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Biomedical subjects

P Schnider

Publications and source records attributed to P Schnider.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Stroke and intracranial hemorrhage after cocaine abuse].

Cocaine abuse as a risk factor for acute cerebrovascular events has received too little attention, in particular in young patients. Cocaine hydrochloride causes mainly intracerebral and subarachnoidal bleeding, while crack (freebase) causes intracranial hemorrhage and ischemic infarctions with equal frequency. Although no specific antidote is known, an attempt should be made to detect the substance or its metabolites in the urine so as to provide optimal management, and encourage the patient to seek expert counselling.

Adolescent↗
PubMed1997

Whipple's disease: comparison of histology with diagnosis based on polymerase chain reaction in four consecutive cases.

BACKGROUND: Polymerase chain reaction (PCR) based detection of species specific sequences of the 16S rRNA gene of Tropheryma whippelii is a recently described method for diagnosis of Whipple's disease. AIMS: Comparison of histology with PCR in mucosal samples of patients with Whipple's disease before, during, and after treatment. Detection of T whippelii in peripheral blood mononuclear cells as a non-invasive test for infection. METHODS: Four consecutive patients with histologically proven Whipple's disease were studied prospectively. RESULTS: In untreated patients biopsy specimens taken from regions with PAS positive macrophages gave a positive result with PCR for T whippelii; however, a PCR signal was also found in tissue biopsy specimens from mucosal regions with negative histology. In two of the patients the PCR performed with nucleic acids extracted from peripheral blood mononuclear cells was positive. After treatment with sulfamethoxazole/trimethoprim the PCR became negative after one month in two patients and after two months in the third patient treated, whereas PAS positive macrophages were found throughout the treatment period in two patients and disappeared in only one of them thereafter. CONCLUSIONS: Detection of T whippelii specific sequences based on the PCR is useful to confirm the diagnosis, is able to detect a positive signal in samples taken from histologically negative mucosal areas, and can be used to monitor treatment. The PCR can sometimes be positive in peripheral blood mononuclear cells, but this cellular compartment cannot be taken as a substitute for duodenal biopsy specimens in the diagnosis of Whipple's disease.

Actinobacteria↗
PubMed1997

Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms.

We performed a randomized double-blind study within-group comparison in 11 patients to study the effect of subcutaneous injections of botulinum A toxin in focal hyperhidrosis of the palms. A total dose of 120 mU (mouse units) of botulinum A toxin (Dysport) was injected into six different sites on one palm, whereas the other was injected with sterile saline. Objective quantification of sweat production was performed using digitized ninhydrin-stained sheets. Three weeks after treatment, the mean reduction of sweat production in the botulinum A toxin-treated palms was 26% (P < 0.001), after 8 weeks 26% (P = 0.002) and after 13 weeks 31% (P < 0.001). Subjective assessment of sweat production by the patients using a visual analogue scale showed a 38% improvement in the botulinum A toxin-treated palms at 3 weeks (P = 0.002), 40% at 8 weeks (P = 0.002) and 38% at 13 weeks (P = 0.002). Neither the objective measurement nor the subjective rating showed a statistically significant reduction of sweating in the placebo-treated palms. Three patients reported reversible minor weakness of powerful handgrip after injection at the toxin-treated site, lasting between 2 and 5 weeks.

Adult↗
PubMed1996

Dynamic changes of plasma lipids and lipoproteins in patients after transient ischemic attack or minor stroke.

PURPOSE: Only few data are available concerning variations of lipids and lipoproteins in the acute stage after ischemic cerebrovascular events. It was the aim of this study to investigate whether the lipid and lipoprotein levels obtained in the first few days after a transient ischemic attack (TIA) or a minor stroke (MS) actually reflect "correct' values or "changed' (ie, false low) values, as in patients after acute myocardial infarction. PATIENTS AND METHODS: Total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and triglyceride (TG) levels of 37 unselected patients with TIA or MS were determined within 12-48 hours (Group A) or within 49-168 hours (Group B) after the acute event. After a mean observation period of 15.3 months, all patients were re-examined; the results were compared with those of the baseline evaluation. RESULTS: At the time of the baseline evaluation, TC and LDL-C levels of Group B patients were significantly lower than Group A levels. At the end of the observation period, however, Group A and Group B patients did not differ with regard to all four parameters. In comparison with the baseline examination, the values of Group A patients had not changed. In Group B patients, however, TC, HDL-C, LDL-C, and TG levels had significantly increased. CONCLUSION: Our results strongly suggest that lipid and lipoprotein levels of patients with TIA or MS should be assessed within a maximum of 48 hours after the acute event. If the examination cannot be performed within that period, the determination of reliable values is possible only after several weeks or months.

Adult↗
PubMed1996

Long-term outcome of patients with headache and drug abuse after inpatient withdrawal: five-year follow-up.

