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PubMed1983

Pharmacology of opioids.

The concept of multiple opioid receptors reconciles a large body of clinical and pharmacological data. Recent studies have shown that there are also multiple opioid binding sites. It would appear that there is considerable variability between species in both the specificity and selectivity of opioid receptors. This issue has not been explored systematically regarding opioid binding sites. Better characterization of the pharmacological profiles and receptor binding specificity for different species may help resolve some of the apparent disparities. The number of putative receptors now number nearly a dozen. Already subspecies of mu, kappa, and sigma receptors are being postulated. Both pharmacological and neurochemical methods may reveal even more. Some of the newer kappa agonists differ in their pharmacology from the prototypic kappa agonist ethylketazocine.

Analgesia↗
PubMed1984

Pupillary sparing oculomotor palsy from acute subdural hematoma.

An acute subdural hematoma presented as a partial third nerve palsy with complete pupillary sparing. The patient was alert and oriented, and except for a subtle hemisensory hypalgesia, there were no other neurologic signs. Preoperative diagnosis was made by CT scan and cerebral angiography. The patient underwent successful craniotomy and within six weeks after surgery, her third nerve palsy had completely resolved.

Adult↗
PubMed1993

Amaurotic mydriasis.

Amaurotic mydriasis is characterized by larger than normal pupils in patients with visual loss. In sought to establish whether amaurotic mydriasis can reliably identify different kinds of visual loss and whether this static measurement might prove useful in discerning "balanced" bilateral optic neuropathies where no relative afferent pupillary defect (RAPD) is detected. Patients with binocular pregeniculate visual loss, patients with balanced binocular pregeniculate loss without RAPD, and patients with monocular pregeniculate visual loss had significantly larger pupils than age-matched controls. Although pupils of patients with binocular pregeniculate visual loss (20/50 or better in one or both eyes) were significantly smaller than pupils of age-matched patients with binocular pregeniculate deficits of worse than 20/50 in one or both eyes, no such correlation between Snellen visual acuity and amaurotic mydriasis was found in patients with monocular pregeniculate visual loss. Amaurotic mydriasis is a clinically useful phenomenon that may identify pregeniculate disease in the absence of a RAPD or distinguish pregeniculate from postgeniculate visual loss.

Blindness↗
PubMed1993

Effects of verapamil on morphine-induced euphoria, analgesia and respiratory depression in humans.

Organic calcium (Ca++) channel antagonists enhance opiate-induced analgesia and antagonize respiratory depression produced by morphine in rodents. Our preliminary data indicated that verapamil reduces the subjective effects of morphine in humans. We therefore assessed morphine-verapamil interactions in 12 experienced, male polydrug users with histories of heroin abuse by using a double-blind, cross-over study design. Treatments consisted of two drug infusions. Either verapamil, 2.5 or 10 mg, or saline was infused, 30 ml i.v. over 2 min; half way through this infusion either 10 mg of morphine or saline was infused, 3 ml i.v. over 10 sec, via a second catheter. Autonomic parameters, responsiveness to pain and subjective self-reports of mood and feeling state were measured over 4 hr. Analgesia was measured using a finger pressure test and hand immersion in ice water. Respiration was measured by using respiratory inductive plethysmography and transcutaneous CO2 levels. The Addiction Research Center Inventory (ARCI) was used to measure the subjective effects. Morphine had a liminal effect on pain threshold, but verapamil potentiated this effect to elevate pain threshold significantly. Verapamil did not affect the ability of morphine to increase pain endurance or to produce respiratory depression. Morphine produced positive affective responses, as demonstrated by elevated scores on the Morphine-Benzedrine Group subscale of the ARCI. Verapamil alone produced no effects on any ARCI subscales; however, 10 mg of verapamil significantly reduced morphine-elevated MBG scores over a 3-hr period. The results suggest the euphorigenic and analgesic effects of opioids may be differentiated by using Ca++ channel blockers.

Adult↗
PubMed1993

Nonmydriatic retinal color photography in young Indian diabetic patients.

Retinopathy was assessed using a Canon nonmydriatic retinal camera (CR-45NM) in 42 young Indian diabetic patients (26 with malnutrition-related and 16 with insulin-dependent diabetes). Four patients with malnutrition-related diabetes (15.38%) had retinopathy (Level 3 in all 4). The duration of diabetes in them was 3.25 years. None of the four had hypertension or albuminuria. Five patients with insulin-dependent diabetes mellitus (31.25%) had retinopathy (Level 2 in 1 patient, Level 3 in 2, Level 5 and 6.5 in 1 each). The duration of diabetes in this group was 9.7 years. Three each (60%) had albuminuria and hypertension. Thus, retinopathy seemed to occur earlier in patients with malnutrition-related diabetes, and its incidence was discordant with that of nephropathy.

