Biomedical subjects

M Shandling

Publications and source records attributed to M Shandling.

11 recordsLinked to original sources

PubMed1998

L-deprenyl in Alzheimer's disease: cognitive and behavioral effects.

BACKGROUND: Short-term studies of L-deprenyl in Alzheimer's disease (AD) suggest a beneficial effect, whereas longer-term studies are less convincing. Accordingly, we undertook a 6-month, randomized, double-blind, placebo-controlled clinical trial to assess the potential benefit of L-deprenyl in AD. METHODS: Sixty subjects were assigned to L-deprenyl (10 mg daily) or placebo. After 4 weeks of single-blind placebo, 51 subjects entered the double-blind phase. The Brief Psychiatric Rating Scale (BPRS) was the primary outcome measure. Secondary outcome measures were the Mini-Mental State Examination, Global Deterioration Scale, Alzheimer's Disease Assessment Scale (noncognitive), Cornell Scale for Depression in Dementia, Buschke Selective Reminding Test (BSRT), Relative's Assessment of Global Symptomatology-Elderly (RAGS-E), Controlled Oral Word Association Test, and Modified Continuous Performance Test. In addition, several exploratory tasks were included for future hypothesis testing. RESULTS: We found no significant differences between the L-deprenyl and placebo groups on the primary or secondary measures. However, several measures appeared to be sensitive to change over time, including the total score on the BPRS and some of its components as well as parts of the BSRT and the RAGS-E. CONCLUSION: Oral L-deprenyl provides no detectable benefit on general behavior, neuropsychiatric symptoms, or cognitive function in AD after 6 months of treatment. Protocols for future drug studies should utilize measures that are sensitive to change over time such as the BPRS.

Aged↗

PubMed1997

Safety and immunogenicity of Chiron/Biocine recombinant acellular pertussis-diphtheria-tetanus vaccine in infants and toddlers.

OBJECTIVE: To evaluate the safety and immunogenicity of the recombinant acellular pertussis-diphtheria-tetanus (aPDT) vaccine (C-aPDT, Chiron/Biocine). STUDY DESIGN: This is a randomized blinded trial evaluating the safety and immunogenicity of the recombinant aPDT vaccine (C-aPDT, Chiron/Biocine) in 2000 infant recipients compared with 498 controls who received whole cell diphtheria-pertussis-tetanus (wDPT; Connaught) vaccine at 2, 4 and 6 months of age. In addition the safety and immunogenicity of the same C-aPDT vaccine were evaluated as a booster dose in a subset of the same population when given at 15 to 18 months of age and compared with licensed Lederle aPDT vaccine. RESULTS: The C-aPDT vaccine was associated with very few local or systemic reactions when compared with wDPT. In toddlers the local and systemic side effects observed were similar after either acellular vaccine. When the immunogenicity of the C-aPDT vaccine was compared with the wDPT (Connaught) in infancy, the vaccines were equivalent for anti-diphtheria response, the wDPT developed higher anti-tetanus response and the C-aPDT vaccine was significantly more immunogenic for all other antigens tested. In toddlers the C-aPDT acellular vaccine exhibited equal or improved immunogenicity for antigens tested as compared with Lederle aPDT except for a higher anti-filamentous hemagglutinin response with the Lederle aPDT vaccine. CONCLUSION: The Chiron/Biocine aPDT vaccine offers an improved safety profile as well as improved immunogenicity when compared with a licensed wDPT product.

Antibodies, Bacterial↗

PubMed1996

Progressive multifocal leukoencephalopathy: clinical and MR response to treatment.

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease that occurs in immunocompromised hosts. We describe two patients with biopsy-proved PML who showed improvement clinically and radiologically after medical therapy. These cases reveal that interval improvement can in rare instances be consistent with a diagnosis of PML.

Adult↗

PubMed1996

Neuropsychologic deficits and clinical features of posttraumatic temporomandibular disorders.

