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Biomedical subjects

A M Rubin

Publications and source records attributed to A M Rubin.

At least 19 recordsLinked to original sources
PubMed1999

Astrocyte reaction in the rat vestibular nuclei after unilateral removal of Scarpa's ganglion.

Unilateral vestibular ganglionectomy (UVG) results in a complete degeneration of vestibular nerve fibers and terminals in the ipsilateral vestibular nuclear complex (VNC). A subsequent glial reaction may affect the activities of VNC neurons and thereby influence compensation for lesion-induced vestibular disorders. Expression of glial fibrillary acidic protein (GFAP), a specific marker for reactive astrocytes, was demonstrated immunohistochemically in the rat VNC at 7, 14, and 35 days after UVG. An increased GFAP-positive astrocytic response was evident at 7 days after lesion in all the VNC regions on the lesioned side and in some regions on the unlesioned side and remained through 35 days. The glial response included hypertrophy, which was more prominent at 7 days than at 14 days or 35 days, and proliferation, more prominent at the later times, of GFAP-positive astrocytes. Astrocytic projections around VNC neuron somata and proximal dendrites increased in number and became thicker and more elongated, especially at 14 days, in the lateral vestibular nucleus. It is suggested that UVG results in a bilateral astrocytic reaction in the VNC that would affect the subsequent compensation.

Animals↗
PubMed1999

Otolaryngologic management of dizziness in the older patient.

Studies report that dizziness is the most common presenting symptom in older patients who seek primary care. To understand the causes of dizziness, which is one of the major risk factors in causing falls in the older population, basic anatomy and physiology are reviewed in this article. Age-specific histopathologic changes occur in the labyrinth of the inner ear. To display evidence of the patient's symptoms, evaluation must include a comprehensive history, neurotologic examination, and diagnostic testing. There are common disorders associated with dizziness; thus, management depends on the cause. Once a diagnosis is secured, treatment is instituted based on sound medical principles.

Aged↗
PubMed1999

Tinnitus: etiology and management.

Tinnitus is the perceived sensation of sound in the absence of acoustic stimulation. Individuals who suffer from it are commonly between the ages of 40 and 80 years. Tinnitus is often classified as objective or subjective, yet the pathophysiologic cause is still unknown. Subjective tinnitus is largely identified with hearing loss. Management of tinnitus is based on an individual approach; there is no single treatment or regimen for it.

Aged↗
PubMed1997

Quantitative autoradiography of 5-[3H]6-cyano-7-nitro-quinoxaline-2,3-dione and (+)-3-[3H]dizocilpine maleate binding in rat vestibular nuclear complex after unilateral deafferentation, with comparison to cochlear nucleus.

The distributions of non-N-methyl-D-aspartate and N-methyl-D-aspartate receptors in the rat vestibular nuclear complex were estimated by quantitative autoradiography of 5-[3H]6-cyano-7-nitro-quinoxaline-2,3-dione and (+)-3-[3H]dizocilpine maleate binding, respectively. The binding of 5-[3H]6-cyano-7-nitro-quinoxaline-2,3-dione in the vestibular nuclear complex was also compared with that in the cerebellar cortex and cochlear nucleus. Measurements were made in control rats and in rats with unilateral destruction of the inner ear and removal of the vestibular ganglion. Compared to the unlesioned side, 5-[3H]6-cyano-7-nitro-quinoxaline-2,3-dione binding in the lesioned-side vestibular nuclear complex was decreased significantly in all regions at two to four postoperative days. However, the bilateral asymmetry disappeared in most regions by 30 days. 5-[3H]6-Cyano-7-nitro-quinoxaline-2,3-dione binding increased in the molecular layer of the cerebellar cortex at 30 days after lesion, although there were no clear changes at two to seven days. 5-[3H]6-Cyano-7-nitro-quinoxaline-2,3-dione binding in the cochlear nucleus decreased on the lesioned side, compared to the unlesioned side, in regions receiving significant auditory nerve innervation, but increased in the molecular layer of the dorsal cochlear nucleus. (+)-3-[3H]Dizocilpine maleate binding in regions of the vestibular nuclear complex was reduced on the lesioned side, compared to the unlesioned side, after deafferentation, with the largest reductions usually at 30 postoperative days. It is suggested that: (i) non-N-methyl-D-aspartate receptors are involved in synaptic transmission for both vestibular and auditory nerve fibers, while the involvement of N-methyl-D-aspartate receptors is less certain; (ii) unilateral deafferentation of the vestibular nuclear complex can result in bilateral asymmetries for non-N-methyl-D-aspartate and N-methyl-D-aspartate receptors, which are most prominent at earlier and later survival times, respectively; and (iii) vestibular compensation may involve regulation of both non-N-methyl-D-aspartate and N-methyl-D-aspartate receptors in the vestibular nuclear complex and activation of non-N-methyl-D-aspartate receptor-related processes in cerebellar cortex.

