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Biomedical subjects

A Kazis

Publications and source records attributed to A Kazis.

At least 37 records · Page 2Linked to original sources
PubMed1997

Peripheral blood stem cell transplantation in the treatment of progressive multiple sclerosis: first results of a pilot study.

Several experimental autoimmune diseases (AID), including allergic encephalomyelitis, ie the multiple sclerosis (MS) model, respond to TBI and chemotherapy followed by BMT. Remissions of AID may also occur in patients with concomitant malignancies treated with allogeneic or autologous BMT. These observations have emphasized the possibility of treating AID with high-dose therapy and haematopoietic stem cell transplantation (HSCT). In a phase I/II pilot study, 15 patients with progressive MS were treated with BEAM followed by autologous blood SCT and antithymocyte globulin (ATG). Patients were severely disabled, with median EDSS and SNRS scores of 6 (5-7.5) and 42 (33-62), respectively. Cyclophosphamide (4 g/m2) and G/GM-CSF (5 microg/kg/day) were used for stem cell mobilization, which caused no neurotoxicity. On days +1 and +2, ATG (2.5-5 mg/kg) was given for in vivo T cell-depletion. Allergy (93%) and infections (87%) were the principal toxic complications. Mild, transient, neurotoxicity was observed in six patients in the immediate post-transplant period. The median follow-up time is 6 months (6-18). Durable neurologic improvements have been detected on both the EDSS (7/15) and SNRS (15/15) systems. One patient worsened at 3 months and two have relapsed. Autologous HSCT appears feasible in MS; it does not aggravate disability and seems to offer a clinical benefit. However, these observations need confirmation and long-term outcomes will show if benefits counterbalance toxicity and cost.

Adult↗
PubMed1996

Cognitive event-related potentials and magnetic resonance imaging in myotonic dystrophy.

Fourteen patients with myotonic dystrophy (MyD) were studied with means of an auditory "oddball" event-related potential (ERP) paradigm. The results were compared with data from 53 controls. The early components (N1, P2) of the ERP were not affected, whereas later components (N2, P3), which are thought to reflect cognitive processes, were abnormal in eight patients who were the oldest in the sample. Magnetic resonance imaging (MRI) was performed in twelve patients and revealed, in five of them, multiple focal white matter lesions. These findings, however, could not be associated with neurophysiological abnormalities. It is concluded, that cognitive ERP, particularly N2 and P3 components, are abnormal in some patients suffering from MyD. Possible etiologies of the electrophysiological abnormalities are discussed.

Adolescent↗
PubMed1992

Cytogenetic damage by melphalan and hyperthermia in patients with an initial epileptic attack.

Sister-chromatid exchanges (SCEs) and cell kinetics in cultured lymphocytes of patients with an initial epileptic attack, and prior to any anticonvulsant treatment, were studied. Spontaneous melphalan (MEL) and MEL-hyperthermia (MEL-HYP) induced SCE frequencies have been studied in 18 adults with an initial epileptic seizure. Fifteen age and sex matched healthy subjects were used as the control group. The incidence of spontaneous SCEs in lymphocytes from epileptics was not significantly greater than in those from the control subjects. However, when exposed to MEL in vitro, cells from both groups showed an increase in SCE frequency. When exposed to MEL and HYP (41 degrees C for 3 h) in vitro, cells from both groups showed a further increase in SCE frequency with yields from epileptics higher (P less than 0.05) than from controls. HYP in combination with MEL enhanced synergistically SCEs and cell division delays in both groups with synergistic effects in cells from epileptics (P less than 0.01 and P less than 0.01 respectively) higher than from controls (P less than 0.05 and P less than 0.05 respectively.

Adult↗
PubMed1987

Almitrine effect on nocturnal hypoxaemia in patients with chronic obstructive pulmonary disease (COPD).

