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At least 1,261 records · Page 70Linked to original sources

Coronary artery spasm in a patient with unstable angina pectoris.

A 32-year-old male with the clinical syndrome of unstable angina is presented. During cardiac catheterization and coronary cineangiography, the coronary arteries were found to be free of atherosclerosis, but segmental spasm of the right coronary artery was observed. Spasm was reproduced, but to a milder degree, upon the administration of ergonovine maleate intravenously. The patient was discharged on a regimen of oral nylidrin HCL, with symptomatic improvement.

Adult↗

Traumatic arterial spasm resulting in gangrene.

A fracture of the tibia in a child resulted in diffuse arterial spasm and ultimately gangrene. No evidence of a specific arterial injury was found. The role of spasm alone in the production of gangrene has been controversial. The case presented underscores its occurrence in the pediatric population and its potential consequences. Loss of limb can occur despite prompt recognition and treatment. A review of therapeutic options is presented.

Arteries↗

Discharge planning for the child with infantile spasms.

Infantile spasms is a type of seizure disorder usually occurring within the first 24 months of life. The standard treatment is intramuscular injections of repository corticotropin (HP ACTHAR gel). The child with infantile spasms is at risk for developmental delay, even if the seizures are controlled. The parents' grief reaction to this prognosis may affect their ability to learn and implement the treatment plan. Discharge planning for children and families is extensive and must begin at the time of the child's admission to the hospital.

Adaptation, Psychological↗

Narcotics and spasm of the sphincter of Oddi. A retrospective study of operative cholangiograms.

The operative cholangiograms of 112 patients undergoing elective cholecystectomy were reviewed independently and retrospectively by two radiologists who were not aware of the anaesthetic technique used. Fifty four patients who received opioid drugs either pre- and/or intra-operatively comprised one study group whilst 58 patients who received no opioids comprised the other. Spasm of the sphincter of Oddi was observed in two patients in the opioid group and in one patient in the non-opioid group. The use of opioid drugs as part of the anaesthetic management for cholecystectomy did not appear to interfere with the radiological interpretation of operative cholangiography nor to increase the low incidence of spasm of the sphincter of Oddi.

Adolescent↗

Transtympanic surgery for hemifacial spasm--an electrophysiological study.

Producing deliberate damage to the facial nerve in the middle ear is an established method of treating idiopathic hemifacial spasm. However, no previous electrophysiological studies have investigated the effect of this operation on facial nerve function. Eleven patients undergoing transtympanic facial nerve needling were investigated with electromyography. Following operation reduction in the abnormal discharges and synkinesis typical of hemifacial spasm was seen in the majority of patients. The success of this type of operation, although temporary in some patients, together with other neurophysiological studies conflicts with the hypothesis that this disorder is due to ephaptic transmission caused by vascular compression of the facial nerve in the cerebello-pontine angle.

Ear, Middle↗

Effect of muscle spasms on blood gases and acid-base status in tetanus patients.

Blood gas tensions and acid-base status were determined in six patients with tetanus before and after the onset of severe muscle spasms. Hypoxaemia and metabolic acidosis present in all the patients, were worsened by muscle spasms. It is suggested that frequent measurements of blood gases should be carried out where such facilities are available.

Acidosis↗

Spasm of the near reflex associated with cerebrovascular accident.

Spasm of the near reflex most often has a functional basis, but may be associated with organic disease. This case report describes a patient with a progressive 11-year history of spasm of the near reflex associated with cerebrovascular accidents and reviews the differential diagnosis, management and aetiology of this disease.

Accommodation, Ocular↗

Coronary artery spasm: use of ergonovine in diagnosis.

Ergonovine maleate was administered to 69 patients with chest pain but without significant coronary artery disease (less than 10% luminal diameter obstruction) to determine whether coronary artery spasm could be provoked. Coronary artery spasm was seen at angiography, or inferred from ECG or thallium myocardial perfusion scan changes. The test was positive in 16 patients: all five patients with documented variant angina (Group A); ten of the 19 patients with suspected variant angina (Group B); one of the 11 patients with exercise-induced chest pain (Group C); and none of the 34 patients with atypical chest pain (Group D). Patients with a positive test usually smoked, complained of recurrent nocturnal or early morning chest pain, showed ST changes during spontaneous chest pain and had minot degrees of fixed coronary obstruction (30--70%), when compared to those with a negative test. The only major side effect of the test was transient ventricular tachycardia which occurred in three patients and was reverted by sublingual and parenteral nitroglycerine.