6-Cyano-7-nitroquinoxaline-2,3-dione↗
PubMed1996

Effects of oral propafenone on defibrillation and pacing thresholds in patients receiving implantable cardioverter-defibrillators. Propafenone Defibrillation Threshold Investigators.

OBJECTIVES: The effects of propafenone, a predominantly class IC antiarrhythmic drug, on defibrillation and pacing thresholds were evaluated in patients undergoing cardioverter-defibrillator implantation. BACKGROUND: Previous studies have shown that the class IC agents encainide and flecainide may increase the energy requirements for pacing and defibrillation. Animal studies with propafenone have shown inconsistent results regarding its effect on defibrillation energy requirements. This report investigated the effects of propafenone on defibrillation and pacing thresholds in humans. METHODS: After cardioverter-defibrillator implantation, 47 patients were enrolled in a double-blind, three-way parallel, randomized trial of 450 mg/day (Group 1) or 675 mg/day (Group 2) of oral propafenone or placebo (Group 3) for 3 to 7 days. Predischarge defibrillation and pacing thresholds after treatment were compared with baseline thresholds obtained at implantation. RESULTS: There was no statistically significant difference between implantation and predischarge defibrillation thresholds in the three groups (Group 1: [mean +/- SE] 11.0 +/- 1.3 vs. 12.1 +/- 1.5 J; Group 2: 11.5 +/- 1.1 vs. 13.6 +/- 1.3 J; Group 3: 12.5 +/- 1.2 vs. 13.3 +/- 1.6 J), and no significant difference between treatment groups was found with a 0.86 power to detect a 5-J difference between groups. Paired pulse width pacing thresholds at 2.8 V were compared in 14 patients. A small increase of 0.02 ms was noted at predischarge testing in patients treated with propafenone and placebo. CONCLUSIONS: Short-term oral propafenone (450 and 675 mg/day) does not significantly affect defibrillation or pacing thresholds. Concomitant use of propafenone in patients with implantable cardioverter-defibrillators with recurrent ventricular or atrial tachyarrhythmias should not interfere with proper device function.

Administration, Oral↗
PubMed1996

Quantitative changes of amino acid distributions in the rat vestibular nuclear complex after unilateral vestibular ganglionectomy.

Changes of amino acid concentrations in the vestibular nuclear complex (VNC) during lesion-induced vestibular compensation were studied in rats after unilateral vestibular ganglionectomy. Distributions of 12 amino acids within the VNC were measured at 2,4,7, and 30 days after surgery, using microdissection of freeze-dried brain sections and HPLC. Glutamate decreased on the lesioned side in nearly all VNC regions. Changes were fully developed 2 days after lesion and persisted through 30 days. In some regions, glutamate decreased also on the unlesioned side, especially at longer survival times, so that bilateral asymmetries became reduced. Aspartate changes were similar to those of glutamate on either side. Lesion-induced glutamine asymmetry was usually opposite to that of glutamate. Although GABA concentration decreased at early survival times, it recovered at later times and sometimes increased in dorsal parts of lateral and medial nuclei. Taurine changes were similar to those of GABA in most regions. Glycine change was primarily limited to a bilateral decrease in the dorsal part of the lateral vestibular nucleus. Concentrations of other amino acids were much lower, but some showed postlesion changes.