Almitrine bismesylate (A) is a peripheral chemoreceptor agonist that increases ventilation, improves V/Q matching, increases PaO2 and decreases PaCO2 in patients with COPD. We have used a placebo-controlled double-blind cross-over study to compare the effect of 1.5 mg.kg-1 A and placebo (P) (given orally twice a day for 14 days with a 2 wk wash-out period between) on sleep quality, blood oxygenation during sleep and the ventilatory response to hypoxia and hypercapnia when awake. We have measured ear oxygen saturation (SaO2) and EEG sleep stages during nocturnal sleep in 13 patients with COPD (FEV1 0.94 +/- 0.31 1). When awake and during P period PaO2 was 51.4 +/- 10.7 mmHg (SD), PaCO2 53.1 +/- 7.1 mmHg and SaO2: 83.1 +/- 8.0%: during A treatment PaO2 increased to 55.8 +/- 7.8 mmHg (p less than 0.01 paired Wilcoxon test), PaCO2 decreased to 48.5 +/- 6.4 mmHg (p less than 0.05) and SaO2 increased to 86.9 +/- 2.6 (p less than 0.01). A reduced nocturnal hypoxaemia: 1) during P treatment mean stage I SaO2 was 73.2 +/- 13.2%, stage II 70.5 +/- 15.7%, stage III 66.5 +/- 18.5%, stage IV 73.3 +/- 12.7% and rapid eye movement (REM) sleep 59.2 +/- 14.8%; the corresponding SaO2 values during A treatment were higher: stage I SaO2 80.6 +/- 5.2% (p less than 0.05), II 78.6 +/- 6.2% (p less than 0.01), III 77.3 +/- 7.4% (p less than 0.01), IV 80.4 +/- 3.8% (p less than 0.05), REM 69.9 +/- 7.9% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1984

CT in the diagnosis of cerebral vascular malformations.

In 72 patients with spontaneous intracranial haemorrhage and vascular malformation, 27 of 49 arterial aneurysms were diagnosed by CT (the smallest one of 4mm diameter being stalked), as were all (18) of the arteriovenous aneurysms (angiomas), but of the venous malformations (5) only 2 (aneurysms of the vein of Galen) were so diagnosed. In the 25 patients with spontaneous subarachnoid haemorrhage, in whom vascular malformation had not been diagnosed through angiography or CT, CT showed the position and extent of the parenchymatous lesion or the existence of blood in the subarachnoid space or ventricules. Finally, in 15 patients with subjective or neuropsychiatric disturbances, 9 arterial and 6 arteriovenous aneurysms were diagnosed by CT and were verified by angiography, which would probably not have been performed if CT had not been performed. Thus it is clear that vascular malformations are often diagnosed by CT. In many cases information is revealed which would not be suspected with angiography, while in other cases angiography is more selective and accurate.

Adolescent↗
PubMed1982

Fever and evoked potentials in multiple sclerosis.

The somatosensory evoked potentials (SEPs) and visual evoked potentials (VEPs) were studied in 19 patients with multiple sclerosis; 17 controls were studied during fever (38.0 degrees - 39.7 degrees C) and 2-3 days following return to normal temperature. The latencies of components N20 and P114 were measured and specified as abnormal when their value exceeded the standard deviation of the controls by 2.5 times. The corresponding criterion for the evaluation of the amplitude of components N20 and P114 was a reduction in amplitude of more than 50%. In the controls fever did not cause significant changes in evoked potentials. On the other hand, patients with multiple sclerosis showed abnormalities in evoked potentials during fever in a greater number of recordings (26 of SEPs and 33 of VEBs) than after return to normal temperature (19 and 27 respectively). In addition, the average latency of components N20 and P114 was clearly greater in the patients during fever (N20 = 29.5 +/- 5.2 ms and P114 = 143 +/- 18.1 ms) than after return to normal temperature (N20 = 6.6 +/- 3.5 ms and P114 = 134 +/- 16 ms). The amplitude of components N20 and P114 in patients during fever was clearly smaller than after return to normal temperature. These differences were statistically significant. Finally, in two patients, a decrease was found, during fever, in the conduction velocity of the peripheral somatosensory pathway from the median nerve to the wrist at Erb's point.

Adult↗
PubMed1982

[Cranial computerized tomography in senile dementia].

Axial tomograpum (CAT), of 59 patients with dementia and 102 controls suffering from headaches and dizziness were examined. The CAT was normal in 13 demented patients (22%) and in 37 controls (36,3%), and revealed enlarged spaces of the CSF in 46 anoic patients (78%) and 65 controls (63.7%). Multiple areas of subnormal density were observed in 23 anoic patients (39%) and in 6 controls (5.9%). This indicates that the multi infarct syndrome is frequently associated with dementia, while the correlations between Hydrocephalus and dementia is weak.