Adolescent↗
PubMed1997

[Hypoxic-ischemic coma in children. Factors related to the prognosis].

OBJECTIVE: The purpose of this study was to analyze the etiology, evolution and predictive value of clinical variables and complementary explorations in children admitted to a PICU with hypoxic-ischemic coma. PATIENTS AND METHODS: A retrospective review (1991-1996) of 24 children with hypoxic-ischemic coma admitted to the pediatric ICU of a reference hospital was performed. Clinical data on admission and results of complementary explorations (EEG and neuroimaging techniques) were collected and the findings compared according to the evolution and underlying pathophysiological mechanism. RESULTS: Non-reactive and dilated pupils, existence of neurohypophyseal disorders and isoelectric EEGs were exclusively found in dead patients. A score of 3-4 on the Glasgow Coma Score was obtained more frequently in groups with the worse evolution (exitus and surviving with sequelae), as well as positive findings with neuroimaging techniques and the appearance of seizures, though without meaningful differences. More significant was the existence of associated problems, which was more frequent in groups with a negative evolution. The differences among the pathophysiological groups were not meaningful. Global mortality in the series studied was 41.6%, with 29.2% of the survivors having neurological sequelae and 29.2% being healthy. CONCLUSIONS: Hypoxic-ischemic coma in children has a high mortality and morbility. The prognosis for each patient is based on the clinical facts and complementary explorations. No isolated data allows the establishment of the final outcome with certainty.

Brain Ischemia↗
PubMedDate not supplied

Acute sensorimotor polyneuropathy with tonic pupils and an abduction deficit: an unusual presentation of polyarteritis nodosa.

A tonic pupil may occur in isolation or as part of a systemic disorder. We report a patient who developed tonic pupils and an abduction deficit in the setting of polyarteritis nodosa. The combination of a tonic pupil and an abduction deficit should suggest the possibility of a vasculopathic disorder, because the ciliary ganglion and lateral rectus muscle are both supplied by the lateral muscular artery. Widespread small artery and arteriolar narrowing and occlusion are the hallmarks of polyarteritis nodosa. Unusual ischemic syndromes may occur, such as this rare combination of neuro-ophthalmic signs, by involvement of both the nutrient artery and its collaterals. We are unaware of other reports of neuropathic tonic pupils in association with polyarteritis nodosa.

Acute Disease↗
PubMed1991

[Catamnestic study of school children with behavioral disorders].

A catamnestic study of disturbed pupils, who have been examined by a child neuropsychiatrist for admission to a balancing class, revealed that the accumulation of biological and psychosocial load factors presents a risk for persisting behavioural disturbance. Failure at school was prevented by a temporary stay in a balancing class, but psychic maldevelopment indicated by the high percentage of odd children in the disturbed population could not be precluded. The refore the life-long medical and special pedagogic care for these children beyond discharge from the balancing class is considered to be necessary.

Adolescent↗
PubMed2001

Cocaine abuse, generalized myasthenia, complete external ophthalmoplegia, and pseudotonic pupil.

We present the case of a 29-year-old woman with generalized myasthenia. Myasthenia with complete external ophthalmoplegia was unmasked by cocaine abuse. It was associated with changes of the pupillary motility, including light-near dissociation and positive 0.1% pilocarpine test. Treatment with acetylcholinesterase inhibitors improved the patient's condition rapidly, and led to complete normalization of extraocular movements and pupillary function. To our knowledge, this is the fourth case of cocaine-related myasthenia, and the first case of myasthenia with pseudotonic pupil.

Adult↗
PubMed1991

[Evaluation of the autonomic innervation of the pupil].

The purpose of the study was to examine vegetative innervation of the pupil in different diseases associated and not associated with vegetative disorders. In addition to the ++clinico-neurological method, the main method of examination was to study the pupillary cycle (determination of the time of the pupillary cycle (TPC) with the aid of a slit lamp). Fifty healthy test subjects and 262 patients suffering from different somatic and neurologic diseases were examined. The patients were divided in 9 clinical groups: spinal amyotrophy, neural Charcot-Marie amyotrophy, Guillain-Barre syndrome, diabetes mellitus, thyrotoxicosis, hemicrania, Raynaud's disease, idiopathic hyperhidrosis, vegetative crises. The data obtained demonstrate varying grades of the rise of the TPC in the indicated diseases, which reflects varying degrees of vegetative innervation of the pupil insufficiency. However, no well-defined correlation was obtained between the intensity of the psychovegetative syndrome and the TPC. Therefore, it has been shown that the method of determining the TPC is unsophisticated and noninvasive and can be successfully used in different forms of pathology to identify vegetative insufficiency at different stages of the disease.

Autonomic Nervous System Diseases↗
PubMed1996

Pupil response to tropicamide in Alzheimer's disease and other neurodegenerative disorders.