Amino Acids↗
PubMed1996

Monomorphic right ventricular tachycardia in a patient with mitral valve prolapse.

A patient with mitral valve prolapse and symptomatic ventricular ectopy underwent an electrophysiological study during which a sustained monomorphic ventricular tachycardia with a left bundle branch block/right axis deviation morphology was induced. This morphology was replicated by pace mapping at the right ventricular outflow tract. To the best of our knowledge, this finding has not been previously described and suggests that the association between ventricular arrhythmias and mitral valve prolapse may not necessarily be causal.

Adult↗
PubMed1995

Effect of left ventricular hypertrophy and its regression on ventricular electrophysiology and vulnerability to inducible arrhythmia in the feline heart.

BACKGROUND: Left ventricular hypertrophy (LVH) is associated with an increased risk of death, susceptibility to ventricular arrhythmia, and multiple electrophysiological abnormalities. The purpose of the present study was to determine whether the susceptibility to arrhythmia and electrical abnormalities persists after regression of hypertrophy in an animal model of LVH. METHODS AND RESULTS: We placed constricting bands on the ascending aorta of cats (n = 9) or performed sham operations (n = 9). Serial cardiac echocardiography was performed to measure left ventricular wall thickness. After LVH had developed in the banded animals, the constricting bands were removed and serial echocardiograms were used to monitor for regression of hypertrophy. Electrophysiological studies were performed in cats that showed regression of LVH (Regress, n = 5), those that showed no change in LV wall thickness (No Regress, n = 4), and in the sham-operated animals (Sham). Cats with persistent LVH had a higher incidence of inducible polymorphic ventricular tachycardia (4 of 4) compared with Regress (1 of 5) or Sham (1 of 9) cats (P < .05) and had lower ventricular fibrillation thresholds (9 +/- 2 mA) than Regress (17 +/- 4 mA) or Sham (16 +/- 3 mA) cats (P < .05). Persistent LVH in the No Regress group was associated with prolongation of epicardial monophasic action potential duration (MAPD) in the left but not the right ventricle. Dispersion of refractoriness was greater in the No Regress group (P < .05 versus Regress or Sham). Regress cats were identical to Sham cats in having a low incidence of inducible polymorphic ventricular arrhythmia, high fibrillation threshold, and MAPD measurements (P = NS versus Sham). CONCLUSIONS: LVH produces multiple electrophysiological abnormalities and increased vulnerability to inducible polymorphic ventricular arrhythmia in this model of LVH. Cats that show regression of hyperthrophy have normal ventricular electrophysiology and have the same low vulnerability to inducible ventricular arrhythmia as Sham animals.

Action Potentials↗
PubMed1995

Comparison of surgeries for removal of primary vestibular inputs: a combined anatomical and behavioral study in rats.

Unilateral removal of Scarpa's ganglion and neurectomy of the peripheral vestibular nerve branches were compared in rats as methods to eliminate primary vestibular input. Ocular nystagmus was consistently observed after both types of lesion, but it completely disappeared within 4 to 7 days. Imbalance and rotation were more serious and prolonged after ganglionectomy than after peripheral neurectomy. Corresponding with these differences in symptoms were differences in terminal degeneration. After ganglionectomy, degenerated axons and terminals were distributed throughout all terminal regions of primary vestibular fibers on the lesioned side, while after peripheral neurectomy, the degeneration was more limited. The results of this study suggest that vestibular ganglionectomy is a more successful approach than peripheral vestibular neurectomy for removing the primary vestibular input.

Afferent Pathways↗
PubMed1995

Sudden hearing loss and unstable angina pectoris.

Acute sudden sensorineural hearing loss has been extensively described in the literature and is a well recognized clinical entity. The exact etiology for this entity has been difficult to ascertain. Multiple etiologies have been promoted including infectious agents, vascular abnormalities, acoustic trauma, metabolic disorders, and autoimmune syndromes. In some cases, neoplasms such as acoustic neurinoma can be identified. On occasion, ototoxic medications are present in the history. Moulonguet and Gougelot have associated mitral valve prolapse, microemboli, transient hemiparesis and sudden hearing loss. This report describes a patient who had sudden sensorineural hearing loss in conjunction with unstable angina pectoris, in whom coronary bypass surgery appeared to have resulted in acute and significant hearing improvement and stabilization.