Aged↗
PubMedDate not supplied

Pharmacokinetics of dextromethorphan and dextrorphan in epileptic patients.

The present report describes the pharmacokinetic characteristics of dextromethorphan (DM) and its main active metabolite dextrorphan (DX) in a group of epileptic patients receiving comedication. Patients were sequentially dosed with DM 40 mg/6 h (8 weeks) and 50 mg/6 h (8 weeks) while concurrent antiepileptic drugs were kept stable. During baseline period, patients were phenotyped with regard to their drug metabolizing capacity. At the end of each treatment period, timed plasma DM and DX levels were determined post-dose by HPLC. Urine and cerebrospinal fluid f1p4) samples were also collected. The pharmacokinetic parameters of DM showed a wide intersubject variation. The genetic polymorphism of DM metabolism was identified as the possible cause of the observed variability. For both DM and DX mean values for Cmax and AUC increased in a linear fashion with dose, while the mean values of tmax and t 1/2 were not dependent on dose. The mean values of CL/F and Vss/F for DM were also dose-dependent. 3-Methoxymorphinan, an N-demethylated metabolite of DM was detected in plasma and CSF of some patients and warrants further investigation as to its possible CNS effects. In conclusion, DM given in doses up to 50 mg/6 h can produce plasma and brain concentrations similar to the in vitro antiepileptic levels, without causing significant adverse effects.

Adult↗
PubMedDate not supplied

Epidemiological dementia index: a screening instrument for Alzheimer's disease and other types of dementia suitable for use in populations with low education level.

INTRODUCTION: MMSE and CAMCOG are neuropsychological scales developed for use in everyday clinical practice and epidemiological surveys. MATERIAL AND METHODS: These two instruments were used as part of the assessment during an epidemiological survey in the municipality of Pylaia, Greece. The project was based on the World Health Organization Program for Research on Aging and Age-Associated Dementias (1992). It had two phases. During phase I, nursing students collected demographic data, risk factors, personal and family history data and they applied MMSE, CAMCOG and scales of everyday life functioning. During phase II, 4 physicians examined all subjects that manifested possible cognitive deterioration (MMSE<27), in order to reach a final diagnosis. The final diagnosis was made according to DSM-IV and NINCDS-ADRDA criteria. MMSE and CAMCOG were not taken into consideration in the diagnostic process. Three hundred and eighty subjects were initially screened. All were aged over 70 years. After the exclusion of subjects who were illiterate, blind, etc., the results of 277 subjects were finally analyzed. Subjects with 6 years of education or less accounted for 92.42% of the total study sample. Twelve of them (5.33%) suffered from Alzheimer's disease, 7 from vascular dementia (2.52%) and 1 suffered from secondary dementia (0.36%). RESULTS: MMSE exceeded 90% sensitivity at the level 22/23 and specificity at 14/15. The levels for CAMCOG were 56/57 and 43/44, respectively. This low performance of both tests is to a large extent due to the functional illiteracy of elderly individuals in Greece, to possible coexistence of mood disorders or simply to lack of cooperation. The analysis of data led to the development of an Epidemiological Dementia Index (EDI), with a scale ranging from 0 to 7. Nondemented subjects had a mean EDI of 5.12 (SD = 1.67) and demented patients had a mean EDI of 1.6 (SD = 1. 92). At the level 4/5 sensitivity was 93.33. Specificity was 93.56 at the level 2/3.

Aged↗
PubMedDate not supplied

Alzheimer's Disease Assessment Scale: the validation of the scale in Greece in elderly demented patients and normal subjects.

