Biomedical subjects
Publications and source records attributed to K M Adams.
This paper discusses the indications and contraindications of continuous passive motion (CPM) in hand therapy. The pros and cons of portable and stationary CPMs available for the hand, wrist, forearm, elbow, and shoulders are reviewed.
This paper reviews the development of the International Neuropsychological Society (INS) over the last 14 years in the term of the author as Executive Secretary. The problems and challenges that remain for the INS are presented in their historical context.
In an extension of previous work, we studied the behavioral correlates of medial frontal lobe glucose hypometabolism in chronically alcohol-dependent patients. Thirty-one male patients who were detoxified, medically stable, and free of other central nervous system risk factors for neuropsychological impairment were examined with (1) anatomic imaging (CT or MR), (2) functional imaging with [18F] fluorodeoxyglucose (18F-FDG) and positron emission tomography (PET), and (3) a battery of neuropsychological tests, including two measures of abstraction known to be generally sensitive to frontal lobe disease or dysfunction [the Wisconsin Card Sorting Test (WCST) and the Halstead Category Test (HCT)]. 18F-FDG PET data from 18 age- and sex-matched normal control subjects were used for comparison. All patients met criteria for severe alcohol dependence and for at least a mild degree of alcoholic-induced cognitive impairment. Although the mean IQ level of the alcoholic patients was in the average range, the concepts attained and the error scores on the WCST and HCT were significantly impaired in comparison with established norms. Local cerebral metabolic rate for glucose (LCMRglc) was significantly decreased in a sagittal strip of the medial frontal cortex in the alcoholic patients as compared with the normal controls. Comparison of data from PET scans and anatomic images indicated that the reduced LCMRglc could not be attributed to reduced amounts of tissue alone. A statistically significant relationship was found between LCMRglc in the medial frontal region of the cerebral cortex and performance on the WCST, but not the HCT. These findings suggest that chronic alcohol intake results in impaired function of cerebral tissue in the medial frontal region.(ABSTRACT TRUNCATED AT 250 WORDS)
16 right hemisphere and 16 left hemisphere, nonaphasic brain-injured stroke patients were compared with 16 matched normal controls on the verbal and visuospatial paired-associate tasks developed by Stark in 1961 as a partial replication to a more severely impaired population. Right brain-injured patients showed a significant visuospatial deficit and contralateral motor impairment; while left brain-injured patients, screened for aphasia, showed contralateral motor impairment but did not show impairment on the verbal task. Examination of the areas of infarct resulting from the cerebrovascular accident in the left-hemisphere patients suggested that the presence of a contralateral motor deficit without verbal impairment results from specific focal occlusions of branches of the middle cerebral artery in this selective group of patients.
Bispecific monoclonal antibodies that bind simultaneously to human fibrin and tissue plasminogen activator (tPA) enhance the fibrinolytic potency of tPA. Two bispecific antibodies (F36.23 and F32.1) were generated by somatic cell fusion. Antibody F36.23 derives its tPA binding from monoclonal anti-tPA antibody TCL8 and its fibrin binding from monoclonal antifibrin antibody 59D8. After purification from cell supernatants and ascites by two steps of affinity chromatography, hybrid-hybridoma bispecific antibody F36.23 simultaneously bound tPA and fibrin in solution and in solid-phase assays. In an assay for the lysis of human fibrin monomer, F36.23 increased the fibrinolytic potency of tPA by 5 to 10 fold, regardless of whether the bispecific antibody had been combined with the tPA before or during the assay. Bispecific F36.23 F(ab')2 also bound tPA and fibrin simultaneously, and the enhancement in fibrinolysis in the presence of F36.23 F(ab')2 was identical to that in the presence of intact F36.23. The second bispecific antibody, F32.1, was produced by an alternative strategy that has a wider potential for application in other systems. Hybridoma bispecific antibody F32.1 was derived from the fusion of immune splenocytes (in mice immunized with a synthetic oligopeptide representing the amino terminus of the alpha-chain of human fibrin) with the anti-tPA cell line TCL8. The properties of hybridoma bispecific antibody F32.1 and its F(ab')2 were indistinguishable from those of hybrid-hybridoma bispecific antibody F36.23 in solid-phase binding assays and in assays of fibrinolysis. Bispecific antibodies produced by somatic cell fusion, particularly in the form of F(ab')2, may have potential for use in clinical thrombolysis.
The long-term effects of severe penetrating head injury on adjustment levels were studied. Forty-one World War II veterans who suffered penetrating injury to the brain were interviewed 40 years after their initial injury using the Washington Psycho-Social Seizure Inventory (WPSI). The results support a comparable behavioral impact of right and left hemispheric lesions. Similarly, no significant relations were found between anterior and posterior locus of damage and psychosocial difficulties, although the results pertaining to the right-anterior group could be interpreted as suggestive of much greater maladjustment in all life dimensions assessed by the WPSI. Findings are discussed in terms of theoretical positions on hemispheric specialization and long-term expectancies that hold implications for planning rehabilitation programs for such patients.
