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Biomedical subjects

R L Bruno

Publications and source records attributed to R L Bruno.

28 records · Page 2Linked to original sources
PubMed1983

A correlational study of cardiovascular autonomic functioning and unipolar depression.

Cardiovascular autonomic functioning was assessed in 22 drug-free inpatients diagnosed by DSM-III criteria as having a unipolar depression. Sympathetic cholinergic, alpha- and beta-adrenergic activity were assessed via the measurement of forearm blood flow (FBF), digital blood flow (DBF), and the cardiac pre-ejection period (PEP), respectively. These parameters were correlated with total Hamilton score (HT) (using partial correlations to control for extraneous autonomic variables) to identify the specific autonomic correlates of unipolar depression. Significant negative correlations were found between HT and supine FBF and significant positive correlations between HT and PEP. Large effect-size, negative correlations (which approached significance) were found between HT and DBF. It is concluded that there is a specific autonomic profile of unipolar depression, characterized by a decrease in central sympathetic cholinergic outflow, coupled with increases in alpha-adrenergic and decreases in beta-adrenergic activity. Further, this profile is not merely a static hallmark of depression but covaries with the severity of the depression, independent of other autonomic activity.

Aged↗
PubMed1982

Factors related to orthostatic hypotension associated with tricyclic antidepressants.

A group of 45 depressed patients treated with imipramine hydrochloride were examined in an attempt to identify factors that might influence the risk of developing orthostatic hypotension. Although the literature suggests that age and/or heart disease influences the occurrence of orthostatic hypotension, these conclusions are controversial. To pursue this issue, a sample of older depressed patients, many with severe cardiovascular disease, was chosen. The incidence of orthostatic hypotension rose dramatically among those with severe heart disease. There was a significant association between symptomatic orthostatic hypotension and cardiac medication (p less than .01), and trends between orthostatic hypotension and both ejection fraction (p = .11) and baseline forearm resistance (p = .16). The sample is too small to permit determination of the relative independent importance of these variables or the contribution of specific cardiovascular drugs among these sicker cardiac patients.

Aged↗
PubMedDate not supplied

Bromocriptine in the treatment of post-polio fatigue: a pilot study with implications for the pathophysiology of fatigue.

Fatigue is the most commonly reported and most disabling of all post-polio sequelae (PPS). Bromocriptine mesylate (Parlodel) was employed in a placebo-controlled trial in five survivors of paralytic polio who continued to report moderate to severe daily fatigue after complying with the conservative treatments prescribed for PPS. Placebo was given for 4 wk followed by increasing doses of bromocriptine mesylate, administered at 12:00 pm for 28 days, which reached a total dose of 12.5 mg/day. Three subjects reported marked symptom improvement on bromocriptine but not on placebo. Their reported difficulty with attention, concentration, word finding, mind wandering, memory, thinking clearly, and fatigue on awakening was significantly negatively correlated with days on bromocriptine but not with days on placebo. Before the drug trial began, responders had clinically impaired performance on neuropsychologic tests of attention and information processing speed, more than twice as many hyperintensities on magnetic resonance imaging of the brain, abnormally low fasting adrenocorticotropic hormone levels, and nearly double the mean plasma prolactin level compared with nonresponders. The implications of these findings for the pathophysiology of fatigue are discussed. A double-blind, placebo-controlled, multicenter study will be needed to confirm bromocriptine's efficacy in treating attentionally and neurophysiologically impaired polio survivors whose severe and disabling fatigue does not respond to conservative therapies.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Compliance with treatment for postpolio sequelae: effect of type A behavior, self-concept, and loneliness.

