Defining neurosurgical and neurological nursing practice: establishing our clinical parameters, Part II.
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Certification↗
Biomedical subjects
R M Stewart
Publications and source records attributed to R M Stewart.
Neuroleptic malignant syndrome: response to dantrolene sodium.
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Dantrolene↗
Urinary 5-S-cysteinyldopa in Parkinsonism after DOPA and carbidopa.
The effect of anti-Parkinson therapy on the urinary excretion of 5-S-cysteinyldopa (5SCD), a catechol metabolite of dihydroxyphenylalanine (DOPA) and marker for the melanocyte, was studied by means of high performance liquid chromatography. 5SCD was normal in Parkinson patients treated with anticholinergics. DOPA administration increased 5SCD excretion. Carbidopa and DOPA together elevated 5SCD markedly in a dose-dependent manner to values higher than seen in some patients with metastatic malignant melanoma. The effect of anti-Parkinson therapy should be considered when using 5SCD as a tumor marker or when a Parkinson patient has a melanoma.
Adult↗
Duration of effect of pilocarpine gel.
Thirty-five patients participated in a clinical trial of pilocarpine hydrochloride gel applied once daily at 10 PM. Patients tolerated the medication well and there were no untoward side effects. Significant lowering of intraocular pressure was found for 24 hours after administration. The effect 12 hours after administration was greater than 24 hours after administration. Therefore, pilocarpine gel can be endorsed as an effective medication for 24 hours in the vast majority of patients. However, it is incumbent on the prescribing ophthalmologist to measure the IOP at 10 PM at least once after prescribing pilocarpine gel to ensure adequate control of IOP at that time.
Aged↗
Normal checkerboard pattern reversal evoked potentials in parkinsonism.
The utility of checkerboard pattern reversal visual evoked potentials in the evaluation of Parkinson disease (Pd) was studied in 25 patients and controls without eye pathology. The results did not reveal differences in potential latency but the amplitude appeared slightly larger in PD than controls. Major intraocular differences were observed only in Pd patients with glaucoma, cataracts or retinal degeneration. The commonly employed high contrast and luminance, checkerboard pattern reversal technique did not appear useful in the evaluation of Pd. Selection of proper stimulus parameters may be critical in detecting VEP abnormality in Pd.
Aged↗
T-lymphoblastic leukaemia and aspartate aminotransferase.
AST levels from 11 untreated children with T-ALL were found to be significantly higher than those from 74 children with non-T disease. The enzyme was not related to haemoglobin or bilirubin levels nor to the presence of hepatosplenomegaly in any of the patients. It was correlated with the white cell count, but only in the T-cell group and not the remainder. It was also correlated with a parallel (but lesser) rise in ALT, but again only in the T-cell group. The blast cells themselves contained little or no transaminase activity, so it is probable that T-ALL produces more extramedullary tissue damage than non-T disease.
Alanine Transaminase↗
Membrane biophysical studies of lymphocytes and erythrocytes in manic-depressive illness.
Recent research suggests that manic-depressive illness is associated with a membrane abnormality which is detectable in peripheral tissues. Using fluorescence spectroscopy, the cellular membrane dynamics of intact erythrocytes and lymphocytes from manic-depressive patients and controls were studied in a double blind fashion. A cross-sectional analysis of membrane dynamics was obtained by using fluorescent probes with known affinity for specific regions of erythrocyte membranes. This preliminary study demonstrates alterations in the hydrocarbon region of erythrocyte membranes and the cell surface of lymphocytes in patients with manic-depressive illness. These abnormalities appear to be independent of clinical symptomatology and medication. The membrane abnormality demonstrated by fluorescence spectroscopy may provide clues to the molecular pathophysiology in manic-depressive illness, as well as a method of diagnosis in presymptomatic patients.
Adolescent↗
Lead poisoning from retained bullets. Pathogenesis, diagnosis, and management.
Lead intoxication (plumbism) from retained bullets has rarely been reported but may be fatal if unrecognized. Bullets lodged within joint spaces or pseudocysts are more likely to develop this complication, although patients with retained missiles in other locations may also be at risk. Subtle findings such as the occurrence of unexplained anemia, abdominal colic, nephropathy, or neurologic deterioration in patients with retained missiles may suggest consideration of plumbism. An intercurrent metabolic stress such as infection, endocrinopathy, or alcoholism may be a precipitating factor. Among the various diagnostic studies available, mass spectrometric stable isotope dilution analysis may be the most reliable. It is important to employ chelation therapy prior to any operative intervention. This will reduce the mobilization of lead from bone during or following the surgical procedure.
Adult↗
Baclofen in tardive dyskinesia patients maintained on neuroleptics.