Thirty-eight patients with "chronic daily" headache and ergotamine and/or analgesics abuse according to the criteria proposed by the International Headache Society were re-investigated 5 years after inpatient drug withdrawal. At the end of the observation period, 19 patients (50.0%) had their headaches on only 8 days per month or less, 18 patients (47.4%) were free of symptoms or had only mild headaches. A close correlation was found between the frequency of headache and the duration of drug abuse, as well as between the intensity of headache and the number of tablets taken per month. Frequency and intensity of headache had changed within the first 2 years after withdrawal, but remained stable afterwards. Fifteen patients (39.5%) reported on recurrent drug abuse. Patients with migraine showed a tendency towards a better prognosis compared to patients with tension-type headache or with combined migraine and tension-type headache. The results of this study highlight the long-term efficacy of inpatient drug withdrawal in patients with headache and ergotamine and/or analgesics abuse.

Adult↗
PubMed1996

[Hyperhomocyst(e)inemia--an independent risk factor of stroke].

The total of free and protein-bound homocysteine including its derivatives is usually summarised as "homocyst(e)ine [H(e)]". Several congenital enzyme deficiencies may cause markedly elevated H(e) plasma levels, leading to the well-known clinical syndromes of homocystinuria. Recently, mild hyperhomocyst(e)inemia has been recognised as an independent risk factor for ischaemic cerebrovascular disease, coronary heart disease, and peripheral artery disease. H(e) levels are also related to the extent of atherosclerotic vessel wall alterations. The role of mild hyperhomocyst(e)inemia in venous thromboembolic disease, however, is not yet clear. A considerable proportion of patients with mild hyperhomocyst(e)inemia suffers from a deficiency of folate, vitamin B12, and/or vitamin B6. Supplementation of these agents--alone or combined with betain--leads to a decrease or even to a normalisation of elevated H(e) levels in the majority of such patients. Hitherto, no prospective randomised studies dealing with the clinical efficacy of such a--probably innocuous--supplementation have been performed. In the meantime, adequate alimentary intake of folate should be ensured.

Amino Acid Metabolism, Inborn Errors↗
PubMed1996

Monocular elevation paresis and contralateral downgaze paresis from unilateral mesodiencephalic infarction.

A 26 year old woman presented with monocular elevation paresis of the right eye, contralateral paresis of downward gaze, and subtle bilateral ptosis. Magnetic resonance imaging disclosed a unilateral embolic infarction restricted to the mesodiencephalic junction involving the left paramedian thalamus. Preserved vertical oculocephalic movements and intact Bell's phenomenon suggested a supranuclear lesion. This rare "crossed vertical gaze paresis" results from a lesion near the oculomotor nucleus affecting ipsilateral downward gaze and contralateral upward gaze fibres, originating in the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF).

Adult↗
PubMed1996

[Subjective disability caused by physical and psychological complaints in long-term follow-up after transient ischemic attacks or "minor stroke"].

Fifty-nine patients with transient ischaemic attacks or minor strokes were re-evaluated after a mean observation period of 16 months. The aim of this study was to assess their somatic and/or psychic complaints semiquantitatively. Judging from the Beschwerdenliste and the Depressivitätsskala (von Zerssen) filled in by the patients, they exhibited hardly more complaints than healthy controls; their scores were considerably lower than those of patients suffering from other organic or psychiatric diseases. Patients who not only suffered from cerebrovascular disease but also from coronary heart disease showed significantly higher scores on both scales than patients with cerebrovascular disease without clinically manifest coronary heart disease. Patients under observation for more than 2 years exhibited considerably fewer psychic complaints than those under observation for shorter periods of time. The Beschwerdenliste and the Depressivitätsskala (von Zerssen) proved useful for assessing somatic and/or psychic complaints in patients after transient ischaemic attacks or minor strokes.

Activities of Daily Living↗
PubMed1995

[Sumatriptan--side effects and problems in routine clinical practice].

AIM: The study tried to investigate the efficacy, adverse events and possible risk factors of sumatriptan in daily clinical practice. PATIENTS AND METHODS: 72 outdoor patients, who had treated their headaches at least once with sumatriptan, partly prescribed to them by outdoor physicians, were asked about their experiences with the drug. According to the criteria of the International Headache Society (1988) 55 patients were suffering from migraine, 11 from cluster headache and 6 from tension-type headache. RESULTS: Migraine and cluster patients rated the drug as effective as described in literature. Adverse events were reported by 69% of the patients which was more frequent than in most clinic studies described. Adverse events were usually not serious and transient. They were reported significantly more often by migraine patients than by patients with cluster headache and might not all be correlated to the therapy of sumatriptan. CONCLUSION: Sumatriptan has shown to be effective in the treatment of an acute migraine- and cluster-headache. The risk as to severe adverse events, especially cardial adverse events, exists if contraindications for sumatriptan are not considered. Sumatriptan should therefore only be prescribed to carefully diagnosed migraine and cluster headache patients. It should, however, not be given to patients suffering from drug abuse, because they might just change over to sumatriptan.

Adult↗
PubMed1995

MMPI and critical flicker frequency (CFF) analysis in headache patients with and without drug abuse.

