The coal miner.
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Biomedical subjects
Publications and source records attributed to Ludwig Gutmann.
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The study purpose was to assess the efficacy of intermittent subcutaneous apomorphine (APO) as acute therapy for off episodes in advanced Parkinson's disease (PD) patients who had previously received APO for 3 months. Patients (n=62) were randomized to receive double-blind treatment with APO at their typically effective dose (TED; APO), APO at their TED+0.2mL (2.0mg; APO+2), placebo at volume equal to their TED (PL), or placebo at volume equal to their TED+0.2mL (PL+2), for a single off episode. Significantly greater improvement in mean Unified PD rating scale motor scores was seen with pooled APO versus pooled placebo 20min after administration (-24.2 vs. -7.4; p<0.0001); the difference was also significant at 10min (p<0.0001). Overall adverse event incidence did not significantly differ between pooled APO and pooled PL. This study supports the long-term use of intermittent APO as effective acute therapy for off episodes in advanced PD patients.
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There are approximately 420 venomous species of snakes living on the earth. Their venoms, each unique, can affect multiple organ systems. The venoms have a predilection for the peripheral nervous system where the neuromuscular junction is a favorite target. Those venoms affecting the release of acetylcholine from the presynaptic membrane are called beta-neurotoxins and those affecting the postsynaptic membrane are called alpha-neurotoxins. alpha-Bungarotoxin has been used in quantitative studies of acetylcholine receptor density and turnover and for the assay of antibodies directed against the acetylcholine receptor. A unique feature of timber rattlesnake venom is its ability to cause clinical myokymia. This likely results from a blockade of voltage gated K+ antibodies.
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There is a significant number of individual patients with cranial nerve palsies as the sole manifestation of MRI- and, less frequently, CT-documented small brainstem infarctions or hemorrhages. The 3rd and 6th nerves are most commonly involved and, less frequently, the 4th, 5th, 7th, and 8th nerves. An intra-axial basis for such lesions may be underestimated if the diagnosis is based solely on MRI. The electrophysiologic abnormalities indicating brainstem lesions may be independent of MRI-documented morphological lesions. This paper reviews the literature on cerebrovascular brainstem diseases manifesting as isolated cranial nerve palsies. It supports the concept that small pontine and mesencephalic infarctions are the main cause of non-traumatic cranial nerve palsies in the middle-aged and elderly population. Microvascular infarction of the respective extra-axial cranial nerve segments seem to be less important.