Biomedical subjects
V U Fritz
Publications and source records attributed to V U Fritz.
Sinemet (CR4): an open-label study in moderately severe Parkinson's disease.
Almost all patients with idiopathic Parkinson's disease respond to levodopa and progress steadily, requiring an increased overall dosage with time. Sinemet CR4 offers a theoretically attractive method of achieving gradual sustained release of levodopa over time which may be more physiological to striatal dopamine receptors in the early stages of the disease. This study evaluated 20 patients with moderate to severe Parkinson's disease who were treated with Sinemet CR4 over a 1-year period. Eleven patients completed the full year on therapy, and nine subjects withdrew. Of the withdrawals, two subjects died from non-Parkinson's disease-related illness, three showed no therapeutic benefit, and four responded well for a minimal 6-month period, but then lost therapeutic benefit and developed more severe dystonias. A higher overall levodopa dosage was required by all patients, and side-effects of levodopa were still present in most patients. However, the nocturnal benefit of this long-acting preparation was observed by all the patients in the study. Slow onset of action of Sinemet CR4 resulted in early-morning immobility. Sinemet CR4 cannot replace standard Sinemet, but appears to be a useful form of adjunct therapy in selected patients.
Pure word deafness.
Two cases of pure word deafness, both with bilateral temporal lobe lesions due to cerebrovascular disease, are presented. This rare disorder is briefly discussed.
Adjunctive therapy with bromocriptine in Parkinson's disease.
Patients with moderately severe Parkinson's disease complicated by the adverse effects of chronic levodopa use benefited from the addition of bromocriptine (Parlodel; Sandoz) in doses up to 26 mg daily, which allowed an approximate 30% reduction of levodopa dose. This resulted in a significant decrease in the amount of levodopa side-effects while maintaining or improving the original parkinsonian clinical stage. Increased effectiveness in these patients was not associated with increased dosage beyond 25-30 mg daily. When the doses of bromocriptine were increased slowly, the adverse reactions were minor and usually transient.
Recommendations regarding driving after a single seizure.
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A comparative trial of flunarizine and propranolol in the prevention of migraine.
The calcium-entry blocker flunarizine (Sibelium; Janssen) was compared with the beta-adrenoreceptor-blocking agent propranolol in the prophylaxis of migraine. Fifty-eight patients were entered into a double-blind 4-month treatment trial. Patients in whom beta-blockers were contraindicated were excluded from the trial. At the end of the trial 28 patients had received 10 mg flunarizine at night during the study, 29 patients had received 60 mg propranolol 3 times a day and 1 patient was withdrawn. Both groups responded well; and there was a 4-fold drop in frequency of attacks. There was no significant difference between the two groups in terms of patient profile, onset of response to therapy, final response to therapy, incidence of dropout from the trial or incidence of side-effects. Side-effects for flunarizine were weight gain (9 patients) and tiredness (6), and for propranolol sleep disturbances including nightmares (6), tiredness (8), mental changes (e.g. irritability) (3) and weight gain (4). Both flunarizine and propranolol are useful drugs for migraine prophylaxis and can be used effectively as first-line drugs. The low incidence of generally mild side-effects with flunarizine may make it preferable to many of the agents at present in use for migraine prophylaxis.
Pathogenesis of transient ischemic attacks and stroke in baboons.
We describe a series of experiments in which a subhuman primate model was used to create temporary and permanent cerebral ischemia by three separate mechanisms. In the first group of five baboons, a hemodynamic model was produced by creating unilateral and bilateral carotid stenotic lesions of varying degrees with and without associated reduction in systemic perfusion pressure. Only global ischemic changes and no focal changes resulted. In the second group of three baboons, a macroembolic model was produced by introducing solid particulate material into the extracranial circulation. No reversible contralateral focal neurologic changes resulted. In the third group of 11 baboons, cerebral ischemia was produced by introducing agents known to cause platelet aggregation (arachidonic acid, adenosine diphosphate, and collagen) into the extracranial arterial circulation. Arachidonic acid caused seizures, adenosine diphosphate caused severe postural hypotension, and only collagen fibrils produced a picture resembling a transient ischemic attack. We propose a theory that intravascular activation of the prostaglandin cascade by chemical initiation may result in the pathophysiologic changes of transient cerebral ischemia.
The value of magnetic resonance imaging in multiple sclerosis in South African-born patients.
The results of magnetic resonance imaging (MRI) in supporting the diagnosis of multiple sclerosis in 24 South African-born white patients were studied. MRI confirmed the diagnosis in 87.5% of cases. It appears that MRI is useful in strengthening the diagnosis of multiple sclerosis in patients with clinically established disease. This study supports the validity of the clinical diagnosis of multiple sclerosis in South African patients and stresses the need for re-evaluation of the incidence and prevalence of multiple sclerosis in this country.
