Biomedical subjects
Publications and source records attributed to A Heyman.
Aminocaproic acid is a widely used antifibrinolytic agent. Serious adverse effects associated with its use are rare, but we report on a patient with liver disease and cirrhosis who experienced a grand mal seizure during the intravenous administration of aminocaproic acid. Clinicians should be alert to the occurrence of this adverse effect in patients with no previous neurological problems.
The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) has developed brief, comprehensive, and reliable batteries of clinical and neuropsychological tests for assessment of patients with the clinical diagnosis of Alzheimer's disease (AD). We administered these batteries in a standardized manner to more than 350 subjects with a diagnosis of AD and 275 control subjects who were enrolled in a nationwide registry by a consortium of 16 university medical centers. The tests selected for this study measured the primary cognitive manifestations of AD across a range of severity of the disorder, and discriminated between normal subjects and those with mild and moderate dementia. The batteries also detected deterioration of language, memory, praxis, and general intellectual status in subjects returning for reassessment 1 year later. Interrater and test-retest reliabilities were substantial. Long-term observations of this cohort are in progress in an effort to validate the clinical and neuropsychological assessments and to confirm the diagnosis by postmortem examinations. Although information on validation is limited thus far, the CERAD batteries appear to fill a need for a standardized, easily administered, and reliable instrument for evaluating persons with AD in multicenter research studies as well as in clinical practice.
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Impairment of writing ability was studied in 20 patients with mild to moderate dementia caused by early-onset Alzheimer's disease. A multicomponent analysis was made of a brief narrative writing sample obtained from each patient, and this writing proficiency score was compared with results of standard tests of cognitive function as well as ratings of the degree of dementia. In these patients, significant correlations were observed between this brief test of narrative writing ability and the severity of dementia. An analysis of writing proficiency appears to be a simple means of assessing the severity of dementia caused by Alzheimer's disease. Further studies are needed to show the potential usefulness of such measures of agraphia in subtyping this disease.
The Pilot Stroke Data Bank obtained information on 94 patients with intracerebral hemorrhage. These data were used to identify factors predictive of 30-day outcome from among 85 demographic, historical, clinical, and laboratory variables generally available to clinicians on the day of admission. The 9 univariate factors statistically associated with outcome were Glasgow Coma Scale score, systolic blood pressure, pulse pressure, horizontal and vertical gaze palsies, severity of weakness, presence of brainstem-cerebellar deficits, interval stroke course, and parenchymal hemorrhage size. Beginning with these factors, a step-down variable selection procedure was used to derive a logistic regression model, containing only Glasgow Coma Scale score, pulse pressure, and hemorrhage size, that could be used to categorize correctly 92% of the patients as alive or dead at 30 days after onset.
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Mini-Mental State findings from an age 60+ random community sample (N = 1681) indicate that score is related to education, age and race (but not sex) and to functional status, but not to selected aspects of physical or mental health. Adjustment for demographic characteristics, particularly education, is recommended lest cognitive impairment be overestimated.
A 39-year-old man and a 79-year-old woman developed dynamic ileus soon after erythromycin stearate was administered for a respiratory tract infection. Both had had prior uncomplicated abdominal operations: the man, vagotomy and pyloroplasty for bleeding duodenal ulcer, 3 years earlier; and the woman, an appendectomy some 44 years before. The temporal association with erythromycin therapy, resolution of signs and symptoms when the drug was stopped, an uneventful recovery, and the absence of other causes, suggest a possible role of erythromycin in the pathogenesis of dynamic ileus in these patients. Disturbed gastrointestinal motility patterns caused by erythromycin, in the presence of structural changes of the alimentary tract due to prior surgical procedures, may have contributed and we review these events.
A patient who underwent coronary bypass surgery and was treated with nifedipine subsequently developed an erysipelaslike erythematous itching plaque on both shins. Histopathologic examination of a biopsy specimen from the area showed findings compatible with a lichen-planus-like drug eruption. An awareness of varied skin reactions produced by nifedipine may reduce the suffering of patients and help prevent unnecessary local and general treatments.
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The Mini-Mental State Examination (MMSE) and the Blessed Orientation-Memory-Concentration test (BOMC), a six-item derivative of the Blessed Information-Memory-Concentration Test, were each administered to 36 patients with a clinical diagnosis of Alzheimer's disease. In 24 patients, both tests were readministered a month later. The correlation between the MMSE and BOMC was -0.83 with a test-retest correlation of 0.89 (MMSE) and 0.77 (BOMC). Factor analysis indicated that the multiple MMSE cognitive components could be explained by two factors, which together accounted for 66% of the variance. These factors are conceptually similar to the components of the BOMC, and so may explain the substantial correlation between the two tests. Since these cognitive status tests seem to be equivalent for Alzheimer patients, the briefer measure (BOMC), which offers additional advantages, may be preferred.
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Two tests for genetic heterogeneity within the framework of linkage analysis were performed among 18 caucasian families with Alzheimer's disease, for each of 27 phenotypic markers. Both tests were performed twice, first assuming that individuals with Down's syndrome were also "affected" with Alzheimer's disease, and second assuming that they were not. No statistically significant heterogeneity was found under either test, regardless of the affected status assumption. However, trends in the data were consistent with heterogeneous etiology between families with both Alzheimer's disease and Down's syndrome versus families with Alzheimer's disease only. The trends were stronger when the Down's syndrome members were considered affected, and were most striking for linkage with the MNSs locus.
Follow-up observations were made of 92 white patients with early-onset Alzheimer's disease to determine the demographic, clinical, and neuropsychological factors predictive of institutionalization or death. The cumulative mortality rate 5 years after entry into the study was 23.9%, compared with an expected rate of 9.5%. The 5-year cumulative rate of admission to nursing homes was 62.8%. The language ability of the patients on entry to the study, their scores on a brief screening test of cognitive function, and their overall ratings of clinical dementia were found to be predictors of subsequent institutional care and death. The age of the patients had a significant modifying effect on these predictive factors, resulting in a greater risk of institutionalization and death in younger patients with severe cognitive impairment as compared with older individuals with the same degree of dysfunction.