To examine the effect of Type A behavior, self-concept, and loneliness on completion of and compliance with a postpolio sequelae treatment program, all 204 individuals who had been evaluated by the Postpolio Service were mailed the Postpolio Fatigue Questionnaire, the revised UCLA Loneliness Scale, and the Tennessee Self-Concept Scale. Patients were also asked to rate the frequency of assistive device use, their engaging in self-care activities, and requesting physical assistance from others; they had previously been administered the brief Type A Scale. Of the 46 respondents, 63% had completed the Postpolio Sequelae treatment program (completers), and 37% had either been discharged for noncompliance or refused treatment (noncompleters). Wheelchair use was significantly positively correlated with age at the time of contracting polio, number of limbs affected by polio, the Loneliness score, and months since leaving the treatment program, but significantly negatively correlated with Social Self and Family Self scores on the Tennessee Self-Concept Scale. Family Self score was significantly negatively correlated with crutch use but significantly positively correlated with asking co-workers for assistance. The frequency of taking two 15-minute breaks each day was significantly negatively correlated with a Type A score. Noncompleters reported a 61% increase in muscle weakness compared with a 1% decrease for completers. These results indicate that Type A behavior must be decreased so polio survivors complete and comply with a postpolio sequelae treatment program, be able to make necessary lifestyle changes, and possibly feel less lonely. Friends and family members must help polio survivors to accept lifestyle changes and support new assistive device use if patients are to feel valuable within their families and society and treat their postpolio sequelae.

Adult↗
PubMedDate not supplied

Abnormal movements in sleep as a post-polio sequelae.

Nearly two-thirds of polio survivors report abnormal movements in sleep, with 52% reporting that their sleep is disturbed by these movements. Sleep studies were performed in seven polio survivors to document objectively abnormal movements in sleep. Two patients demonstrated generalized random myoclonus, with brief contractions and even ballistic movements of the arms and legs, slow repeated grasping movements of the hands, slow flexion of the arms, and contraction of the shoulder and pectoral muscles. Two other patients demonstrated periodic movements in sleep with muscle contractions and ballistic movements of the legs, two had periodic movements in sleep plus restless legs syndrome, and one had sleep starts involving only contraction of the arm muscles. Abnormal movements in sleep occurred in Stage II sleep in all patients, in Stage I in some patients, and could significantly disturb sleep architecture even though patients were totally unaware of muscle contractions. Poliovirus-induced damage to the spinal cord and brain is presented as a possible cause of abnormal movements in sleep. The diagnosis of post-polio fatigue, evaluation of abnormal movements in sleep, and management of abnormal movements in sleep using benzodiazepines or dopamimetic agents are described.

Electromyography↗
PubMedDate not supplied

Paralytic vs. "nonparalytic" polio: distinction without a difference?

Nonparalytic polio (NPP) is commonly thought to be synonymous with "abortive polio," in which the poliovirus neither entered the central nervous system nor damaged neurons. Described are two epidemic illness-"The Summer Grippe" and Iceland disease-apparently caused by a low virulence but neuropathic type 2 poliovirus. Studies show that neuronal lesions in the brain and spinal cord and muscle weakness were common in NPP, and epidemiologic studies document late-onset weakness and fatigue in 14% to 42% of NPP survivors. These findings indicate that clinicians should not require a history of paralytic polio, electromyographic evidence of denervation, and new muscle weakness for the diagnosis of "Postpolio Syndrome" but should be aware that NPP, and possibly even poliovirus-induced "minor illnesses," can be associated with acute central nervous system damage and late-onset muscle weakness and fatigue.

Denmark↗
PubMedDate not supplied

Word finding difficulty as a post-polio sequelae.

OBJECTIVE: Seventy-nine percent of respondents to the 1990 National Post-Polio Survey reported difficulty "thinking of words I want to say," with 37% reporting frequent, moderate-to-severe word finding difficulty. This study was undertaken to objectively document polio survivors' word finding difficulty and to identify its relationship to fatigue, neuropsychologic processes requiring cortical activation, and a peripheral marker for brain dopamine secretion. DESIGN: In this study, 33 polio survivors were administered the Post-Polio Fatigue Questionnaire, Animal Naming and FAS Tests, and tests of attention and information processing speed. Plasma prolactin was also measured as a marker for brain dopamine secretion. RESULTS: Subjects reporting high fatigue severity and word finding difficulty had clinically abnormal or significantly lower Animal Naming Test scores compared with subjects with low symptom severity. Impaired performance on the most difficult tests of attention and information processing speed were also associated with lower scores on the word finding tests. A significant negative correlation between Animal Naming Test scores and plasma prolactin suggests that a decrement in brain dopamine secretion is related to reduced animal naming ability. CONCLUSIONS: These data support the hypothesis that decreased dopamine secretion, possibly secondary to poliovirus damage to the basal ganglia, may underlie not only fatigue and impaired attention but also word finding difficulty in polio survivors.

Anomia↗