Ocular reticulum cell sarcoma. A case report.
A case of ocular reticulum cell sarcoma (RCS) is described. Its relationship to systemic and central RCS and the eye signs, pathology and treatment are discussed. The importance of early diagnosis is stressed and vitreous biopsy should be considered in any unexplained vitritis in patients over the age of 40 years. Chemotherapy should be added to the usual dosage of radiation and may improve the survival period.
Therapy for isolated, low and high grade symptomatic carotid artery stenosis.
This study evaluates whether medical therapy alone can achieve satisfactory results in the treatment of low grade carotid stenosis or ulcerated plaques. Out of 525 patients presenting with transient or minor strokes, 64 were found with unilateral extracranial vascular disease as the sole potential source for their neurological symptoms. Utilizing arteriographic criteria, 35 patients with ulcerated plaques or carotid artery stenosis of less than 50% luminal artery diameter were treated conservatively with aspirin and dipyridamole (300 mg/day each). Twenty-nine patients with unilateral internal carotid artery stenosis of greater than 50% luminal artery diameter were treated by means of carotid endarterectomy. Follow-up in the two groups for a mean period of 24-26 months revealed no major strokes or neurological deaths in either group. Myocardial infarction was the major cause of death. Two patients developed subsequent transient ischemic attacks, and one a minor stroke with total recovery in the conservatively treated group. All became asymptomatic when warfarin replaced aspirin therapy. The findings in this study confirmed that "low grade" stenoses can be safely treated by medical measures alone.
Diabetes as risk factor for transient ischaemic attacks as opposed to strokes.
This study examined the hypothesis that diabetes mellitus predisposes the brain to irreversible ischaemic damage rather than to reversible transient ischaemic attacks. Of 525 patients presenting with transient or minor strokes, 54 patients were found to have diabetes mellitus and 471 patients had no evidence of diabetes. The diabetic subgroup was significantly more hypertensive than the non-diabetic subgroup (P less than 0.001). In an overall comparison of the prevalence of strokes and transient ischaemic attacks in diabetic and non-diabetic subgroups, 26 (6.7%) of 388 patients with transient ischaemic attacks had diabetes mellitus, and 362 (93.3%) of 388 patients with transient ischaemic attacks were non-diabetic. Thus diabetes was not a significant risk factor for TIAs (P less than 0.001). However when the role of diabetes in causing strokes was assessed in all 525 patients evaluated in the study, 28 of 54 diabetics presented with strokes whereas 109 of 471 non-diabetics presented with strokes. Statistically diabetics were 3-4 times more likely to present with a stroke than non-diabetics (P less than 0.0001) in keeping with the findings in other centres. The findings of this study appear to support the hypothesis that diabetics are at a greater risk of permanent cerebral ischaemia without prior warning of a transient ischaemic event than their non-diabetic counterparts. It may be advisable to screen asymptomatic diabetic patients aggressively and to consider these patients as a high risk subgroup for potential stroke if extracranial carotid vascular disease is present.
Unusual drug interactions between monoamine oxidase inhibitors and tricyclic antidepressants.
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Neurological complications of systemic vasculitis. A report of 2 cases.
In up to 72% of patients with systemic vasculitis the neurological system may be involved. This may be peripheral or central (brain or spinal cord), and is usually due to infarction or a ruptured aneurysm. Diagnosis and evaluation are based peripherally on examination of a biopsy specimen or centrally on angiography. Therapy is usually with steroids and/or immunosuppressive agents. Two patients with systemic necrotizing vasculitis with unusual neurological complications are presented.
Some aspects of neurological presentation of patients with important cardiac arrhythmias requiring pacemaker therapy: a preliminary report.
We report the short- and long-term effects of pacing on 82 patients presenting with significant bradyarrhythmias and neurological symptoms. The 3 categories of neurological symptoms were dizziness alone, syncope with or without dizziness and focal neurological symptoms with a history of dizziness or syncope.
Intra-operative transluminal angioplasty in the management of symptomatic aortic arch vessel stenosis.
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Bacillus cereus endocarditis. A case report.
Bacillus cereus may cause infective problems in compromised patients. No previous record of infective endocarditis due to this organism could be found. A 51-year-old White woman with B. cereus endocarditis after prosthetic mitral valve replacement is described. The problems of interpreting the significance of B. cereus bacteraemia, delayed diagnosis, and the inherent resistance of the organism are discussed.
Peri-partum cardiomyopathy in white women.
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Mitral components of the first heart sound.
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