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In previous work we showed that patients with chronic obstructive pulmonary disease (COPD) suffered decrements in neuropsychologic functioning suggestive of organic mental disturbance. This study combined data from two multicenter clinical trials to explore the nature and possible determinants of such neuropsychologic change. Three groups of patients with COPD whose hypoxemia was mild (N = 86), moderate (N = 155), or severe (N = 61) were compared with age- and education-matched nonpatients (N = 99). The rate of neuropsychologic deficit rose from 27% in mild hypoxemia to 61% in severe hypoxemia. Various neuropsychologic abilities declined at different rates, suggesting differential vulnerability of neuropsychologic functions to progress of COPD. Multivariate analyses revealed a consistent significant relationship between degree of hypoxemia and neuropsychologic impairment, but the amount of shared variance was small (7%). Increasing age and lower education were also associated with impairment.
An assessment strategy using multiple levels of observation permitted description of problems in everyday living experienced by cerebral revascularization candidates. We contrasted the neuropsychological deficits and real-world dysfunction displayed by candidates for cerebral revascularization with that manifested by patients with severe spinal complaints. Correlations between selected neuropsychological scores and life quality measures were modest. Prediction of real-world performance in individuals likely will require multivariate combinations of measures. Relationships between life quality measures and neuropsychological scores may differ for patients with known or suspected neurological disease and patients with disorders which do not threaten cognitive functioning.
We examined the relationship of history of alcoholism in first-degree relatives to neuropsychological performance of alcoholics abstinent from several weeks to several years. Eighty-four men were assigned to four groups based on "strength" of family history of alcoholism. The groups were: (1) "strong history," a parent plus another first-degree relative positive; (2) "moderate," parent only positive; (3) "weak," nonparent first-degree relative only positive; and (4) "negative," no first-degree relative positive. There were no significant between-group differences in NP performance. In other analyses there were no NP differences between alcoholics classified positive or negative purely on basis of paternal alcoholism, and no differences between subjects who had multigenerational versus unigenerational versus negative familial histories of alcoholism. It is concluded that genetic loading for alcoholism does not significantly affect the NP status of abstinent alcoholic groups equated for education, drinking history, and medical risk.
In a longitudinal study of 136 male alcoholics and controls, the authors found evidence of slowly reversible, subtle organic mental disorders in relation to prolonged abstinence from drinking by alcoholics. They suggest criteria for two new nosologic categories to describe these alcohol-related neuropsychiatric phenomena: (1) intermediate-duration organic mental disorder associated with alcoholism and (2) subacute organic mental disorder associated with alcohol abuse or alcoholism.
Previous reports on the use of the MMPI with chronic pain patients have produced a variety of results. No single configural feature or scale identifies the chronic pain patient, regardless of the origin or verifiability of the etiology of the pain. Elevations on the neurotic triad occur frequently, but do not have the specificity of more recently reported chronic-pain subtypes on the MMPI. The present nonexperimental study (N = 72) provides an example of a multi-method analysis of a carefully selected sample of chronic pain patients without physical findings. Blind clinical analysis, simple two-point code aggregation, and multivariate profile methods were used and produced similar subtypes of the sample and understanding of the data. The obtained sample subtypes were similar to those found in other studies and were hypothesized to be related to each other along an underlying continuum of what might be depression. Further research is needed to facilitate understanding of the causation of chronic pain of obscure origin.
This report provides new evidence that neuromedical risk factors influence levels of behavioral impairment in alcoholics. Using a factorial model, the effects of age, neuromedical risk history, and duration of sobriety were studied in relation to neuropsychological performance. The data showed a consistent interaction between duration of abstinence and risk status: Recently detoxified alcoholics (sober 1 month) with a positive premorbid risk history had worse neuropsychological performance than did those without such historical risk events. By contrast, long-term abstinent alcoholics (sober 4 years) did not demonstrate the interaction between alcohol history and positive premorbid risk history. The present results are held to mean that neuromedical risk factors may exert a differential influence on test scores of recently detoxified men, suggesting a source of variance in neurobehavioral studies of alcoholism requiring attention by investigators.
In a sample of 31 cerebral revascularization candidates, severity and dissemination of atherosclerosis on the cerebral angiogram were correlated with two of three global indicators of neurobehavioral impairment. Additionally, the angiographic rating was correlated with age and with an index of medical risk factors, but not with duration of the longest symptomatic episode. It seems likely that several variables, particularly collateral circulation, help to determine whether a given pattern of stenoses results in neuropsychological dysfunction and what type of behavioral deficit occurs. In many cases, the configuration of neuropsychological test scores may not directly mirror the pattern of cerebrovascular stenoses.