Aged↗
PubMed1995

Postural stability following mild head or whiplash injuries.

Studies of the sequelae of head injury suggest that cochlear and vestibular dysfunctions, comprise some of the most frequently reported delayed complications following head trauma. To date, little attention has been given to the relation between post-traumatic subjective symptoms of dizziness and the objective measures of postural stability or balance. The purpose of this study was to quantify the balance deficits in individuals who had developed symptoms of dizziness following mild head and whiplash injuries. The balance abilities of 29 patients, who developed dizziness following some type of mild head or whiplash injury, were compared to those of 51 healthy symptom-free subjects. Balance was assessed by examining the center-of-pressure movements, in the anterior-posterior and medial-lateral directions, and the total movement displacement. The isolated contributions of visual and somatosensory inputs were estimated by comparing the magnitudes of the center-of-pressure movements for the various sensory conditions. Data were collected from three 30-second trials of each combination of three visual conditions (accurate, absent, and inaccurate) and two somatosensory conditions (accurate and inaccurate), with the patient standing on a fixed-force platform. Univariate analyses of variance indicated that the group with head injury, compared to the control group, exhibited significantly greater anterior-posterior movements in four of the six sensory conditions and greater total movement displacement during the inaccurate vision/inaccurate somatosensation condition. These data suggest that patients who have sustained head or neck trauma exhibit increased reliance on accurate visual input and are unable to utilize vestibular orienting information to resolve conflicting information from the visual and somatosensory systems.

Adolescent↗
PubMed1994

Central dizziness associated with cerebral blood flow disorders.

This retrospective study describes the use of transcranial Doppler (TCD) and history for further defining and diagnosing cerebral blood flow (CBF) disorders in patients with central dizziness. Central dizziness was defined as dizziness of nonlabyrinthine, non-peripheral causes. It was believed that at least some of the causes for central dizziness are not unknown but are associated with CBF disorders. Fifty patients who presented with central dizziness were examined and subsequently tested with TCD. In 33 of 50 cases (66%) a diagnosis could be assigned after TCD; whereas, on the basis of both history and TCD a diagnosis was assigned to 38 patients (76%).

Adolescent↗
PubMed1994

Static stabilometry, transcranial Doppler, and single photon emission computed tomography in patients with central dizziness.

Previous studies have found that transcranial doppler (TCD) and single photon emission computed tomography (SPECT) are effective means of diagnosing cerebral blood flow disorders in patients with central dizziness whose etiology was unknown by standard audiologic and/or vestibular assessment techniques. Also, static stabilometry, which measures a person's standing center of pressure (COP) movements, has been used to distinguish between patients with central neurologic and peripheral vestibular disorders. The purpose of this retrospective study was to examine the relation between TCD, SPECT, and stabilometry in patients with central dizziness attributable to cerebral blood flow disorders. Stabilometry testing was conducted on 50 normal subjects and 31 subjects with dizziness, the latter group consisting of persons with cerebral dysautoregulation, migraines, and unknown etiology with negative or positive SPECT results. The results indicated that patients with cerebral dysautoregulation were not significantly different from normal subjects or the other three groups in their COP movements. The other three groups exhibited significantly higher COP movements than the normal subjects, particularly when visual inputs were compromised. Patients with negative SPECT results were significantly different in their COP movements from the other three groups of subjects with dizziness. These results suggest that the pattern of COP movements may be useful in identifying patients with postural dysfunctions whose etiology may then be detected by TCD and SPECT.

Adult↗
PubMed1993

Electrophysiologic testing in patients who respond acutely to intravenous amiodarone for incessant ventricular tachyarrhythmias.