INTRODUCTION: The Alzheimer Disease Assessment Scale (ADAS) is a scale specifically structured for the assessment of the cognitive decline and behavioral disorder seen in Alzheimer disease (AD) patients. AIM OF THE STUDY: The validation of ADAS in the Greek population. MATERIAL: One hundred and thirty-one subjects took part in the current study. Fifty of them were nondemented subjects (35 normal subjects and 15 suffering from age-associated memory impairment) and 81 demented patients (68 AD patients and 13 vascular dementia, VD, patients). METHOD: Diagnosis was made according to DSM-IV and NINCDS-ADRDA criteria. Hachinski Ischemia Scale was used to help to differentiate between AD and VD patients. Geriatric Depression Scale was used to quantify depressive symptomatology. MMSE and CAMCOG were used to assess the cognitive functioning of all subjects and FRSSD for the assessment of daily functioning. All subjects underwent a complete laboratory and biochemical testing, according to the protocol proposed in CAMDEX. All demented patients underwent brain CT. RESULTS: ADAS-Cog discriminates perfectly AD patients and nondemented subjects at the score level of 13/14 and/or 14/15. Principal components analysis, using only AD patients, revealed 4 factors: cognitive, psychotic, depressive, and 'severe apraxia' factors. CONCLUSION: ADAS is suitable for use in the discrimination between AD patients and nondemented subjects. It is also suitable for a more comprehensive assessment of the clinical symptomatology of AD patients, and for the evaluation of new therapeutic methods for AD, as well.

Age Factors↗
PubMedDate not supplied

Efficacy of acetylcholinesterase inhibitors versus nootropics in Alzheimer's disease: a retrospective, longitudinal study.

The aim of this study was to investigate the efficacy of nootropics (piracetam, aniracetam, nimodopine and dihydroergicristine) versus acetylcholinesterase inhibitors (AChE-Is) (tacrine and donepezil) in the treatment of Alzheimer's disease. This is a retrospective study of 510 patients with Alzheimer's disease. To determine clinical efficacy of treatment, we used the mean change over time in scores for the following tests: the Mini-Mental State Examination (MMSE); the Cambridge Cognitive Examination for the Elderly; and the Functional Rating Scale for Symptoms of Dementia. In all patients and in patients with severe Alzheimer's disease (baseline MMSE < 11), no significant differences were seen in the neuropsychological test scores between the two treatment groups. In patients with moderate dementia (baseline MMSE between 11 and 20), however, there was a significantly greater deterioration, as shown on the CAMCOG scale, after 12 months' treatment for patients receiving AChE-Is compared with those receiving nootropics (-4.38 for AChE-Is group versus 1.48 for nootropics group). For patients with mild dementia (baseline MMSE score between 21 and 26), there was a significantly greater deterioration on the MMSE scale for each time-point in the nootropics group compared with the AChE-Is group. In conclusion, we did not find any strong evidence that a difference in efficacy exists between AChE-Is and nootropics in the treatment of Alzheimer's disease.

Aged↗
PubMedDate not supplied

Correlation of rCBF (SPECT), CSF tau, and cognitive function in patients with dementia of the Alzheimer's type, other types of dementia, and control subjects.

BACKGROUND: The diagnosis of Alzheimer's disease (AD) during life remains difficult and a definite diagnosis of AD relies on histopathological confirmation at post-mortem or by cerebral biopsy. It is well known that levels of tau proteins are consistently and significantly increased in the cerebrospinal fluid (CSF) of Alzheimer's patients versus levels in normal controls. However, the sole use of this biochemical marker as a test for AD is hampered by mediocre specificity, since tau concentrations may also be elevated in certain other neurological disorders (OND). Studies of the regional cerebral blood flow (rCBF) are widely performed because of their convenience and usefulness in a variety of neurological disorders. Most studies have reported high diagnostic accuracy for brain perfusion single-photon emission tomography (SPECT) in Alzheimer's disease. METHODS: In order to improve specificity, in this study, correlation of 99mTc-HMPAO SPECT scanning and CSF tau protein levels was made in 117 patients with AD, 67 patients with OND (26 of which had other dementias), and 23 age-matched controls. Means and standard deviations of tau protein levels were 297, 42 +/- 221, 12 in AD patients and 78, 07 +/- 98, 51 in patients with OND (p = 0.0006). No correlation was noted between CSF tau protein levels and age, duration of the disease, and neuropsychological scores of mini-mental state examination (MMSE), Cambridge Cognitive Examination (CAMCOG), and Functional Rating Scale for Symptoms of Dementia (FRSSD). FINDINGS: There was a bilateral parietal and temporal hypoperfusion in patients with AD in SPECT in comparison to normal subjects (p < 0.05) and there was a statistical correlation between this hypoperfusion and neuropsychological tests, such as MMSE and CAMCOG (p < 0.01). There was no correlation between tau protein levels and hypoperfusion in SPECT. INTERPRETATION: Conclusively, the correlation between elevated levels of tau proteins and hypoperfusion in SPECT in AD patients therefore cannot improve the specificity of tests in AD and this means that the determination of CSF tau proteins levels is not a specific diagnostic test for AD.

