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Biomedical subjects

J M Minderhoud

Publications and source records attributed to J M Minderhoud.

At least 73 records · Page 4Linked to original sources
PubMed1982

Neurotransmitters in the treatment of patients with severe head injuries.

Results of treatment with L-dopa and/or physostigmine of patients with severe head injuries were examined and discussed. This treatment given to patients still unconscious a long period after trauma resulted in clinical improvement in 29 of the 45 trials (64%). Results were poor in patients with a low motor score and no paradoxical response on the caloric oculogram. In nearly all patients motor activity increased, but did not always result in clinical improvement. The results were explained by the presence of functional, reversible dysfunctions present in the majority of patients in the course of recovery.

Adolescent↗
PubMed1981

Cell-mediated immune reactivity in multiple sclerosis.

The primary cellular immune responses in multiple sclerosis (MS) patients as compared with healthy controls were investigated with alpha-HPH and DNCB sensitization tests. The results did not reveal significant differences, indicating that no defect or hyperactive state of the cellular immune system is present in MS patients. Some minor and not significant differences between groups of patients or controls could be related to age differences and the degree of invalidism.

Adult↗
PubMed1980

Treatment of minor head injuries.

The results of various forms of treatment of patients with minor head injuries have been examined. The number and frequency of post-concussional sequelae was markedly reduced by treatment which included information, explanation and encouragement. Dizziness, loss of hearing and loss of balance were related to external lesions to the vestibular system caused by injuries to the parieto-temporal region of the skull. PTA proved to be a reliable indicator of the severity of cerebral concussion and correlated with post-concussional sequelae and periods of disability. Other factors which increased the number and frequency of post-traumatic sequelae, especially those related to stress before the accident, could be counteracted by better treatment of the patient. The results bear out the hypothesis that post-concussional sequelae start off on an organic basis (PTA) and that persistent sequelae after minor head injuries are also caused by psychogenic, and especially by iatrogenic factors.

Accidents↗
PubMed1980

Systematic selection of prognostic features in patients with severe head injury.

In this study small sets of clinical features were identified that, when combined, yield high quality predictions of long term outcome. The study is based on a series of 305 consecutive head-injured Dutch patients, all of whom had been in coma for at least 6 hours. The overall social outcome was assessed after 6 months using the Glasgow outcome scale. Predictions of outcome were made by assigning probabilities to each possible outcome category. The prognostically most promising features recorded during the early post-traumatic course were identified, and powerful combinations of prognostic features were selected on admission and 1, 3, 7, 14, and 28 days after the start of coma by an appropriate statistical method. At each time point, optimal prediction required sets of only three to five features, typically including age in decades, depth and duration of coma as assessed by the Glasgow coma scale, pupil reactivity to light, and spontaneous and reflex eye movements. The method described allows bedside predictions in individual patients and provides a tool for comparing the severity of injury between series of patients.

Adolescent↗
PubMed1979

Lacrimal sweating in a patient with Reader's syndrome.

A patient is described with a right-sided Reader's syndrome and extensive sweating in the frontal area above the right eye. This pathological sweating can be explained by sprouting of lacrimal parasympathetic fibres in the previous denervated sympathetic sudomotor pathways to that area.

Adult↗
PubMed1977

Biochemical and ultrastructural aspects of the inhibited phagocytosis by neutrophil granulocytes in acute brain-damaged patients.

In a study of 60 head-injured patients inhibition of phagocytosis by neutrophil granulocytes was observed over a period of up to 5 weeks. This inhibition of phagocytosis could be correlated with the severity of head injury as well as with the state of unconsciousness at the time of the investigation. No correlation was found between neutrophil granulocyte counts and the inhibition of phagocytosis. A good correlation could be demonstrated between the level of lumbar CSF 5-HIAA and the inhibition of phagocytosis. After in vitro incubation with albumin the cells showed a recovery of phagocytosis. Electron micrographs of the cells showed ultrastructural appearances suggesting a changed permeability of the plasma membrane and, in addition, alterations in the cytoplasmic region beneath the plasma membrane. It is suggested that head injury may influence the pituitary-adrenal system and the autonomic nervous system, giving changes of neutrophil function and of neurotransmitter metabolism; these changes may represent an adaptation mechanism.

Adolescent↗
PubMed1977

Cell-mediated hypersensitivity in multiple sclerosis and other neurological diseases.

Using a direct macrophage migration inhibition test the hypersensitivity against encephalitogenic protein and phytohaemagglubinin in normal persons, multiple sclerosis patients and patients with other diseases of the central nervous system were examined. It proved that the vast majority of patients were sensitised to brain antigen. The percentage of positive tests and the percentage of migration inhibition was related to the activity of the disease. No differences were found between lymphocytes of multiple sclerosis patients and of patients with the other neurological diseases patients. Foetal calf serum was proven to depress the hypersensitivity to phytohaemagglutinin as did multiple sclerosis serum on normal lymphocytes. The results did not support the hypothesis that multiple sclerosis is caused by a cell-mediated auto-immune process.

