Biomedical subjects
M Rosenthal
Publications and source records attributed to M Rosenthal.
Central nervous system IgG synthesis rates in Alzheimer disease: possible differences in early-onset and late-onset subgroups.
Central nervous system IgG synthesis rates were determined for 51 patients with autopsy-confirmed Alzheimer disease and 23 age-matched controls. Rates were no different between patients and controls when overall groups were compared. Age-at-dementia-onset data were available on 37 patients. Comparisons of 11 early-onset (< 65 years of age) patients with 26 late-onset patients revealed significantly increased intrathecal IgG synthesis rates for the late-onset group. These results suggest that IgG synthesis may be a contributing pathogenic factor in a subgroup of patients with late-onset Alzheimer disease.
Trazodone for antidepressant-associated insomnia.
OBJECTIVE: The authors investigated trazodone as a hypnotic for depressed patients who had persistent, exacerbated, or new insomnia while taking either fluoxetine or bupropion. METHOD: Seventeen depressed patients who had insomnia while taking fluoxetine or bupropion were given either trazodone or placebo in a double-blind crossover trial. Sleep was assessed by self-report with the Pittsburgh Sleep Quality Index and the sleep items of the Yale-New Haven Hospital Depressive Symptom Inventory. RESULTS: Improvement with trazodone, but not with placebo, was shown by the total Pittsburgh index scores and Yale-New Haven inventory total sleep scores and by the Pittsburgh index measures of sleep duration and Yale-New Haven inventory measures of early morning awakening, and there was a trend toward improvement in the Yale-New Haven inventory item regarding middle of the night awakenings. Subjective sleep quality and sleep latency also showed a trend toward improvement, but the Pittsburgh index measures of sleep efficiency and disturbances and the Yale-New Haven inventory item regarding difficulty falling asleep were unaffected by trazodone. One patient dropped out because of excessive daytime sedation with trazodone, and another dropped out because of nonresponse to placebo. Of the completers, 67% experienced overall improvement in sleep with trazodone according to a priori criteria, whereas only 13% experienced improvement with placebo. CONCLUSIONS: Trazodone is an effective hypnotic for patients with antidepressant-associated insomnia.
Predicting community integration after traumatic brain injury with neuropsychological measures.
A neuropsychological test battery was administered to 23 subjects with traumatic brain injury during initial inpatient rehabilitation who were participating in the national Traumatic Brain Injury Model Systems study. Trails B and the Rey Auditory Verbal Learning Test total scores obtained during inpatient rehabilitation were significantly correlated with the Community Integration Questionnaire total score that was administered at one year postinjury. These findings suggest that performances on tests of cognitive speed and flexibility, complex attention, and memory during the acute phase of recovery may be useful for the later prediction of "real world" behavior and psychosocial outcome after one year postinjury.
Adverse interaction of cyproheptadine with serotonergic antidepressants.
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Exposure of rats to a 50-Hz, 30-mT magnetic field influences neither the frequencies of sister-chromatid exchanges nor proliferation characteristics of cultured peripheral lymphocytes.
The issue of potential carcinogenic effects of extremely low-frequency (50/60-Hz) electric and magnetic fields (EMF) has developed almost completely from epidemiological studies suggesting a link between residential or occupational exposure to EMF and an elevated risk of various cancers. Concerning chromosome-altering effects of EMF, in vitro studies gave ambiguous results and only few in vivo studies have been done. In the present study, we investigated the effect of long-term exposure of rats to a 50-Hz, 30-mT magnetic field (MF) on cell proliferation and frequencies of sister-chromatid exchanges (SCE) in peripheral lymphocytes of rats following exposure to MF for 7 or 28 days. As a positive control, rats were treated with cyclophosphamide. In contrast to cyclophosphamide, MF exposure influenced neither SCE frequencies nor proliferation characteristics of cultured peripheral lymphocytes.
Mild traumatic brain injury syndrome.