The outcome of patients who receive intravenous amiodarone for suppression of incessant ventricular tachyarrhythmia has not been studied conclusively. We conducted a prospective study in which all patients who responded acutely to intravenous amiodarone and went on to receive a subsequent oral loading dose were subjected to electrophysiologic testing before hospital discharge to determine whether additional or alternative therapy would be required. Among 18 patients (17 with ischemic heart disease) who entered the protocol, 16 had a clinical response to intravenous amiodarone alone (12 patients) or in combination with another antiarrhythmic drug (4 patients) and survived to study. Of these, 10 had monomorphic ventricular tachycardia (VT) when first seen, five had polymorphous VT or ventricular fibrillation (VF), and three had both. In seven patients sustained monomorphic VT was inducible (group 1), and in nine it was not (group 2). The only clinical factor that distinguished group 1 from group 2 was age (group 1 > group 2). Five patients in group 1 and one in group 2 received an implantable cardioverter defibrillator; one patient in group 1 had a successful endocardial resection. During a mean follow-up period of 11 months, four patients in group 1 have had appropriate implantable cardioverter defibrillator discharges, whereas only one patient in group 2 has had a clinical event (sudden death). We conclude that intravenous amiodarone is a highly effective drug used alone or in combination to suppress spontaneous incessant VT/VF. Predischarge electrophysiologic testing, even in patients who have polymorphous VT, has predictive value over and above the observed clinical response. These preliminary results favor predischarge testing and aggressive device treatment in this cohort.

Administration, Oral↗
PubMed1993

Differentiation of balance deficits through examination of selected components of static stabilometry.

Stabilometry, which measures the body's center of pressure (COP) movements, during relaxed standing, has been used to distinguish individuals with vestibular and neurologic dysfunctions from normal subjects. The purpose of this study was to determine whether mathematical differences in the magnitudes of the COP obtained from six somatosensory testing conditions could be used to discriminate between different types of balance deficits. Stabilometry measures, using a fixed force platform, were obtained from normal (N = 52) and dizzy (N = 149), peripheral vestibular dysfunction (PVD), post-concussion syndrome (PCS), psychogenic (PSG), and unknown/undetermined etiology (UNK). The data significantly differentiated CVD, PVD and PSG patients from normals and between some of the dizzy groups: CVD versus PVD, PCS; and PSG versus CVD, PVD, PCS and UNK. The measures of anterior-posterior COP movements provided the greatest discrimination.

Adolescent↗
PubMed1992

Head-upright tilt-table testing: a useful tool in the evaluation and management of recurrent vertigo of unknown origin associated with near-syncope or syncope.

Recurrent idiopathic vertigo associated with near-syncope and syncope is a common perplexing problem, some cases of which are considered autonomically mediated (vasovagal). Upright-tilt-table testing has emerged as a potential method to test for vasovagal episodes. This study evaluated the use of this technique in the evaluation and management of patients with recurrent idiopathic vertigo associated with near-syncope or syncope. Twenty-one patients with recurrent unexplained vertigo and syncope/near-syncope and 11 control subjects were evaluated by use of an upright-tilt-table test for 30 minutes, with or without a graded isoproterenol infusion (1 to 4 micrograms/min given intravenously), in an attempt to provoke hypotension, bradycardia, or both, which reproduced the patient's symptoms. The patients included 10 men and 11 women (mean age, 51 +/- 16 years). Eleven controls with no history of vertigo were also studied. Transcranial Doppler sonography was used to assess cerebral arteriolar blood flow during tilt. All tilt-positive patients were placed on therapy with either beta-blockers, disopyramide, or transdermal scopolamine, the effectiveness of which was determined with another tilt-table study. Symptoms occurred in seven patients (33%) during the baseline tilt and in eight patients (38%) during isoproterenol infusion (total positives, 71%). Transcranial Doppler sonography demonstrated a 225% +/- 192% increase in pulsatility index and a 70% +/- 29% increase in resistance index (indicative of cerebral arteriolar vasoconstriction) at the time of vertigo. No control subject experienced syncope during this test. Each tilt-positive patient eventually became tilt-negative with therapy, and over a mean follow-up period of 26 months, no further episodes have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