Aged↗

Infantile spasms and the CHARGE association.

A case is reported who had developmental delay, infantile spasms and the salient features of the CHARGE association--colobomatous micropthalmia, congenital heart-disease, mental retardation and hearing loss. This syndrome represents a distinct and clinically recognisable entity, and should be considered in patients with infantile spasms and ocular malformations.

Abnormalities, Multiple↗

Non-verbal communication skills of surgically treated children with infantile spasms.

The authors present preliminary findings on the effects of surgery on the development of early non-verbal social communication skills in eight children with intractable infantile spasms. After a mean follow-up of 15.2 months, there was no statistically significant change in the post-surgical non-verbal communication behavior of these children beyond the expected developmental change. Implications of these findings for the developmental impairment associated with infantile spasms are discussed.

Cerebral Cortex↗

Continuous intrathecal baclofen treatment of severe spasms in two children with spinal-cord injury.

This study reports the use of intrathecal baclofen in two ventilator-dependent children with severe spasms secondary to spinal-cord injury. Baclofen was delivered via a subcutaneously implanted, programmable pump. The children were followed for 12 and 24 months. Baclofen dramatically reduced spasms, resulting in more stable ventilation, improved ease of care, reduced distress and better integration into the community. Although effective, intrathecal baclofen represents a significant intervention; careful consideration must be given to potential complications and the need for long-term management. Full effectiveness was dependent on free CSF flow.

Adolescent↗

The effect of non-depot ACTH(1-24) on infantile spasms.

However, side-effects such as severe infections, hypertension and electrolyte imbalance have been found, assumed to be related to hypercortisolism induced by chronic ACTH treatment. The authors treated 18 patients with infantile spasms with non-depot ACTH(1-24). The therapeutic effect of non-depot ACTH was comparable to that of depot ACTH, with no severe bacterial infection or sepsis. The incidence of hypertension was significantly lower in the non-depot ACTH group, and persistent hypercortisolaemia was not found. Non-depot ACTH(1-24) appears to be as effective as ACTH(1-24) depot therapy in the treatment of infantile spasms, and its side-effects are mild. It would appear that the effect of non-depot ACTH is not mediated by hypercortisolism, but by a direct neurotropic effect on the brain.

Adrenal Glands↗

SL651498, a GABAA receptor agonist with subtype-selective efficacy, as a potential treatment for generalized anxiety disorder and muscle spasms.

SL651498 (6-fluoro-9-methyl-2-phenyl-4-(pyrrolidin-1-yl-carbonyl)-2,9-dihydro-1H-pyrido[3,4-b]indol-1-one) was identified as a drug development candidate from a research program designed to discover subtype-selective GABA(A) receptor agonists for the treatment of generalized anxiety disorder and muscle spasms. The drug displays high affinity for rat native GABA(A) receptors containing alpha(1) (K(i) = 6.8 nM) and alpha(2) (K(i) = 12.3 nM) subunits, and weaker affinity for alpha5-containing GABA(A) receptors (K(i) = 117 nM). Studies on recombinant rat GABA(A) receptors confirm these findings and indicate intermediate affinity for the alpha(3)beta(2)gamma(2) subtype. SL651498 behaves as a full agonist at recombinant rat GABA(A) receptors containing alpha(2) and alpha(3) subunits, and as a partial agonist at recombinant GABA(A) receptors expressing alpha(1) and alpha(5) subunits. SL651498 produced anxiolytic-like and skeletal muscle relaxant effects qualitatively similar to those of benzodiazepines (BZs) [minimal effective dose (MED): 1 to 10 mg/kg, i.p. and 3 to 10 mg/kg, p.o.]. However, unlike these latter drugs, SL651498 induced muscle weakness, ataxia or sedation at doses much higher than those having anxiolytic-like activity (MED: 30 to 100 mg/kg, i.p. or p.o.). Moreover, in contrast to BZs, SL651498 did not produce tolerance to its anticonvulsant activity or physical dependence. It was much less active than BZs in potentiating the depressant effects of ethanol or impairing cognitive processes in rodents. The differential profile of SL651498 as compared to BZs may be related to its selective efficacy at the alpha(2)- and alpha(3)-containing GABA(A) receptors. This suggests that selectively targeting GABA(A) receptor subtypes can lead to drugs with increased clinical specificity. SL651498 represents a promising alternative to agents currently used for the treatment of anxiety disorders and muscle spasms without the major side effects seen with classical BZs.