The mild post-traumatic brain injury syndrome has continued to pose clinical management problems for medical specialists from the emergency physician to the family practitioner. The contribution of preinjury medical and psychosocial factors, along with the concomitant risk of litigation, complicates the diagnostic task. This review examines selected aspects of this problem, including definition and classification, pathophysiology, symptom constellation, medicolegal pitfalls, diagnostic procedures, and treatment recommendations. Practitioners need to be particularly alert to the optimal strategies for emergency department management to prevent "mild" injuries from becoming major disabilities.
Adenosine, a "retaliatory" metabolite, promotes anoxia tolerance in turtle brain.
Contrary to what is found in most vertebrates, the brains of certain turtle species maintain ATP levels and ion homeostasis and survive prolonged anoxia. The hypothesis tested here is that the release of adenosine and its binding to A1 receptors are essential for this anoxic tolerance. Studies were conducted in the isolated turtle cerebellum, which did release adenosine to the extracellular space during anoxia. When adenosine receptor antagonists [theophylline, 8-cyclopentyltheophylline (CPT), or 8-cyclopentyl-1,3-dipropylxanthine (DPCPX)] were added to the superfusate under control conditions, they had no effect on extracellular potassium ion activity ([K+]o). During anoxia, however, these antagonists provoked maximal efflux of K+ (anoxic depolarization). Anoxic depolarization occurred earlier during anoxia with theophylline (a nonspecific adenosine receptor antagonist) than with CPT or DPCPX, which specifically block A1 receptors. Therefore, adenosine release and effects mediated by A1 receptors are essential to anoxia tolerance in turtle brain.
A pathophysiological approach to the patient in shock.
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The pathophysiology of respiratory failure.
Although the treatment of respiratory failure requires therapeutic modalities aimed at the underlying disease process, the approach in this chapter provides an additional format for understanding and treating the physiological abnormalities that predominate in nearly all forms of respiratory failure. Treatment to normalize VA, FRC, lung water, and PVR in addition to specific diagnostic tests and disease-oriented therapies will provide the best opportunity for successful outcome.
Lung function in white children aged 4 to 19 years: I--Spirometry.
OBJECTIVE: A study was performed to produce reference standards for spirometric lung function in white children and to calculate standard deviation scores adjusted for gender and pubertal stage. METHODS: A cross sectional study was made of 772 white children aged 4.6 to 18.8 years (455 male) tested on an OHIO 840 spirometer and assessed anthropometrically and pubertally. RESULTS: Before puberty there was a linear increase in all lung function measurements with height. During puberty a sudden increase occurred, but subsequently the relationship was again linear. No simple single equation described this pattern. Advanced puberty in younger children conferred a respiratory advantage, whilst delayed puberty resulted in the converse. Girls had poorer volumes per unit height, but young girls had superior airflow/unit lung volume. In both sexes lung volumes and flows bore a constant relationship to external thoracic dimensions. CONCLUSIONS: Puberty has a dramatic effect on lung function. Regression equations for predicted values of lung function measurements and for calculation of standard deviation scores are given (with pubertal correction factors) for each gender.
Lung function in white children aged 4 to 19 years: II--Single breath analysis and plethysmography.
OBJECTIVE: A study was performed to determine reference ranges for whole body plethysmographic gas volumes and single breath gas transfer in healthy prepubertal and pubertal schoolchildren. METHODS: The study was performed in 772 white London schoolchildren (455 male) who were clinically examined, assessed auxologically and, in 63% of cases, pubertally staged. Regression equations for the calculation of standard deviation scores were derived. RESULTS: Male lung function variables showed a discontinuous pattern of increase with standing height. Linear increases until puberty were followed by a sudden pubertal rise and a further increase with height which was more marked than before puberty. Correction for varying thoracic dimensions eliminated these changes. In females a smoother curvilinear relationship was observed with no correction possible for thoracic size. CONCLUSIONS: Male puberty leads to profound changes in pulmonary function mostly related to thoracic size, an effect not observed in females.
