Biomedical subjects
Publications and source records attributed to O Kristensen.
In a double-blind crossover pilot study with placebo, choline chloride, the physiologic precursor of acetylcholine, was tested in six patients with cerebellar ataxia. Neither subjectively nor objectively could any statistical significant difference be demonstrated.
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Brain stem electric responses (BSER), evoked by acoustic stimuli, were investigated in 29 patients with multiple sclerosis and compared with the responses in a control group of 26 young adults without neurological disease or hearing defect. The procedure included monaural and binaural stimulus presentation of single clicks and pairs of clicks. In the evaluations the vertex-positive Jewett I, III and V response components, and the vertex-negative "FFP7" peak were considered. In the assessment of the BSER components, the FFP7 (the vertex-negative 7 ms far field potential following the JewettV wave) proved to be the best single component with respect to reproducibility in normal subjects. In addition the FFP7 was the single most consistently abnormal component in the patient group. Determination of the latency of the Jewett components and the interpeak conduction times, however, contributed further to the disclosure of the abnormal cases. Five of the patients whose hearing was impaired were considered separately. Of the remaining 24 patients, 20 (83%) had BSER abnormalities. Further analysis did not reveal a clear correlation between BSER abnormalities and clinical signs of brain stem dysfunction.
Endoscopic retrograde brush cytology (ERBC) was performed in 29 patients with primary pancreatic malignancies verified later by histology. Results were positive in 21 patients, suspicious in five, and negative in three. ERBC performed in seven patients with uncertain findings at endoscopic retrograde cholangiopancreatography (ERCP) was positive for malignancy in six and suspicious in one. Endoscopic aspiration cytology (EAC) performed in 10 patients with primary tumours was positive for malignancy in three, suspicious in two, and negative in five cases. ERBC and/or EAC performed in five cases with secondary tumours were positive for malignancy in one and negative in four. It is concluded that ERBC gives a high rate of positive or suspicious (90%) diagnosis of malignancy in patients with primary pancreatic lesions. In secondary tumours cytology seems to be negative in most cases. The study further shows that many of the malignant tumours found by ERP are secondary lesions. Cytology is often able to detect malignancy when ERP has proved inconclusive.
In a controlled investigation of paranoid hallucinatory chronic or episodic epileptic psychoses, the social data, psychopathological symptoms and the psychological test findings (WAIS, Rorschach, object-sorting, proverb-interpretation and the Stroop test) were analyzed in order to delineate the characteristics of the psychotic syndrome and to evaluate the significance of organic etiological factors. The study comprised 45 patients with complex partial epilepsy followed by psychosis after median 23 years, and 34 control patients with the same type of epilepsy of median 30 years' duration. Among the psychotic symptoms, simple, mostly empathizable persecutory delusions and auditory hallucinations predominated. The affect tended to remain appropiate, and autistic traits were uncommon. In accordance with this finding of a relatively circumscribed psychotic personality disturbance, psychotic test indicators were infrequent in the psychological tests, the Rorschach test 28%, and the object-sorting test 18% of the cases. The poorer test performances in the WAIS and the Stroop tests, and the preponderance of organic Rorschach test signs in the psychotic group indicate that organic cerebral damage is of etiological significance in paranoid epileptic psychosis.
In a controlled investigation the clinical findings in 96 patients with paranoid/hallucinatory psychosis and partial epileptic seizures with complex symptoms, were compared with the findings in 96 control patients with the same type of epilepsy without psychosis of median 24 years' duration. The median age at onset of psychosis was 34 years, after epilepsy of median 21 years' duration. The seizure frequency of complex, partial seizures was significantly lower in the psychotic group, while the frequency of generalized seizures did not differ. A significant preponderance in the psychotic group of left-handed patients, etiological factors and neurological signs reflecting organic damage, and seizures of automatic behaviour indicates that epileptic psychoses are caused by structural lesions affecting the deep parts of the temporal lobe.
An isoquinoline derivative Ro 8-4650 (rac-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-7-methoxy-2-methylisoquinoline hydrochloride) with dopaminergic properties was studied in a randomized crossover trial. The group studied comprised 37 patients with idiopathic parkinsonism and persistent symptoms, despite levodopa treatment. Median Webster rating before allocation was 11.5. The trial drug did not differ significantly from placebo as regards effect and involuntary movements. It led to more frequent minor side effects.
The diagnostic value of sphenoidal electrode EEG recordings in patients with seizures characteristic for epilepsy with complex partial symptomatology was assessed in a study comprising 404 patients; 71.3% of the patients had seizures with automatisms and amnesia, and 28.7% had psychic seizures with subjective phenomena such as hallucinations and illusions. A total of 59.6% of the patients had diagnostic EEG changes in routine waking or sleep EEG. In sphenoidal EEG recording including thiopenthone activation, diagnostic changes were found in 40.5% of the patients without specific changes in waking or sleep EEG, the chance of a positive finding being more than five times higher in patients with automatisms than patients with psychic seizures. Apart from cases where surgical treatment of temporal lobe epilepsy is considered, sphenoidal electrode EEG recording, including intravenous thiopenthone activation, should be performed in patients with seizure phenomena raising suspicion of epilepsy with complex partial symptomatology but where waking and sleep EEGs fail to demonstrate specific abnormalities.
