Biomedical subjects
Publications and source records attributed to A Adunsky.
Corticosteroids are frequently prescribed in terminal cancer. They were prescribed in more than 50% of 100 consecutive patients of our hospice for palliation of anorexia, weakness, symptoms of cerebral metastases and of hypercalcemia, and other problems. There was objective and/or subjective improvement in most, though usually of short duration. If there is no improvement after a few days, corticosteroids should be discontinued.
We present the results of a case control study on the concentration of intracellular calcium [Ca+2]i in peripheral blood mononuclear cells (PBMC) of patients with Alzheimer's disease (AD), major affective disorder unipolar type (DEP), and elderly controls. We used the fluorescent dye Quin-2 to measure intracellular calcium concentration in PBMC both in their basal resting state [Ca+2]b and after activation [Ca+2]a with phytohemagglutinin (PHA). The [Ca+2]b and [Ca+2]a values in PBMC of AD patients were significantly higher than those of the elderly controls and of the DEP patients. In the DEP patients the [Ca+2]a values in PBMC were significantly higher than those of the elderly controls, but the [Ca+2]b values were not. [Ca+2]i levels did not correlate with age, gender, or duration and severity of the diseases investigated. These findings indicate that higher values of [Ca+2]b and [Ca+2]a may differentiate most AD patients from elderly controls or DEP patients.
Thirty young stroke patients were retrospectively assessed for levels of activities of daily living and of basic functional movements. Scores upon admission, discharge, and follow-up were compared in order to evaluate course of rehabilitation and functional outcome. Mean length of stay in the rehabilitation ward was 87 +/- 17 days, and duration of follow-up was 31 +/- 8 months. Multivariate analysis of covariance confirmed significant improvements during hospitalization, in transfer, standing, sitting and walking abilities (F = 3.5, p less than 0.02), as well as in activities of daily living (F = 4.7, p less than 0.01). Further improvement during the follow-up period was observed for standing and walking abilities (F = 10.2, p less than 0.001) only. No fatalities occurred among the patients during the study period. Eighty-one percent of the patients resumed their previous or other jobs six months after discharge. We conclude that for young stroke patients admitted to a rehabilitation ward shortly after the event, prognosis in terms of survival and functional outcome is favorable, and independent of precipitating factor, age, sex, or side of weakness.
Free cytosolic calcium content [Ca2+]i was determined in peripheral blood mononuclear cells (PBMC) from healthy volunteers, Alzheimer's disease and multi-infarct dementia patients. Measurement of [Ca2+]i by the fluorescent dye quin-2, before and at several time intervals during incubation with phytohemagglutinin (PHA), showed a higher resting [Ca2+]i in PBMC of Alzheimer's disease patients as compared to controls and multi-infarct dementia patients. However, the addition of supra-optimal PHA doses (100 micrograms/ml) induced strikingly higher [Ca2+]i levels in Alzheimer's disease patients (1647 +/- 200 nM versus 398 +/- 27 nM in controls, and 346 +/- 40 nM in multi-infarct dementia patients). The increased [Ca2+]i concentration was also found after a specific stimulation with a monoclonal anti-CD3 antibody. The results may have important implications in understanding the pathophysiology of Alzheimer's disease and suggest that [Ca2+]i may prove diagnostically valuable.
31 young patients who were hospitalized and rehabilitated after acute cerebral stroke, we are reassessed. In 58% there was a wide array of underlying diseases and risk factors, while in the others the cause could not be established. 74% suffered from nonhemorrhagic, thrombotic or embolic phenomena and 25% from intracerebral or subarachnoid hemorrhage. There were no alarming preceding signs. After an average of 31 months following the cerebrovascular accident, more than 90% were independent in all daily living activities. Functional outcome did not depend on the underlying disorder.
Seventy-five patients with probable Alzheimer's disease were screened for binding of alpha 2 receptors (A2R) to their platelet membranes; the results were compared with 51 age- and sex-matched controls. Receptor binding assays were performed using [3H] Yohimbine as the radioligand. The results showed a higher binding capacity in the demented population as compared to the control group (2.18 +/- 0.15 fmol/mg protein, as compared to 1.73 +/- 0.13, P less than 0.03). This increased binding to platelets in the demented patients was more prominent in demented females: 34% higher binding as compared with female controls (2.06 +/- 0.5 vs 1.54 +/- 0.04). The difference between demented and normal males was less (2.34 +/- 0.05 vs 1.88 +/- 0.05). The results indicate an involvement of the A2R system, either primarily or secondarily, in the disease process. Since there is an overlap between results from the patients with Alzheimer's disease and the normal subjects, A2R may serve as only a supportive marker for Alzheimer's disease.
Explore the source record for details and available documents.
The Stevens-Johnson syndrome is a relatively uncommon, severe form of erythema multiforme. A case is presented in which Mycoplasma pneumoniae infection was established as the causative agent. Clinicians need to be aware of this uncommon association. We emphasize the need to consider M. pneumoniae infection as one of the many agents responsible for the Stevens-Johnson syndrome.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A 13-year-old girl was admitted with meningeal signs. A lumbar puncture was followed shortly by cardiorespiratory arrest. In spite of intensive resuscitation she remained comatose and severe polyuria diagnosed as diabetes insipidus appeared. The differential diagnosis of dehydration and polyuria in patients after cardiorespiratory arrest and resuscitation should include hypothalamic injury causing diabetes insipidus.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This prospective study was undertaken to assess the state of hydration in terminal cancer patients with and without intravenous fluids during the last 48 hours of their lives and to correlate various measures of hydration with their state of consciousness. We examined indicators of hydration in the plasma and urine of 68 consecutive patients for whom data were available at 48 hours or less before death. Thirteen of the patients were being treated with intravenous (IV) fluids. Nearly all of the patients studied were found to be dehydrated, as determined by laboratory measurements. State of consciousness correlated inversely with serum sodium (p < 0.001) and urine osmolality (p < 0.02). Patients receiving intravenous fluids were not better hydrated than those without IV therapy, nor was their state of consciousness improved. In light of these findings, which suggest there is no clinical benefit from intravenous infusions, decisions regarding intravenous fluid therapy during the last hours of life should be guided by the preferences of the dying patient and his family.