Amnesia, Anterograde↗

Quantitative analysis and characterization of infantile spasms.

An effective, time-synchronized monitoring system for the study of patients with infantile spasms has been developed. This system utilizes concurrent graphically recorded data, including EEG, body movement via triaxial accelerometry, respiration, electrocardiogram, electromyogram, electro-oculogram, and galvanic skin response. These data, when evaluated in conjunction with a closed-circuit TV recording of the patient, greatly facilitate the differentiation of seizures from nonictal activity and permit the characterization and quantification of the behavioral, motor, and autonomic phenomena intrinsically associated with infantile spasms.

Electrocardiography↗

Long-term prognosis of patients with infantile spasms following ACTH therapy.

The influence of ACTH on the prognosis of patients with infantile spasms remains controversial. We have examined retrospectively the long-term benefits of initially successful ACTH therapy in patients treated at this institution between 1961 and 1974. Individuals with equivocal or minimal improvement during ACTH therapy were excluded from this study. Eighteen affected infants showed a favorable early response consisting of cessation of seizures for at least 3 weeks during ACTH therapy and concurrent disappearance of the hypsarhythmic EEG pattern. Modal age at last follow-up was 5 years (range, 15 months to 16 years). Infantile spasms recurred in 7 patients (39%), and 8 patients subsequently had other seizure types. All epileptiform (spike) activity disappeared from the EEGs of 8 patients during ACTH therapy, but in 4 of these cases epileptiform activity was present in later tracings. In the remaining 10 patients the hypsarhythmic pattern disappeared in association with ACTH therapy, but the EEG remained epileptiform (often only in sleep). Later EEGs were free of epileptiform activity in 5 of the 10 patients whose tracings contained spike discharges in the early follow-up period. Four patients (22%) were seizure free and without intellectual impairment when last evaluated.

Adrenocorticotropic Hormone↗

De novo reciprocal translocation t(6;14)(q27;q13.3) in a child with infantile spasms.

A boy with infantile spasms was found to have a balanced de novo translocation, 6q;14q. The karyotype was 46,XY,t(6;14)(q27;q13.3). He had mental retardation and microcephaly but no dysmorphic features. Whether or not there is a relationship between the translocation in our patient and his infantile spasms is unknown. If there is a connection, a gene or genes on chromosome 14 may be implicated in the seizure disorders that are common in patients with ring chromosome 14 syndrome or proximal partial trisomy 14 syndrome.

Chromosomes, Human, 13-15↗

Treatment of infantile spasms with tetrabenazine.

Twelve patients with infantile spasms and hypsarrhythmic EEGs were treated with tetrabenazine, a drug with antiserotonergic and antiadrenergic activity. Before treatment, and after 3 weeks of therapy, 24-h polygraphic/video monitoring studies were performed to determine response objectively. None of the patients showed cessation of spasms, EEG improvement, or improvement in development and social skills during treatment with tetrabenazine.

Humans↗

Treatment of infantile spasms with methysergide and alpha-methylparatyrosine.

Twenty-four newly diagnosed and previously untreated infantile spasm patients were treated for 3 weeks with either methysergide (12 patients) or alpha-methylparatyrosine (12 patients). Response to therapy was determined objectively with 24-h polygraphic/video monitoring techniques and was defined as cessation of spasms and disappearance of the hypsarrhythmic EEG pattern. Two (17%) of the patients treated with alpha-methylparatyrosine responded to therapy, and one (8%) of the methysergide-treated group showed a response.

Adrenocorticotropic Hormone↗