PubMed HealthSearch

Biomedical subjects

C Saunte

Publications and source records attributed to C Saunte.

At least 19 recordsLinked to original sources

ABR amplitude and dispersion variables. Relation to audiogram shape and click polarity.

ABR amplitude behaviour to condensation (C) and rarefaction (R) clicks was investigated in normal ears, ears affected by Ménière's disease and ears with high-frequency hearing loss (HF ears). The wave IV-V amplitude-intensity function was steeper in ABRs evoked by R than by C clicks. This may suggest that two different cochlear generator components, one intensity-dependent as well as one polarity-dependent, contribute to click-evoked ABRs. Wave IV-V amplitude was significantly higher in Ménière ears compared to HF ears in spite of comparable 2-4 kHz hearing loss in the two groups. Hence, audiometric steepness (which is lower in Ménière ears than in HF ears) seems to predict the wave IV-V amplitude decline more precisely than the 2-4 kHz perception threshold. The wave IV-V dispersion variable (SR IV-V) was close to normal in Ménière ears, while wave IV-V was more dispersed in HF ears. In general, C click ABRs were less affected than R click ABRs by 'peripheral' factors (i.e. intensity and audiometric steepness).

Acoustic Stimulation

[Topographic mapping of electric activity of the brain].

Quantitated neurophysiology and topographic brain mapping are reviewed. Certain information on the electrical activity of the brain may be more easily comprehended with the aid of topographic visualization of EEG and evoked potentials. Quantitated neurophysiology promises to make an important contribution to research in several fields of neuroscience, e.g. cognitive processing, psychiatry, dementia, epilepsy, cerebrovascular disorders, auditory and visual electrophysiology, and migraine. Provided that careful attention is paid to the elimination of artefacts, such methods may also be used as supplementary diagnostic tools in the clinic.

Brain

Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea.

Three grown-up males with a long-lasting history of rather uniform, unilateral headache in the ocular-periocular area, in cluster fashion, are examined. Pain paroxysms of short duration (15-60 sec) appear up to 5-30 times per h. The headache is unilateral without side shift. Conjunctival injection appears at the very beginning of the attack and is partly massive, lasting the entire duration of the attack, and fading away at the end of it. Tearing (massive), forehead sweating (subclinical) and rhinorrhea, all on the symptomatic side, accompany the attack. In the youngest patient, the headache became chronic after clustering for six months initially, and after approximately 3 1/2 years it became bilateral. However, even in this patient, a clear unilateral pain preponderance prevails, and the autonomic disturbances are all on the original pain side. Attacks can partly be precipitated by chewing, eating (e.g. citrus fruits), moving the head, etc. The headache is completely refractory to drug therapy, including indomethacin.

Aged

Septoplasty and/or submucous resection? 5 years nasal septum operations.

Information obtained from the case-records and completed questionnaires from 478 patients operated in the 5-year-period 1980 through 1984 with either septoplasty or submucous resection (SMR), has been analysed on an average 31 months after surgery. Two hundred (42 per cent) underwent SMR and 278 (58 per cent) septoplasty. Twenty per cent presented for a clinical follow-up examination. Of the 478 patients, 63 per cent were satisfied. More patients were satisfied with the functional results after septoplasty, which also resulted in fewer and smaller perforations than SMR. Septoplasty ought to replace the latter as the routine procedure. 10 per cent had troublesome crusting independent of the technique used. Change in the external shape of the nose is a minor problem for the patients, and was not regarded as an indication for re-operation. Patients with allergic rhinitis may undergo septal surgery on general lines.

Adolescent

Cluster headache-like headache, Hageman trait deficiency, retrobulbar neuritis, and giant aneurysm. Autonomic function studies.

A 56-year-old, previously reported woman with cluster headache-like headache with bouts of unilateral (the side of predominance changing through the years) severe headache had a familial history (three generations) of partial Hageman factor deficiency and bleeding episodes. A giant aneurysm was found to be lodged in the anterior communicating artery on the left side. Clinically, the features were atypical for cluster headache: onset at a young age (14 years), episodes of retrobulbar neuritis appearing at the side of pain, etc. Studies of forehead sweating indicated that the right side was the pathologic one, from an autonomic point of view, as did pupillometric studies. However, during attacks, which were left-sided at the time, forehead sweating was marked laterally on the left side and on the upper eyelid, but not on the right. The "signal" usually reaching the autonomically stigmatized side during attacks of cluster headache, therefore, did not seem to reach the sweat glands on that (the right) side during the attack in the present case. This headache may, therefore, be distinct from cluster headache, both from a clinical and from an autonomic function point of view.

Autonomic Nervous System

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

Chronic paroxysmal hemicrania: salivation, tearing and nasal secretion.

Autonomic functions have been studied in seven patients with chronic paroxysmal hemicrania (CPH). A test battery comprising tearing, salivation and nasal secretion was employed. Under basal conditions these parameters did not differ significantly from those in a control group. After stimulation with pilocarpine the patients responded rather inhomogeneously. This test battery may therefore help find and classify subgroups of these types of patients. During attacks, there is a clear discrepancy between minimal salivation on the one hand and the marked increase in tearing, nasal secretion and sweating on the other. CPH attacks may be associated with an increased firing of sympathetic impulses to the different organs. In the event of a uniform type of autonomic firing taking place during attack, these findings may suggest a different innervation pattern for the salivary glands compared to the other glands involved. The innervation pattern of these secretory organs may seem to be more intricate and sophisticated than hitherto assumed.