Of 156 consecutive patients with malignant tumor of the testis 99 were alive two years after treatment. Of these, 12 had radiation-induced neurologic complications which, in 5 instances, consisted of persisting, wholly or partially disabling paresis in the lower limbs. Five had mild, transient symptoms and had persisting symptoms which were not incapacitating. In all those with disabling symptoms the irradiation dose had been higher than 1 600 reu, corresponding to 54.5 Gy over 6 weeks with daily fractions 5 days a week.
The EEG findings in waking, sleep, and sphenoidal electrode recordings in 96 patients with partial epileptic seizures with complex symptoms, who, after a median interval of 18 years developed paranoid/hallucinatory psychosis, were compared with the findings from a group of patients without psychosis, who had had the same type of epilepsy in median 24 years. There were no significant differences between the two groups with regard to median age at onset of epilepsy or complex partial seizures, age, or duration of epilepsy at time of examination. The psychotic patients had a significant preponderance of temporal medio-basal spike foci, recorded on the sphenoidal electrode, indicating deep temporal lobe dysfunction as an important factor in the pathogenesis of psychosis. A significant higher frequency of bilateral and multiple spike foci, together with a significant frequency of slow-wave admixture to the waking background EEG activity, indicated more extensive and severe epileptogenic lesions in the psychotic patients. There was no correlation between psychosis and unilateral EEG-foci in either temporal lobe.
The clinical findings in four cases of radiation injury to the lumbosacral spinal cord and cauda equina, occuring after radiotherapy of malignant testicular tumours with radiation doses of 1597-1670 ret, are reported. The main feature in each case was a flaccid paraparesis, without sensory loss in three cases, while one patient presented a doubtful sensory deficit. Symptoms of sphincter dysfunction were absent. In all cases the symptoms caused a marked and persistent incapacity. It is suggested that the principal site of radiation injury is the proximal parts of the lower motor neuron.
The dopaminergic agonist bromocriptine in doses of 2.5-40 mg was compared with placebo in a double-blind cross-over study (12 + 12 weeks) in 11 Parkinson patients in whom bothering dyskinesia occurring after prolonged levodopa treatment limited in the levodopa dose to a level, where Parkinson symptoms still were present to an unsatisfactory degree. On the basis of changes in rating scales and the patients' preference, bromocriptine was significantly superior to placebo. Dyskinesia, occurring during bromocriptine treatment in 9 of 11 patients, disappeared within the period of study in 6 patients after dose reduction without changes in Parkinson disability scores to placebo level. Bromocriptine seem to be of value in cases where the balance between minimal dyskinesia and Parkinson symptoms is impossible to obtain with levodopa treatment alone.
In order to evaluate the prognosis and possible prognostic factors associated with a bening course, 118 cases of motor neuron disease diagnosed 1948-1975 were followed up. Survival curves, based on the actuarial method showed a survival rate of 18.7 per cent (95 per cent confidence limits: 11.4-26.0) and 7.6 per cent (95 per cent confidence limits: 2.7-12.5) after 5 and 10 years respectively. Comparing the survival curves of males/females, cases with bulbar/spinal- and upper/lower extremity onset, cases with/without upper motor neuron signs, only bulbar onset was associated with a significantly poorer prognosis. However, cases with bulbar onset had a significantly higher mean age of onset. Based on cases from Funen county with a 1970-population of 432,699 we found an average annual incidence rate, mortality rate and period prevalence rate of 0.85, 0.86 and 2.5 per 100,000 respectively. Comparing the incidence per 5-year period through 1948-1972, no significant deviations indicating a changing environmental factor were found.
Of 24 patients with newly diagnosed thyrotoxicosis, 13 were randomly selected for treatment with methimazole 40 mg per day, and 11 for treatment with lithium carbonate in such doses that the serum lithium lay between 0-5 and 1-3 meq. per litre. The lithium treatment brought about a fall in serum-thyroxine iodine (T4I) of 27.0%, and in the free-thyroxine index (F.T.I.) of 38.1% after 10 days. A comparison of the two patient groups with regard to the fall in F.T.I. after 3 and 10 days showed no statistically significant difference; similarly the calculated confidence limits appeared to exclude any difference of clinical importance. 8 of the 11 patients subjected to lithium treatment had side-effects, so that the general condition, which was already affected by the hyperthyroidism, was worsened. It is concluded that lithium cannot be considered superior to thiocarbamides for the rapid control of thyrotoxicosis.
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