Biomedical subjects
Publications and source records attributed to J F Patterson.
I have reported a case of myoclonus induced by nortriptyline. Serum nortriptyline levels were measured in an attempt to find whether there was any correlation between serum level and onset of myoclonus. There is clearly a need for scientific research in the neuropharmacologic features of myoclonus caused by tricyclic antidepressants, as well as possible methods of treatment.
Thirteen patients with progressive early onset scoliosis have been managed operatively in an attempt to achieve correction without bracing and to allow the spine to grow. All had posterior segmental spinal instrumentation (SSI) without fusion and 9 of 13 had anterior apical growth arrest as a separate additional procedure. At 2-year follow-up, curve correction averaged 46%. Patients who had anterior apical growth arrest and SSI without fusion had less curve deterioration than those who had SSI alone. New methods are described for 1) measuring growth of the instrumented segment of the spine and 2) calculating the predicted growth of the instrumented segment. Eight of the 13 had more than 50% of predicted growth, three had 30-50% of predicted growth, and two had less than 30% of predicted growth. Operative treatment has been successful in the short term in all but the most malignant form of infantile idiopathic scoliosis.
Clinical observations of 37 alprazolam-dependent patients are presented. Seventeen inpatients and 20 outpatients, the majority suffering from posttraumatic stress disorder, were withdrawn from alprazolam by means of clonazepam substitution in an open-label fashion. Two patients experienced rebound panic symptoms; true withdrawal syndromes were not observed. Although the limitations of an open series are evident, it was found that this method of discontinuation is safe and effective and, in particular, does not pose a danger of withdrawal seizures.
In the case presented, enalapril is implicated as the causative agent of a major depressive episode. Previous depressive episodes associated with propranolol and atenolol may well have been seen as indicators that this patient was susceptible to any therapeutic agent that possessed central nervous system effects.
I have presented a case of NREM parasomnia with violent aggression against another person. Treatment with clonazepam failed, but imipramine therapy was successful.
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The case of neuroleptic malignant syndrome presented was associated with the use of metoclopramide, a dopamine-blocking agent, which is normally used in nonpsychiatric patients. The patient was successfully treated with dantrolene and bromocriptine. Nonpsychiatrist physicians should be aware of this complication of metoclopramide, as it is potentially fatal.
Ten alprazolam-dependent patients were studied with clinical and biologic variables after equal doses of clonazepam were substituted for alprazolam. Withdrawal was accomplished over a seven-day period. Anxiety and plasma cortisol levels were measured and found not to be significantly different between the withdrawal period and the postwithdrawal medication-free period.
The successful use of carbamazepine in treating a case of severe phantom limb pain prompted me to review this condition and its experiential treatment with carbamazepine, as well as the drug's possible mechanism of action on phantom limb pain. Experience to date indicates the need for controlled double-blind crossover studies to test the therapeutic validity of carbamazepine.
Carbamazepine was administered in an open pilot study to 13 patients with primary degenerative dementia characterized by aggressive and assaultive behavior refractory to conventional treatment. Tentatively, from this preliminary study, carbamazepine appears to have advantages in the treatment of assaultive patients with dementia.
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I have described five elderly patients who had a syndrome characterized by reversible delirium, automatic movement, and anterograde amnesia after ingesting triazolam as a hypnotic. These cases raise concern about the use of short-acting, rapidly eliminated benzodiazepine hypnotics in the elderly.
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Approximately 250 computed tomography (CT) systems were surveyed in a nationwide study to determine the average radiation dose resulting from a typical adult head procedure. The multiple scan average dose (MSAD) was selected as the dose descriptor. For the typical adult CT head procedure, the MSAD was generally within 2.2-6.8 rads (22-68 mGy). Variations in dose by a factor of two or more were often seen for a given manufacturer and model. These dose ranges indicate a potential to reduce dose by carefully selecting imaging techniques. Overall, variations in dose can result from differences in the user's choice of technique (desired image quality) or from actual differences in scanner performance (caused by differences in collimation, filtration, or geometry). To use CT appropriately, a facility should consider dose as well as image quality in selecting optimal techniques for typical modes of operation.