Previous studies have shown that characteristics of posttraumatic temporomandibular disorders (pTMD) differ considerably from those of nontraumatic or idiopathic temporomandibular disorders (iTMD). Both the rate of recovery and the amount of treatment required appear to be different for both groups. In this blinded study, 14 patients with iTMD and 13 patients with pTMD were examined. Patients submitted to a variety of reaction-time tests and neuropsychologic assessments to test their ability to cope with simple and more complex tasks with and without a variety of cognitive interferences. Clinical examination was used to assess signs of TMD. Eleven of the subjects (six iTMD, five pTMD) consented to a second phase of the investigation, whereby the patients were studied with single-photon emission computerized tomography (SPECT) using 99mTc-hexamethylpropyleneamineoxime (HMPAO). For simple and complex reaction-time tests, the pTMD group was significantly slower than the iTMD group (P < .05 to P < .001). Other neuropsychologic assessment tools such as the Consonant Trigram Test and the California Verbal Learning Test indicated that pTMD patients were more affected by both proactive and retroactive interferences and were more likely to perseverate on a single thought. In clinical examination, pTMD patients demonstrated greater reaction to muscle palpation than did iTMD patients (P < .05). The SPECT results suggested that there were mild differences between the two populations, and further ther studies are required to confirm this finding. The results lend support to the concept that there are differences between pTMD and iTMD populations. It is suggested that although patients with pTMD may have some similarities to those with iTMD, the former population may benefit from being handled somewhat differently and should be assessed and treated using a more broad, multidisciplinary treatment paradigm. These results must be confirmed in studies of larger populations.

Accidents, Traffic↗

PubMed1996

Effects of salmon calcitonin on patients with atypical (idiopathic) facial pain: a randomized controlled trial.

The analgesic properties of salmon calcitonin for the treatment of atypical facial pain (AFP) were investigated. An initial open-label trial of salmon calcitonin in subjects with refractory AFP was followed with a randomized, double-blind, placebo-controlled crossover trial of salmon calcitonin in the management of AFP. Salmon calcitonin (100 IU in 1 mL saline) was administered in an open-label fashion to 13 subjects with refractory AFP five times per week for 6 weeks. In the subsequent randomized investigation, salmon calcitonin (100 IU in 1 mL saline) or placebo (1 mL saline) was delivered three times per week for 3 weeks, with a 1-week washout prior to crossover. The percentage of subjects dropping out (57%) exceeded that reported in other pain studies using calcitonin. Therefore, it was imperative to halt the study for ethical reasons. There was no difference in outcome measures (P > .05) in subjects administered either active drug or placebo, and a high incidence of side effects led to dropout in subjects taking salmon calcitonin. Although salmon calcitonin may have analgesic properties, it is not efficacious for AFP, largely because of the side effects.

Adult↗

PubMed1994

Differentiation between musculoligamentous, dentoalveolar, and neurologically based craniofacial pain with a diagnostic questionnaire.

A self-administered questionnaire consisting of 21 questions, diagrams for chief pain location, and a digital pain scale was used prospectively to sort 92 patients with orofacial pain into three categories: (1) musculoligamentous (ie, temporomandibular disorders); (2) neurologically based (ie, migraine, trigeminal neuralgia, tension-type headache, cluster headache, and atypical facial pain); and (3) dentoalveolar pain. Sensitivity, specificity, as well as negative and positive predictive values suggest that this questionnaire may be used reliably to identify patients with orofacial pain that fits the above-described pain categories without prior knowledge of the clinical diagnosis. Digital pain scale findings indicated that on presentation, pain level could not be correlated with any particular pain category, but when using this scale to describe past pain experience, patients with neurologically based pain selected the highest digital pain scale values up to six times more frequently than patients with musculoligamentous or dentoalveolar pain. Patients with musculoligamentous or dentoalveolar pain selected the lowest digital pain scale values up to 15 times more frequently than those with neurologically based pain. Although this questionnaire may be used for initial categorization of pain, there is still no substitute for a thorough history and clinical examination.