Double-blind, placebo-controlled study of a once-a-day, sustained-release preparation of alprazolam for the treatment of panic disorder.
OBJECTIVE: The goals of this study were to assess the antipanic efficacy of a new, sustained-release formulation of alprazolam and to assess the safety and tolerability of once-a-day administration of 1-10 mg of sustained-release alprazolam. METHOD: One hundred ninety-four patients with diagnosis of agoraphobia with panic attacks or panic disorder with limited phobic avoidance underwent a 1-week placebo washout before being randomly assigned to groups receiving 8 weeks of double-blind treatment with either sustained-release alprazolam or placebo. RESULTS: There was a significant treatment effect favoring sustained-release alprazolam (highest mean dose = 4.7 mg/day) across almost all measures of anxiety, panic, and phobic avoidance, despite a significantly higher dropout rate in patients receiving placebo. Eighty-five percent of the patients treated with sustained-release alprazolam, compared with 61% of the patients given placebo, reported complete blockade of panic attacks by the end of 6 weeks of treatment. Sedation was the most commonly reported adverse effect. Discontinuation of sustained-release alprazolam was associated with moderate but transient levels of distress in 48% of the patients; discontinuation of placebo led to distress in only 10% of the patients. Nonetheless, there was no difference in the proportion of patients who were able to remain off the study drug for at least 2 weeks. CONCLUSIONS: These results suggest that sustained-release alprazolam is highly effective in the acute treatment of panic disorder at doses comparable to those in the originally marketed compressed tablet of alprazolam. The medication was well tolerated but showed rebound effects during a rapid drug taper after 6 weeks of treatment.
Vitamin E treatment of tardive dyskinesia.
OBJECTIVE: The authors studied the effects of vitamin E treatment of tardive dyskinesia; earlier studies have produced contradictory results. METHOD: Twenty-eight patients with tardive dyskinesia were treated in a double-blind, parallel-group comparison study of 8-12 weeks of treatment with vitamin E (1600 IU/day) or matching placebo capsules. RESULTS: The Abnormal Involuntary Movement Scale scores of the patients treated with vitamin E improved significantly compared to the scores of the patients given placebo. CONCLUSIONS: These results support earlier findings of the efficacy of vitamin E in treating tardive dyskinesia.
A controlled clinical study on the new topical dosage form of DHEP plasters in patients suffering from localized inflammatory diseases.
In this clinical study the efficacy and the tolerability of a new topical formulation, DHEP plaster, have been evaluated. The plaster consists of an auto-adhesive medicated gauze pad of standard dimensions (10 x 15 cm) containing 180 mg DHEP. The reference drug was a well-known topical drug, diclofenac diethylammonium (DDA) emulgel at 1.16%. Treatments were applied to the affected area for 14 days: DHEP plaster b.i.d. and DDA emulgel q.i.d. A total of 190 patients, affected by various inflammatory diseases, participated in this clinical study. In both treatment groups (DHEP n = 96 patients, DDA n = 94 patients) a clear improvement in the disease and a rapid reduction in pain were observed. The statistical comparison between the two treatments showed a significant difference in favour of DHEP. However a comparison of the results, according to the different diagnoses, did not reveal any statistical significance. Both treatments were well tolerated, although five (DHEP n = 2, DDA n = 3) out of the 190 patients (2.6%) showed transient side effects (pruritus or erythema, both of light intensity).
Vitamin E in tardive dyskinesia: time course of effect after placebo substitution.
Alpha-tocopherol (vitamin E) has been found to be effective in the treatment of tardive dyskinesia (TD). Studies to date have been short in duration and have not found long-term carryover effects of vitamin E. The present study examined the persistence of the effects of vitamin E after longer term (36-week) treatment was discontinued. Vitamin E significantly improved TD over this period. However, the effects of vitamin E persisted so that TD scores approached baseline only after 12 weeks of placebo substitution.
Management of combative trauma patients.
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Diagnosing acute cardiac ischemia.
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