Several short-term trials of baclofen for tardive dyskinesia have yielded conflicting results. We evaluated 33 patients maintained on a constant dose of neuroleptic during a randomized 6-week double-blind placebo-controlled trial, followed by a 6-week open-label trial. During the double-blind part, 67% of baclofen-treated patients and 47% of placebo-treated patients showed a reduction of 25% or more in their original dyskinesia score on the abnormal involuntary movement scale. In the open-labeled part, we further evaluated seven of nine baclofen responders and nine of nine placebo nonresponders. We found a 77% baclofen response rate for the original placebo nonresponders, a loss of efficacy in 23% of the original baclofen responders, and an attenuation of response in others. Patients with major depressive disorders were poorer responders to baclofen than those with schizophrenia. Side effects were infrequent and reversible, but dose limiting in several instances. Although baclofen may help some cases of mild tardive dyskinesia, its efficacy may attenuate with long-term administration.
Adolescent↗
Are hysterical seizures more than hysteria? A research diagnostic criteria, DMS-III, and psychometric analysis.
In a double-blind study the authors compared severity of psychopathology and personality organization in three groups of patients: those with organic (neurogenic) seizures alone (N = 11), those who exhibited both neurogenic and psychogenic ("hysterical") seizures (N = 13), and those with pure psychogenic ("hysterical") seizures (N = 13). Patients with neurogenic seizures were found to have alcoholism, anxiety disorder, and minor affective disorder. Patients with mixed and psychogenic seizures had more severe psychopathology, including major affective disorders and major character pathology. Patients with mixed and psychogenic seizures also had a markedly higher incidence of suicide attempts and past history of psychiatric treatment.
Borderline Personality Disorder↗
Organic lead encephalopathy: behavioral change and movement disorder following gasoline inhalation.
A 15 year old boy was evaluated in the psychiatric emergency room for the acute onset of "confusion,"insomnia, headache, and shaking of one week's duration. Two days later hallucinations, formication and a movement disorder emerged characterized by action tremor, myoclonus, chorea and ataxia. Further history revealed inhalation of gasoline for its euphoric effects. Plasma lead levels were in the toxic range. Chelation therapy reversed the clinical symptoms. Behavioral changes and a movement disorder in the context of gasoline inhalation are highly suggestive of organic lead encephalopathy. Recognition of this syndrome is important as chelation therapy is effective.
Adolescent↗
Hydrogen peroxide contracts airway smooth muscle: a possible endogenous mechanism.
Both distal (canine lung strips) and proximal (bovine trachealis strips) airway smooth muscle contract in isolated organ baths as the percentage of environmental oxygen is increased from 12% to 95%. This effect is blocked by prostaglandin synthetase inhibitors (indomethacin, 10(-4)M; meclofenamate, 10(-4)M). To determine whether this contractile response is due to molecular oxygen, or to other products of oxidative metabolism, we examined the effects of ozone, hydrogen peroxide, and superoxide radical generating systems (paraquat and xanthine-xanthine oxidase) on the smooth muscle preparations. Ozone (3 ppm), paraquat (2 mM), and xanthine (10(-3)M)-xanthine oxidase (1 unit) were without effect. Hydrogen peroxide (10(-5)-10(-3)M) produce consistent contractions in both preparations, an effect which was appreciably greater in an hypoxic environment and which was blocked by both indomethacin and meclofenamate. Contraction from both hyperoxia and hydrogen peroxide was partially reversed by various oxygen radical scavengers, including methional (10 mM), ascorbic acid (10 mM), nitroblue tetrazolium (0.3 mM), butylated hydroxyanisole (1 mM), and 2',7' naphthalonediol (1 mM). These results suggest that hyperoxic contraction in airway smooth muscle is mediated by active oxygen species, perhaps by their effects on prostaglandin metabolism.
Animals↗
Membrane studies in Huntington's disease: steady state and time-dependent fluorescence spectroscopy of intact lymphocytes.
Recent evidence suggests that a membrane abnormality, expressed in peripheral tissues such as the lymphocyte, may be present in Huntington's disease (HD). Both steady state and time-dependent fluorescence spectroscopic methods were performed on lymphocytes from patients with HD and from age- and sex-matched controls. Lymphocyte membrane dynamics were studied, using fluorescence probes with known specificity for certain membrane areas. These probes included 4-phenylspiro(furan-2(3H)-1'-phthalan)-3,3'-dione (fluorescamine), which binds to surface membrane primary amines, 1-8-anilinonaphthalene sulfonate (1,8-ANS), which inserts at the aqueous-hydrocarbon interface, and 12(9) anthroyl stearate (12(9)AS), which inserts deep in the hydrocarbon core. Steady state fluorescence studies, using fluorescamine, 1-8 ANS, or 12(9)AS, revealed no significant difference between intact HD and control lymphocytes. Time-dependent energy-transfer polarization studies for fluorescamine (tryptophan leads to fluorescamine) did, however, reveal a slower time decay of (formula see text) for intact HD lymphocytes as compared with controls. This time-dependent difference may relate to alterations in translational (lateral) and angular mobilities of membrane donors (tryptophan) relative to acceptors (fluorescamine) in intact HD lymphocytes. Such observations support the concept of a membrane abnormality in HD.
