age calculation in bilateral ECT is simple, practical, avoids overdosing and repeat stimulation, and is a useful substitute for the more complex strategy based on threshold estimation.

Aging↗
PubMed1996

[The influence of heart infarction on the concentration of aminoterminal type III procollagen peptide in blood serum].

UNLABELLED: The reconstructive processes in a heart infarction pertain also the fibrous tissue sceleton, of which the main element are collagen fibres. The aim of the study was determination of variability of a specific collagen synthesis marker, i.e. the serum aminoterminal type III procollagen peptide (PIIINP) and its correlation with hydroxyproline (HP), hydroxylysin (HL) concentration as well as activity of creatine kinase (CK) and aspartate aminotransferase (AspAT) in serum after heart infarction. The investigations were carried out in 30 patients with a heart infarction with Q wave (group I), in 20 subjects with a heart infarction without Q wave (group II) and in 30 healthy subjects, comprising the C group. All these parameters were determined on the 1st, 2nd, 3rd, 5th and 10th day after onset of infarction. In comparison to the C group, in group I on the 1st day the PIIINP concentration was 3-fold higher and in group II it 2 1/2-fold higher (C = 4.3 +/- 1.8; I = 14.2 +/- 3.9; II = 10.4 +/- 2.0 micrograms/l; p < 0.001). In group I even on the 10th day the concentration did not return to normal values, instead in group II it reached the values x + SD in C group after 5 days. There was no significant correlation between concentration of PIIINP and all other examined parameters stated. Heart infarction with a Q wave caused a relatively highest (% of mean values in C group) increase in CK and AspAT activity, PIIINP held a medial position, while HP and HL the lowest. After infarction without a Q wave the relative elevation of PIIINP concentration was near to the AspAT and HP increase. CONCLUSIONS: 1. the differences of serum PIIINP concentration are probably resulted by the magnitude of heart infarction. 2. During 10 days after the onset of heart infarction the serum concentration of PIIINP does not show any correlation with HP, HL and enzymatic heart infarct markers. 3. The results indirectly show, that the scar formation after heart infarction begins already on the first day.

Adult↗
PubMed1996

[Effect of heart infarction on levels of type I procollagen carboxyterminal peptide in blood serum].

The aim of the study was determination of the influence of heart infarction on the blood serum level of type I procollagen carboxyterminal peptide (PICP) and its covariability with concentration of hydroxyproline (HP) and hydroxylysine (HL) as well as activity of creatine kinase (CK) and aspartate transferase (AspAT). The investigations were carried out in 30 patients with a heart infarction with Q wave (group I) and in 20 subjects with a heart infarction without Q wave. The control group comprised 30 healthy subjects. The determination of all parameters was performed on the 1st, 2nd, 3rd, 5th and 10th day after the infarct onset. On the 1st day of heart infarction, the concentration of PICP in serum was (x +/- SD): gr. I-235 +/- 33, gr. II-209 +/- 8, gr. C-65 +/- 17 micrograms/l. There was no co-variability of PICP concentration and the values of all other determined parametres. The authors conclude: 1. the increase of serum PICP concentration is connected probably with the magnitude of heart infarction, 2. the reconstruction process of the heart fibrous tissue and scar formation begins already on the first day of infarction onset, 3. during 10 days after infarction onset the serum PICP concentration does not correlate with HP, HL as well as the enzymatic heart infarct indices, namely CK and AspAT.

Adult↗