Sixty-three headache patients (migraine: n = 28; tension-type headache: n = 35) who fulfilled the IHS criteria of 'drug abuse' were investigated by means of the Minnesota Multiphasic Personality Inventory (MMPI) and the Critical Flicker Frequency (CFF) analysis. The results were compared to those of 63 headache patients without drug abuse (matched-pair case-control study). With respect to the MMPI results, no statistically significant differences between patients with drug abuse and patients without drug abuse were found. However, patients with drug abuse showed significantly decreased CFF values compared to patients without drug abuse. This was true both for patients with migraine and for patients with tension-type headache. Thus, CFF analysis may serve as a useful method to differentiate between headache patients with drug abuse and those without drug abuse.

Adolescent↗
PubMed1995

Improvement of decreased critical flicker frequency (CFF) in headache patients with drug abuse after successful withdrawal.

A considerable proportion of headache patients fulfill the criteria of "drug abuse" (definition according to the International Headache Society [IHS] criteria). These patients exhibit markedly reduced vigilance and continuous performance, as shown by the results of critical flicker frequency (CFF) analysis. The present study deals with the question whether this impairment of vigilance and continuous performance is reversible. Forty-eight headache patients with drug abuse were investigated three times by means of CFF analysis: immediately before (A), immediately after (B), and 3 weeks after having finished (C) inpatient drug withdrawal. Immediately after withdrawal, a significant decrease of headache intensity was observed. The CFF values, however, remained unchanged at a depressed level, probably due to withdrawal medication and the initial sedative side effects of thymoleptic agents (given as prophylaxis). Three weeks after withdrawal, however, the CFF values were significantly improved, and were now within a range not far from the normal values known from a healthy general population. Thus, even after many years of drug abuse, headache patients have a good chance to improve their vigilance and continuous performance and to reach normal or close to normal levels.

Adult↗
PubMed1995

[Cocaine abuse--with special reference to cerebrovascular complications].

The role of drug abuse as a risk factor for cerebrovascular events has been underestimated, particularly in patients with juvenile stroke. The drug most often associated with acute cerebrovascular events is cocaine. After cocaine hydrochloride abuse intracerebral hemorrhages or subarachnoid hemorrhages--predominantly caused by ruptured aneurysms or arteriovenous malformations--are by far the most frequently observed cerebrovascular complications, whereas on abuse with the alkaloidal form ("crack") intracranial hemorrhages and ischemic strokes are encountered with equal frequency. In most cases, the time interval between drug abuse and the cerebrovascular event is less than 3 hours. Several pathophysiological mechanisms are discussed as serving as triggers for the cerebrovascular event, either alone or in combination. No specific antidote to cocaine is known. Nevertheless drug screening (urine analysis) should be performed immediately to allow optimal management of patients with drug-associated acute cerebrovascular events, especially in cases with juvenile stroke.

Cerebrovascular Disorders↗
PubMed1995

[Parkinson disease and neurologic rehabilitation].

Modern rehabilitation is becoming more and more "social integration" instead of "going back to work". Therefore rehabilitation is also a matter in chronic disease and in old people. Parkinson patients are somewhat disabled in nearly every aspect of their life, although the extent is related to the stage of the disease. Moreover, symptoms do not respond equally to drug treatment, balance (with succeeding falls) and swallowing being special problems for anti-parkinsonian drug treatment, but also vegetative symptoms, dysarthria, motor skills etc. Apart from medication patients get relief also from adjuvant therapy like physiotherapy, occupational therapy, and speech therapy, which all can lead to improvement of quality of life. Rehabilitation needs team effort. Patient and family supporting groups (like Parkinson Disease Society and others) are an important factor for all needs of neurological rehabilitation.

Activities of Daily Living↗
PubMed1995

[Increased residual urine volume after local injection of botulinum A toxin].

After major head trauma, a 28-year-old male patient developed tetraparesis with marked left-sided contractions of the leg adductors. Spasticity was resistant to antispastic drugs and intensive physiotherapy. Therefore, we injected 12.5 ng botulinum A toxin (Dysport) in the left adductor longus and adductor magnus. Eight measurements of the post-micturition residual urine of the bladder before botulinum-A-toxin administration gave no evidence for urinary retention. Between day 5 and 14 after injection we measured pathologically increased urinary volumes up to 130 ml at five different points of time. This case report indicates possible subclinical side effects on the autonomic nervous system of the urinary bladder.

Adult↗
PubMed1994

Use and abuse of analgesics in tension-type headache.

Eighty patients suffering from tension-type headache for an average of 21 years were asked to report on all drugs they had ever taken (type, dosage, duration of intake, efficacy) or were taking currently. The patients had consumed on average 6.3 different drugs. The cumulative doses of derivatives of para-aminophenol, pyrazolone, and salicylic acid in some cases reached a maximum of several kilograms. Most drugs were classified by the patients as "moderately effective". The rating "very effective" was assigned primarily to barbiturates; however, barbiturates are no longer used as components of compound analgesic drugs in Austria. At the time of investigation, patients consumed 2.5 (mean) different drugs, primarily as compound preparations. Seventeen patients (21%) showed signs of possible analgesics- or ergotamine-induced headache and were therefore advised to undergo withdrawal therapy. Our results show that patients with tension-type headache are at considerable risk of becoming drug-dependent and of acquiring analgesics-induced headache.

Adult↗