Adult↗

PubMed1991

Pathological and molecular biological features of a myelopathy associated with HTLV-1 infection.

We report the pathological and molecular biological findings of human T-cell lymphotropic virus type 1 (HTLV-1) infection of the spinal cord in a patient with a chronic progressive myelopathy. Light microscopy disclosed loss of myelin and axons, thickening of blood vessels and a lymphocytic cell infiltrate in the spinal cord especially at the cervical and thoracic levels. Electron microscopy confirmed the vascular appearance seen with light microscopy but virus particles were not observed. The HTLV-1 gag gene could be amplified (by polymerase chain reaction) from cervical spinal cord tissue while not from elsewhere in the neuroaxis. The presence of HTLV-1 genomic material in spinal cord tissue has not been previously reported.

DNA, Viral↗

PubMed1990

Parkinsonism in alcohol withdrawal: a follow-up study.

Transient parkinsonism associated with alcohol intake and withdrawal has previously been described. We followed-up three patients with acute alcohol withdrawal-induced parkinsonism 9-11 years after their initial presentation. None showed any evidence of parkinsonism at follow-up. This suggests that withdrawal-induced parkinsonism is caused by a completely reversible abnormality in nigrostriatal dopamine transmission, which is unaccompanied by underlying nigral degeneration, as we had previously hypothesized.

Acute Disease↗

PubMed1985

Variable adrenocortical function in acute medical illness.

Acute medical illness may produce dramatic changes in endocrine function. Although cortisol levels rise in acute medical illness, changes in adrenocortical function and reserve have not been well documented in medical ICU patients. We evaluated plasma ACTH and cortisol levels, and cortisol response to intravenous ACTH in 40 acutely ill patients and 20 anxious but nonacutely ill controls. A wide range of plasma cortisol values (212 to 8430 nmol/L) was observed. More severely ill patients did not necessarily have higher plasma cortisol values. Patients who survived hospitalization had lower mean initial and post-ACTH cortisol levels than patients who succumbed. ACTH levels varied widely and correlated poorly with levels of plasma cortisol. There was no evidence of occult adrenocortical insufficiency. We conclude that plasma cortisol elevations are common in acute medical illness.

Acute Disease↗

PubMed1982

Advantages in the use of L-asparaginase-albumin polymer as an antitumor agent.

Polymeric conjugates of L-asparaginase and an excess of homologous albumin were compared with free L-asparaginase for antitumor activity using a mouse model 6C3HED lymphosarcoma and a human pancreatic tumor cell line, PANC-1. The asparaginase-albumin polymer is more resistant to proteolytic degradation compared to equivalent amounts of free enzyme and is more effective as an antitumor agent in prolonging survival of C3H/HeJ mice receiving 6C3HED lymphosarcoma. In terms of antitumor activity, the enzyme is approximately 20 times more effective, compared to free enzyme, when given in polymeric form with albumin. Similarly, the polymeric form of L-asparaginase is more effective in inhibiting cell growth of human pancreatic tumor cells grown in tissue culture. The increased effectiveness of the polymeric form of L-asparaginase is probably related to its resistance to biodegradation. The use of cell surface-specific monoclonal antibodies to target the polymer to tumor cells is also demonstrated.

Albumins↗

PubMed1979

Liposomes: a new approach to gold therapy?

Gold sodium thiomalate (GST) can be encapsulated in egg phophatidyl choline (and cholesterol) vesicles. Leakage from vesicles at room temperature is negligible allowing storage for at least 6 days prior to use. Intravenous injection of GST encapsulated in egg phosphatidyl choline vesicles results in: 1) delayed blood clearance, 2) enhanced uptake by the liver and spleen, 3) reduced uptake by the kidney, 4) reduced 24 hr urine excretion, and 5) enhanced uptake by inflamed tissues compared to free GST given by the same route. Thus, our preliminary findings suggest that egg phosphatidyl choline vesicles may be a suitable carrier of GST for parenteral administration.

Animals↗