Excessive mydriatic response to dilute tropicamide has been suggested as a possible non-invasive diagnostic test in patients with Alzheimer's disease (AD). To further evaluate the sensibility and specificity of this test we studied the pupillary response to tropicamide in 24 patients with AD, 30 age-matched controls, 7 patients with dementia other than AD and 13 patients with extrapyramidal disorders (EXD). Maximum dilatation response over baseline was much higher in AD with significant differences compared to controls (p < 0.001) and to EXD (p < 0.05). However, there was a quite wide range of overlap between AD and controls and no cut-off point was found with a high enough specificity to consider this a conclusive diagnostic test. Lower dilatation response in the overlapping range (13%), however, may be useful because of its negative predictive value (93.5%) and as a screening tool due to its sensitivity (87.5%).

Aged↗
PubMed2001

Asymmetric pigment dispersion in a patient with the unilateral Adie pupil.

PURPOSE: Pigmentary glaucoma is a bilateral disorder. When it occurs asymmetrically or unilaterally, a cause should be sought because it may help us to understand the pathophysiology of this condition better. We describe a patient with unilateral pigmentary glaucoma and the Adie pupil in the same eye and discuss the possible role of the Adie pupil in the development of the pigmentary glaucoma. METHODS: A case report. A 37-year-old woman presented with asymmetric pigment dispersion resulting in pigmentary glaucoma in the right eye and an unilateral Adie pupil in the same eye. RESULTS: We believe that the dilated Adie pupil in the right eye might have resulted in a decreased amount of relative pupillary block. This, then, might have led to an increased contact between the posterior iris and the zonules, resulting in greater pigment dispersion and trabecular obstruction in the right eye. CONCLUSION: It has been proposed that the pigment is liberated from the iris pigment epithelium because of the mechanical rubbing of the posterior iris against the anterior zonular packets. Our case supports this proposed mechanism of pigment release.

Adult↗
PubMed1992

Long-term ergotamine abuse: effect on adrenergically induced mydriasis.

The mydriatic action of sympathomimetic eyedrops after a therapeutic dose of ergotamine was measured in migraine patients with and without histories of long-term ergotamine abuse. Mydriasis induced by the postsynaptic alpha 1-agonist phenylephrine was similar in both groups of patients tested, whereas pupillary dilation caused by the release of noradrenaline tyramine was markedly greater in patients with histories of ergotamine abuse. The enhanced response to tyramine disappeared after drug withdrawal. These findings indicate that continuous ergotamine medication causes a reversible alterations in iris sympathetic transmission. This manifestation may reflect a central inhibition of pupillary sympathetic activity.

Adult↗
PubMed1998

[Respiratory and skin diseases among school children in the industrial and rural regions].

The studies were done among the school-children in 3 grammar schools (2 in the industrial and 1 in rural regions). Allergological examination (anamnesis, physical exam and skin prick tests with inhalants) were performed among the pupils suspected of the allergic disorders on the basis of the questionnaire analysis made in all school-children. The results were compared to the environmental air pollution in the school region. The frequency (4.9-7%) and the type of the allergic diseases were similar in all 3 schools. The most frequent allergens were pollen, mites and animal epithelia. In rural region familial predisposition to allergy was 2 times higher in pupils suffering from allergy. 70% of pupils suffering from allergy in the industrial regions had no familial predisposition to allergy.

Allergens↗
PubMed2000

Aberrant regeneration of the third nerve.

We describe three patients with aberrant regeneration of the third nerve secondary to traumatic brain injury. The full blown features of the syndrome include horizontal gaze-eyelid synkinesis, pseudo-Graefe sign, limitation of elevation and depression of the eye with retraction of the globe on attempted vertical movements, adduction of the involved eye on attempted elevation or depression, pseudo-Argyll Robertson pupil and absent vertical optokinetic response. The 'misdirection' incidence in our study is 15%.

Adult↗
PubMed2005

[Cranial imaging and serology tests are not helpful in tonic pupil. A retrospective study].

BACKGROUND: Tonic pupil (TP) is a common disorder of parasympathetic innervation. In contrast to textbook recommendations, cranial imaging is still being performed in most of the patients with TP. The intention of the present study is to show that cranial imaging is of no benefit. PATIENTS AND METHODS: The medical records of 33 patients with TP were analyzed retrospectively. All patients had undergone a complete ophthalmological, orthoptic, and neurological investigation. Cranial imaging was performed by computed tomography or magnetic resonance imaging. Serology tests were carried out in some of the patients. RESULTS: Diagnostic imaging provided no additional data revealing the underlying cause of TP. CONCLUSIONS: Cranial imaging in isolated tonic pupil is not helpful. Because of therapeutic implications, diagnostic evaluation can be recommended only in patients older than 50 years to exclude giant cell arteritis and syphilis.

Adolescent↗