Anilino Naphthalenesulfonates↗
Akinetic mutism from hypothalamic damage: successful treatment with dopamine agonists.
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Adult↗
Familial spastic paraplegia, peroneal neuropathy, and crural hypopigmentation: a new neurocutaneous syndrome.
A neurocutaneous syndrome is described in which spastic paraplegia, peroneal neuropathy, and crural hypopigmentation are inherited in a dominant pattern. Spastic paraplegia becomes clinically apparent during adolescence or in childhood and progresses slowly throughout the adult years with a variability in severity of expression. Peroneal neuropathy is documented clinically and by slowing on nerve conduction studies. Pattern-reversal visual evoked potentials also yield a delayed response, but brainstem auditory evoked potentials and somatosensory evoked potentials in upper and lower extremities are normal. Crural hypopigmentation is present in each neurologically affected family member. Although the pattern may vary, a pretibial distribution predominates. The lower-extremity abnormalities of the central and peripheral nervous system and neural crest cell derivatives may share a common relationship, but the abnormal visual evoked potentials suggest a more generalized involvement. This family may represent a transition form between familial spastic paraplegia and the spinocerebellar degenerations.
Adult↗
Parkinson's disease: new treatments.
Parkinsonism is a movement disorder related to a central nervous system dopamine deficiency. L-dopa with or without carbidopa is presently the most effective medication. The use of this drug should be delayed as long as possible, and overtreatment should be avoided. Complications of long-term parkinsonism may respond in part to the direct dopamine receptor agonists. Physical therapy and emotional support for the patients and their families are an integral part of the management of the patient with Parkinson's disease.
Acetylcholine↗
Increased sensitivity to intracerebroventricular infusion of serotonin and deaminated indoles after lesioning rat with dihydroxytryptamine.
Rats were prepared with a chronic intracerebroventricular cannula, and treated with intracisternal 5,7-dihydroxytryptamine (DHT) after i.p. desmethylimipramine or control vehicle. After recovery, they were tested behaviorally by direct observation and electronic monitoring of motor activity. Intraventricular infusion of a placebo or 5-hydroxyindoleacetic acid (5-HIAA) had little effect, but serotonin (5-HT) decreased, and norepinephrine increased locomotor activity in intact rats. Following pretreatment with 5,7-DHT, a small increase in locomotor activity was noted which was not altered by intracranial infusion of vehicle. In contrast, infusions of 5-HT produced a striking dose-dependent (ED50 = 5 micrograms/min) pattern of hyperactivity, 'myoclonic' jerking movements, postural changes, and autonomic responses. Norepinephrine increased locomotor activity in the DHT-lesioned rats (but not significantly more than in controls), but failed to produce the myoclonic syndrome. The deaminated indoles, indoleacetaldehyde and 5-HIAA were more potent than 5-HT in producing the myoclonic response; tryptamine when infused at an equimolar dose had no effect. The putative serotonin antagonists, cyproheptadine and methiothepin (i.p.), were more effective in blocking responses to infused 5-HT than to equipotent doses of deaminated indoles. These behavioral responses may represent exaggerated ex"itatory effects mediated by serotonin in the brain stem and spinal cord, possibly modified by altered forebrain mechanisms. A neurophysiologic or neuropharmacologic role for deminated indoles should be reconsidered as they may not merely be inactive metabolites.
5,7-Dihydroxytryptamine↗
Membrane studies in Huntington's disease: steady-state fluorescence studies of intact erythrocytes.
Recent evidence suggests that a membrane abnormality may be present in Huntington's disease (HD), including peripheral tissues such as erythrocytes. Steady-state fluorescence spectroscopy was performed on intact erythrocytes from patients with HD and from normal age- and sex-matched controls. Fluorescent probes with known specificity for certain membrane areas were used to survey membrane dynamics; these probes included fluorescamine, which binds to primary amines on the cell surface, and both 12(9)-anthroyl stearate, 12(9)AS, and 2(9)-anthroyl stearate, 2(9)AS, which insert at different depths in the hydrocarbon core of membranes. In the intact HD erythrocyte, fluorescamine revealed decreased polarization, 12(9)AS showed increased polarization, and 2(9)AS showed no difference as compared to normal erythrocytes. These studies suggest that fluorescamine, attached to primary amines of the cell surface in intact HD erythrocytes, has increased rotational mobility whereas the anthroyl moiety of 12(9)AS in the hydrocarbon interior has decreased rotational mobility. These studies thus support the concept of a membrane abnormality in HD.
Biophysical Phenomena↗