Autoimmune Diseases↗
PubMed1976

On the nature of brain stem disorders in severe head injured patients.

In head injured patients changes were found in the CSF levels of metabolites of the dopaminergic and the serotonergic neurotransmission (HVA and 5-HIAA). After the fifth day following trauma a significant decrease of the HVA levels in the lumbar CSF after probenecid treatment was found. The intensity of this decrease was found to be related to the severity of the trauma (period of unconsciousness), but not to the state of consciousness. Also the probenecid-induced 5-HIAA levels in conscious patients were decreased after the fifth post-traumatic day. In unconscious patients, the period of unconsciousness, particularly in the period of 5-20 days after trauma. Between 21 and 60 days after trauma the 5-HIAA concentrations in unconscious patients decreased remarkably, but they were still significantly higher than in the conscious patients. It can be concluded that during unconsciousness serotonergic neurons have a high rate of turnover, but that both neurotransmitter systems are damaged by the direct or indirect consequences of the injury.

Adolescent↗
PubMed1976

On the nature of brain stem disorders in severe head injured patients. II. A study on caloric vestibular reactions and neurotransmitter treatment.

The results of electro-oculographic recordings made after caloric vestibular stimulation (C.O.G.) in severe head injured patients are discussed. It was found that: 1. The C.O.G. correlates with the state of consciousness of the patients. 2. The rate of improvement of the C.O.G. correlates with the rate of the clinical improvement. 3. A prediction of the duration of unconsciousness can be made by repeated C.O.G. scores as well as by repeated scoring of the clinical state. 4. In all patients a paradoxical response is present except in those who have regained clear consciousness and in those persisting in a vegetative state, so the presence of a paradoxical response indicates the possibility of further improvement. It was supposed that in patients with a paradoxical response a functional brain dysfunction was present, which was at least partly caused by disturbed neurotransmitter metabolism. Therapeutic trials with L-DOPA and physostigmine were successful in patients with a paradoxical response, but without any result in those without this phenomenon. The responses to L-DOPA and to physostigmine are related respectively to motor pattern and to verbal or non-verbal communication.

Akinetic Mutism↗
PubMed1976

A direct macrophage migration inhibition test applied in man.

A direct macrophage migration test is described, which proved to be useful for the detection of cellular hypersensitivity in man. We used a modification of the method described by Hughes & Paty (1972). In this method the MLR is abolished by 100 rad gamma-irradiation of the peritoneal exudate cells prior to pooling with human lymphocytes. Experiments with various intensity of irradiation, PPD, muscle antigen and encephalitogenic factor were performed to check this method. In a pilot study lymphocytes of patients with diseases of the central or peripheral nervous system or of muscle were tested. This proved that a hypersensitivity of Ef was present in various diseases of the CNS, while in muscle diseases positive tests were found using muscle antigen.

Antigens↗
PubMed1975

Homovanillic acid and 5-hydroxyindoleacetic acid cerebrospinal fluid levels. A study with and without probenecid administration of their relationship to the state of consciousness after head injury.

Homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) concentrations were measured in the lumbar cerebrospinal fluid of 98 patients after closed head injury. The HVA levels decreased in patients, whether or not they were given the drug probenecid, which inhibits the active transport of these acids from the brain. The decline of HVA was more notable in patients with the longest duration of unconsciousness. The HVA levels showed no correlation with the state of consciousness at the moment of the lumbar puncture. The 5-HIAA levels were below normal in the conscious patients, but paradoxically, at about normal levels in unconscious patients. The overall results suggest a decreased cerebral dopamine and serotonin metabolism after head injury.

Blood-Brain Barrier↗
PubMed1975

Electro-oculographic study of caloric vestibular reactions in patients with severe head injuries.

In this study electro-oculographic recordings were made after caloric vestibular stimulation (C.O.G.) in 42 patients with severe head-injuries. The curves with eyes open and the changes when eyes were closed were evaluated and scored. A correlation was found between the C.O.G. and the state of consciousness but only the degree of improvement of the C.O.G. showed a good correlation with the clinical improvement. The presence of a paradoxical response in patients with a prolonged coma was found to predict possibilities of further improvement. It was proposed that in the patients with a paradoxical response a rather diffuse biochemical dysfunction of the brain-stem was present, which could be influenced by treatment. In the second part of this study the results of the trials with a treatment with L-Dopa and physostigmine are given. It was found that patients in a vegetative state or in a state of prolonged coma could be stimulated with the therapy only when the paradoxical response had been present. L-Dopa and physostigmine respectively improved the motor pattern and the contact activities.

Adolescent↗