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Biomedical subjects

A Hestnes

Publications and source records attributed to A Hestnes.

At least 19 recordsLinked to original sources

[Treatment of Parkinson disease with levodopa depot preparations].

The majority of parkinsonian patients on long-term treatment with levodopa develop fluctuations in motor performance. Several of the features of long-term levodopa treatment seem to be associated with levodopa concentrations in the plasma. In order to overcome the dose-related clinical fluctuations, sustained or controlled-release oral tablets have been developed to achieve more stable plasma concentrations of the drug. This paper describes a Norwegian multi-centre study of Sinemet CR in 56 patients with mild to moderate parkinsonism. After 24 weeks on Sinemet CR the performance of 40 patients was evaluated as improved, i.e. better than when they were treated with standard levodopa. Patients with mild disease or with no motor fluctuations experienced similar clinical benefit from controlled-release levodopa as the more advanced parkinsonian patients. The authors also discuss the advantages and problems of controlled-release levodopa in parkinsonian patients in general.

Aged

Hormonal and biochemical disturbances in Down's syndrome.

Clinical and laboratory endocrine variables in 29 adult institutionalized patients with Down's syndrome were compared with those of matched controls consisting of other mentally retarded patients from the same institution. Of the clinical variables, testes volume and body height were significantly lower in patients with Down's syndrome than in control patients. The thyroid function tests documented a higher average TSH level in Down's syndrome than in other mentally retarded patients. However, there was no clear-cut correlation between TSH and thyroid hormone levels. The data indicate that there is a tendency towards primary thyroid dysfunction in Down's syndrome. In addition, there is some evidence indicating a relative failure of TSH secretion. In male patients, estradiol was elevated compared to controls. FSH and LH also seemed slightly higher in the study group, but the differences only reached statistical significance when patients on chronic medication were omitted. Prolactin was significantly greater in the Down's syndrome patients than in the controls, both over the entire sample and in the subgroup of men with Down's syndrome, with P-values of around 0.001. The elevation of prolactin was not due to medication and did not correlate to thyroid function or difficulties during blood sampling. In females, the difference was not statistically significant. Laboratory tests that may be associated with endocrine disease or might indicate disease which could influence the endocrine status, were also included in this study. Compared with the controls, ESR, creatinine and uric acid levels were higher in Down's syndrome patients, while albumin was lower, all with P-values lower than 0.001. Vitamin B12 was moderately lower in Down's syndrome patients than in controls (P less than 0.05).

Adult

Ocular findings in Down's syndrome.

This communication presents the ocular findings in 30 patients with Down's syndrome residing in a central institution for the mentally retarded. The findings have been compared to those in matched controls consisting of mentally retarded people from the same institution. The ocular status in patients with Down's syndrome has been extensively studied previously, and to a large extent, findings in previous materials were confirmed. However, in this institution, which consisted of adult patients only, some unusual findings have also been made: nine of the 30 patients had keratoconus, which is a remarkably high figure. A compilation of data shows that only one of the patients with Down's syndrome had nearly normal ocular status.

Adult

Somatomedin C (insulin-like growth factor 1) in adults with Down's syndrome.

In a Norwegian institution for the mentally retarded, 29 adults with chromosomally verified Down's syndrome were compared to other mentally retarded patients with respect to serum somatomedin C (SmC) (insulin-like growth factor 1 [IGF-1]). Contrary to what has been observed in children, no shortage of SmC could be demonstrated in the adults with Down's syndrome. The results were within the normal range, and there was no difference between those with Down's syndrome and the other mentally retarded patients. Human growth hormone (HGH) and body height were studied in a previous work. Some correlations with these data are, nevertheless, included herein because they are of relevance. SmC correlated with body height in Down's syndrome, while there was no correlation between SmC and HGH or between HGH and body height.

Adult

Degenerative changes in the cervical spine in Down's syndrome.

It is well established that there is an increased frequency of atlanto-axial instability in Down's syndrome. In two out of the 27 patients with Down's syndrome who were examined, there was an atlanto-axial dislocation, but without any corresponding neurological symptoms. However, scrutiny of the X-rays revealed many cases with marked degenerative changes, particularly in the upper part of the cervical spine. The degenerative changes in Down's syndrome patients were compared with those in age- and sex-matched patients examined because of cervicalgia. Patients examined because of acute neck traumatas constituted a second control group. The results indicate that there is a significant increase in degenerative changes in the upper part of the cervical spine in Down's syndrome.

Adult

Cystathioninuria in Down's syndrome.