Adult

Autonomic disorders in cluster headache, with special reference to salivation, nasal secretion and tearing.

Attacks of cluster headache are often associated with symptoms of an autonomic nature. A test battery allowing quantitation of salivation, nasal secretion and tearing has been employed. Fourteen patients examined under basal conditions hardly differed from a group of controls (N = 20). After stimulation with pilocarpine the patients responded like the controls. During attacks we found minimal bilateral salivation, but an increase of tearing and nasal secretion, mostly on the symptomatic side. These results correspond with those found in CPH. The finding of the minimal salivation is consistent with the notion that the headache attacks are associated with increased sympathico-tonus. The results may suggest that the complexity of the innervation pattern of the different secretory organs examined is more marked than hitherto known.

Adult

Chronic paroxysmal hemicrania. VII. Mechanical precipitation of attacks: new cases and localization of trigger points.

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4-C5 vertebrae, or beneath the posterior part of the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4-C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.

Adult

"Hemicrania continua". An indomethacin responsive headache. II. Autonomic function studies.

Various autonomic parameters have been studied in two patients with "hemicrania continua", a newly described unilateral headache which is aborted by indomethacin. Striking findings were made on pupillometry: In both patients, isocoria was present when untreated. Bilateral instillation of tyramine in the conjunctival sac resulted in a late appearing anisocoria, with the smaller pupil on the symptomatic side. Indomethacin medication corrected this anomaly. These findings add further evidence to our firm belief that "hemicrania continua" differs fundamentally from chronic paroxysmal hemicrania, where such pupillometric changes are not found. There thus seem to be at least two different types of hemicranias with an absolute indomethacin effect.

Autonomic Nervous System

Chronic paroxysmal hemicrania. VIII. The sweating pattern.

Evaporimeter measurements of forehead sweating during attack were carried out in six female patients with chronic paroxysmal hemicrania. The patients served as their own controls. Increased sweating on the symptomatic side was found in two patients, both when compared to the non-symptomatic side during attack and when compared with the symptomatic side outside attack. The remaining four patients, two of whom had only weak attacks at the time of study, showed sweat values within the control range. In one patient, attacks could be precipitated by head flexion and by pressure against certain circumscribed points in the neck ("mechanical" precipitation of attacks). These attacks were also associated with increased sweating on the symptomatic side. Increased forehead sweating does not seem to be a sine qua non in CPH.

Adult

Quantification of salivation, nasal secretion and tearing in man.

The purpose of this study has been to establish a battery of tests of autonomic functions: Quantification of submandibular/sublingual salivation, nasal secretion and tearing on both sides. The tests were performed in a control group of 20 healthy students. We used a parasympathomimetic drug, pilocarpine 0.1 mg/kg body weight, to stimulate the different secretory functions. Saliva was collected with a pair of dentistry spiral suctions. Tearing was assessed with Schirmer's test tapes. Nasal secretion was quantified using Schirmer's test tapes, too. Nasal secretion and salivation on average was fairly symmetrical, whereas there was some asymmetry in tearing (which may be artificial). In single individuals, there may be considerable asymmetry in salivation as well. This test battery will be used in the study of possible autonomic dysfunctions in patients with unilateral headache.

Adolescent

Cluster headache: on the mechanism behind attack-related sweating.

Eighteen cluster headache patients were studied using body heating or exercise tests; all but two of them were also studied with a pilocarpine test (0.1 mg/kg body wt, s.c.). Evaporimeter measurements were made on both sides of the forehead under standard conditions in a thermo room. Heat- and exercise-induced sweating was clearly less pronounced on the symptomatic side than on the non-symptomatic side of the forehead, and was significantly different compared to controls. Pilocarpine on the other hand induced a clearly more pronounced response on the symptomatic side than on the non-symptomatic side, which was also statistically significantly higher than in the control group. These findings suggest a supersensitivity of the sweat glands to pilocarpine on the symptomatic side of the forehead in most cases of cluster headache.

Adult

Chronic paroxysmal hemicrania. IX. On the mechanism of attack-related sweating.

In eight patients with chronic paroxysmal hemicrania (CPH), forehead sweating was measured after various provocation tests-body heating, exercise, and subcutaneous pilocarpine administration (0.1 mg/kg body weight). Evaporation was measured bilaterally on the forehead with an Evaporimeter (in g/m2/h). This was carried out in a thermo room under standardized conditions. There was no definite deficit in heat-induced or exercise-induced sweating on the symptomatic side of the forehead, contrary to findings in cluster headache. Neither did pilocarpine lead to any marked initial, temporary predominance of sweating on the symptomatic side, which has previously been found in cluster headache. In cluster headache there may be denervation supersensitivity of the sweat glands in the forehead of the symptomatic side. The present study does not therefore provide evidence for supersensitivity phenomena which could explain the homolateral forehead sweating increase seen during attacks in some CPH patients. The localized sweating increase in the forehead during attacks of CPH may possibly be a result of direct sympathetic stimulation.

Adult