Aged↗
PubMedDate not supplied

Extrapyramidal symptoms and signs in Alzheimer's disease: prevalence and correlation with the first symptom.

OBJECTIVES: To determine the prevalence and clinical correlates of extrapyramidal signs (EPS) in outpatients with probable Alzheimer's disease (AD); to examine the appearance of EPS in association with the first symptom that led the patient or family to ask for medical help; to examine the association of the prevalence of EPS with gender, age at onset of the disease, duration of the disease, severity of dementia, functional disability, and potential use of neuroleptics; and to address the issue of the possible role of EPS as a predictive factor for the clinical course of the disease. PATIENTS AND METHODS: We examined 126 patients meeting NINCDS-ADRDA* criteria for probable AD and 29 healthy, nondementia controls of comparable age and gender. Thirteen of the patients taking neuroleptics at the time of the examination were excluded from the main study group and formed a separate subgroup of AD/neuroleptics-positive. Twenty-eight of the AD/neuroleptics-free patients were re-examined during an 18-month period in order to determine the possible role of EPS as a predictive factor of the clinical course of the disease. RESULTS: Only 8 percent of the AD/neuroleptics-free patients were free of EPS, while the corresponding percentage in the control group was 61.5 percent. The most common types of EPS presented in the patient group were hypomimia ([facial mask] 60 percent), difficulty in talking (53.66 percent), bradykinesia (51.4 percent), postural instability (47.33 percent), abnormal gait (34.66), and rigidity (26 percent), respectively. No significant differences were found when examining for the presence of resting tremor, other tremors, dystonias, and dyskinesias. With regard to the presence of EPS and the first symptom, no significant difference was found among patients whose first complaint was memory disorder (probable AD) and patients with other symptoms. When examining the association between the prevalence of EPS and gender or age at onset of the disease, no special correlation was detected. However, such a correlation was found between the prevalence of EPS and duration of the disease, as indicated by the fact that EPS appear in 78.9 percent of the patients with a duration of illness less than two years, but in 97 percent of the patients with a corresponding duration of two years or more. The mean duration of the disease in patients appearing with EPS is found to be 2.68 +/- 1.98 years. The presence of EPS increases proportionally with the progression of the disease and cognitive and functional decline. Patients with poor results in the MMSE (score of less than 11) appear to present EPS at a greater percentage than those with better performance on the examination (MMSE scores greater than 11). With regard to the association between EPS and functional ability in AD, it seems that the presence of EPS imposes difficulties in daily activities, as seen by the fact that patients with EPS have lower FRSSD scores (mean +/- SD: 14.87 +/- 10.53) than patients without EPS (5 +/- 2.58). After controlling for duration of the disease, the use of neuroleptics is found to influence the appearance of EPS in patients with AD. Almost all of the patients AD/neuroleptics-positive patients presented EPS (100 percent), while 92 percent of the AD/neuroleptics-free patients manifested such symptoms. Finally, we re-evaluated 28 patients, who were part of the initial AD/neuroleptics-free group, in order to determine whether the appearance of EPS could have prognostic value for the clinical course of the disease. Patients who presented EPS at initial examination appeared to deteriorate faster, mainly cognitively, but also functionally. The mean decrease in MMSE scores in patients with EPS was found to be 2.65 +/- 3.46; while in patients without EPS at initial visit, MMSE scores were 0.63 +/- 3.88. The functional decline seems to be less influenced by the presence of EPS. The corresponding mean decrease in FRSSD scores of the two groups was 2.1 +/- 5.55 and 1.8 +/- 2.1, respectively.

Aged↗