Secondary cystathioninuria is associated with various pathological conditions (Gjessing, 1963; Gjessing & Mauritzen, 1965; Endres & Wuttge, 1978). In many cases, cystathioninuria has been associated with mental retardation (Harris et al., 1959; Robb et al., 1984). As far as the authors know, cystathioninuria has not previously been described in Down's syndrome. In 1981, in the author's institution for the mentally retarded, all patients with Down's syndrome were screened with regard to aminoaciduria, using thin layer chromatography. In the course of this process, a case of cystathioninuria was discovered. The results are presented in detail.

Adult

Transdermal scopolamine in drooling.

The effect of oral anticholinergic drugs has been limited in the treatment of drooling. Transdermal scopolamine (1.5 mg/2.5 cm2) offers advantages. One single application is considered to render a stable serum concentration for 3 days. A distinct reduction of basal salivation was demonstrated in an open trial of six healthy volunteers. Eighteen mentally retarded patients with a drooling problem were studied in a double-blind, placebo-controlled cross-over trial. The therapeutic effect of transdermal scopolamine was assessed by a visual analogue scale. Three patients dropped out due to loss of the system. In the remaining 15 patients, the active drug caused a reduction of drooling which was significant in the period from 24 to 72 h. There were few and slight objective signs of unwanted effects. Scopoderm may cause drowsiness and affect tooth health. The management of drooling should primarily be focused on the cause. Sensomotor training is often valuable in cerebral palsy. Factors such as nasal obstruction, mucosal irritation, and drug-induced parkinsonism should be given attention. Sometimes, however, a temporary symptomatic treatment is indicated, for example on special occasions or in order to cure peri-oral skin lesions. Transdermal scopolamine may offer this possibility.

Administration, Cutaneous

Sensory signs and symptoms in scapuloperoneal atrophy: a report of a family.

A Norwegian family with asymmetrical scapuloperoneal atrophy is described. Chronic, aching shoulder pain, slight proximal and distal sensory dysfunction, and atrophy of the extensor digitorum brevis muscle occurred in some individuals. The proband had slightly impaired sensory conduction velocity, and his father exhibited impaired position sense and a vibration threshold asymmetry. EMG and muscle biopsy findings were equivocal. The syndrome is probably of neurogenic origin. It may be classified as a variant of Davidenkow's syndrome.

Adult

Primitive reflexes in Down's syndrome.

The clinical value and prevalences of three primitive reflexes, i.e. the palmomental, the snout, and the corneomandibular, were examined in 30 institutionalized patients with Down's syndrome and the results were compared with those in a control group. The prevalence of palmomental reflex was clearly higher, i.e. 47% (31,63) in DS as compared to 7% (2,16) in controls (confidence limits, P = 0.9, is given in the parenthesis) (P = 0.0001). The prevalences of the snout reflex in the DS and control group were estimated to be 14% (5,29) and 0% (0,6) respectively (P = 0.02). The corneomandibular reflex was found unreliable in DS, mainly because of lack of cooperation. Neither the palmomental nor the snout reflex correlated well with the degree of mental retardation. No correlation of reflex incidence with age was demonstrated for the palmomental reflex. The prevalence of the snout reflex in DS patients less than 35 years was estimated to be 0% (0,18). This is significantly (P less than 0.05) less than the prevalence of 29% (10,54), found in the group older than 35 years of age. The possible value of the snout reflex as a sign of dementia in Down's syndrome is discussed.

Adult

Cluster headache. The sweating pattern during spontaneous attacks.

Sweating in the forehead, on the eyelids, in the face and on the trunk was measured with the Evaporimeter during 31 spontaneous cluster headache attacks of varying severity in 18 patients. The evaporimeter measures evaporative water loss (sweating + transepidermal water loss) rapidly and accurately as g/m2/h. The patients themselves acted as controls. Sweating was also estimated in 25 healthy individuals at a temperature of 27 +/- 1 degree C, and a mean relative humidity of 19%. During eight severe attacks, sweating in the medial part of the forehead on the symptomatic side was invariably increased. In moderate attacks the increment was less pronounced and in the inter-cycle period, no definite increase was found. The cause of increased sweating during cluster headache attacks remains enigmatic.

Adolescent

Familial amyotrophic lateral sclerosis. Report of a family with predominant upper limb pareses and late onset.

Familial occurrence of neuromuscular disease similar to sporadic amyotrophic lateral sclerosis has been reported from several countries. A Norwegian family with muscular wasting in men and women of three generations is described. The propositus and his father's sister were examined, as well as a second cousin of the propositus. The disease was characterized by late onset, predominantly upper limb peripheral pareses, and "pyramidal" signs in the lower extremities. Although peripheral neuromuscular affection in the lower limbs tended to be subclinical, chonchotome biopsies from the tibialis anterior muscle showed neurogenic atrophy in all three cases.

Aged